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Friday, 8 September 2017


 

Walter Freeman: The Father of the Lobotomy

Walter Freeman is known in history as the father of the lobotomy, an infamous procedure that involved hammering an ice pick-like instrument into a patient’s brain through their eye sockets. The horrifying procedure often left patients in a vegetative state and is responsible for an estimated 490 deaths.

Freeman was born on Nov. 14, 1895 and after graduating from Yale University, he enrolled as a medical student at the University of Pennsylvania and earned a medical degree in 1920.  Freeman worked as a pathology intern at the Hospital of the University of Pennsylvania before traveling to Europe to study neurology in 1923. He returned to the United States a year later, taking a position as the director of laboratories at a leading psychiatric institution in Washington, D.C. -- Saint Elizabeth’s Hospital -- practicing as the first neurologist in the city. Over the next few years he earned his PhD in neuropathology and secured a position at George Washington University as head of the neurology department. 

Influenced by the devastating effects of mental illness, Freeman began using oxygen therapy and experimented with chemical treatments for patients. In 1935, Freeman learned of a frontal lobe ablation technique that had been used on chimpanzees with the effects of subduing their temperament. That same year, a new procedure intended to treat mental illness was performed in Portugal under the direction of neurologist and physician Egas Moniz called a “leucotomy,” which took small corings out of the frontal lobes.

Freeman modified the procedure, renaming it a “lobotomy” with the help of neurosurgeon James Watts. Freeman and Watts performed a number of lobotomies carried out at his private practice in Washington, D.C. The first lobectomies consisting on drilling into a person’s head. Such procedure was improved rendering a patient unconscious by electroshock before inserting a sharp ice-pick-like instrument above the patient’s eyeball. Four hours later, the patient awoke without any anxiety or apprehension.


Photo of Walter Freeman performing a lobectomy


In reality, the procedure resulted in leaving many patients in a vegetative state, or reduced them to child-like behavior. Despite its shortcomings, many hospitals adopted the procedure for no other apparent reason than the fact that lobotomized patients were easier to handle than emotionally charged ones.

Freeman began traveling across the county visiting mental institutions and spreading the use of the lobotomy by training staff to perform the operation. Despite much criticism toward the controversial procedure, it gained popularity through major publications across the country hailing the lobotomy as a “miracle” surgery.

By 1949, 5,000 lobotomies were being performed annually, up from just 150 in 1945 and a total of 490 individuals are estimated to have died as a result of a lobotomy. For the survivors, some were left with no noticeable differences, but others were crippled for life or lived in a persistent vegetative state.

One of Freeman’s most notable patients was Rosemary Kennedy, sister to the man who would later become President of the United States, who was born with mild learning difficulties. She was given a lobotomy in 1941 with the consent of her father, but it ended in failure. She was left incapacitated by the procedure and spent the rest of her life in and out of various institutions.

Freeman performed his last lobotomy in 1967. The lobotomy eventually came under attack from the medical community. By the 1970s, several countries had banned the procedure altogether. Freeman eventually retired the lobotomobile and opened a private practice in California. Contrary to popular belief, he never lost his license to practice medicine.

Today, surgical lobotomies are no longer performed.

 

Luis Mendoza, MD, PhD

8 September 2017

Thursday, 7 September 2017


Spinalonga: The Greek Island of Lepers
The island of Spinalonga, officially known as Kalydon, is located in the Gulf of Elounda in the north-eastern of Crete. In 1903, a leper colony was established on Spinalonga, to isolate people suffering from Hansen’s Disease from the healthy population. The cure for leprosy had not yet been discovered, and the contagious disease was regarded with horror. Hansenites, as lepers are known, were quarantined in leper colonies outside towns, living off the charity of passers-by.
The patients of Spinalonga were entitled to a small monthly allowance, which was often not enough to cover their food and medicine. These were hard times, when Greece was rocked by successive wars (Macedonian Struggle, two Balkan Wars, two World Wars, the Civil War), worsening the position of the lepers on Spinalonga. Living conditions were extremely poor, and some lepers’ accounts paint a picture of utter squalor.
The great change came about in 1930, when Epameinondas Remoundakis was brought to Spinalonga. Remoundakis was a third-year law student when he fell ill, and he seems to have been the person the others were waiting for in order to demand humane living conditions. The last inhabitant form Spinalonga flew to the continent in 1962. Now, Spinalonga is a place visted by thousand of tourist every year.
Photo of Spinalonga Island.
 
Leprosy or Hansen’s Disease
Hansen’s Disease is still a scourge today. In many countries, such as Greece, the disease has been eradicated, but this is not true of India, Africa and Latin America. In 2001, 763,000 new cases of leprosy were recorded, mainly in southeast Asia (668,000), while in 2005 the number of new cases fell to 300,000. Leprosy is caused by the bacterium Mycobacterium leprae, which is related to the tuberculosis bacterium. This microorganism was discovered by Doctor G. A. Hansen in 1873, which is why leprosy is officially known as Hansen’s Disease. The disease is contagious through prolonged contact with a sufferer, but most of the population (95%) is naturally immune. Today leprosy is curable and sufferers can lead a normal life without transmitting the disease. However, the world “leper” still carries a social stigma, and this is the main reason some patients do not seek medical assistance in the early stages of the disease.
 
By Luis Mendoza, MD, PhD
07 September 2017

Wednesday, 16 December 2015

Detection of PD-L1 in cell surface vimentin positive circulating tumor cells is associated with poor survival in cancer patients

UT MD Anderson Cancer Center, Houston, TX.
Proceedings: AACR 106th Annual Meeting 2015; April 18-22, 2015; Philadelphia, PA
Abstract 1596
Circulating tumor cells (CTCs) are the cells that detach from the primary tumor of patients and enter in to the blood stream and these can be represented as the seeds of metastasis. Increasing evidence has shown the detection of circulating tumor cells (CTCs) from blood of cancer patients parallels with tumor burden and is associated with poor prognosis. Although CTC counts change indicates a good modality to detect therapeutic response to drug treatments, there is an increasing need of a reliable marker that can be used to predict survival in cancer patients. One of the most prevalent markers detected in cancer patients is the cell surface glycoprotein called PD-L1 (also called B7-H1 and CD274). Aberrant expression of PD-L1 has been reported in several cancer types. Here in this study we tested the hypothesis that detection of PD-L1 in CTCs is associated with poor prognosis. To validate the hypothesis, we isolated cell-surface vimentin (CSV) positive CTCs from colorectal cancer patients using 84-1 method and analyzed for PD-L1 expression. Our results indicated that PD-L1 detection in CTCs was associated with poor overall survival (HR, 2.43; 95% CI, 1.11 to 5.35; p, 0.0264) in colorectal cancer patients undergoing treatment. These findings thus suggest that PD-L1 detection in CSV CTC could serve as a new prognostic tool. We further extend our observations in other types of cancers including breast, prostate and sarcoma. 
Citation Format: Arun Satelli, Zachary Brownlee, Hyangsoon Noh, Qing H. Meng, Scott Kopetz, Michael Overman, Shulin Li. Detection of PD-L1 in cell surface vimentin positive circulating tumor cells is associated with poor survival in cancer patients. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1596. doi:10.1158/1538-7445.AM2015-1596 
  • ©2015 American Association for Cancer Research.

Tuesday, 15 December 2015

IMBRUVICA® (ibrutinib) Phase 3 RAY Data Show Significant Improvements in Progression-Free Survival Versus Temsirolimus in Patients with Relapsed or Refractory Mantle Cell Lymphoma

ORLANDO, Fla. and HORSHAM, Pa., Dec. 7, 2015 /PRNewswire/ -- Data from the Phase 3 RAY (MCL3001) study, an investigational clinical trial, showed oral IMBRUVICA® (ibrutinib) significantly improved progression-free survival (PFS; the primary endpoint) versus intravenous temsirolimus in patients with relapsed or refractory mantle cell lymphoma (MCL). Janssen Biotech, Inc. announced IMBRUVICA was associated with a 57 percent reduction in the risk of disease progression or death with a median follow-up of 20 months. These data were published online in The Lancet today and presented in an oral session at the 2015 American Society of Hematology (ASH) meeting in Orlando, FL. IMBRUVICA is jointly developed and commercialized by Janssen and Pharmacyclics LLC, an AbbVie company.