Early Designs Of Total Artificial Hearts

In 1949, a precursor to the modern artificial heart pump was built by Dres. William Sewell and William Glenn of the Yale School of Medicineusing an Erector Set, assorted odds and ends, and dime store toys. The external pump successfully bypassed the heart of a dog for more than an hour.
On Dec. 12, 1957, Dr. Willem Kolff, the world’s most prolific inventor of artificial organs, implanted an artificial heart into a dog at Cleveland Clinic. The dog lived for 90 minutes.
In 1958 Domingo Liotta initiated the studies of TAH replacement at Lyon, France and in 1959-60 at the National University of Cordoba, Argentina. He presented his work at the meeting of the American Society for Artificial Internal Organs meeting held in Atlantic City in March 1961. On that meeting Dr Liotta described the implantation of three types of orthotopic (inside the pericardial sac) TAHs in dogs, each of which used a different source of external energy: an implantable electric motor, an implantable rotating pump with an external electric motor and a pneumatic pump.
In 1964, the National Institutes of Health started the Artificial Heart Program, with the goal of putting a man-made organ into a human by the end of the decade.
In 1967, Dr. Kolff left Cleveland Clinic to start the Division of Artificial Organs at the University of Utah and pursue his work on the artificial heart.- In 1973, a calf named “Tony” survived for 30 days on an early Kolff heart.- In 1975, bull “Burk” survived 90 days on the artificial heart.- In 1976, a calf named “Abebe” lived for 184 days on the Jarvik 5 artificial heart.- In 1981, calf “Alfred Lord Tennyson” lived for 268 days on the Jarvik 5.
Over the years, more than 200 physicians, engineers, students and faculty developed, tested and improved Dr. Kolff’s artificial heart. To help manage his many endeavors, Dr. Kolff assigned project managers. Each project was named after its manager. Graduate student Robert Jarvik was the project manager for the artificial heart, which was subsequently renamed the Jarvik 7.
In 1981, Dr. William DeVries submitted a request to the FDA to implant the Jarvik 7 into a human being. On Dec. 2, 1982, Dr. Kolff’s 35 years of dedication culminated in the first implant of the Jarvik 7 artificial heart into Dr. Barney Clark. Clark was hours from death prior to the surgery. He lived for 112 days with the artificial heart.
On Feb 11, 2009, Dr. Kolff died at the age of 97 in Philadelphia

Artificial Heart

An artificial heart is a mechanical device that is implanted into the body to replace the biological heart.
The term “artificial heart” has often inaccurately been used to describe ventricular assist devices (VADs), which are pumps that assist the heart but do not replace it.
An artificial heart is also distinct from a cardiopulmonary bypass machine (CPB), which is an external device used to provide the functions of both the heart and lungs. CPBs are only used for a few hours at a time, most commonly during heart surgery.

FDA Approved Artificial Hearts

CardioWest temporary Total Artificial Heart
The CardioWest temporary Total Artificial Heart (TAH-t) (SynCardia Systems, Inc.) is the world’s first and only FDA-approved Total Artificial Heart. It received FDA approval on Oct. 15, 2004, following a 10-year pivotal clinical study.
Originally designed as a permanent replacement heart, it is currently approved as a bridge to human heart transplant for patients dying because both sides of their hearts are failing (irreversible end stage biventricular failure). There have been more than 780 implants of the CardioWest artificial heart, accounting for more than 150 patient years of life on this device.
In the 10-year pivotal clinical study of the CardioWest artificial heart 79% of patients receiving the artificial heart survived to transplant (New England Journal of Medicine 2004; 351: 859-867). This is the highest bridge-to-transplant rate for any heart device in the world. See

AbioCor Replacement Heart

The AbioCor Replacement Heart (Abiomed) received FDA approval under a Humanitarian Device Exemption (HDE) on Sept. 5, 2006. The AbioCor is approved for use in severe biventricular end stage heart disease patients who are not eligible for heart transplant and have no other viable treatment options. The AbioCor has been implanted 14 times. The most recent implant was May 24, 2004. See FDA Summary of Safety and Probable Benefit

Cardiac Surgery

Cardiac surgery is surgery on the heart and/or great vessels performed by a cardiac surgeon. Frequently, it is done to treat complications of ischemic heart disease (for example, coronary artery bypass grafting), correct congenital heart disease, or treat valvular heart disease created by various causes including endocarditis. It also includes heart transplantation.

Open heart surgery

This is a surgery in which the patient chest is opened and surgery is performed on the heart. The term "open" refers to the chest, not to the heart itself. The heart may or may not be opened depending on the particular type of surgery. Surgeons realized the limitations of hypothermia - complex intracardiac repairs take more time and the patient needs blood flow to the body (and particularly the brain); the patient needs the function of the heart and lungs provided by an artificial method, hence the term cardiopulmonary bypass. Dr. John Heysham Gibbon at Jefferson Medical School in Philadelphia reported in 1953 the first successful use of extracorporeal circulation by means of an oxygenator, but he abandoned the method, disappointed by subsequent failures. In 1954 Dr. Lillehei realized a successful series of operations with the controlled cross-circulation technique in which the patient's mother or father was used as a 'heart-lung machine'. Dr. John W. Kirklin at the Mayo Clinic in Rochester, Minnesota started using a Gibbon type pump-oxygenator in a series of successful operations, and was soon followed by surgeons in various parts of the world.
Dr. Nazih Zudhi worked for four years under Drs. Clarence Dennis, Karl Karlson, and Charles Fries, who built an early pump-oxygenator. Zudhi and Fries worked on several designs and re-designs of Dennis' earlier model from 1952-1956 at the Brooklyn Center. Zuhdi then went to work with Dr. C. Walton Lillehei at the University of Minnesota. Lillehei had designed his own version of a cross-circulation machine, which came to become known as the DeWall-Lillehei heart-lung machine. Zudhi worked on perfusion and blood flow trying to solve the problem of air bubbles while bypassing the heart so the heart could be stopped for the operation. Zudhi moved to Oklahoma City, OK, in 1957, and began working at the Oklahoma University College. Zudhi, the heart surgeon, teamed up with Dr. Allen Greer, a lung surgeon and Dr. John Carey, forming a three man open heart surgery team. With the advent of Dr. Zudhi's heart-lung machine which was modified in size, being much smaller than the DeWall-Lillhei heart-lung machine, and with other modifications, reduced the need for blood down to a minimal amount, and the cost of the equipment down to $500.00 and also reduced the prep time from two hours to 20 minutes. Dr. Zudhi performed the first Total Intentional Hemodilution open heart surgery on Terry Gene Nix, age 7, on February 25, 1960, at Mercy Hospital, Oklahoma City, OK. The operation was a success; however, Nix died three years later in 1963.[7] In March, 1961, Zudhi, Carey, and Greer, performed open heart surgery on a child, age 3 1/2, using the Total Intentional Hemodilution machine, with success. That patient is still alive

Podiatry (or chiropody) is a branch of medicine devoted to the study, diagnosis and treatment of disorders of the foot, ankle and lower leg.

Within the United Kingdom, the titles “podiatrist” and “chiropodist” are to some extent interchangeable. Although the UK government-appointed regulator acknowledges both titles and makes no distinction between them, they are used differently within the occupation. 'Podiatrist' is a reserved title in the UK, meaning that it can only be used by those registered with theHealth Professions Council. Inside the profession, chiropody is used to suggest the routine processes of foot care, whilst podiatry is indicative of the higher skills and academic levels.
In the United States, a podiatrist is a Doctor of Podiatric Medicine (DPM), also known as a podiatric physician or surgeon, qualified by their education and training to diagnose and treat conditions affecting the foot, ankle and related structures of the leg. Podiatrists are uniquely qualified among medical professionals to treat the foot and ankle based on their education, training and experience.
Podiatry is also practiced in other countries such as Australia, Canada, New Zealand and the UK. The level and scope of practice may vary in these countries as compared in the US.

Neurosurgery

Neurosurgery is the surgical discipline focused on treating those central and peripheral nervous systemsand spinal column diseases amenable to surgical intervention. In the United States there are only about 3,000 neurosurgeons

In the United States, neurosurgeons typically have completed four years of pre-medical education (typically an undergraduate degree in the biological sciences), four years of medical school, and six to eight years of neurosurgical residency training (including the intern year). Neurosurgeons may also elect to complete a fellowship of one to two additional years in a neurosurgical subspecialty (pediatrics, oncology, endovascular, spine, functional, etc.). This training is the longest of all U.S. medical specialties. Neurosurgery is one of the five most-competitive specialties to which graduating medical students may apply, with fewer than 200 positions offered in each year's residency match (the other four being plastic surgery, dermatology, orthopaedic surgery, andotolaryngology)

Orthopedic Surgery

Orthopedic surgery or orthopedics (also spelled orthopaedics) is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and non-surgical means to treat musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors, and congenital conditions.
Nicholas Andry coined the word "orthopaedics", derived from Greek words for orthos ("correct", "straight") and paideia ("rearing" (usually of child)), in 1741, when at the age of 81 he published Orthopaedia: or the Art of Correcting and Preventing Deformities in Children.
In the US the spelling orthopedics is standard[citation needed], although the majority of university and residency programs[citation needed], and even the AAOS, still use Andry's spelling. Elsewhere, usage is not uniform; in Canada, both spellings are common; orthopaedics usually prevails in the rest of the Commonwealth, especially in Britain.

Jean-Andre Venel established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children's skeletal deformities. He is considered by some to be the father of orthopedics or the first true orthopedist in consideration of the establishment of his hospital and for his published methods.
Antonius Mathysen, a Dutch military surgeon, invented the plaster of Paris cast in 1851.
Many developments in orthopedic surgery resulted from experiences during wartime. On the battlefields of the Middle Ages the injured were treated with bandages soaked in horses' blood which dried to form a stiff, but unsanitary, splint. Traction and splinting developed during World War I. The use of intramedullary rods to treat fractures of the femur and tibia was pioneered by Gerhard Küntscher of Germany. This made a noticeable difference to the speed of recovery of injured German soldiers during World War II and led to more widespread adoption of intramedullary fixation of fractures in the rest of the world. However, traction was the standard method of treating thigh bone fractures until the late 1970s when the Harborview Medical Center in Seattle group popularized intramedullary fixation without opening up the fracture. External fixation of fractures was refined by American surgeons during the Vietnam War but a major contribution was made byGavril Abramovich Ilizarov in the USSR. He was sent, without much orthopedic training, to look after injured Russian soldiers in Siberia in the 1950s. With no equipment he was confronted with crippling conditions of unhealed, infected, and malaligned fractures. With the help of the local bicycle shop he devised ring externalfixators tensioned like the spokes of a bicycle. With this equipment he achieved healing, realignment andlengthening to a degree unheard of elsewhere. His Ilizarov apparatus is still used today as one of thedistraction osteogenesis methods.
David L. MacIntosh pioneered the first successful surgery for the management of the torn anterior cruciate ligament of the knee. This common and serious injury in skiers, field athletes, and dancers invariably brought an end to their athletics due to permanent joint instability. Working with injured football players, Dr. MacIntosh devised a way to re-route viable ligament from adjacent structures to preserve the strong and complex mechanics of the knee joint and restore stability. The subsequent development of ACL reconstruction surgery has allowed numerous athletes to return to the demands of sports at all levels.
Modern orthopaedic surgery and musculoskeletal research has sought to make surgery less invasive and to make implanted components better and more durable.
Additionally, there is currently under development highly promising research involving the regrowth of Anterior Cruciate Ligament Tissue by the use of scaffolding around the Ligament, thereby providing an environment in which the tissue can clot and heal like other areas of the body which are not surrounded by the clot-preventing liquids which surround the major ligaments. This research among others conducted at the Sports Medicine Research Laboratory is still in the Research and Development stage.

Otolaryngology

Otolaryngology is the branch of medicine that specializes in the diagnosis and treatment of ear, nose, throat, and head and neck disorders. The full name of the specialty is otolaryngology-head and neck surgery. Practitioners are calledotolaryngologists-head and neck surgeons, or sometimes otorhinolaryngologists(ORL). A commonly used term for this specialty is ENT (ear, nose and throat). The term comes from the Greek ωτολαρυγγολογία (oto = genitive for ear, laryngo = genitive for larynx/throat, logy = study), and it literally means the study of ear and neck. The full term ωτορινολαρυγγολογία (otorhinolaryngology), also includes rhino, which is the genitive of nose. Otolaryngology is one of the most competitive specialties to enter for physicians.

Surgical Oncology

Surgical oncology is the branch of surgery which focuses on the surgical management of malignant neoplasms (cancer).
Whether surgical oncology constitutes a medical specialty per se is the topic of a heated debate. Today, some would agree that it is simply impossible for any one surgeon to be competent in the surgical management of all malignant disease. However, there are currently 14 surgical oncology fellowship training programs in the United States that have been approved by the Society of Surgical Oncology. While many general surgeons are actively involved in treating patients with malignant neoplasms, the designation of "surgical oncologist" is generally reserved for those surgeons who have completed one of the approved fellowship programs. However, this is a matter of semantics, as many surgeons who are thoroughly involved in treating cancer patients may consider themselves to be surgical oncologists.
Most often, surgical oncologist refers to a general surgical oncologist (cf. General Surgery), but thoracic surgical oncologists, gynecologic oncologists and so forth can all be considered surgeons who specialize in treating cancer patients.
The importance of training surgeons who sub-specialize in cancer surgery lies in evidence, supported by a number of clinical trials, that outcomes in surgical cancer care are positively associated to surgeon volume -- i.e. the more cancer cases a surgeon treats, the more proficient he becomes, and his or her patients experience improved survival rates as a result. This is another controversial point, but it is generally accepted -- even as common sense -- that a surgeon who performs a given operation more often, will achieve superior results when compared with a surgeon who rarely performs the same procedure. This is particularly true of cancer resections such aspancreaticoduodenectomy (Whipple procedure) for pancreatic cancer, and gastrectomy with extended (D2) lymphadenectomy for gastric cancer.

Trauma surgery

Trauma surgeons are physicians (MBBS, MBChB, MB, MD) or (DO) who have completed residency training in general surgery and fellowship training in trauma or surgical critical care. The trauma surgeon is responsible for the initial resuscitation and stabilization of the patient, as well as ongoing evaluation. The attending trauma surgeon also leads the trauma team, which typically includes nurses, resident physicians, and support staff.

The broad scope of their surgical critical care training enables the trauma surgeon to address most injuries to the neck, chest, abdomen, and extremities (other than fractures). Injuries to the central nervous system are generally treated by neurosurgeons. Skeletal injuries are treated byorthopedic surgeons. Facial injuries are often treated by maxillofacial surgeons. There is significant variation across hospitals in the degree to which other specialists, such as cardiothoracic surgeons, plastic surgeons, vascular surgeons, and interventional radiologists are involved in treating trauma patients.
Trauma surgeons must be familiar with a large variety of general surgical, thoracic, and vascular procedures and must be able to make complex decisions, often with little time and incomplete information. Proficiency in all aspects of intensive care medicine/critical care is required. Hours are irregular and there is a considerable amount of night, weekend, and holiday work. Salaries for trauma surgeons are comparable to those for general surgeons.
Most patients presenting to trauma centers have multiple injuries involving different organ systems, and so the care of such patients often requires a significant number of diagnostic studies and operative procedures. The trauma surgeon is responsible for prioritizing such procedures and for designing the overall treatment plan. This process starts as soon as the patient arrives in the emergency department and continues to the operating room, intensive care unit, and hospital floor. In most settings, patients are evaluated according to a set of predetermined protocols (triage) designed to detect and treat life-threatening conditions as soon as possible. After such conditions have been addressed (or ruled out), non-life-threatening injuries are addressed.

Vascular Surgery

Vascular surgery is a specialty of surgery in which diseases of the vascular system, or arteries and veins, are managed by medical therapy, minimally-invasive catheter procedures, and surgical reconstruction. The specialty evolved from general and cardiac surgery. Dr Robert Paton, one of the first Australian vascular surgeons, was a pioneer of the field, pushing for it to become a speciality. Edwin Wylie of San Francisco was one of the early American pioneers in the specialty who developed and fostered advanced training in vascular surgery and pushed for its recognition as a specialty in the United States in the 1970s. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system except that of the heart and brain. Cardiothoracic surgeons manage surgical disease of the heart and its vessels. Neurosurgeons manage surgical disease of the vessels in the brain (eg intracranial aneurysms).

Plastic Surgery

Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. While famous for aesthetic surgery, plastic surgery also includes two main fields: cosmetic and reconstructive surgery. The word "plastic" derives from the Greek plastikos meaning to mold or to shape; its use here is not connected with the synthetic polymer material known as plastic.

Reconstructive surgery techniques were being carried out in India by 2000 BC.[1] Sushruta (6th century BC) made important contributions to the field of Plastic and Cataract surgery.[2] The medical works of both Sushruta and Charak were translated into Arabic language during the Abbasid Caliphate (750 AD).[3] These Arabic works made their way into Europe via intermediaries.[4] In Italy the Branca family of Sicily andGaspare Tagliacozzi (Bologna) became familiar with the techniques of Sushruta.[4]
British physicians traveled to India to see Rhinoplasty being performed by native methods.[5] Reports on Indian Rhinoplasty were published in the Gentleman's Magazine by 1794.[5] Joseph Constantine Carpuespent 20 years in India studying local plastic surgery methods.[5] Carpue was able to perform the first major surgery in the Western world by 1815.[6] Instruments described in the Sushruta Samhita were further modified in the Western world.[6]
The Romans were able to perform simple techniques such as repairing damaged ears from around the 1st century BC. Due to religious reasons they didn't approve of the dissection of both human beings and animals, thus their knowledge was based in its entirety on the texts of their Greek predecessors. Notwithstanding this Aulus Cornelius Celsus has left some surprisingly accurate anatomical descriptions, some of which —for instance, his studies on the genitalia and the skeleton— are of special interest to plastic surgery.[7]
The Egyptians were also one of the first people to perform plastic cosmetic surgery.
In 1465, Sabuncuoglu's book, description, and classification of hypospadias was more informative and up to date. Localization of urethral meatus was described in detail. Sabuncuoglu also detailed the description and classification of ambiguous genitalia (Kitabul Cerrahiye-i Ilhaniye -Cerrahname-Tip Tarihi Enstitüsü, Istanbul)[citation needed] In mid-15th century Europe, Heinrich von Pfolspeundt described a process "to make a new nose for one who lacks it entirely, and the dogs have devoured it" by removing skin from the back of the arm and suturing it in place. However, because of the dangers associated with surgery in any form, especially that involving the head or face, it was not until the 19th and 20th centuries that such surgery became commonplace.
Up until the techniques of anesthesia became established, all surgery on healthy tissues involved great pain. Infection from surgery was reduced once sterile technique and disinfectants were introduced. The invention and use of antibiotics beginning with sulfa drugs and penicillinwas another step in making elective surgery possible.
In 1792, Chopart performed operative procedure on a lip using a flap from the neck. In 1814, Joseph Carpue successfully performed operative procedure on a British military officer who had lost his nose to the toxic effects of mercury treatments. In 1818, German surgeon Carl Ferdinand von Graefe published his major work entitled Rhinoplastik. Von Graefe modified the Italian method using a free skin graft from the arm instead of the original delayed pedicle flap. In 1845, Johann Friedrich Dieffenbach wrote a comprehensive text on rhinoplasty, entitled Operative Chirurgie, and introduced the concept of reoperation to improve the cosmetic appearance of the reconstructed nose. In 1891, American otorhinolaryngologist John Roe presented an example of his work, a young woman on whom he reduced a dorsal nasal hump for cosmetic indications. In 1892, Robert Weir experimented unsuccessfully with xenografts (duck sternum) in the reconstruction of sunken noses. In 1896,James Israel, a urological surgeon from Germany, and In 1889 George Monks of the United States each described the successful use of heterogeneous free-bone grafting to reconstruct saddle nose defects. In 1898, Jacques Joseph, the German orthopaedic-trained surgeon, published his first account of reduction rhinoplasty. In 1928, Jacques Joseph published Nasenplastik und Sonstige Gesichtsplastik.
The first American plastic surgeon was Dr. John Peter Mettauer, who in 1827 performed the first cleft palate operation with instruments that he designed himself.
In World War I a New Zealand otolaryngologist working in London, Sir Harold Gillies, developed many of the techniques of modern plastic surgery in caring for soldiers suffering from disfiguring facial injuries. His work was expanded upon during World War II by one of his former students and cousin, Archibald McIndoe, who pioneered treatments for RAF aircrew suffering from severe burns. McIndoe's radical, experimental treatments, led to the formation of the Guinea Pig Club. In 1951 Gillies carried out the first male-to-female sex change operation.
Plastic surgery as a specialty evolved remarkably during the 20th century in the United States. One of the founders of the specialty, Dr. Vilray Blair, was the first chief of the Division of Plastic and Reconstructive Surgery at Washington University in St. Louis, Missouri. In one of his many areas of clinical expertise, Blair treated World War I soldiers with complex maxillofacial injuries, and his paper on "Reconstructive Surgery of the Face" set the standard for craniofacial reconstruction. He was also one of the first surgeons without a dental background to be elected to the American Association of Oral and Plastic Surgery (later the organizations split to be renamed the American Association of Plastic Surgeons and the American Association of Oral and Maxillofacial Surgeons) and taught many surgeons who became leaders in the field of plastic surgery.

Pediatric Surgery

Pediatric surgery (AE) or paediatric surgery (BE) is a subspecialty of surgery involving the surgery of fetuses, infants, children, adolescents, and young adults. Many pediatric surgeons practice at children's hospitals.
Pediatric surgeons have completed a general surgery residency (medicine), then complete 2 years (or more according countries) of subspecialty fellowship training. After completion of specialty training in pediatric surgery, the surgeon is then eligible for certification by theAmerican Board of Surgery in the United States. In Canada it leads to eligibility for Certification by and Fellowship of the Royal College of Physicians and Surgeons of Canada. In Australia and New Zealand it leads to eligibility for Fellowship of the Royal Australasian College of Surgeons.
In order to become a pediatric surgeon in Mexico, two years of residency in Pediatrics are required, before one can start four years of pediatric surgery.
Pediatric surgery arose in the middle of the 20th century as the surgical care of birth defects required novel techniques and methods and became more commonly based at children's hospitals. One of the sites of this innovation was Children's Hospital of Philadelphia. Beginning in the 1940s under the surgical leadership of C. Everett Koop, newer techniques for endotracheal anesthesia of infants allowed surgical repair of previously untreatable birth defects. By the late 1970s, the infant death rate from several major congenital malformation syndromes had been reduced to near zero.
Subspecialties of pediatric surgery itself include: neonatal surgery and fetal surgery.
Other areas of surgery also have pediatric specialties of their own that require further training: pediatric cardiothoracic surgery, pediatric nephrology, pediatric neurosurgery, and pediatric urological surgery.
Common pediatric diseases that may require pediatric surgery include
congenital malformations: lymphangioma, cleft lip and palate,esophageal atresia and tracheoesophageal fistula, hypertrophic pyloric stenosis, intestinal atresia, necrotizing enterocolitis, meconium plugs, Hirschsprung's disease, imperforate anus, undescended testes,...
abdominal wall defects: omphalocele, gastroschisis, hernias,...
chest wall deformities: pectus excavatum
childhood tumors: like neuroblastoma, Wilms' tumor, rhabdomyosarcoma, ATRT, liver tumors, teratomas,...
Separation of conjoined twins