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The ruptured abdominal aortic aneurysm of Albert Einstein

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... 12 During his stay in the United States, he operated on the famed physicist Albert Einstein's abdominal aortic aneurysm in 1948, wrapping the aneurysm with cellophane which was then the treatment method. 30 Seven years later in 1955, Einstein died at the age of 76 because of the same problem, this time refusing surgery, saying, "It is tasteless to prolong life artificially. it is time to go. ...
... I will do it elegantly." 30 Nissen was six years junior to Burhaneddin Toker, but this did not pose a problem between them. (Figure 3) Toker's speaking fluent German and familiarity with the German culture also should have eased communication. ...
Article
Orthopedic surgery, the medical discipline that deals with diseases and injuries of the musculoskeletal system has been considered a distinct medical discipline in the west since the beginning of the twentieth century. However, in Turkey, the acceptance of musculoskeletal traumatology as an integral part of orthopedic surgery actualized as late as 1961. Previously, orthopedic trauma patients were usually treated in general surgery departments. Dr. Burhaneddin Toker, a true pioneer, changed this conduct of the time in Turkey. He transformed Cerrahpaşa Hospital, then a municipality hospital today the well-known Cerrahpaşa Medical School of Istanbul University, to a trauma center. He pioneered systematic surgery of the musculoskeletal injuries, created a separate service for musculoskeletal traumatology, trained many surgeons in this field, wrote textbooks, and reported his clinical experience in scientific publications. This study examines the biography of Burhaneddin Toker and how he was able to further medical training in Turkey with a focus on Turkey in the stormy 1930s, the way the young republican government under Atatürk’s leadership handled educational issues, and the refugee scientists who found a safe haven in Turkey fleeing Nazism.
... Several surgeons worked hard, in the 19th and 20th centuries, to develop safe surgical treatment methods with low mortality. Nissen performed the surgical treatment of an abdominal aortic aneurysm in Albert Einstein by wrapping him in cellophane [6,7]. This surgery allowed Einstein to live more 7 years. ...
... "I have done my share, it is time to go. I will do it elegantly," stated by Albert Einstein in 1955 on the day before his death as a consequence of a ruptured abdominal aortic aneurysm (1). Abdominal aortic aneurysms (AAAs) often remain asymptomatic until rupture, which is until today associated with a grave prognosis and 85% to 90% mortality (2). ...
Article
Open repair (OR) of aortic aneurysms is still relatively mutilating and risky in older and high-risk patients. Since the introduction of EVAR, a significantly lower perioperative mortality has been noted. Apart from advantages, endovascular treatment has some disadvantages as well, due to which OR still has a very important role in the endovascular era. In a vast majority of the patients younger than 65, with good overall condition, long life expectancy and favorable anatomy, as well as in patients with hostile aneurysm neck anatomy, heritable connective tissue disorders, complete thrombosis of abdominal aortic aneurysm (AAA) and potent accessory renal arteries, OR is the first treatment option in comparison with the endovascular treatment. EVAR is recommended as the first treatment option in patients with inflammatory aneurysms and OR should be considered only in better shaped patients with inflammatory AAA and significant hydronephrosis. Late open surgical conversion (LOSC) is a noted event after endovascular treatment and is associated with a significantly higher perioperative mortality and other serious perioperative complications compared to primary OR. Multicenter randomized controlled trials (RCT) did not find a significant difference regarding 30-day mortality between open and endovascular repair of ruptured AAA. However, not all ruptured AAA are suitable for endovascular repair. In a hemodynamically unstable patients, when there is no time for MDCT angiography, EVAR is not possible, and OR is the only option. The incidence of abdominal compartment syndrome after OR is significantly lower in comparison with EVAR thanks to surgical evacuation and drainage of retroperitoneal hematoma. The improvement of the results of aortic aneurysm treatment largely depends on the volume of yearly aortic operations. Having in mind all the mentioned advantages and disadvantages of OR and endovascular repair, we can conclude that in high volume centers, younger generations of vascular surgeons should be educated in standard and complex open aortic surgery.
Thesis
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Fluoroscopy-guided endovascular aortic repair (EVAR) has become the predominant treatment strategy for elective repair of abdominal aortic aneurysms in many western countries. During the procedure, stent grafts are implanted into the vasculature to reduce the pressure on the vessel wall and prevent a potentially fatal aneurysm rupture. The fusion of preoperative information with intraoperative fluoroscopy has garnered considerable interest as a means to reduce the use of nephrotoxic contrast agent and to decrease radiation exposure and procedure time, thus limiting the negative side effects of the procedure. A rigid overlay of pre- and intraoperative images, however,disregards the substantial deformations caused by the endovascular instruments. This thesis proposes and analyses different approaches to maintaining the usefulness of image fusion during EVAR by identifying and modeling the instrument-induced deformation. Particular attention is given to compliance with the interventional workflow, specifically in terms of underlying assumptions, requirements and computational costs. An algorithmic pipeline is developed that allows for the segmentation of relevant instruments in fluoroscopic images, the reconstruction of the instrument shape from single X-ray projections and the intraoperative deformation modeling based on this information. For instrument segmentation, a deep learning approach is proposed that is able to reliably identify and distinguish stent grafts, guidewires and catheters in a multi-task setting. In contrast to prior methods applied to these tasks, the approach requires neither an explicit model of the stent graft nor a handcrafted segmentation pipeline for each instrument. To allow for deformation modeling in 3-D, a method is designed that recovers the 3-D instrument shape from a single projection image. This avoids cumbersome repositioning of the fluoroscopic C-arm system. The approach estimates a second, virtual view of the wire based on the preoperative information that takes the intraoperative vessel deformation into account. To model the deformation solely on the instrument shape, an as-rigid-as-possible modeling is devised that allows to account for the interaction between the instrument and a surface model of the vessel in a flexible manner. This is extended by a semi-automatic approach that adapts the deformation in a “one-click” scenario and further increases the accuracy of the deformation modeling. In contrast to previous methods, a bone-based initial alignment of pre- and intraoperative data suffices for accurate deformation modeling. Other approaches that assess the deformation are either based on computationally expensive finite element analysis, require a contrast-enhanced acquisition of the aortic vessel tree or demand complex user interaction. The pipeline is able to adapt the preoperative information to match the intraoperative deformation without the need for contrast injections. Still, available information can be integrated by using the semi-automatic method, resulting in a high in-plane accuracy of 0.5 mm at relevant anatomical landmarks. While each step of the proposed pipeline constitutes a value of its own, the proposed methods can be applied successively and allow for an adaption from X-ray segmentation to 3-D deformation modeling in less then 10 s, integrating smoothly with the interventional workflow. The results on clinical data show the potential to further improve navigation, reduce the use of nephrotoxic contrast agents and decrease radiation exposure, ultimately increasing the safety of both patients and medical personnel.
Article
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Objetivo: conocer la prevalencia de los aneurismas de aorta abdominal infrarrenal (AAA) y factores de riesgo en pacientes remitidos a consultas externas de Angiología y Cirugía Vascular para valoración de enfermedad arterial periférica (EAP). Material y métodos: entre febrero de 2012 y diciembre 2016 se realizó eco Doppler aortoilíaco a los pacientes mayores de 50 años remitidos para descartar arteriopatía de miembros inferiores. En todos los casos se realizó exploración física y recogida de factores de riesgo cardiovascular. Diseño observacional, longitudinal. Análisis univariante y multivariante. Resultados: el estudio incluyó a 454 pacientes. De estos, se excluyeron 11 en los que no fue posible la medición del diámetro del aneurisma por obesidad/gas abdominal. El total de pacientes estudiados es de 443. La prevalencia en la población estudiada de aneurisma fue del 8,8% (n = 39). La media del diámetro de los aneurismas diagnosticados fue 4,1 cm (± 1,1). En los pacientes que presentaron ITB menor de 0,9 (EAP), la prevalencia fue del 11,2% (²⁹) frente al 5,2% (¹⁰) en pacientes con ITB mayor de 0,9 (p < 0,05). Los pacientes con EAP presentaron un mayor porcentaje de hipertensión arterial y tabaquismo (p < 0,05). En el análisis univariante de los factores de riesgo asociados a presentar AAA (grupo 1) frente a no presentar AAA (grupo 2), que fueron estadísticamente significativos (p < 0,05), la diabetes mellitus (DM) apareció como factor protector (grupo 1: 28,2%; grupo 2: 71,8%), mientras que los pacientes con broncopatía crónica (EPOC) (grupo 1: 64,1%; grupo 2: 35,9%), EAP (grupo 1: 74,4%; grupo 2: 55,2%), tabaquismo (grupo 1: 100%; grupo 2: 82,2%) y los mayores de 65 años (grupo 1: 89,7%; grupo 2: 70%) presentaron mayor riesgo de AAA. En el análisis multivariante, EPOC (OR 4,7), edad > 65 años (OR 3,4) y el grupo de pacientes con EAP (OR 2,4) se mostraron como factores de riesgo, mientras que la DM se mostró como factor protector (OR 0,4). Conclusiones: en nuestra población, EPOC, EAP y edad > 65 años son factores de riesgo de AAA, mientras que la DM es un factor protector. El análisis de estos datos puede ayudar a definir la población de riesgo para la realización de estudios de despistaje en una consulta de cirugía vascular.
Chapter
Die Gefäßchirurgie ist in Deutschland eine junge Disziplin, doch ihre Geschichte beginnt mit den ersten Versuchen, Blutungen chirurgisch zu stillen. Mit dem medizinischen Fortschritt entstand vor allem in den vergangenen 120 Jahren eine Vielzahl von Techniken; entwickelt und perfektioniert von einer Vielzahl wichtiger Protagonisten. Ihnen allen in einem Buchkapitel gerecht zu werden, ist unmöglich. Wir versuchen jedoch einen Überblick über die wichtigsten Meilensteine zu geben.
Article
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Palabras clave: Aneurisma de aorta abdominal roto. Código aneurisma. Comunidad de Madrid. Protocolo estandarizado. Proceso. Resumen El aneurisma de aorta abdominal roto (AAAr) es una entidad que aún ocasiona una elevada mortalidad a pesar de las mejoras en el cuidado intraoperatorio y posoperatorio de los pacientes y del beneficioso impacto del tra-tamiento endovascular. La implementación de un protocolo estandarizado de las medidas terapéuticas que incluya criterios de selección, abordaje multidisciplinar de equipo y adecuación científico-técnica en centros con experiencia ha mostrado claros beneficios. La creación de códigos específicos como herramienta de actuación protocolizada en la Comunidad de Madrid también ha generado beneficios en los resultados terapéuticos de las patologías seleccionadas. La Sociedad Madrileña de Angiología, Cirugía Vascular y Endovascular promueve la creación de un Código Aneu-risma en una comunidad donde la existencia de múltiples centros eleva la complejidad en términos de traslado y circuitos de derivación con el objetivo de aumentar la sospecha diagnóstica, ordenar los traslados a centros de idoneidad y proporcionar asistencia protocolizada que asegure los mejores resultados tras el tratamiento del aneurisma de aorta abdominal roto. Abstract Ruptured abdominal aortic aneurysm (rAAA) is an entity whose mortality remains high, despite improvements in the intra and postoperative care of patients and the beneficial impact of endovascular treatment. Systematic standardized protocol of therapeutic measures that include selection criteria, multidisciplinary team approach and technical scientific adaptation in centres with experience, have shown clear benefits. The creation of specific Codes, as a protocolized action tool in the Community of Madrid, has also generated ostensible benefits in the results of the treatments in the selected pathologies. The Madrid Society of Angiology, Vascular and Endovascular Surgery promotes the creation of an Aneurysm Code, in a Community, where the existence of multiple centres increases complexity in terms of transfer and referral circuits. In order to increase the diagnostic suspicion, order transfers to Suitability Centres and offer protocolized assistance to ensure the best results after the treatment of the ruptured abdominal aortic aneurysm.
Chapter
Albert Einstein war nicht nur ein genialer Physiker, er ist auch in die Medizingeschichte eingegangen – zumindest im angloamerikanischen Sprachraum.
Book
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A patobiographic account of the life of Albert Einstein, his diseases and the relation with his medical friends.
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