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Sunday, November 7, 2010

Who's Coming To Dinner?


Thanks to Jane over @ Life On Planet Baby for the Who's Coming To Dinner? tag. The deal is to describe the setting, list the menu & then the 6 guests who you'd most like to invite. I thought about it & immediately names like George & Jon & Clive & Patrick came to mind. Then I got to thinking - while I do love those chaps, there are 6 other very special gentleman who are far more important to me. Although not household names, they are my idols. Of course, I would be far too excited to cook, so it would be off to the famed Le Cinq at the legendary Hotel George V in Paris for the evening - it would be heaven. And come to think of it, sadly that's where all these lovely men are these days.


My 6 guests have shaped my working life like no others. A day doesn't go past when I don't think of them & their pioneering courage & achievements all mixed with a high degree of chutzpah. And as today is the 115th Anniversary of the discovery of X-Rays, it's the perfect day for this post!

As it all started with Wilhelm Roentgen (1845-1923), he will have pride of place at my table. A mechanical engineer & physicist, his work on cathode rays led him to observe that objects of different thicknesses interposed in the path of these rays showed variable transparency to them when recorded on a photographic plate. On the evening of November 8, 1895 he immobilised the hand of his wife Anna in the path of the rays over a photographic plate, & observed after development of the plate, an image of the bones of her hand and that of a ring she was wearing. This was the first röntgenogram ever taken & because their nature was then unknown, he gave them the name X-rays (X=unknown). He was awarded a Nobel Prize in 1901 for his achievement.


Seated next to Roentgen is Dr. Sven-Ivar Seldinger (1921-1998), the pioneer of angiography. No single technical contribution has impacted the development of angiography, as Seldinger's technique of introducing catheters percutaneously via a needle & guidewire into the vasculature. Every Interventional Radiologist & Cardiologist around the world uses this technique each day of their working life to gain access to the arteries of their patients. The technique's elegance and its usefulness lie in its very simplicity - 'Needle in—wire in—needle out—catheter in—wire out' is the mantra with which I & hundreds of thousands live by each day.



Next to join us will be Dr. Charles Dotter (1920 - 1985), the father of Interventional Radiology (& my great passion!), a brilliant innovator and Nobel Prize nominee. As a Radiologist he became fed up with receiving patient radiology request forms from his medical & surgical colleagues often with the same scribbled note on the bottom ' Look but do not fix.' So he modified the Seldinger technique for treatment/therapeutic purposes, where previously it was a diagnostic tool only. With Dr. Melvin Judkins, Dr. Dotter was also the inventor of percutaneous transluminal balloon angioplasty, using a balloon catheter to unclog peripheral arteries and to restore blood flow.



Seated next to his friend & mentor Dr. Dotter is Dr. Melvin Judkins (1922 -1985) a Radiologist with a special interest in Cardiology. He begun work in the mid-1970's on creating a technique of introducing catheters that were specially shaped to reach the coronary arteries, as the conventionally shaped peripheral catheter curves did not work for coronary vessels. Known as theJudkins technique, it's still used in Cardiac Cath. Labs. around the world today. He is pictured holding the 3 diagnostic catheters we call the Holy Trinity - a Judkins Right Heart, a Judkins Left Heart & Pigtail.



Then we'll be joined by Dr. Caesare Gianturco (1905 - 1995), a creative genius with a warm & inquring mind & prolific inventor who gave Interventionalists many tools of their trade.
These include embolization coils & vena cava filters, but most importantly of all, the expandable metallic stent. Whilst Drs. Dotter & Judkins had revolutionalized medicine with the use of arterial balloons to treat strictures & occlusions, once the balloon was used, the artery often closed off again. He designed a simple metal structure that could be deployed after balloon angioplasty that would 'tack' back the occlusion to the vessel wall, like a scaffold to prevent reocclusion.




Then lastly we would be joined by that bundle of bouncing energy, the brilliant Dr. Andreas Gruentzig (1930 - 1985). An eminent German cardiologist, Gruentzig built on the work of Charles Dotter, working hard to miniaturise the Dotter balloon catheters for use in coronary arteries. He presented the results of animal studies with the balloon at the American Heart Association (AHA) meeting in 1976 and was met with skepticism. However an opportunity to prove the skeptics wrong came the following year, when a 38-year-old insurance salesman with severe proximal stenosis (blockage) of the left anterior descending artery (LAD) and intractable angina agreed to undergo the procedure & Gruentzig successfully performed the first coronary angioplasty in the world. A year later, when he presented the results of his first four angioplasty cases to the 1977 AHA meeting, the audience burst into applause, acknowledging his breakthrough with a standing ovation.
Tragically, Dr. Gruentzig did not live to see his life's work come to fruition. In October 1985, the light plane he was piloting in stormy weather crashed near Macon, Georgia. Dr. Gruentzig was killed at the young age of 46, along with his new bride Margaret.

So what an evening we will have. There are so many questions I want to ask my gadget guys, my heroes. I hope my guest list has given you a look into my specialty area of work, & how we got to this point. While it's not everyone's thing, by golly it's mine!!!! Bon appetit.


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