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Found an old lecture

In 2006 I had to give the fellows a lecture on nocturnal dialysis. I remember being delighted with how it turned out. It was a fellow-level lecture that would have little appeal to non-nephrologists. The lecture goes into the different ways to measure dialysis dose and deep-dives into the National Cooperative Dialysis Study and the HEMO trial.

A month or so after giving the lecture I had a hard drive crash. After that, I couldn’t find the lecture.

Well, today I was mucking through an old external hard drive and found the lecture! Yay me! I backed it up!

If you are interested the lecture is now resting safely under the Lectures Tab.

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HeLa, Salk and the Tuskegee Institute

The Immortal Life of Henrietta Lacks is a multi-headed beast. The story is structured around three discernable plot lines. The first, is the history of the Lacks Family from slavery war up through present day. Another, is the author’s story of  how she met the family and uncovered the history. And the last leg is the history of science and how it relates to human cell culture and the HeLa cells.

This last story line is amazing, but I’m a little cooler to the other two. So far I’d say the third line is strong enough to justify reading the whole book but this is no The Checklist Manifesto.

One of the most interesting stories is regarding the first scientific win for the brand new science of human cell culture. HeLa cells were instrumental in the widespread testing of the Salk Polio vaccine. (All of the following excerpts from the book come from here)

“..in April 1952, [George] Gey and one of his colleagues from the NFIP* advisory committee –William Scherer, a young postdoctoral fellow from the University of Minnesota– tried infecting Henrietta’s cells with poliovirus. Within days they found that HeLa was, in fact, more susceptible to the virus than any cultured cells had ever been… they knew they’d found exactly what the NFIP was looking for”… “On Memorial Day 1952, Gey…sent Mary to the post office…When the package arrived in Minneapolis about four days later, Scherer put the cells in an incubator and they began to grow. It was the first time live cells had ever been successfully shipped in the mail.” …”When the NFIP heard the news that HeLa was susceptible to poliovirus and could grow in large quantities for little money, it immediately contracted Scherer to oversee development of a HeLa Distribution Center at the Tuskegee Institute… [p95] …it was the first-ever cell-production factory and it started with a single vial of HeLa that Gey had sent Scherer in their first shipping experiment, not long after Henrietta’s death. [p96]

George Gey was the original scientist who created the immortal HeLa cell line.
*NFIP was the  National Foundation for Infantile Paralysis, the organization now known as the March of Dimes, created by FDR to fight polio.

I had never known that the Tuskegee Institue had a role in the war on Polio and development of the Salk Vaccine. The HeLa cells were used in wide spread testing of the vaccine to make sure it was immunogenic. Since HeLa were able to be infected and killed by the Polio virus, they became a convenient means of testing the vaccine. The vaccine was administered to volunteers and six weeks later if that patient’s serum protected HeLa cells from Polio infection that alloquot of vaccine and its administration technique was immunogenic.

The only thing I knew of the Tuskegee Institute was its role in medicine’s most horrific racial crime, the studying of 400 African American men with syphillis without telling them they were infected or offerring treatment. This deception lasted for forty years. From Wikipedia:

By 1947 penicillin had become the standard treatment for syphilis. Choices might have included treating all syphilitic subjects and closing the study, or splitting off a control group for testing with penicillin. Instead, the Tuskegee scientists continued the study, withholding penicillin and information about it from the patients. In addition, scientists prevented participants from accessing syphilis treatment programs available to others in the area. The study continued, under numerous supervisors, until 1972, when a leak to the press resulted in its termination. Victims included numerous men who died of syphilis, wives who contracted the disease, and children born with congenital syphilis.[4]

So finding out that Tuskegee had a role in Polio was interesting, but discovering that the technicians and scientists in Tuskegee were all African American and that the Tuskegee institue had won the contract to produce the cultures in a form of proto-afirmative action blew my mind. An afirmative action program was happening at the same place, and at the same time, as one of the darkest moments in the mistreatment of African Americans.

…”Black scientists and technicians, many of them women, used cells from a black woman to help save the lives of millions of Americans, most of them white. And they did so on the same campus –and at the very same time– that state officials were conducting the infamous Tuskegee syphilis studies.

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New Lecture Tab.

I gave a lecture to the internal medicine residents of Saint Johns today. The lecture was case based and focused on non-anion gap metabolic acidosis. Later, I received this e-mail:

Dear Dr Topf,

I appreciate your lecture this morning on Non-anion gap metabolic acidosis, I tried to get a copy from your website, but i couldnt find it. I would appreciate if I could get a copy

Thank you,
Saif

Saif, you want it? You got it.

Look above and next the Blog and Handout tabs is a brand new tab, Lectures.

If the presentation is a powerpoint-style slideshow then I’ll post it under that tab. If the lecture was paper based then look under Handout for the supporting material.

Enjoy.

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Epocrates announces that it is ending support of WebOS

Epocrates got its start in the PDA boom of the late 90’s on the backs of the Palm platform. I am surprised that they are pulling up stakes and dumping WebOS. It feels like HP was too slow in releasing new metal or doing anything to show the developer community that there is a reason to stick it out. Could the last WebOS developer shut off the lights and lock the door when they leave.

Sad day. It’s beginning to feel like just a two horse race, Apple and Google.

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My Apple predictions for 2011

Every year the gadget blogs and podcasts give their predictions for the next year. I’m watch Apple pretty closely and I think I have a pretty good feel for the next year. Here are my predictions for 2011. Let’s see how I do.

iPad

The iPad 2 comes out in April after being announced 2-3 weeks earlier. Not a lot of surptrises. It has front and back face-time cameras, weighs less, goes faster and is thinner. It will have a higher resolution screen that Apple will brand a Retina Display but it will not have the same pixel density of the iPhone 4. There wil be three versions, WiFi only, a 3g version with CDMA and a new 4G LTE version from Verizon, AT&T and eventually Sprint.

The current iPad, with the low resolution screen, no camera will live on as a low cost model at $399. With the upcoming entry of Palm, RIM and Android in to the tablet space Apple will try to suck all the atmosphere from the room by lowering the entry level price as aggressively as possible. This will upset all the other competitors pricing plans and provide less maneuvering room in the price umbrella under the iPad.

By the end of the year Apple will have sold 70 million iPads (total 2010 an 2011 sales) and have a market share of 70+%.

iPhone

iPhone 5 is introduced in June and goes on sale in July. It sports the same form factor as iPhone 4 but has a faster processor, longer battery life, and better front and rear camera. The major new feature is near field communication. Apple sticks with 16 and 32 gb memory options. Prices remain the same.
The Verizon iPhone is introduced with the iPhone 5, the first iPhone 4 for Verizon is the $99 8 gb model introduced along with the iPhone 5. 
The white iPhone makes it first appearance since the 3gs as an iPhone 5.
Apple will sell a 65 million iPhones in 2011.

iOS
iOS 5 focuses on the cloud. Music and movies purchased through iTunes can now be streamed over the net. All devices tied to the same apple ID can stream the content, iMacs, Apple TV, iPods, iPads and iPhones.

iOS 5 also gets over the air updating of the OS and over the air continuous back-up, a internet enabled Time Machine back-up service. This major update will better allow iPads to be used without a computer to tether to.

Document management moves forward allowing seamless management of a single document on an iPad then desktop mac and then an iPhone. The document lives in the cloud with synced copies on all of your apple devices.

iOS 5 also adds new APIs that allow software developers to accept voice control and voice feedback for applications.

iOS 5 allows FaceTime over 3g.

Macintosh
The big story for Mac hardware will be the addition of Lightpeak to replace firewire and display port. By the end of 2011 all Macintosh’s will ship with Lightpeak. RIP Firewire.

MacBook Pros will all go SSDs. There maybe an option for a second drive, a magnetic spinning hard drive but the primary drive will be an SSD. The MacBook will continue to have a spinning hard drive further differentiating the Pro models form the baseline MacBook. This trend will continue across the iMac and MacPro lines both of which will be updated to include an SSD as the primary drive with spinning hard drives as additional drive options.

Video professionals and HD enthusiasts looking for Macs to ship with Blu-Ray will continue to be disappointed. No Blue-Ray drives will ship in any Macintosh’s.

MacOS 10.7 Lion will be announced at WWDC to be introduced in the Fall. 10.7 will introduce a new look and feel with a more iOS-like theme.

The Mac App Store will be a huge hit and will reinvigorate innovation on the PC. The amount of money most people spend on desktop apps will rise and this will intropduce many people to the creativity of the independent Mac Software developer. This will further loosen Microsoft’s and Adobe’s hold on on the software market as people get exposed to a myriad of less expensive, less complex and more focused single purpose applications.

iLife 2011 will add a new application. This application will allow hobbyists, enthusiasts and educators to create interactive content for the iPad. A Hypercard for a new era. See this post.

iPods
In September the big announcement will be that the iPod Nano adopts iOS and becomes the smallest general purpose computer. Apple will open the Nano to a specialized corner of the App store where developer focus on voice and speech for much of the interface.

iPod classic goes away and along with it the last click wheel iPod. The iPod Touch gets a version with 128 gb to replace the lost Classic.

Apple TV adds apps that primarily function as channels. So there is the National Geographic app which allows you to view NG video content on your TV.

Apple
Apple will not release a release a large screen TV or any other sized TV.

They will not make a major acquisition, though they will continue to gobble up small, engineering-focussed companies with core technologies.

The Apple-Google  will not jettison Google or Google Maps.

AAPL will hit a high of $415 and finish the year at $395.

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I’m reading The Immortal Life of Henrietta Lacks

The Immortal Life of Henrietta Lacks is about the HeLa cells and the woman they came from. I’ve just started it but it is really interesting.

One of the most striking parts of the story is hearing how Jim Crow laws and segregation affected medicine. Rebecca Skloot discusses sick black patients coming to a hospital and being turned away to go to a “Colored” hospital and then dying in the parking lot without ever receiving therapy. Hard for me to imagine.

Henrietta and David Lacks

The other interesting story was that of Alexis Carrel the winner of the  1912 Nobel Prize for medicine. His Nobel was for his work in creating a surgical technique for sewing blood vessels together. He is important in the HeLa story as he claimed to have created the first immortal tissue cell culture. This was embryonic chicken heart cells. The heart tissue long outlived the lifetime of the chicken and even outlived Carrel himself but the book states that Carrell faked his results by adding fresh embryonic cells periodically. The book also discredits him as a Nazi sympathizer and a eugenics proponent.

The book is good. I recommend it.

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New Handout Tab.

Look up, just below General Jack Ripper and Group Commander Lionel Mandrake are two new tabs: Blog and Handouts. This fulfills a constant request I get from residents and medical students, how do I get a copy of your handouts. Clicking on Handouts will take you to an index with every handout in PDF and Pages format.

I plan on adding pages for presentations and the Fluid and Electrolyte Companion.

Enjoy.

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Renal week day 4: The case for DDAVP in severe hyponatremia

Today I went to see Richard Stern talk about Therapeutic Considerations in the Hyponatremic Patient. It was an excellent talk. One of the concepts he introduced, at least to me, was the use of DDAVP in the patient with severe hyponatremia.

His argument was that the biggest threat to to these patients is the overly rapid correction of sodium due to the sudden suppression of endogenous ADH in the middle of therapy. This is exactly what I was worried about when I was treating that severe case of hyponatremia a couple of weeks ago. My solution up to now is to write an order for the nurse to call me if the patient’s urine output rises over 100 mL an hour. Unfortunately this is an unusual call order and nurse compliance with it is questionable.

He proposes using DDAVP to essentially lock, or hold constant urinary losses. Then you use 3% saline and the increases in plasma sodium should be more predictable.

This maneuver has a high degree of difficulty but I think it solves an important problem. I’m going to try this on my next case of extreme hyponatremia.

Has anyone else used this technique?

– Posted using BlogPress from my iPad