In a series of videos, surgeons at the Swedish Medical Center in Seattle present their skills with the DaVinci surgical robot in novel ways, including folding a paper plane, lacing an American football and painting fingernails.

A very creative way to communicate the precision of robotic surgery to the public. You can find all the videos here.

Photo by Øystein Horgmo © All rights reserved.

While shooting lab photos at the University of Oslo’s Department of Medical Biochemistry, I came across this little guy – an atlantic horseshoe crab kept in a desiccator. What was this odd-looking sea creature doing in a hospital research lab?

One of the lab technicians told me the fascinating story of the medical contribution of this living fossil. More closely related to scorpions and spiders than crabs, the atlantic horseshoe crab is most common along the east coast of North America and in the Gulf of Mexico. The horseshoe name comes from the shape of the animal’s carapace. In Norway we call them “dolkhale”, which translates as “daggertail”, from the long pointy tail.

While doing research on blood circulation using the Atlantic horseshoe crab in the 1950s, Frederick B. Bang MD at Johns Hopkins University found that the injection of certain bacteria into the crab’s blood stream resulted in massive clotting of the blood (his original paper from 1956 can be found here). Further research showed that the clotting reaction was only produced by gram-negative bacteria and that the reaction was also produced when dead bacteria were injected. Joined by hematologist Jack Levin, Bang continued his research into the clotting and found that it was produced by endotoxins, toxins found in the membrane of gram-negative bacteria.

As was the case, endotoxins were a big problem for the medical industry. Endotoxins can cause severe immune reactions in humans, and the toxins are still present when the bacteria itself has been killed. So sterilizing injectable medicines, IV fluids, surgical instruments etc. will not eradicate the endotoxins. Bang and Levin realized that the horseshoe crab blood, which clots in the presence of endotoxins could be used to detect the toxin. Together they developed the Limulus Amebocyte Lysate (LAL) test.

The horseshoe crab don’t have an immune system, but have developed a defense against the gram-negative bacteria which saturates the shallow waters where the crab live. When the blood cells (amebocytes) detect the presence of endotoxins they release granules containing a clotting agent. A clot forms and encapsulates any bacteria in that area. If the bacteria entered through a wound the clot also acts as a barrier to the outside until the wound is healed. Unlike mammals, the horseshoe crab’s blood has a copper-containing protein as an oxygen carrier, and their blood turns a milky blue when oxygenated. To make the LAL test, blood is collected from living horseshoe crabs which are released back into the sea after the procedure. The amebocytes are isolated from the blood serum and mixed with distilled water. The water causes the cells to burst (lysis) and the clotting agent inside the cells is released. When substance to be tested is added to this solution the clotting will occur even if as little as one part per trillion endotoxin is present.

Here is a short clip from PBS which shows how the blood collection is done:

The specimen at the lab was quite small and not an adult it would seem. They told me it had been at the lab since the 80s, probably brought home by someone who visited a LAL test manufacturer as a curiosity. It was not kept in the desiccator to keep it dry. I just think it seemed like a nice display jar.

Fascinating story and a fascinating animal!

Sources:

• The Marine Biological Laboratory (MBL)
• Maryland Department of NAtural Resources
• Horseshoecrab.org

Photos by Øystein Horgmo © All rights reserved.

A collage of some of my photos, used on the University of Oslo Medical Photography Section’s new website (Norwegian).

Happy new year!

© Journal of the Norwegian Medical Association.

A case report in the latest issue of the Journal of the Norwegian Medical Association describes a 7-month-old boy who was admitted to hospital after problems with drooling, vomiting of any non-mashed food and laboured breathing. Thoracic CT revealed a star-shaped foreign body stuck in the esophageal wall (above). The foreign body was removed endoscopically and turned out to be an 18 mm large plastic star from a christmas decoration.

And with that story The Sterile Eye wish all readers and friends a merry christmas and a happy new year!

We sat down and talked about some selected medical photos of mine and it turned out pretty good, I think. Now I’ve finally gotten my hands on the recording, for your (Norwegian) listening pleasure.

Listen to the interview in Norwegian (© NRK, used with kind permission):

Geronimo - detail showing photographer reflected in his eye. Public domain.

The Sterile Eye turned four years on 11.11.11, and it passed me by! The last year haven’t been my most active in blogging, but I should have remembered that.

To celebrate four years of life, death and surgery through a lens, I bring you four “forgotten” posts (i.e. with few visits) from each year from 11.11.2007 to 11.11.2011. Here’s to more time for blogging in 2012. Enjoy!

2007/2008

1. A Sudden Jolt of Sadness
2. Diagnosis and Aspiration
3. Yo Mammae
4. A False Alarm

2009

1. The Patient and the Photographer
2. The Party Bag
3. Living for a Suture
4. Anatomy Detective

2010

1. A Picture Before Dying
2. The Card
3. The Mind is a Weirdo
4. Superpowers

2011

1. Mugshots
2. Found Anatomy
3. Brave Boy
4. Mirror of the Body

Photo by Øystein Horgmo © All rights reserved.

A nurse talked to the family outside the room while I photographed the little girl they had just lost.

In black and white.

The teddy bear she had her arm around wore a t-shirt with a picture of her.

She had hair in that color picture.

Another day, another interesting find in the storage room rubble. The brochure “LEICA – Fotografie in der Medizin” (Photography in Medicine) was published by Leitz in 1961 (I think).

The front page reads (my translation):

The photograph helps the physician and scientist in the fulfillment of his tasks in a variety of ways. A picture - photo or slide - is far more effective and probative than written records. The photographic subject should complement the clinical findings in medical records and illustrate the author’s text in scientific publications. In the university the instructive picture has a high educational value, and through slide projection a very large audience can be addressed at once.

I love that medical photography was big enough back in the 60s that Leica could make a special catalogue for the field. ‘Cause make no doubt about it – Leica is the best camera for the job – er so the brochure says:

The variety of tasks: recording patients - at the operating table - with the reproduction setup - in combination with microscope or endoscope - require a universal system camera; it must be easy to handle and robust, have few operating controls, camera shutter and lens should be independent of each other.

This requirements are met perfectly in Leica.

I have an interest both in spaceflight and Hasselblads, so I was very excited when I found that Hasselblad has made their 1984 NASA Astronaut’s Photography Manual available to the public.

As a guidebook for the NASA Photography Training Program, it not only describes the operation of the Hasselblad 500 EL/M cameras used on the U. S. Space Shuttle but is also a concise manual on photography to assist astronauts in creating the best possible space photographs.

Hasselblad cameras have performed with precision on every manned space flight since 1962 and undoubtedly future missions will continue to yield those awe-inspiring and beautiful images from space – a priceless pictorial legacy for future generations.

A lot of the info applies to all photography, but I love that all the examples are taken from space shuttle travel.

Photo from the Museum of Photographic Arts Collections. Public domain.

If you ever got your picture taken in school you will know that photographers who shoot people tend to stick with a set of jokes and phrases they know will get the photos they need every time. Wedding photographers know how to get the look they need from their couples and us medical photographers know how to make our patients relax. Did I say the jokes work every time? Well, almost.

The ear-nose-throat docs at my hospital use our services a lot. One of the most frequent types of patients we get are “noses”. Patients who are going to have their noses operated on for a variety of different reasons. The photos taken of these patients is a standardized set of six photos, including frontal view and profiles. The only other instance when people are shot like this is if they’re in police custody. Mugshots.

I actually shot a set like this of a guy once who suddenly said “normally I’m the one taking these photos”. He turned out to be a policeman. In my experience most patients do not think about this similarity and that’s why the joke works. After two or three shots I normally say “Well, the only thing missing now is your prisoner number.” Nine out of ten will laugh, say “yeah, that’s true” and relax a little more, and the last one will smile politely, leaving me a bit awkward. There’s a couple of times however, we’re the joke have been much less successful, all because of my too frequent use of it.

One time was a really busy day with an especially large number of nose patients. I brought patient number twelve into the studio, a young man with a broken nose, and started shooting. When I’m doing the profiles the mugshot joke automatically pops out. No reaction but I don’t notice. I tell him to face me again for a final shot and he looks slightly angry. That’s when I realize I’ve just pulled the joke to an actual prisoner. A cuffed one at that. His prison guard who’s been in the room with us didn’t laugh either.

The other time it sort of was the other way around. This was no prisoner, but also a young man with a (severely) broken nose. He was in a somber mood, so I decided it ws time for the joke. But the prisoner number didn’t cheer him up, he only went from somber to slightly angry, just like the prisoner. I didn’t understand why , but later that day it dawned on me that he must have thought I was joking about him looking like an inmate with the broken nose and not the mugshot setting.

Because most patients don’t think mugshots when they’re sitting there, you see. But I do, and nowadays I often think before I pull jokes too.