Immersed in medical drama

2008-02-02

in Daily updates, Films and movies

Recent obsessive watching of House has taught me something: while whiteboards are the new standard, in relation to blackboards, the smoked plastic board is the cool option.

Also, pharmaceutical drugs are powerful, the human body is complex, and keyhole surgery changes everything. Also, people underestimate Rabies.

[Update: 4 February 2008] One medical inaccuracy I noted in this series concerns MRI machines. At several points, there are interactions between metal and the machine. In one case, bullet fragments that House shot into a corpse; in another, metal-laden prison tattoos. In both cases, there is no effect on the metal before the scan begins. This ignores how the magnet in an MRI machine is always on. The magnetic field is always there, aligning the magnetization of hydrogen atoms. The actual scan consists of radio waves used to alter the alignment of the magnetization. As such, the metal would have been drawn into the bore of the machine as soon as it got near it, not after the scans started.

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{ 8 comments… read them below or add one }

Litty February 2, 2008 at 10:31 pm

Why the interest in House?

. February 2, 2008 at 10:34 pm

Rabies can be prevented by vaccination, both in humans and other animals. Virtually every infection with rabies was a death sentence, until Louis Pasteur and Emile Roux developed the first rabies vaccination in 1885. This vaccine was first used on a human on July 6, 1885 – nine-year old boy Joseph Meister (1876–1940) had been mauled by a rabid dog.

Their vaccine consisted of a sample of the virus harvested from infected (and necessarily dead) rabbits, which was weakened by allowing it to dry for 5 to 10 days. Similar nerve tissue-derived vaccines are still used now in some countries, and while they are much cheaper than modern cell culture vaccines, they are not as effective and carry a certain risk of neurological complications.

The human diploid cell rabies vaccine (H.D.C.V.) was started in 1967. Human diploid cell rabies vaccines are made using the attenuated Pitman-Moore L503 strain of the virus. Human diploid cell rabies vaccines have been given to more than 1.5 million humans as of 2006. Newer and less expensive purified chicken embryo cell vaccine, and purified Vero cell rabies vaccine are now available. The purified Vero cell rabies vaccine uses the attenuated Wistar strain of the rabies virus, and uses the Vero cell line as its host.

Some recent works have shown that during lethal rabies infection the blood-brain barrier (BBB) does not allow anti-viral immune cells to enter the brain, the primary site of rabies virus replication. This aspect contributes to the pathogenicity of the virus and artificially increasing BBB permeability promotes viral clearance. Opening the BBB during rabies infection has been suggested as a possible novel approach to treat the disease.

. February 2, 2008 at 10:37 pm

Treatment after exposure, known as post-exposure prophylaxis or “P.E.P.”, is highly successful in preventing the disease if administered promptly, within fourteen days after infection. The first step is immediately washing the wound with soap and water, which is very effective at reducing the number of viral particles. In the United States, patients receive one dose of immunoglobulin and five doses of rabies vaccine over a twenty-eight day period. One-half the dose of immunoglobulin is injected in the region of the bite, if possible, with the remainder injected intramuscularly away from the bite. This is much less painful compared with administering immunoglobulin through the abdominal wall with a large needle, which is how it was done in the past. The first dose of rabies vaccine is given as soon as possible after exposure, with additional doses on days three, seven, fourteen, and twenty-eight after the first. Patients that have previously received pre-exposure vaccination do not receive the immunoglobulin, only the post-exposure vaccinations. Since the widespread vaccination of domestic dogs and cats and the development of effective human vaccines and immunoglobulin treatments, the number of recorded deaths in the U.S. from rabies has dropped from one hundred or more annually in the early twentieth century, to 1–2 per year, mostly caused by bat bites, which may go unnoticed by the victim and hence untreated.

P.E.P. is effective in treating rabies because the virus must travel from the site of infection through the peripheral nervous system (nerves in the body) before infecting the central nervous system (brain and spinal cord) and glands to cause lethal damage. This travel along the nerves is usually slow enough that vaccine and immunoglobulin can be administered to protect the brain and glands from infection. The amount of time this travel requires is dependent on how far the infected area is from the brain: if the victim is bitten in the face, for example, the time between initial infection and infection of the brain is very short and P.E.P. may not be successful.

SurfTheChannel February 3, 2008 at 10:27 pm
Ashuri Marksdottir February 4, 2008 at 9:01 am

Where are you getting House episodes? I thought the new season was over due to the writer’s strike. I need my crusty Hugh Laurie.

Milan February 4, 2008 at 6:33 pm

I have finished season one. I think ‘DNR’ was the best episode. The season finale was a bit of a letdown: the premise was interesting, but the conclusion was not.

Milan February 4, 2008 at 8:51 pm

In series two “Autopsy” is a quite moving.

Milan February 14, 2008 at 12:17 am

Season 4: Episode 8

Same MRI error, again.

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