Medical Photography Section, University of Oslo © All rights reserved.

Browsing through some old hospital newsletters, I found an article on cesarean sections and noticed a photographer in one of the photos. Being a photography section we typically don’t have many photos of ourselves at work, so I dived into our negative archive in hope of locating the shoot.

We have not yet been able to digitize our archives in a systematic way, and most of it is hard to search, as the entries for many years were logged only with the department and the requesting doctors name. This time however, I knew the year and the doctor from the newsletter story, and of course it was the department of obstetrics.

The year is 1978 and they must have been two photographers present at the surgery. I’m guessing this was a high-profile story and they didn’t want to risk missing a shot. Photographers are not mentioned in the story, so maybe one photographer decided to shoot the other for our archives (or out of boredom?).

The photographer is a former head of section and she’s sporting what seems to be a Nikon F SLR with a Sunpak auto124 flash.

Medical Photography Section, University of Oslo © All rights reserved.

This is the official poster for the the 19th Workshop of the International Society for the Study of Vascular Anomalies (ISSVA). What on earth were they thinking?

• Did the parents of this child agree to their child being used on a poster in this way?
• Did they know ISSVA would choose a photo were their child looks frightened?
• Did they know ISSVA would make the poster the shape of their child’s head?
• Did they know ISSVA would desaturate everything but their child’s hemangiomas?
• Did they know ISSVA would put text all over their child’s face?
• Even if they knew and agreed to all of the above, why did ISSVA use the photo like this?

Beside being a bad photo, I find this a very disrespectful use of a medical photograph.

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.