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outline of human head

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Outline of human anatomy - Wikipedia


Inthe first cephalosomatic linkage was achieved in the monkey. However, the technology did not exist for reconnecting the spinal cord, and this line of research was no longer pursued. In this paper, an outline for the first total cephalic exchange in man is provided and spinal reconnection is described. The use of fusogens, special membrane-fusion substances, is discussed in view of the first human cord linkage.

Several human diseases without cure might benefit from the procedure. InRobert White and his colleagues successfully transplanted the head of a rhesus monkey on the body of another one, whose head had simultaneously been removed.

The monkey lived 8 days and was, by all measures, normal, having suffered no complications. Whether such dramatic procedures will ever be justified in the human area must wait not only upon the continued advance of medical science but more appropriately the moral and social justification of such procedural undertakings, outline of human head.

The greatest technical hurdle to such endeavor is of course the reconnection of the donor D 's and recipient R 's spinal cords. It is my contention that the technology only now exists for such linkage. This paper sketches out a possible human scenario and outlines the technology to reconnect the severed cord project GEMINI.

It is argued that several up to now hopeless medical outline of human head might benefit from such procedure. The only way to perform a cephalic exchange in man is to cool the body-recipient R 's head to such a low temperature to allow the surgeons to disconnect and reconnect it to the donor D 's body, whose head has been removed in the same operating theater by a second surgical team.

Once R's head has been detached, it must be joined to D's body, that is, it must be reconnected to the circulatory flow of D, within the hour. Hypothermia can be achieved in several ways,[ 2 ] but, in this particular endeavor, it will not involve total body extracorporeal circulation TBECin order to avoid the attendant ill effects brain damage and coagulopathyand make the procedure as simple and as cheap as possible.

The first patient submitted to this protocol was operated on in November for removal of a brain lesion. Here follows a short description. Drawing depicting White's autocerebral hypothermic perfusion in place from White After induction of anesthesia and intubation, and insertion of a cerebral 21G thermistor into the outline of human head parietal lobe and appropriate exposure, the common carotid arteries and their bifurcations were exposed.

The two vertebral arteries were uncovered on each side of the neck as they coursed toward their body canals just caudal to the C6 body. Silk ligatures were passed around each individual artery and threaded through a short glass tube with a narrow opening and capped with a rubber tip for temporary nontraumatic occlusion. Following total body heparizination, the left femoral F artery and both common carotid C arteries were cannulated with small slightly curved metal cannulas single carotid cannulation had been found to be unsafe in that it did not afford homogeneous bi-hemispheric cooling in monkeys.

These were connected to each other via a pediatric Brown-Harrison high-efficiency heat-exchanger, outline of human head. Fluids of varying temperatures were circulated into the cylinder chamber around the tube containing the perfusing blood from a plastic reservoir using a sump pump, outline of human head. Under electroencephalography EEG control and with the F-C shunt open, each cervical artery was occluded beginning with the external carotids and ending with outline of human head closure of the vertebrals.

With the demonstration that the shunt could maintain a normal EEG at normothermia, ACHP was instituted by altering the temperature of the fluid entering the heat-exchanger: After 48 minutes of perfusion, the intracerebral temperature had reached Brain rewarming could be significantly retarded during the ischemic period by surrounding the head with ice.

The patient made an uneventful recovery. White[ 2931 ] also experimented with biventricular cooling [ Figure 2 ]. Here, two 18G ventricular cannulas are inserted in the anterior horn of each lateral ventricle through small burr holes in the skull and fixed with acrylic cement; a similar cannula is inserted percutaneously in the cisterna magna for egress of the perfusate, outline of human head.

This technique has been employed in man: It is rapid and easy and obviates vascular cannulation, extracorporeal routing of the outline of human head, and total body anticoagulation. No damage to the brain has been reported.

Drawing depicting biventricular cooling for deep brain hypothermia in a monkey from White No neurologic deficit was detected. A thermistor in the brain can be replaced by one placed in the temporalis muscle TMas this closely correlates with intraparenchymal brain temperature.

D's spinal outline of human head will be selectively cooled, that is, no systemic PH will be necessary. Segmental hypothermia of the cervical cord produced no measurable temperature change of the brain. In the seminal experiment,[ 28 ] a Rhesus outline of human head [ Figure 4 ] was sedated, tracheotomized and mechanically respired, then transected at C4-C5 vertebral level. Surgical isolation was accomplished stepwise, under antibiotic coverage:.

Drawing depicting the outline of human head total cephalosomatic exchange in a monkey from White et al. Circumferential soft tissue and muscle were divided around the entire surface of the cervical vertebra with ligation and transection of the trachea and esophagus following appropriate intubation. Cervical laminectomy was performed at C4-C6 vertebral level with ligation and division of the spinal cord and its vasculature at C Following spinal cord division, an infusion of catecholamine was begun to counteract the hypotension of ensuing spinal shock with the maintenance of mean arterial pressure MAP mmHg.

Mechanical respiration was begun and continued throughout the experiment. The vertebral sinus was obliterated with judicious use of cautery and intravascular injection outline of human head fast-setting celloidin. The vertebral body or interspace was transected. At this point, outline of human head head and body were completely separated save for the two neurovascular bundles. Each carotid artery and jugular vein in turn was divided and reconnected by means of a suitable sized tubing arranged in loops during constant EEG surveillance.

Prior to cannulation, the preparation was heparinized and the vagi sectioned under ECG monitoring. For vascular transference of the cephalon to the new isolated body, the individual cannulas were occluded and withdrawn from the parent body carotid arteries and jugular veins in sequence, allowing for continuous cerebral perfusion from one set of cannulas during the exchange and replaced into the appropriate somatic vessel under EEG observation.

Following successful cannula-vascular transfer, direct suture anastomosis of the carotid arteries and jugular veins was undertaken silk andrespectively under the operating microscope. This permitted discontinuance of purposeful anticoagulation. Fresh monkey blood was available if significant losses were encountered under prolonged heparizination.

The monkey survived, neurologically intact, for 36 hours, outline of human head, having reacquired awareness within hours. With time, some blood loss was encountered from the muscles at the surfaces of surgical transection, outline of human head, due to chronic heparinization.

The initial attempt to suture the vessels directly and thus eliminate the necessity outline of human head anticoagulation was only partially successful because of the constriction that developed in the jugular vein at the suture line, impeding venous return from the head. No evidence of cellular changes compatible with a hyper-rejection reaction in cerebral tissue was seen on pathological examination up to 3 postoperative days.

During the GEMINI procedure, the surgeons will cut the cooled spinal cords with an ultra-sharp blade: This is of course totally different from what happens in clinical spinal cord injury, where gross damage and scarring hinder regeneration. Several families of inorganic polymers polyethylene glycol [PEG], outline of human head, nonionic detergents triblock copolymers, outline of human head, i. Membrane fusion and attendant mixing of the cytoplasm of fused cells occurs when adjacent membranes touch in the presence of PEG or similar compound.

PEG is dislodged once the membrane is sealed. This reorganization of cellular water is believed to result from the strongly hydrophilic structure of PEG. In contrast, triblock copolymers, outline of human head, which are mainly composed of PEG side chains around a high molecular mass hydrophobic core, act differently, namely, the hydrophobic head group inserts itself into the membrane breach, seal-plugging it.

The diameter of injured axons does not affect their susceptibility to repair by PEG: Both myelinated and unmyelinated axons are equally susceptible, but also neurons. PEG is easy outline of human head administer and has a strong safety record in man, often employed as vehicle to clinically injected therapeutic agents. Bittner et al. This is a clear indication for the need to use a topical approach. In any case, PEG appears to be superior to poloxamer A successful phase I human trial of PEG on human volunteers has been completed.

Outline of human head sum up, no more than 2 minutes of application of PEG can fuse previously severed myelinated axons in completely transected spinal cordsenough outline of human head permit the diffusion of intracellular markers throughout the reconnected segments and immediate recover of conduction of compound action potentials lost after injury.

Injected PEG crosses the blood—brain barrier and spontaneously targets areas of neural injury, without accumulating or lingering in undamaged tissues.

Similarly, PEG injected beneath the perineural sheath near the lesion in peripheral nerves is effective in functional repair. These polymeric micelles, sizing from 10 to nm, possess unique properties such as biocompatibility and long blood residence time, and have been widely investigated as nano-carriers of water-insoluble drugs. Much lower micelle concentration is required for treatment than pure PEG. Another way exploits monodispersed, mesoporous spherical PEG-decorated silica nanoparticles: These are hydrophilic, biocompatible, nontoxic, outline of human head stable.

This colloid-based PEG derivative may do an even better job compared with polymer solution by controlling the density of PEG molecules at cord level.

An alternative, possible better way to fuse severed axons has been described. Then, a hypotonic solution of PEG mM is applied to open closely apposed axonal ends to induce their membranes to rapidly flow into each other PEG-fusion.

This technique has been applied to experimentally cut sciatic nerves in rats with excellent results. Better agents than PEG have been identified and are available. It is biocompatible, biodegradable, and nontoxic. It is normally used as clinical hemostatic and wound healing agent in both gauze and granules. Combining the actions of both chitosan and PEG leads to a newly developed hydrogel based on photo-cross-linkable chitosan Az-Cprepared by partial conjugation of 4-azidobenzoic acid ABA to chitosan.

Low-molecular-weight PEG with a nonreactive terminal group would be best. This gel can be applied as a viscous liquid that flows around the damaged cord temporarily held together. The gel precursor solution can be quickly cross-linked in situ by short-term UV illumination, covering the tubular part of the nerves and providing a reliable linkage during the healing process. These effects are likely due to the formation of a semi-IPN network, where PEG interpenetrates the covalent Az-C network and physically reinforces the network.

PEG is slowly released over a prolonged period, providing additional fusogenic potential. A possible objection to GEMINI involves the supposed need for proper mechanical alignment abutment of outline of human head severed axons. The behavioral results of the PEG experiments, however, make a strong point that, while the number of axons reconnected to be expected is unknown, the results are nonetheless clinically meaningful, as highlighted by Bittner et al. Here, interneuronal chains can function as a relay between the supraspinal input and the lower motor circuitry, given proper active training and provision of sensory cues in order to promote plasticity.

Interneurons may act as central pattern generator for movement in man, and treatment strategies that promote their sprouting and reconnection of interneurons have great potential in promoting functional recovery.

Parenthetically, these interneuronal chains can be set into operation by nonpatterned stimulation delivered via intact segmental input pathways: SCS has proved effective in this regard too in humans. What follows is a possible scenario in order to give the reader a feel for the whole endeavor. Donor is a brain dead patient, matched for height and build, immunotype and screened for absence of active systemic and brain disorders.

If timing allows, an autotransfusion protocol with D's blood can be enacted for reinfusion after anastomosis. The procedure is conducted in a specially designed operating suite that would be large enough to accommodate equipment for two surgeries conducted simultaneously by two separate surgical teams. The anesthesiological management and preparation is outlined elsewhere.

Heads are locked in rigid pin fixation, outline of human head.

 

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outline of human head

 

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