Five of my favourite - medical therapies in use today

Creative use of the appendix - Mitrofanoff

Ever wondered what happens when scientists daydream, mess around, and throw around ideas on late nights in the pub?  Sometimes nothing but sore heads and giggles.  Often nothing, of course.  The cutting edge science of yesterday was shaped through routines, big research agendas, pigeon steps.  But, just occasionally, a little bit of creative genius emerges.  I offer you, dear reader, a few moments to glance back and smile at some of the delightfully curious medical things these characters have developed which we still use today.

(1) Human menotropins - these are for women who do not ovulate due to a lack of the sex hormones FSH and LH, and are therefore infertile.  So what's the curiosity?  The source of these hormones - they're from the best available supply - the urine of postmenopausal women, purified, concentrated and injected!  This technique was first used in 1961, and 'Menopur' and similar drugs are still a significant part of the $3.5bn global infertility market.

(2) Mitrofanoff procedure - schooldays teach us of the appendix as a relatively superfluous evolutionary remnant.  Or, if you've been a little more recently schooled, as a reservoir to repopulate gut bacteria post-dysentery.  Well, for some patients, this little worm is exactly what they need for another purpose.  If the urethra becomes permanently blocked, or the need for recurrent self-catheterisation is painful and leads to scarring, a 'chimney' can be created between the bladder and a stoma on the skin surface using the appendix as the conduit.  Continence is therefore regained!

(3) Azithromycin - a commonly prescribed macrolide antibiotic drug.  For this, I'll reuse the words of an American pharmacist, who tell the story better than I could hope to.

"With azithromycin, we accidentally created the nearly perfect antibiotic. High concentrations at the site of infection where you need it, significantly lower concentrations everywhere else in the body where you don't need it, it kills a broad range of bacteria, and it has a built-in time release formula. Most people can take it with few to no side effects and allergic reactions are very uncommon (mostly due to the red dye in the pills but manufacturers no longer use the red dye).

How awesome is that? Doesn't that sound exactly like how you want an antibiotic to work?

When you take the medication, it gets absorbed by your phagocytes without damaging them. Phagocytes are part of your immune system, they are warriors sent in to fight bacteria and other infections. The phagocyte travels to the infection, eats up the bacteria, and then dies by bursting open. When the phagocyte pops, the azithromycin is released right there at the site of the infection. You take the medicine and your body naturally makes sure the drug concentrates exactly where the infection is located.

As days pass and your body fights off the infection, the phagocytes live longer because there is less bacteria to eat. When you're first sick and the infection is high, the phagocytes are dying faster and the concentration of the drug is higher. As you get better and the phagocytes live longer, the concentration of the drug tapers off to match the lower concentration of infection. Think of it as a natural time release formulation."

(4) Endoscopic thoracic sympathectomy - so, some people just do blush a lot.  And some sweat a lot. This operation is one of those techniques that comes from the understanding that the autonomic nervous system controls the reactive response in the armpits, hands and face to stress.  To resolve these problems, small incisions are made in the armpits, a camera is inserted, and the sympathetic nerves are visualised and cut - 85% of patients report 'total satisfaction' with the outcome.

(5) Osteo-odonto-keratoprosthesis - to treat corneal blindness (i.e. irreparable scarring of the front of the eye).  This one is perhaps the most obscure of all.  A canine is removed, a hole is drilled in the root, a cylindrical lens is inserted in the root, and this is sewn into the cheek mucosa so it can grow a blood supply.  A patch of mucosa from the cheek is then sewn across the surface of the eye.  Two months later, the tooth-lens combination is inserted under the patch, and a hole is cut so light can enter the new lens.  This is simply extraordinary - and the autograft technique (using the patient's own tissue) is used to avoid tissue rejection.  This was first used in the 1960s, and is still predominant today.

Wow.

Thanks to Jason Gallier for review - watch this space for further guidance on faecal transplant (see EuroBiotix for a recent startup) and maggot therapy.