The beeping vibrato of pressure monitors, mechanical rhythm of the blood pump, low hum of the oxygenator and metronomic beat measuring heart rate: These are the sounds that emanate from a complex circuit of pumps, tubes, filters and monitors called ECMO, or extracorporeal membrane oxygenation. ECMO moves blood outside of the body through cannulae, or tubes, to an oxygenator that provides a gas exchange in the blood, removing carbon dioxide and replacing it with oxygen. The oxygenated blood is then warmed to the appropriate temperature and returned to the body using rhythms that mimic a beating heart.
When disease or trauma prevent the body from performing these life-sustaining rhythms, ECMO can take over.
In mid-March 2020, Marta Perez, MD, left her Florida-based private practice in obstetrics and gynecology to return to Washington University School of Medicine and Barnes-Jewish Hospital. Perez had completed her obstetrics and gynecology residence at those institutions, and now her husband, Michael Chomat, MD, was finishing a pediatric cardiology fellowship at the School of Medicine and St. Louis Children’s Hospital, and about to begin a pediatric intensive care fellowship.
Perez welcomed the move because it provided her with the opportunity to change the focus of her career. Rather than continuing in private practice, she wanted to return to academic medicine and focus exclusively on obstetrics. Now, working as an academic laborist, she serves as a hospital-based obstetrician who helps women deliver their babies and teaches residents and medical students about obstetrics.
Two factors in the timing of the move to St. Louis would prove to be extraordinary—for the world and for Perez. First, by early spring 2020, the scope and severity of a new coronavirus became evident worldwide, resulting in a pandemic. And second, Perez had learned she was pregnant with her first child, about to face many of the challenges and uncertainties her pregnant patients were facing.
When a new mother with high blood pressure is sent home with her newborn, she leaves the hospital with instructions to return—or visit her doctor—for a blood pressure check within the first 72 hours after discharge from the hospital. And she must repeat that visit seven to 10 days later.
Some pregnant women have high blood pressure, or hypertension, at the time of conception; others may develop it during pregnancy as a symptom of preeclampsia or eclampsia. In any case, it’s vital for these women to continue to monitor blood pressure after labor and delivery. Left unchecked, high blood pressure can cause headache, fluid retention and nausea, as well as organ damage, stroke and worse. Worldwide, hypertension is the second leading cause of maternal mortality, according to the World Health Organization.
Babies who suffer oxygen deficiencies during birth are at risk of brain damage that can lead to developmental delays, cerebral palsy and even death. To prevent this, most women in labor undergo continuous monitoring of the baby’s heart rate and receive supplemental oxygen if the heart rate is abnormal, with the thought that this common practice increases oxygen delivery to the baby. However, there is conflicting evidence about whether this long-recommended practice improves infant health.
As people age, a normal brain protein known as amyloid beta often starts to collect into harmful amyloid plaques in the brain. Such plaques can be the first step on the path to Alzheimer’s dementia. When they form around blood vessels in the brain, a condition known as cerebral amyloid angiopathy, the plaques also raise the risk of strokes.
People diagnosed with obstructive sleep apnea, or OSA, experience frequent disruptions of breathing while asleep. Those disruptions can range in frequency from five times in an hour for mild sleep apnea to 30 times or more for severe sleep apnea. In other words, a person with severe OSA stops and starts breathing at least every two minutes within an hour.
The very first X-ray image is a blurry, ghostlike view of a woman’s left hand, two sizable wedding rings visible on her third finger. Using his wife as his test subject, German physicist Wilhelm Röntgen used the power of the X-ray to gaze at bones beneath his wife’s skin, something he couldn’t have done before without an incision. Six years later, Röntgen won the 1901 Nobel Prize in Physics. The practice of medicine had changed forever.
All that holds true for the use of robotics in partial knee replacement surgery, also called unicompartmental knee arthroplasty or UKA. In fact, a team of Washington University orthopedic researchers found that using robotics during UKA yielded results that were up to 10 times more accurate than doing the procedure without robotic assistance. The study was published in The Bone & Joint Journal, March 2021.
Cancer is most often detected using traditional tissue biopsy: the removal of tissue by needle, endoscope or open surgery. The tissue sample is then examined for the presence of cancer cells. Though the standard of care, this kind of biopsy comes with some limitations. Because the procedure is invasive, it can be risky, and recovery can be uncomfortable. Additionally, such a procedure may not be safe for some people and may not be practical for those needing a series of biopsies to monitor the progress of cancer treatment.
Functional neurosurgery—surgical interaction with the brain to improve function—was pioneered to treat people in need of pain relief, often those suffering with terminal cancer. Simple early procedures included surgically creating tiny lesions, also called ablations, in specific areas of the nervous system linked to pain.
The field has come a long way since those early days, says Jon Willie, MD, PhD, Washington University neurosurgeon at Barnes-Jewish Hospital.
Three billion is such a large number that it’s hard to fathom. To put it in perspective:
Three billion also happens to be the number of DNA building blocks, or base pairs, that make up a human genome. And nearly every single cell in our bodies contains two copies of those 3 billion base pairs.
Noah was just six years old when he walked up behind someone mowing the lawn who didn’t know he was there. In an instant, as the lawnmower was backed up, Noah’s foot was caught underneath it, sharp blades cutting through skin, muscle and bone in his foot and toes. “They told us at the hospital that his foot might have to be amputated,” says Hingst. “We were in total shock.”