El auge y la caída del mito de la epinefrina en la mano / The Rise and Fall of the Epinephrine Myth in the Hand

La posibilidad de operar a los pacientes con afecciones de la mano bajo anestesia local con la lidocaína y la epinefrina usando la técnica WALANT provocó una revolución en la cirugía de la mano, que facilitó la vida de los pacientes y disminuyó los costos de los servicios hospitalarios. Es necesario que los cirujanos conozcan la técnica y la historia de esta técnica. El objetivo fue identificar los orígenes del auge y la caída del mito y del dogma de la prohibición de la adrenalina en los bloqueos anestésicos de los dedos. Se realizó un análisis crítico de los principales textos de los artículos y los libros sobre el uso de la epinefrina en la anestesia de los dedos. La creación del mito de prohibir el uso de la epinefrina en los bloqueos anestésicos de los dedos se produjo debido a la mala interpretación de los informes de los casos de necrosis ocurridos que, en realidad, no fueron causados por la epinefrina. Ese mito influyó en la aparición de un dogma. La historia del uso de la epinefrina en los bloqueos de los dedos anestésicos demuestra que las interpretaciones superficiales y erróneas de las complicaciones clínicas publicadas como informes de casos pueden generar mitos y dogmas. Solo la ciencia puede prevenir y destruir tales mitos y dogmas médicos(AU)

The possibility of operating patients with hand conditions under local anesthesia, with lidocaine and epinephrine, using WALANT technique caused a revolution in hand surgery, which made life easier for patients and lowered the costs of hospital services. Surgeons need to be aware of the possibilities and history of WALANT technique. The objective was to identify the origins of the rise and fall of the myth and dogma of the prohibition of adrenaline in anesthetic finger blocks. A critical analysis of the main texts of the articles and books on the use of epinephrine in finger anesthesia was carried out. The conception of the myth of banning the use of epinephrine in anesthetic finger blocks occurred due to misinterpretation of reports of necrosis occurring, which were not actually caused by epinephrine. That myth influenced the appearance of a dogma. The history of the use of epinephrine in anesthetic finger blocks demonstrates that superficial and misleading interpretations of clinical complications published as case reports can breed myth and dogma. Only science can prevent and destroy such medical myths and dogmas(AU)

Comparison of four documents describing adrenaline purification, and the work of three important scientists, Keizo Uenaka, Nagai Nagayoshi and Jokichi Takamine.

The name of Keizo Uenaka has not been documented in textbooks. However, Uenaka was the scientist who worked on ephedrine and played a practical role in the purification and crystallization of adrenaline. His handwritten memorandum, "On Adrenaline, Memorandum, July to December, 1900" is now stored in a Buddhist temple, Kyougyou-ji in Nashio, Japan. In the present report, we compared Uenaka's original description and Jokichi Takamine's published scientific reports, and examined how each statement in four documents are related to each other in terms of successful adrenaline crystallization. Uenaka's memorandum contained precise procedures and experimental tips for successful purification. The experimental steps were considered to transcribed in the first published document in The American Journal of Pharmacy by Takamine in 1901, and summarized in another document in ``Journal of Physiology'' in 1901. A Japanese version was published in ``Yakugakuzasshi'' in 1903 by translating the English paper in the American Journal of Pharmacy published in 1901. Reading Uenaka's memorandum, we realized that he tirelessly and diligently undertook routine experiments that to some of us might seem boring and laborious. Although the name of Uenaka is not globally well known, he was the main scientist who did the actual work of purifying adrenaline.

[Professor Ivan Tarchanoff]. / Profesor Iwan Tarchanow.

Napoleon Cybulski, generally recognised the father of Polish physiology, was first a student and later an assistant of Tarchanoff at the Chair of Medical and Surgical Physiology of the Imperial Medical-Surgical Academy in St Petersburg. A Professor of the Jagiellonian University himself (whose nomination, by the way, was supported among others on the recommendations from Tarchanoff), Cybulski was a co-discoverer of adrenaline, and one of the first researchers in the world to make an EEG recording. Tarchanoff's ties with Poland are far greater than his biographers would admit. He was more than just a teacher and a friend of Cybulski: after being dismissed from the Academy in St Petersburg , the scientist not only used to visit Kraków but published his scientific works here, built a house in the vicinity of the city, and here he died on 24th August 1908. His wife, Helena Antokolska-Tarchanoff was active in Kraków's artistic circles. Hints suggesting that Tarchanoff planned to spend the rest of his life in what at the time was Galicia are plenty.

History of catecholamine research.

The prominence of catecholamines and their congeners in allergic diseases rests chiefly on their use in asthma and acute hypersensitivity reactions, such as anaphylaxis. They act in these indications by activating both α- and ß-adrenoceptors. Adrenaline, the prototype, was discovered in the adrenals in 1893/1894. In 1939, dopa decarboxylase was the first enzyme in the biosynthesis of catecholamines to be described. Later other catecholamines like noradrenaline and dopamine were characterized. The identification of the active chemicals went along with studies regarding catecholamine receptors. It took until 1948 before the existence of at least two different receptors for the different effects was accepted. Meanwhile, genes from all mammalian catecholamine receptors have been cloned.

[Adrenaline: isolated 111 years ago by an energetic Japanese scientist, Jokichi Takamine].

Adrenaline is one of the most commonly used drugs in anesthesia, intensive care and pain medicine. This organic substance was first isolated by a Japanese scientist, Jokichi Takamine, with an ingenious technical assistance by Keizo Uenaka. Although 111 years have passed from their success, the brightness of this achievement has never faded. Also, conflicts provoked after the invention suggest many fundamental issues regarding scientific invention and business. Anesthesiologists, who take big benefits of adrenaline, should correctly understand how this useful drug became available widely in the world and why the name was fluctuated between "adrenaline" and "epinephrine".

[The Rostock chair of pharmacology under Paul Trendelenburg 1919-1923]. / Das Rostocker Ordinariat für Pharmakologie unter Paul Trendelenburg 1919-1923.

On May 15th 1919 the pharmacologist Paul Trendelenburg, son of the surgeon Friedrich Trendelenburg, was appointed head of the Department of Pharmacology and Physiological Chemistry at the University of Rostock. Though these days still saw the aftermath of World War I, faculty and administrational procedures were pursued in a surprisingly rapid and concise manner, so that less than two months were needed for the appointment. Despite the scarcity of funds and serious postwar inflation, Trendelenburg soon embarked on an ambitious experimental and publicational program, his methodology firmly resting on the physiological basis of any pharmacological finding. The Rostock years mark the completion of his work on adrenaline, he had started earlier when refining the preparation of the perfused frog hindquarters (the Trendelenburg preparation) in Walther Straub's laboratory at Freiburg i. Br. Trendelenburg's vigour and scientific productivity during his 4 years at Rostock can be easily inferred from his almost 400 pages of extensive reviews, separating facts from fiction. Rostock marks as well the beginning of his work on hormones. Trendelenburg's endocrinological work stands out for the development of sensitive bioassays for measuring calcium concentrations after thyroidectomy and for evaluating the oxytocic principle of the posterior lobe of the pituitary gland which not only made him alert the pharmaceutical industry to the insufficient quality of pituitary extracts on the market, but also led him to discover the principle of neurosecretion within the tuber cinereum of the hypothalamus.

Jokichi Takamine (1854-1922), the samurai chemist, and his work on adrenalin.

The samurai chemist Jokichi Takamine (1854-1922) crystallized adrenalin, the first hormone to be isolated in the twentieth century, from the adrenal medulla, in the summer of 1900. This paper reviews Takamine's route to the discovery of adrenalin and presents historical photographs and documents collected in Kanazawa, Japan, where he grew up, and the United States, where he made his major discoveries.

One hundred years of adrenaline: the discovery of autoreceptors.

The active principle of suprenal extract that produces its pressor effects was isolated by the joint research of John Abel in 1899 and Jokichi Takamine in 1901. Within three years Elliott, working in Langley's laboratory, suggested that this active principle, referred to by British physiologists as "adrenaline" and named "Adrenalin" by Takamine, was released from sympathetic nerve terminals to act on smooth muscle cells. However, it was not until 1946 that von Euler showed that demythelated adrenaline (noradrenaline) rather than adrenaline is a sympathetic transmitter. The possibility that this sympathetic transmitter could also act on nerve terminals was not developed until 1971. Research on autoreceptors culminated in the identification of adrenergic receptors on nerve terminals different to those on muscle cells. This paper assesses the contributions that established the idea of the adrenergic autoreceptor, 100 years after the discovery of adrenaline.