The history of fetal therapy.

The Fetal Treatment Center founded by Michael Harrison is credited as the birthplace of fetal surgery. His trainees in pediatric surgery subsequently founded fetal centers throughout the United States. In Europe, the advent of minimally invasive fetal surgical techniques led to the establishment of treatment centers led predominantly by perinatologists. More recently, perinatologists in North America have begun to play a greater role in the field of fetal intervention.Intrauterine transfusion for the treatment of hemolytic disease of the fetus/newborn was the first successful fetal intervention. Although not subjected to the rigors of clinical trials, this treatment has withstood the test of time. Interventions for other fetal disease states such as twin-twin transfusion and repair of fetal myelomeningocele were investigated in animal models followed by randomized clinical trials before widespread adoption. Tracheal occlusion for diaphragmatic hernia is still currently being investigated as the next promising step in fetal intervention.

Historical evolution of hypothermic liver surgery.

The clinical application of hypothermia dates back to the surgical treatment of blue babies (1949) and the early days of open heart surgery (1952), when generalized cooling was employed. The induction of hepatic hypothermia began with whole-body cooling in experimental models in 1953 and clinically in 1961. It was designed to minimize the ischemia-reperfusion injury associated with hepatic inflow occlusion. Body surface cooling and cooling via an extracorporeal circuit, however, were not widely accepted for hepatic surgery because of the adverse effects on the extrahepatic organs. Consequently, with the introduction of improved venovenous bypass techniques, in situ cold hepatic perfusion has been used in selected patients since 1971. In situ hypothermic hemihepatic perfusion, introduced in 1995, prevents an ischemic insult to the contralateral hepatic lobe. Topical cooling using ice slush under total or hemihepatic inflow occlusion was reported in 1993. This technique does not require cumbersome hypothermic perfusion equipment. In attempts to minimize intraoperative bleeding by vascular occlusion, the liver surgeon must consider the benefits and technical demands of hepatic hypothermia.

Dr. James A. Wolff. I. Early progress in treatment of Rh hemolytic disease.

Dr. James Wolff's interest in hematology began while he was assigned on the transfusion service in a field hospital in the European Theatre during World War II. His interest was increased during his pediatric residency at the Boston Children's Hospital (1945-1947). At that time, Dr. Louis Diamond was involved in his important studies on treatment of erythroblastosis fetalis by exchange transfusion. Drs. Farber and Diamond were also involved with the initial clinical trials of aminopterin for the treatment of acute leukemia. The concept of treating erythroblastosis fetalis by exchange transfusion grew from our understanding of the pathophysiology of this disease, as first explained by Philip Levine and Alexander Wiener. Three techniques of exchange transfusion were tried. Diamond's umbilical catheter technique, because of its relative ease and simplicity and because it could be used for multiple exchanges, soon became the accepted method for treating infants with erythroblastosis fetalis.