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Nephrol Nurs J ; 36(2): 127-35, 138; quiz 139, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19397173


An analysis of published literature, interviews with early transplant nurses, and other primary source materials shows how evolving medical treatments for rejection, nurses' ability to learn on the job, and their commitment to patients influenced the development of kidney transplantation as a specialized area of practice. The work of these nurses work is discussed in the context of unfolding nursing specialization at the middle of the twentieth century.

Trasplante de Riñón/historia , Rol de la Enfermera/historia , Especialidades de Enfermería/historia , Historia del Siglo XX , Humanos , Inmunosupresión/historia , Fallo Renal Crónico/historia , Especialización/historia , Inmunología del Trasplante , Irradiación Corporal Total/historia
Hist Stud Nat Sci ; 39(2): 171-218, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-20073126


This study investigates how, in the late 1940s and 1950s, fears of nuclear accidents and nuclear warfare shaped postwar radiobiology. The new and intense forms of radiation generated by nuclear reactor technology, and which would be released in the event of a nuclear war, created concerns about a public-health hazard unprecedented in form and scale. Fears of inadvertent exposure to acute and potentially lethal radiation launched a search for anti-radiation therapies, out of which emerged the new technique of bone marrow transplantation (BMT). This study analyzes the use of BMT first as a research tool to explore the biological effects of ionizing radiation, and then as an adjunct to radiotherapy for the treatment of cancer. In highlighting how BMT became the province of different research and clinical constituencies, this study develops an understanding of the forces and contingencies that shaped its development. Exploring the emergence of BMT and the uses to which it was put, it reveals that BMT remained a technique in the making -- unstable and far from standardized, even as it became both a widely used research tool and rapidly made its way into the clinic. More broadly, it casts new light on one route through which the Manhattan Project influenced postwar radiobiology; it also affords new insights into one means by which radiobiology came to serve the interests of the Cold War state. In its focus on BMT this paper provides a new perspective on the evolving relationship between radiobiology and biomedicine in the postwar period.

Trasplante de Médula Ósea , Leucemia , Reactores Nucleares , Radiobiología , Investigadores , Células Madre , Irradiación Corporal Total , Investigación Biomédica/educación , Investigación Biomédica/historia , Trasplante de Médula Ósea/educación , Trasplante de Médula Ósea/etnología , Trasplante de Médula Ósea/historia , Trasplante de Médula Ósea/fisiología , Trasplante de Médula Ósea/psicología , Historia del Siglo XX , Leucemia/economía , Leucemia/etnología , Leucemia/historia , Leucemia/psicología , Personal de Laboratorio Clínico/educación , Personal de Laboratorio Clínico/historia , Personal de Laboratorio Clínico/psicología , Medicina Nuclear/economía , Medicina Nuclear/educación , Medicina Nuclear/historia , Reactores Nucleares/economía , Reactores Nucleares/historia , Salud Pública/economía , Salud Pública/educación , Salud Pública/historia , Salud Pública/legislación & jurisprudencia , Práctica de Salud Pública/economía , Práctica de Salud Pública/historia , Práctica de Salud Pública/legislación & jurisprudencia , Radiobiología/educación , Radiobiología/historia , Investigadores/educación , Investigadores/historia , Investigadores/psicología , Irradiación Corporal Total/economía , Irradiación Corporal Total/historia , Irradiación Corporal Total/psicología
Semin Hematol ; 36(4 Suppl 7): 95-103, 1999 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-10595758


Bone marrow transplantation has evolved over a period of 50 years. Laboratory observations and animal studies defined the essentials of transplantation biology. The first attempts to transfer these studies to patients met with little success. The definition of the complexities of the human leukocyte antigen (HLA) system made it possible to select compatible sibling donors and more recently unrelated donors. Transplantation of stem cells from marrow, blood, or cord blood is now the treatment of choice for a variety of hematological and genetic diseases. Transplantation using less toxic preparative regimens to induce mixed chimerism makes possible an application to autoimmune diseases. Laboratory and clinical research directed toward induction of tolerance and elimination of malignant cells point the way to a wider application of hematopoietic cell transplantation in the next decade.

Trasplante de Médula Ósea/historia , Animales , Trasplante de Médula Ósea/métodos , Enfermedad Injerto contra Huésped/historia , Historia del Siglo XX , Humanos , Inmunoterapia Adoptiva/historia , Transfusión de Linfocitos/historia , Irradiación Corporal Total/historia
Cancer Radiother ; 2(3): 245-51, 1998.
Artículo en Francés | MEDLINE | ID: mdl-9749122


The choice of dose and fractionation for total body irradiation is made difficult by the large number of considerations to be taken into account. The outcome of bone marrow transplantation after total body irradiation can be understood in terms of tumour cell killing, engraftment, and normal tissue damage, each of these endpoints being influenced by irradiation-, disease-, transplant-, and patient-related factors. Interpretation of clinical data is further hampered by the overwhelming influence of logistic constraints, the small numbers of randomised studies, and the concomitant variations in total dose and fraction size or dose rate. So far, three cautious conclusions can be drawn in order to tentatively adapt the total body irradiation schedule to clinically-relevant situations. Firstly, the organs at risk for normal tissue damage (lung, liver, lens, kidney) are protected by delivering small doses per fraction at low dose rate. This suggests that, when toxicity is at stake (e.g., in children), fractionated irradiation should be preferred, provided that interfraction intervals are long enough. Secondly, fractionated irradiation should be avoided in case of T-cell depleted transplant, given the high risk of graft rejection in this setting. An alternative would be to increase total (or fractional) dose of fractionated total body irradiation, but this approach is likely to induce more normal tissue toxicity. Thirdly, clinical data have shown higher relapse rates in chronic myeloid leukaemia after fractionated or low dose rate total body irradiation, suggesting that fractionated irradiation should not be recommended, unless total (or fractional) dose is increased. Total body irradiation-containing regimens, primarily cyclophosphamide/total body irradiation, are either equivalent to or better than the chemotherapy-only regimens, primarily busulfan/cyclophosphamide. Busulfan/cyclophosphamide certainly represents a reasonable alternative, especially in patients who may not be eligible for total body irradiation because of prior irradiation to critical organs.

Trasplante de Médula Ósea , Acondicionamiento Pretrasplante/métodos , Irradiación Corporal Total , Busulfano/uso terapéutico , Ciclofosfamida/uso terapéutico , Historia del Siglo XX , Humanos , Inmunosupresores/uso terapéutico , Leucemia/terapia , Neoplasias/terapia , Irradiación Corporal Total/historia