The page you requested is no longer on our site. It is possible that =
the link you followed was out of date. =0A=
Please search for what you were looking for here:
Famous Patients, Famous Operations, 2002 =
- Part 3:=20
The Case of the Scientist with a Pulsating Mass
from Medscape=20
Surgery Posted 06/14/2002
Albert B. Lowenfels, MD
A 69-year-old white male scientist =
consulted his=20
physician because of pain in the upper abdomen. For a number =
of=20
years he had suffered from attacks of upper abdominal pain, =
which=20
usually lasted for 2-3 days and were often accompanied by =
vomiting.=20
These attacks usually occurred about every 3 or 4 months. =
The=20
patient was a pipe smoker and slightly overweight. The rest =
of his=20
history was noncontributory. On physical examination, his =
physician=20
noted a pulsating mass deep in the center of the abdomen.=20
Who is this mystery patient?
The patient is =
Albert=20
Einstein (Figure), considered to be the most influential =
person of=20
the 20th century and ranked as one of the top scientists of =
all=20
time. Albert Einstein, who was born in 1879 in Ulm, Germany, =
died in=20
Princeton, New Jersey, in 1955 at the age of 76. The =
immediate cause=20
of death was a ruptured abdominal aneurysm. In December =
1948, Dr.=20
Rudolph Nissen, famous for developing a widely used =
operation to=20
prevent esophageal reflux, performed an exploratory =
laparotomy on=20
Einstein at the Brooklyn Jewish Hospital. At that time, a=20
"grapefruit-sized" aortic aneurysm was discovered to be the =
cause of=20
Einstein's abdominal pain.
Figure 1. (click image to =
zoom)=20
Albert Einstein.
During that era, ligation of the abdominal aorta had =
already=20
proved to be ineffective, and replacing the aorta with a =
graft was=20
still a decade away. The only available treatment was to =
attempt to=20
reinforce the aortic wall and delay the inevitable rupture.
Polyethene cellophane is a tissue irritant, producing =
marked=20
fibrosis. Dr. Nissen wrapped the visible anterior portion of =
the=20
aneurysm with this type of cellophane, in the hopes of =
stimulating=20
an intense fibrous tissue reaction that would strengthen the =
bulging=20
aortic wall. Einstein recovered from the operation, and =
after a=20
3-week hospital stay, returned to his home in Princeton, New =
Jersey.
Following this palliative operation, Einstein lived for 5 =
more=20
productive years with only minor symptoms. In 1952, he was =
offered=20
and declined the presidency of Israel. He published his last =
scientific paper in 1954, in the Annals of =
Mathematics.=20
During this period he had occasional back pain and pain in =
his right=20
upper quadrant, labeled as "chronic cholecystitis."=20
On Tuesday, April 12, 1955, Einstein developed abdominal =
pain,=20
which became more severe on the following day. Although =
Einstein=20
must have realized that the aneurysm had finally burst, he =
initially=20
refused hospitalization. He finally agreed to be admitted to =
the=20
Princeton Hospital, only because he felt he was becoming too =
much of=20
a burden at home. He was seen by Frank Glenn, MD, then Chief =
of=20
Surgery at New York Hospital, who diagnosed cholecystitis =
and a=20
leaking abdominal aneurysm. Glenn recommended resection of =
the=20
aneurysm, even though the operation was new. At that time, =
Dr. Glenn=20
had only done a few such operations, using cadaver grafts to =
replace=20
the aorta. Einstein refused surgery, saying: "I want to go =
when I=20
want. It is tasteless to prolong life artificially. I have =
done my=20
share, it is time to go. I will do it elegantly."[1] =
Five years after surgery, the patient collapsed at home =
and was=20
rehospitalized. Although he had intermittent bouts of =
generalized=20
abdominal pain requiring morphine for relief, he had =
pain-free=20
intervals when he appeared to be quite comfortable. The pain =
became=20
localized to the right upper quadrant, where a palpable mass =
was=20
noted. Five days after admission, he developed labored =
breathing and=20
expired at 1:15 AM on April 18, 1955.=20
An autopsy, performed by Thomas Harvey, MD, revealed a =
normal=20
gallbladder and a huge abdominal aneurysm. Harvey reported =
that=20
compression of the gallbladder from hemorrhage had simulated =
an=20
attack of cholecystitis.[2]
Was wrapping Einstein's aneurysm with cellophane =
useful, or=20
just a sham operation?
A recent review of life =
expectancy in=20
persons turned down for elective aneurysm surgery showed a =
median=20
survival of only 9 months in patients with aneurysms larger =
than 7=20
cm.[3] Einstein lived for over 5 years; perhaps =
wrapping=20
the aorta did prolong his life.
What would have been the anticipated outcome if =
Einstein had=20
been operated on?
In 1955, although resection of =
aortic=20
aneurysms had been practiced since 1951, resection of a =
ruptured=20
aneurysm, especially after a previous aortic wrapping =
procedure,=20
would have had a prohibitively high mortality rate.=20
How would Einstein's aneurysm be diagnosed=20
today?
There are now many ways to visualize the =
abdominal=20
aorta and to determine the relation of the diseased aorta to =
the=20
renal and iliac vessels. Formerly, arteriography was =
commonly used=20
to detect and evaluate aneurysms, but this procedure has =
been=20
replaced by computerized tomographic angiography or by =
magnetic=20
resonance angiography. These newer procedures are rapid, =
accurate,=20
and provide crucial information about the relationship of =
the=20
aneurysm to the renal and iliac vessels.[4]
Today, any patient without a serious medical =
contraindication who=20
has an aortic aneurysm greater than 5 cm is a candidate for =
surgery.=20
Einstein would have certainly been referred for surgery at =
the time=20
of his initial symptoms because his "grapefruit-sized" =
aneurysm was=20
at least 12 cm in diameter. When performed as an elective =
procedure,=20
the operative mortality rate is about 5%, increasing =
dramatically to=20
about 50% if the aneurysm has ruptured. Operating on =
aneurysms=20
smaller than 5 cm does not seem to improve long-term =
survival.
Until a few years ago, the operation of choice would have =
been=20
resection of the aneurysmal mass, followed by replacement =
with a=20
prosthetic graft.[5] But recently, endovascular =
grafts=20
have been developed that are inserted via the femoral =
artery,=20
positioned within the aneurysm, and secured with =
self-expanding=20
stents or hooks. This procedure is becoming increasingly =
popular=20
because it is less stressful for the patient and reduces the =
length=20
of hospitalization.[6] The long-term results of =
this=20
procedure need additional evaluation to assess the frequency =
of=20
complications, such as leakage around the =
graft.[7]
What happened to the world's most famous =
brain?
It=20
disappeared rather mysteriously after the autopsy, and was=20
discovered to have been secretly hidden by Thomas Harvey, =
the=20
pathologist who performed the 1955 autopsy! Forty years =
later, at=20
age 86, Harvey, along with a journalist, drove Einstein's =
brain=20
across the United States to be given to Einstein's =
granddaughter.=20
Michael Paterniti, the driver, describes the brain's =
discovery and=20
final trip in Driving Mr. Albert: A Trip Across America =
With=20
Albert Einstein's Brain.[8]
Albert B. Lowenfels, MD, =
Professor of=20
Surgery, New York Medical College, Valhalla, New York=20
Medscape Surgery 4(1), 2002. =A9 =
2002=20
Medscape
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Medscape physician members have an =
opportunity to earn CME credits for Internet Point of Care (PoC) through =
self directed learning on topics relevant to clinical care. Physicians =
participate in a 3 step learning cycle to receive a half (0.5) AMA =
PRA Category 1 credit.
The 3 steps include:
Search =
Medscape: Identify a clinical question by entering a search term
Learn: Review information sources =
(search results)
Complete Action Plan: Briefly document how you =
will implement learning in clinical practice
These =
activities will be recorded in your CME Tracker with the 3 step =
documentation available in print format on your certificate and CME =
Tracker.
Medscape physician members have an =
opportunity to earn CME credits for Internet Point of Care (PoC) through =
self directed learning on topics relevant to clinical care. Physicians =
participate in a 3 step learning cycle to receive a half (0.5) AMA =
PRA Category 1 credit.
The 3 steps include:
Search =
Medscape: Identify a clinical question by entering a search term
Learn: Review information sources =
(search results)
Complete Action Plan: Briefly document how you =
will implement learning in clinical practice
These =
activities will be recorded in your CME Tracker with the 3 step =
documentation available in print format on your certificate and CME =
Tracker.
Please note that in order to earn =
AMA/PRA category 1 credit, you must first read at least one article from =
your list of search results.
Medscape physician members have an =
opportunity to earn CME credits for Internet Point of Care (PoC) through =
self directed learning on topics relevant to clinical care. Physicians =
participate in a 3 step learning cycle to receive a half (0.5) AMA =
PRA Category 1 credit.
The 3 steps include:
Search =
Medscape: Identify a clinical question by entering a search term
Learn: Review information sources =
(search results)
Complete Action Plan: Briefly document how you =
will implement learning in clinical practice
These =
activities will be recorded in your CME Tracker with the 3 step =
documentation available in print format on your certificate and CME =
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*=0A=
* SWFObject is (c) 2006 Geoff Stearns and is released under the MIT =
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* http://www.opensource.org/licenses/mit-license.php=0A=
*=0A=
* **SWFObject is the SWF embed script formerly known as FlashObject. =
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// fixes bug in fp9 see =
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deconcept.SWFObjectUtil.prepUnload =3D function() {=0A=
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