Oliver Cope

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Oliver Cope (1902 - 30 April 1994), was an American surgeon known for his work in parathyroid surgery, burns treatment and breast cancer treatment. He is also remembered for describing the Churchill-Cope reflex.

Contents

Biography

Oliver Cope was born in 1902 in Germantown, Pennsylvania. He went to Haverford College in 1919, transferred to Harvard University the following year, and graduated in 1923. He then attended Harvard Medical School, graduating M.D. in 1928. [1] His surgical training was carried out at Massachusetts General Hospital, where he became an assistant to Edward Delos Churchill. During this time he and Churchill published the findings of research which described the Churchill-Cope reflex. [2] He married Alice DeNormandie in 1932, and was awarded a Moseley Travelling Fellowing after completing his surgical residency. The couple travelled to Europe, starting in Berlin where they witnessed Nazi persecution of Jewish academics. [1] They left Germany and moved to London, where Cope studied under Sir Henry Dale at the National Institute of Medicine. During their time in London they developed a friendship with Harold Himsworth of University College Hospital; during the Second World War Himsworth's children stayed with the Cope family in Cambridge, Massachusetts. [1]

Parathyroid surgery

Cope returned to Massachusetts General Hospital in 1934, also joining the faculty of Harvard Medical School. [3] At that time, Edward Churchill and others such as Fuller Albright were starting to perform surgery for the treatment of hyperparathyroidism. Before carrying out surgery, Churchill asked Cope to perform dissections to study the parathyroid glands, to increase knowledge of the normal and abnormal anatomy of these glands. This led to an increase in the success of such surgery. Cope was also involved in the treatment of a patient, Captain Martell, who had previously had exploratory operations to search for parathyroid adenomas which had been unsuccessful. In 1932 Churchill, assisted by Cope, performed the first removal of a parathyroid adenoma from the mediastinum, having converted the initial neck operation to an open thoracotomy. [1] By 1936 Churchill and Cope had successfully treated 30 patients with hyperparathyroidism operatively. [4] Cope, also described primary hyperplasia of the parathyroid glands as a cause for hyperparathyroidism, as distinct from parathyroid adenoma. [5]

During this time Cope also became the senior surgeon at the Thyroid clinic at Massachusetts General, and wrote 20 papers on thyroid surgery. [1]

Treatment of burns

By the early 1940s Cope's interest had turned to the management of patients with burns, particularly the fluid resuscitation of these patients. In November 1942 the Cocoanut Grove fire occurred, with nearly 200 patients from the fire admitted to Massachusetts General. This event led to advances in burns care due to the research carried out in the months after the fire, led by Churchill and Cope with Benjamin Castleman, Tracy B. Mallory and Richard Schatzki. This work included the nature of pulmonary damage caused by smoke inhalation, and the "soft" technique of surface burn management, using boric petroleum-impregnated gauze dressings to allow healing instead of tanning with tannic acid. [6] This work was published in 1943. [7] Work carried out by Cope and Francis Moore led to methods of estimating fluid replacement needs in burns patients. [8] This research into burns management, which continued with the support of the United States Army and Navy, led to the establishment of the Shriner's Burns Institute at Massachusetts General. [1]

Treatment of cancer

In 1962 Cope was elected President of the American Surgical Association. He turned his attention to the surgical treatment of cancer, particularly breast cancer. He warned against reliance on radical surgery, and advocated less invasive surgery and more use of radiotherapy and chemotherapy. [1] He also drew attention to the consideration of psychological and emotional aspects of disease in medical education. He promoted these ideas widely, publishing Man, Mind & Medicine - The Doctor's Education in 1968, [9] and The Breast: Its Problems, Benign and Malignant: And How to Deal With Them in 1977. [10]

Cope became Emeritus Professor of surgery at Harvard Medical School in 1969. He died on 30 April 1994 at his son's home in Woodsville, New Hampshire, the day after his wife of 62 years. [3]

Legacy

Parathyroidectomy is now a part of the standard management of cases of primary hyperparathyroidism. The management of burns, including fluid replacement, surface management and respiratory management, is based on the work carried out by Cope and his colleagues at Massachusetts General. Cancer treatment now is focused on limited surgery and adjuvant chemoradiotherapy rather than radical surgery, and medical education now takes psychosocial considerations into account. [1]

Related Research Articles

General surgery

General surgery is a surgical specialty that focuses on abdominal contents including the esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, appendix and bile ducts, and often the thyroid gland. They also deal with diseases involving the skin, breast, soft tissue, trauma, peripheral artery disease and hernias and perform endoscopic procedures such as gastroscopy and colonoscopy.

Parathyroid gland Endocrine gland

Parathyroid glands are small endocrine glands in the neck of humans and other tetrapods. Humans usually have four parathyroid glands, located on the back of the thyroid gland in variable locations. The parathyroid gland produces and secretes parathyroid hormone in response to a low blood calcium, which plays a key role in regulating the amount of calcium in the blood and within the bones.

Adenoma Type of benign tumor

An adenoma is a benign tumor of epithelial tissue with glandular origin, glandular characteristics, or both. Adenomas can grow from many glandular organs, including the adrenal glands, pituitary gland, thyroid, prostate, and others. Some adenomas grow from epithelial tissue in nonglandular areas but express glandular tissue structure. Although adenomas are benign, they should be treated as pre-cancerous. Over time adenomas may transform to become malignant, at which point they are called adenocarcinomas. Most adenomas do not transform. However, even though benign, they have the potential to cause serious health complications by compressing other structures and by producing large amounts of hormones in an unregulated, non-feedback-dependent manner. Some adenomas are too small to be seen macroscopically but can still cause clinical symptoms.

Hypercalcemia, also spelled hypercalcaemia, is a high calcium (Ca2+) level in the blood serum. The normal range is 2.1–2.6 mmol/L (8.8–10.7 mg/dL, 4.3–5.2 mEq/L), with levels greater than 2.6 mmol/L defined as hypercalcemia. Those with a mild increase that has developed slowly typically have no symptoms. In those with greater levels or rapid onset, symptoms may include abdominal pain, bone pain, confusion, depression, weakness, kidney stones or an abnormal heart rhythm including cardiac arrest.

Disorders of calcium metabolism occur when the body has too little or too much calcium. The serum level of calcium is closely regulated within a fairly limited range in the human body. In a healthy physiology, extracellular calcium levels are maintained within a tight range through the actions of parathyroid hormone, vitamin D and the calcium sensing receptor. Disorders in calcium metabolism can lead to hypocalcemia, decreased plasma levels of calcium or hypercalcemia, elevated plasma calcium levels.

Parathyroid chief cell

Parathyroid chief cells are one of the two cell types of the parathyroid glands, along with oxyphil cells. The chief cells are much more prevalent in the parathyroid gland than the oxyphil cells. It is perceived that oxyphil cells may be derived from chief cells at puberty, as they are not present at birth like chief cells.

Hyperparathyroidism Medical condition

Hyperparathyroidism is an increase in parathyroid hormone (PTH) levels in the blood. This occurs from a disorder either within the parathyroid glands or outside the parathyroid glands. Symptoms of hyperparathyroidism are caused by inappropriately normal or elevated blood calcium leaving the bones and flowing into the blood stream in response to increased production of parathyroid hormone. In healthy people, when blood calcium levels are high, parathyroid hormone levels should be low. With long-standing hyperparathyroidism, the most common symptom is kidney stones. Other symptoms may include bone pain, weakness, depression, confusion, and increased urination. Both primary and secondary may result in osteoporosis.

Technetium (<sup>99m</sup>Tc) sestamibi

Technetium (99mTc) sestamibi (INN) is a pharmaceutical agent used in nuclear medicine imaging. The drug is a coordination complex consisting of the radioisotope technetium-99m bound to six (sesta=6) methoxyisobutylisonitrile (MIBI) ligands. The anion is not defined. The generic drug became available late September 2008. A scan of a patient using MIBI is commonly known as a "MIBI scan".

Endocrine surgery

Endocrine surgery is a surgical sub-speciality focusing on surgery of the endocrine glands, including the thyroid gland, the parathyroid glands, the adrenal glands, glands of the endocrine pancreas, and some neuroendocrine glands.

Parathyroidectomy Surgical removal of one or more of the parathyroid glands

Parathyroidectomy is the surgical removal of one or more of the (usually) four parathyroid glands. This procedure is used to remove an adenoma or hyperplasia of these glands when they are producing excessive parathyroid hormone (PTH): hyperparathyroidism. The glands are usually four in number and located adjacent to the posterior surface of the thyroid gland, but their exact location is variable. When an elevated PTH level is found, a sestamibi scan or an ultrasound may be performed in order to confirm the presence and location of abnormal parathyroid tissue.

Primary hyperparathyroidism Medical condition

Primary hyperparathyroidism is usually caused by a tumor within the parathyroid gland. The symptoms of the condition relate to the elevated calcium levels, which can cause digestive symptoms, kidney stones, psychiatric abnormalities, and bone disease.

Osteitis fibrosa cystica Medical condition

Osteitis fibrosa cystica, is a skeletal disorder resulting in a loss of bone mass, a weakening of the bones as their calcified supporting structures are replaced with fibrous tissue, and the formation of cyst-like brown tumors in and around the bone. Osteitis fibrosis cystica, abbreviated OFC, also known as osteitis fibrosa, osteodystrophia fibrosa, and von Recklinghausen's disease of bone, is caused by hyperparathyroidism, which is a surplus of parathyroid hormone from over-active parathyroid glands. This surplus stimulates the activity of osteoclasts, cells that break down bone, in a process known as osteoclastic bone resorption. The hyperparathyroidism can be triggered by a parathyroid adenoma, hereditary factors, parathyroid carcinoma, or renal osteodystrophy. Osteoclastic bone resorption releases minerals, including calcium, from the bone into the bloodstream, causing both elevated blood calcium levels, and the structural changes which weaken the bone. The symptoms of the disease are the consequences of both the general softening of the bones and the excess calcium in the blood, and include bone fractures, kidney stones, nausea, moth-eaten appearance in the bones, appetite loss, and weight loss.

Tertiary hyperparathyroidism Medical condition

Tertiary Hyperparathyroidism is a condition involving the overproduction of the hormone, parathyroid hormone, produced by the parathyroid glands. The parathyroid glands are involved in monitoring and regulating blood calcium levels and respond by either producing or ceasing to produce parathyroid hormone. Anatomically, these glands are located in the neck, Para-lateral to the thyroid gland, which does not have any influence in the production of parathyroid hormone. Parathyroid hormone is released by the parathyroid glands in response to low blood calcium circulation. Persistent low levels of circulating calcium are thought to be the catalyst in the progressive development of adenoma in the parathyroid glands resulting in primary hyperparathyroidism. While primary hyperparathyroidism is the most common form of this condition, secondary and tertiary are thought to result due to chronic kidney disease (CKD). Estimates of CKD prevalence in the global community range from 11-13% which translate to a large portion of the global population at risk of developing tertiary hyperparathyroidism. Tertiary hyperparathyroidism was first described in the late 1960s and had been misdiagnosed as primary prior to this. Unlike primary hyperparathyroidism, the tertiary form presents as a progressive stage of resolved secondary hyperparathyroidism with biochemical hallmarks that include elevated calcium ion levels in the blood, hypercalcemia, along with autonomous production of parathyroid hormone and adenoma in all four parathyroid glands. Upon diagnosis treatment of tertiary hyperparathyroidism usually leads to a surgical intervention.

Bradford Cannon, the son of Dr. Walter Bradford Cannon, was a pioneer in the field of reconstructive surgery, specialising in burn victims. He was the first chief of plastic and reconstructive surgery at Massachusetts General Hospital and is credited with saving the lives of thousands of soldiers maimed during World War II. As a young doctor, he used a new method he developed with Oliver Cope to treat survivors of the Cocoanut Grove fire in November, 1942.

Endocrine disease Medical condition

Endocrine diseases are disorders of the endocrine system. The branch of medicine associated with endocrine disorders is known as endocrinology.

Parathyroid adenoma Medical condition

A parathyroid adenoma is a benign tumor of the parathyroid gland. It generally causes hyperparathyroidism; there are very few reports of parathyroid adenomas that were not associated with hyperparathyroidism.

Parathyroid carcinoma Medical condition

Parathyroid carcinoma is a rare cancer resulting in parathyroid adenoma to carcinoma progression. It forms in tissues of one or more of the parathyroid glands.

Parathyroid disease Medical condition

Many conditions are associated with disorders of the function of the parathyroid gland. Some disorders may be purely anatomical resulting in an enlarged gland which will raise concern. Such benign disorders, such as parathyroid cyst, are not discussed here. Parathyroid diseases can be divided into those causing hyperparathyroidism, and those causing hypoparathyroidism.

Edward Delos Churchill was an American surgeon known for his work in thoracic surgery and remembered for describing the Churchill-Cope reflex.

Sestamibi parathyroid scan

A sestamibi parathyroid scan is a procedure in nuclear medicine which is performed to localize parathyroid adenoma, which causes Hyperparathyroidism. Adequate localization of parathyroid adenoma allows the surgeon to use a minimally invasive surgical approach.

References

  1. 1 2 3 4 5 6 7 8 Memorial Minute: Oliver Cope. Archived 2011-02-18 at the Wayback Machine Harvard University Gazette, February 20, 1997. Accessed on 28 July 2010.
  2. ↑ Churchill, ED; Cope, O (1929). "The rapid shallow breathing resulting from pulmonary congestion and edema" (PDF). J Exp Med. 49 (4): 531–537. doi:10.1084/jem.49.4.531. PMC   2131565 . PMID   19869562.
  3. 1 2 Oliver Cope, 91, a Top Surgeon Who Was A Harvard Professor New York Times Obituary, 3 May 1994. Accessed on 24 March 2009.
  4. ↑ Churchill ED, Cope O (July 1936). "The Surgical Treatment of Hyperparathyroidism". Ann. Surg. 104 (1): 9–35. doi:10.1097/00000658-193607000-00002. PMC   1390328 . PMID   17856809.
  5. ↑ CASTLEMAN B, COPE O (October 1951). "Primary parathyroid hypertrophy and hyperplasia; a review of 11 cases at the Massachusetts General Hospital". Bull Hosp Joint Dis. 12 (2): 368–78. PMID   14905116.
  6. ↑ NFPA Journal Cover Story November/December 2007 Accessed on 24 March 2009.
  7. ↑ Joseph C. Aub,.Henry K. Beecher, Bradford Cannon, Stanley Cobb, Oliver Cope, N. W. Faxon, Champ Lynons, Tracy Mallory and Richard Schatzki And Their Staff Associates. (Massachusetts General Hospital Staff doctors): Management of the Cocoanut Grove Burns at the Massachusetts General Hospital. Philadelphia, Lippincott, 1943.
  8. ↑ Cope, O; Moore, FD (1947). "The redistribution of body water". Ann Surg. 126 (6): 1016. doi:10.1097/00000658-194712000-00013. PMC   1803539 . PMID   17859039.
  9. ↑ Cope, Oliver. Man, Mind & Medicine - The Doctor's Education. JB Lippincott Co, 1968.
  10. ↑ Cope, Oliver. The Breast: Its Problems, Benign and Malignant: And How to Deal With Them. Houghton Mifflin, 1977. ISBN   978-0-395-25709-8.
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