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SNI Digital, Innovations in Learning, is pleased to present
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a lecture by Ahadi El-Kalili,
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who's the Emeritus Professor of Neurosurgery, the
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University of Baghdad and Baghdad, Iraq, on why do research, the lessons from my medical life?
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Today I have the honor to
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present Professor Ahadi El-Kalili, he's a fellow professor of neurosurgery from Iraq, he's one of the founder of neurosurgery in Iraq, he has a huge
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experience in research and building department from zero and how to manage. neurosurgery and difficult situation through war, through limited resources, and he's now in the United States, and he's
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very supportive for young people, for young young talents, let's say, within the science in general, and has a very unique approach in his career. I call it always, this is the encyclopedic
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approach, and actually we have a paper describing Dr. Faridhi's approach to neurosurgery and how uniquely he advanced through all his phases and steps, and yeah, combining neurosurgery with all
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the possible surrounding scientific field. This is a unique experience. I will invite you to have his
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the paper about him describing his work and I think I will share it with you because it's already free in the surgical knowledge international. I will share the link for the paper and you can read
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more about that technique and
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Dr. Halili agree to be with
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you to share some thoughts that he think it will be helpful for you as a new generation aspiring to be a scientist and doctor maybe surgeons in the future. So welcome Dr. Halili and the stage is
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Lord. Thank you so much. It's really great honor and pleasure to be with you. This is your surgery TV. Thank you so much for this opportunity and thank you Samar for the introduction which was
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more than I think I deserve.
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Thank you so much. I'm sorry I have coffee. So I may be interrupted with Cough at Occasions, I hope not. No problem. I'm really pleased with your mentorship, with your initiative to get such
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wonderful
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colleagues, young colleagues trying to pursue the real path of research and ethical research and to be on the right steps from the beginning which is really the real hope of us to be fruitful and to
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possibly proceed with the outside world research standards.
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My presentation would be something general.
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So this is just highlights, in fact,
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based on basic ideas And
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Our research challenges in the difficult days we went through as Samir was referring to.
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If I give you one dollar, you give me one dollar, each one has one dollar. But if I give you one idea, you give me one idea, each one has two ideas.
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So giving ideas to each other is really richness to both parties What's research, the systematic, although I don't need to tell you about this, you all know about this very well, but I just remind
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you of what I have in mind. It is a systematic investigation into and study of materials and sources in order to establish facts and reach new conclusions.
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And why do research? Research allows you to pursue your interests. Research makes you learn something. New. Research will widen the scope of your problem-solving skills. Research will challenge
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yourself in new ways.
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With research, you can do your research alone or in a large team. You don't need to be with a team, you can do it on your own. Single-handed versus multi-interest institutional. You don't need to
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shell yourself with your specialty, you have to join other specialties and then make a wider research. You could conduct your research in the library, in the museum, in laboratory or community
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and your research problems could be aesthetic, social, political, scientific or technical. You choose the tools, gather and analyze the data, report your findings to a wider audience. so they
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will benefit from that. So again, with diligent and systematic inquiries or investigation into this to
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discover our revised facts, theories or application, this revised facts is very important because things which are facts today may be not facts tomorrow
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So example of two examples of these surviving facts. First example, Antonio Egas Moniz. In 1935, Moniz
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advocated lobotomy, surgery to treat psychosis and mental health conditions such as depression.
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It was seen as a miracle cure for mental illness. Moise was awarded Nobel Prize in 1949 for that surgery, for that approach. The surgery causes most of the connections to and from the anterior part
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of the frontal lobe of the brain cognitive centers to be severed What happens, it was stopped in their fixties and even some advocated to revoke the Nobel Prize from Dr. Moniz. And you can see this
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movie, possibly some of you have seen this movie, that a man flew over a cook who's nest by Jack Nicholson. It represents the problems happened after that surgery
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And by the way, Moniz had been produced for the first time in history in geography in 1927. And he used the substance thorough trust as a contrast.
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And then this thorough trust was discovered to be carcinogenic. And I have seen one of the cases when I was in Scotland of cancer of the liver caused by thorough trust. So again, this was abandoned.
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So it was fact at one time, but then by implementation and revision, it was found not a good fact. Another example is the Thaludamite
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In 1950s, commercially named Thaludamite, the miracle that it was called, it was used to treat morning sickness during pregnancy. And everybody really was happy with that. And then they
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discovered that it produces massive congenital anomalies. So, and then in the '60s, it was abandoned and this fact was not a real fact, it was a bad fact.
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have two examples of inspiring stories.
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First example, Herman Von Helmholtz.
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He is a German doctor
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in the 19th century. He is mathematician. Well, we're fine with mathematics, but he was forced by his parents to go to medicine. So he used his talent in medicine and mathematics in medicine when
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he was graduated. When he was teaching in medical school, one of the students asked him, sir, you say that we see it with our eyes when light goes into the eye. Why do we see the eye black when
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there is light in it, when we can see something? And he said, for two nights, I could not sleep thinking of that question.
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And then,
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trigger an idea and then here evolutionized of salvology by improvising and invention of the fourth thermoscope.
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And what he did, he just brought a candle near the head of the patient, of the person, and then a mirror with the hole inside it so
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he can reflect the light inside the eye that through that hole he can see the retina and then when he saw the retina after he shouted, he was shouting that I am the first man in the mankind history
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to see a living artery of the human body. So that's the ophthalmoscope she invented, eventually was modified of course. Another example is Claude Bernard from France. Claude Bernard is a father of
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experimental medicine In fact, his book, The Experimental. medicine, study and experimental medicine, supposed to be one of the important books in my kind history.
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I have the Arabic translation of that book. It's amazing, book really, at that time, in the second half of the 19th century, he was amazing. He had so many discoveries. One of the important
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discoveries is the extracellular environment, the hobby of stasis, that your temperature will be remain the same, your all electrolytes will be the same around the cell, in spite of any changes
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that happens to you outside that cell. So he discovered that. But the main thing in this area is, he was working in the lab, and then the lab attendant brought him a batch of rabbits.
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And because he was busy, he asked the attendant just to put the rabbit on the table, which he did, and then he left. So the rabbits urinated on that table, And it happens that there was litmus
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papers. the table where it was changed color with the urine of the of the rats. So the urine was acidic and as he has prepared mind, he immediately clicked why this urine of the herbivorous animal
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be acidic, why it should be alkaline. So he called the attendant again and he said, What's happening? Ari, have you brought these rabbits from different places? He said, No, at the same place.
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But then he discovered that rabbits were starving for eight hours. He was going around until he came to this to Claude Bernard. So he gave the rabbits the food and then starved them again. When he
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gave them the food, the urine turned again to be alkaline. And then starved them again for eight hours or so and then it turned to acidic
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So, and then he went to his horse. The horse of course is the herbivorous. So the horse urine was alkaline, and then he starved the horse for so many hours, and then tested his urine and was
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acidic. And then from there he
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put the theory of catabolism. When you are herbivorous and you are starving, so you will be carnivorous, because you will eat your own meat, your own flesh So with that limitation of facilities,
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of research at that time, they created such important foundation of research.
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It's interesting to note that Charles Holland-Duel, he was the commissioner of the United States Patent Office from 1898
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to 1901 You'd be surprised that. Mr. Dewell stated in 1902 that everything can be
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invented, has been invented, so we don't need to this office, we have to close this office of patents
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Now, coming to some personal research ideas and challenges, I must emphasize that in the 60s, research culture in Iraq was developing and later in the 90s, 80s, 90s until 2003, Iraq was involved
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in wars and sanctions and pursuing research was a real challenge because the lack of facilities, lack of time, lack of interest, people tried to survive, really try to get food, something to help
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their children with, it was difficult time but nevertheless, you can pursue if you have the dedication and you can do things as my boss used to say, if you want something to be done, ask a busy
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man to do it because a busy man is so organized he can fit your request in between but the one who has nothing to do, he will postpone until tomorrow or next week, we have plenty of time, don't
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worry, I'll do it
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uh treating one of the project was treating resistant epilepsy.
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Now what's epilepsy? It's the focus of excessive electrical discharge, swarming rapidly to surrounding areas of the brain causing seizures. This is an unknown fact of course.
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Miss Dr. Adrian Upton in Canada McMaster, I knew in 1978 in fact that he postulated that a feedback of the brain for the resistant epilepsy may help minimizing the bad effect of resistant epilepsy.
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So with the University of Technology, I started the project. We bought an electroencephalogram to the University of Technology and then with the help of the well, there was a bachelor student who
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gave him the project and with the help of our colleagues there in electrical engineering, control engineering, We had the project of analyzing the EEG, the electroencephalogram, and filtering it
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into four waves, basic waves of the EEG. And then they changed, they transformed the waves from wave to sound and from wave to light And Dr. Upton's idea was if the patient hears his alpha waves,
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he will calm down and then his epilepsy will be probably minimized, resisted the epilepsy.
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And so this is the idea was, it was there, but of course it was not implemented. We just did this research, but we continued the research in a different way
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I was dreaming of treating epilepsy on
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the principle of lightening protection system. When the electrical chart comes from the cloud, will be sucked out by this lactic protection system to Earth, and then it will minimize the damage of
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the electricity. So can we have a portable Earth thing? And we can put the probe on the area, which we diagnose the focus. And then we try to see if we can do that. There is a company in England,
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that was
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in 1980 And in England, a company called Thackeray, they was interested, but then I had to come back to Iraq with the war, and everything was really disrupted. But then I started with the group
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of four electrical engineers in the Scientific Research Council in Iraq. We worked for two years, maybe more than two years, about the project. hoping to get something about this, and they worked
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really very, very hard, these young engineers. But in 1989,
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unfortunately, the whole scientific research council was canceled, and then all the project was really, went at a tray of tray, but nevertheless, one lady, a girl, engineer, young engineer,
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very bright one, Francis Belcees, she got a master's degree with the detection of an early detection of epileptic attack. And
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we published these two papers on
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scientific journals. In 1982, we did head injury in rabbits and with the professor Morgash from Chico Slovakia at that time.
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and Professor Sahab al-Musavi, and there was
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our master's students, because Ralia Abdullah-Pit is a very bright guy. He is now an Australia professor there, and he did the real great work with our supervision, and then studying the
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physiological changes of head injury and lab is, again, that paper was published in a peer review journal.
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And then 1985, with the professor of computer, sciences, we worked on diagnosing causes of back pain by the computer. So you can sit on the computer in front of the computer, and then computer
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ask you, and you answer, yes or no, yes or no, all the answers, yes or no, and then it takes you to track different tracks until you reach a conclusion. It was something simple, but at least
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was an attempt. And the guy who was having the masters, he got his PhD again in the. similar line, and then he was leading figure in the Ministry of Higher Education, and he became, in fact, a
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ambassador at one time.
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Another project which is interesting and painful,
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we know that third nerve, the third cranial nerves, among other nerves in the moving the eyeball, it has the main function of moving the eyeballs. When
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there is damage of the third cranial nerve for any reason, a trauma or after surgery or tumor or whatever, third nerve may regenerate, but in this generation
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fashion, the fibers will go to different nerve fibers to supplying different muscles. So the function of the nerve which elevates the eye here, for instance, it will not elevate the eye here, it
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will take it down and out. So this is called aberrant regeneration or degeneration. So I thought, why is this? Well, discussed with Professor Mahmoud Tiyawi, however, mash, Professor of
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Anatomy at that time, a leading researcher. And then he was president of a
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university. And then we planned a very well-planned project to the help of the German neuropathologist and American Alfred British neurologist.
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We studied rabbits and they used to open the orbit cell of the rabbits and go back to the orbital apex and crush the third nerve. And that surgery was difficult, not easy, surgery because the
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rabbit is not a good animal, experimental animal, the range of anesthesia is very narrow. If you give more, the rabbit will die. If you give less, it will jump. And then there is a cavernous
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sinus at the orbit's apex. And then if you touch that orbital sinus, the blood loss will kill the animal. So we did 12 animals successfully. And we marked them with their ears and everything was
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fine. And we were watching the progress of those animals. After one year, we came to analyze and to get the results and the neuropathology to be sent to Germany. And then we discovered that all
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the rabbits were distributed to different research projects by the attendant of the animal house. And all the project collapsed. So my response was, I just smiled and because this is not unexpected
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in our culture, unfortunately, or society at that time
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So, that happened, but nevertheless. we didn't care about that. So we followed the myth of the phoenix. And with Mahamut Hayawe again, we started spinal cord regeneration and rats. And we did
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work, which took about a year and a half. And then we published the work in Paraplegia in UK.
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And it was something I think worth mentioning And then after that, a young lady from the College of Veterinary Medicine, she was doing her PhD under mice provision and again a professor of surgery
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at the College of Veterinary Medicine. And we did that on dogs and we had really good results. Let us some debate about the methodology, but the results were really amazing
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Now our. And in Iraq, we have a problem with high-dacted cysts.
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Maybe now minimized these days, but this cyst is called Cancer of Iraq by one of our professors of surgery in Iraq. Because, well, it comes from Kenya, lives in the bowel of the dogs, and then
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the overcomes from outside, from the feces, when it is dried, which will be taken by the sheep, or directly will come with the grass, or the vegetables to the human.
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The problem with the hydrated is this is the cyst, and you can see these dots inside it, each dot, sorry, each dot can produce, or each cyst can produce thousands of hydrated cysts, like this
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one here. And this can affect the brain, the eye, the lung, every part of the body,
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any part of the body it can be affected by the
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cyst.
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The trick of surgery is to try to take the cyst out without being ruptured. And this is not an easy task. So many times it is a ruptures. But for that, we put all sorts of
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goes around the cyst area with soaked with so many things and then hoping that will help, that never helps, in fact, radically. So what I thought of is taking the idea of this children's pistol
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where this part comes and stacks to the wall by vacuum.
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So I thought of having something like this shower And then having this all the shower-like and there is sucking system inside and then making vacuum here. So when this is stuck on the cyst, by
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continuous vacuum, you penetrate the cyst and evacuate all the contents of the cyst and then the wall will still stuck to the instrument and then you can't take everything out because the cyst is not
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attached to the surrounding tissues It is just free and inside the tissue.
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And from there, orbital high-dat it. I'm interested in an orbit as the Samar knows and established a center in Iraq called Orbital Surgery Center and possibly my series of high-datuses of the orbit
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one of the biggest series available in the literature So, The problem was with the orbital hydrated, you see this is the orbit here and the skull and that's the orbit, thick bones around the orbit
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and then fat behind the eyeball.
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And CT scan, when you do CT scan, when you do CT scan, the orbital hydrated will show like the tumor.
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Can you see that?
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Yeah, because it has hidden in my case with the pictures. Okay, yeah, sure.
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So you can see the density by CT scan is the same. Why if you take the liver hydrated or the brain hydrated, it's different density, it has water, looks like water, but this is tumor. So I
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thought, why is this? Is it
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because the pressure inside the cyst is high as it is in closed box or the nature of the fluid is different or because of the location of the cyst itself. So the first thing I did, I contacted
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Amubaba. I know Amubaba, the father of football in Iraq, soccer.
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I'd ask him for an old football, which is made of two parts, leather on the outside and tube inside. So my idea was to push water inside the tube, inside the ball, rubber ball inside, push it
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more water than it can accommodate. So that would not feature because of the wall of the outside wall of the linen. I couldn't get it, unfortunately, but nevertheless, I want to proceed with
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gloves, just ordinary surgical gloves I filled it with tap water and then made out of that smaller. a small ball to put in the orbit and this big ball to put in the cranium and in that case so the
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pressure
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is the same and then the nature of the fluid is the same.
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So we are left with one thing only. So I put again some sheets of fat behind the ball which is in the orbit to simulate orbital fat and then did CT scan and in fact the CT scan I did at night.
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Nobody knew about it and fortunately we had an Irish
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engineer for the CT scan I called him and he came with me at night and then we used to get rid of all the negatives because everybody then said we are wasting your time wasting your money on something
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useless And what I did, we measured. We made sure that in the CT scan, both the balls are in the same section and then proved to be this is 27 units and this is 45 units, so it is
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about 6, 7 times more density on the CT scan in the orbital cyst than the cranial cyst
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And this is very important because if it is a tumor-like, what do I do is open the cranial like this man. I open this cranial to get to the roof of the orbit, to get to the orbit, to get the tumor
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so-called out, it proved to be cysts and then you should be ashamed of yourself. So I then improvise this simple surgery to just anterior surgery because of my background of tharmology, I can't do
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it on my own, just try to get there and then get the cyst out. And then in fact, I presented this in the international meeting in Atlanta, Georgia about this and my own way of doing it in 2008.
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And it was published, this published in computerized ideology in the US. in 18, 1987.
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With the primitive facilities we have, we have to work something, because we have a acoustic neuroma patient, near the fissioner, and they would like to save the fissioner. And with the
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intermingling of all tissues around it, I don't know where is the fissioner So I have no monitor, I have nothing to, to, to a stimulator to avoid this problem. So with the professor of the Sahib
31:07
al-Musawi, we did the pin, or the repin, molded with the thin wire, and connected to a stimulator, which he was with me in the theatre. And then we did the stimulation to make sure that the
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fissioner was not affected, and you What is going on here with the money-stink of the fish and the argyrian ecosystem?
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After 2013, I did not, I was, I retired, but I had not stopped doing things, kept doing things, and then this is the journal that I made, created an organization called Tophir.
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Tophir and then Tophir made this Tophir Journal of Medical Sciences for three years. I was the editor-in-chief and many distinguished friends with me And then we had activities, one of them this
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awards for all
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graduate students, the US. who are distinguished, we can just award them.
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So enough of that, let me share with you some principles. Breakthroughs often come from unexpected and surprising areas.
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So not necessarily to be conventional. You have to think outside the box. And as Louis Pasteur saying, chance favors the prepared mind. One good example of that Newton, his mind was a prepared,
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and when he saw the apple falling from the tree, it clicked, and the same thing with James Watts when he was with his grandmother, seeing that the top of the kettle, when boiling, it was going up
32:54
for flapping So he was thinking of this steam engine, and then he created this steam engine, so his mind was prepared.
33:04
There were two teams trying to climb the very, very high mountain, maybe in the Himalayas. One team reached halfway through, and then they said, well, the oxygen was less than we can afford, we
33:20
can acclimatize with, so they stopped.
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again for any other reason they stopped in the way. But then they saw one guy went to the top of the mountain and came down and then everybody was happy and the clapping and then trying to get him to
33:40
respond to their clapping and their happiness for what he achieved. But he did not care about any one of them because he was deaf.
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So he did not hear any discouragement. He did what he thought is right. So if he was not deaf, possibly he would have joined the club, the two clubs. So being believing in what you have in mind
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is very important.
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And then the other thing you may not know that the entrance of Baghdad University has this entrance.
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Each one, this represents a cerebral hemisphere. This is a cerebral hemisphere and there is a gap in the middle. And he called this the open mind. And this gap would never end, would never be
34:35
filled. So the
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mind is will be always opened for information and knowledge.
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My last thing is, do you know of the chaos theory, the
34:54
butterfly theory? This is well improvised by Edward Lorenz in the early 60s.
35:00
And this is a
35:04
butterfly which flaps its wings in Brazil, and
35:08
then there is a tornado in
35:12
Texas,
35:15
which is very important to remember. And this will be explained by this guy,
35:24
1963 by Edward Lorenz and it was it was presented to the New York Academy of Sciences laughed out of place. It's crazy. The butterfly effect stated that a butterfly could flap its wings on one side
35:37
of the world and set molecules of air in motion. They moved other molecules of air that would eventually move other molecules of air that could eventually create a hurricane on the other side of the
35:46
planet, the butterfly effect. It was nuts, but it was interesting. And because it was so interesting it hung around forever in urban legend and movies and books until finally physics professors in
36:02
the mid 90s proved the butterfly effect was accurate and viable and it worked every time. And not just a butterfly either. It worked with any form of moving matter including people. They gave it
36:17
the status of a law. Just like the law of gravity, the butterfly effect is now known as the law of sensitive dependence upon initial conditions, and it works every time.
36:30
See, Chamberlain is a human example of the butterfly effect. One guy who made one move 140 years ago, whose effect still ripples through our lives today,
36:43
and you are no less an example of the butterfly effect than Chamberlain was Everything you do matters. Every move you make, every action you take, matters not just for you or your family or your
36:56
hometown, everything you do matters to all of us and forever. At the end, I say, Thank you, and that's my email, and that's my website, if anybody is interested to communicate and to have a
37:11
look at my website, where you see a few other things there on the website, and thank you so much.
37:23
Thank you, Professor. It's very inspiring and in many different perspectives,
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connecting the past with the present with the future. And yeah,
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research wise, science wise, medicine and general wise, and even in love. This is really outstanding.
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38:14
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