The Mystery of LVB
The Mystery of LVBSusan A. BenderSummer Research Institute
[email protected]
The Mystery of LVB: The Story BeginsA 56 year old man presents
to his physician in early December with chills, fever, upset
stomach, and right sided chest pain.Within the last two weeks, he
noted a loss of appetite, diarrhea, weight loss, increased thirst,
jaundice, and severe swelling of the lower extremities.Prior to
visiting his physician, he had been visiting his brothers country
home in Germany and enjoying working in the winter air from dawn
until dusk.As his symptoms worsened, he decided to cut his trio
short and returned to Vienna in his open air carriage.
The Mystery of LVB: Preliminary DiagnosisBased on the initial
description of the patient, what do you believe could be the source
of his symptoms?On what evidence do you base your conclusion?What
additional information would you need to proceed?What questions
about family medical history and prior medical conditions in the
patient might be useful?Would your conclusions and treatment
options be different if instead of 2013, this patient presented to
you in the 1770s?
The Mystery of LVB: The Physical ExamCommunication was difficult
because the patient was deaf.Exam revealed a stocky powerfully
built mad who was acutely ill.His skin was hot and flushed and he
was having great difficulty breathing.There was marked swelling in
both lower extremities.There were signs of jaundice.
The Mystery of LVB: Diagnosis Continued Does this additional
information change your conclusions?How would you treat this
patient?
The Mystery of LVB: The DiagnosisThe patient was diagnosed with
pneumonia and edema.Palpation of he abdomen revealed rebound
tenderness and an acutely enlarged liver.
The Mystery of LVB: The TreatmentThe patient was treated with a
series of herbal diuretics which proved to be ineffective.Drains
were inserted to remove abdominal fluid and initially removed 11
liters.In an attempt to remove addition fluid, the patient was
provided with iced alcoholic punch. While this allowed the patient
to sleep, it took several days to begin to flush the toxins from
his system.His battle with pneumonia and fluid retention lasted for
three months.In the final stages of his life, he became anemic,
comatose, and died.
The Mystery of LVB: Treatment TodayGiven the fact that there
were no antibiotics in the 1770s.How would you treat the patient
today?How might the outcome have been different wit the advent of
modern treatment practices?
The Mystery of LVB: Patient Medical HistoryThe patient had
suffered his entire life with several fairly debilitating
illnesses.The worst of which was progressive hearing loss that
began in his 20s and was complete by his early 40s.His deafness was
accompanied by bouts of depression and alcoholism that lasted for
the remainder of his life.He also was plagued by prolonged periods
of abdominal pain, diarrhea and constipation.As a child, the
patient had smallpox, typhus, and asthma.In his late 40s he noted
chronic headaches and joint pain, jaundice and bleeding from the
rectum.The patient was never married, but according to friends was
never without love
The Mystery of LVB: Diagnosis Continued Does this additional
information change your conclusions?How would you treat this
patient?
The Mystery of LVB: Family Medical History Patients alcoholic
father died at age 52 of unknown causes.His mother died at age 35
of tuberculosis.Three of his siblings died before the age of
two.Another sibling, a brother, died at the age of 41 of
poisoning.His eldest brother died at 72 of heart related
complications.
The Mystery of LVB: Diagnosis Continued Does this additional
information change your conclusions?
The Mystery of LVB: The AutopsyThe autopsy revealed dilation of
the auditory nerves. Examination also revealed the presence of
arteriosclerosis, (plaque), in the auditory arteriesThere is also a
continuing dispute about the possible other causes of death:
alcoholic cirrhosis, typhus, infectious hepatitis, lead
poisoningsyphilissarcoidosisWhipple's diseaseUse your electronic
devices to research each of the diseases what are the symptoms of
each? How are these symptoms indicated to determine the validity of
your diagnosis before you proceed with modern tests on the remains
of the patient
The Mystery of LVB: Modern Scientific Tests The evidence
suggests that the deafness may be directly related to tertiary
syphilis.The remainder of the symptoms may be attributable to
complications of lead poisoningThere are skull fragments that still
exist from the remains that are positively identified as belonging
to the patient.There are also hair samples that may belong to the
patient that can be tested with modern techniques.You will perform
a mitochondrial DNA test on the available forensic evidence to
determine the identity of the donor of the hair and will test the
skull fragments for the presence of lethal levels of lead
The Mystery of LVB: The Conclusions MATERIALS
DNA sequence from skull fragment of BeethovenDNA sequence from
Beethovens MotherDNA sequence from hair believed to belong to
BeethovenDNA sequence from Beethovens FatherDNA sequence standard
to ensure the tests accuracy
The Mystery of LVB: The Conclusions 2 Procedure:Review your data
table and you will see the labels that should be attached to create
5 separate columns, as seen in the example below.
Skull fragmentKnown to belongto BeethovenBeethovens motherHair
believed to belong to BeethovenBeethovens FatherSTANDARDThe Mystery
of LVB: Conclusions 3 MAKE SURE THAT YOU KEEP EACH PERSONS DNA
SEPARATE THROUGHOUT THIS ACTIVITY.To simulate the action of
radioactive probes use a highlighter and cover the letters CAT in
each of your segmentsWith your PENCIL you are going to simulate the
action of a restriction enzyme. Scan your DNA strips until you find
the letters GG CC. MARK across the strip between the letter G and
C, you will be forming a fragment that ends with a GG and another
that begins with a CC.
With your PENCIL you are going to simulate the action of a
restriction enzyme. Scan your DNA strips until you find the letters
GG CC. MARK across the strip between the letter G and C, you will
be forming a fragment that ends with a GG and another that begins
with a CC.
The Mystery of LVB: Conclusions 4 Count the number of bases in
each fragment, (the number of letters). Match this number to the
numbers in the chart provided. Then draw a line in the box that
corresponds to the number of letters in that piece. Use your
highlighter to mark the position of each of the CAT sequences in
each piece on the line that you have drawn.
The Mystery of LVB: Diagnosis Continued Now you will repeat this
process for each of the other fragments of DNA that you have
created.
You will compare the DNA sequences from the skull fragments
known to belong to Beethoven to the hair sample whose donor is
still in question. You are attempting to determine if the hair and
the skull fragments are from the same individual in this case
Ludwig van Beethoven.
How will you know if the DNA samples are a match? How can you be
sure that the samples are from the same individual? What further
tests might you be able to conduct to determine the cause and
manner if death for Beethoven?
The Mystery of LVB: Test for LEAD You will now perform a
confirmatory test to determine the presence of lead in several of
the skull fragment samples collected after the death of Beethoven.
This is a colorimetric test that will measure the ppm (parts per
million) or lead in each of the skull fragment samples,You will
perform a colorimetric test for the presence of lead in the skull
fragments. Bear in mind that once you have used a portion of the
sample for the test you have destroyed a portion of the skull
fragment. So use the smallest samples possible to conduct your
test.Break off three small pieces from each of the skull fragments
that have been provided to you.In separate small micro-centrifuge
tubes grind each of the skull fragments into a powder.Add a drop of
the lead indicator solution to each of the tubes and mix
thoroughly.If the sample changes color this is a positive test for
the presence of lead. The darker the color the greater the
concentration. See the chart below.
The Mystery of LVB: Lead Comparison Chart
Based on the results of your testing, did the patient suffer
form lead poisoning?From your research, what is the significance of
this data? Could this account for all of the patients symptoms?,
track 1Blues60080.496Skull fragment
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