Monday, July 5, 2010

Week 3 Yue

Surgery : Posterior Cervical Decompression and Fusion
What I’ve learned: For a posterior cervical procedure, the patient needs to be placed prone in an appropriate manner to avoid pressure points. In this case, the 83-yr old patient’s head was placed in a padded head holder. A few common posterior cervical procedures such as laminectomy and sub-axial fusion were performed. Laminectomy: partial or complete removal of the bony elements allowing increased space for neural structures. Sub-axial fusion: an instrumented fixation of specific cervical vertebrate between levels C2-C7, typically involves up to four levels of fixation with hooks and rods. This case was relatively risky due to the patient’s poor health condition.
Patient Consultation:
Since Dr. Nanus is out of town this week, I’ve decided to explore other areas in the hematology/oncology division such as breast cancer, brain cancer and lung cancer. While I was hanging out with the receptionist, I bravely introduced myself to Dr. Scheff, an assistant Attending Physician at NewYork-Presbyterian Hospital in the medical oncology/solid tumor program. Since Dr. Scheff is also serving as the director of the fellowship training of the department, I had the privilege of being quizzed on diagnosis and treatments of the patients together with a new fellow from the Bronx area. It was interesting that the fellow brought up the dramatic differences in patients’ social and economical status after seeing our first patient, who was an 86-yr old semi-retired general surgeon.
One of the patients we saw was a 71 yr old male with small cell lung cancer. About 10% to 15% of all lung cancers are small cell lung cancer (SCLC), which often start in the bronchi near the center of the chest, and spread widely through the body fairly early in the course of the disease (usually before it starts to cause symptoms). Small cell lung cancer is almost always caused by smoking. It is very rare for someone who has never smoked to have small cell lung cancer. Dr. Scheff kindly explained the two stages in small cell lung carcinoma: limited and extensive stages. While many people respond well to a combination of chemotherapy and radiation therapy (which adds 5-10% of cure rate), only 1% of the patients with extensive stage small cell lung cancer are chemo-curable. The patients presented several side-effects from chemotherapy including fatigue, leg pain, shoulder numbness, chest pain (from radiation), which motivates me to push myself harder as a cancer researcher in developing alternative therapies.
Research Project:
This week I did several patient and normal blood spiking (with different prostate cancer cell lines) experiments. It has been difficult to quantify the capture efficiency since each patient sample varies in its circulating tumor cell counts. Hopefully running experiments with normal blood can set a reasonable baseline for us.
I am very excited about this coming week since I will get to meet two Retinoblstoma experts: Dr. David Abramson and Dr. R.V. Paul Chan. After doing research on Retinoblastoma cancer cell lines for almost a year, I’m ready to see whether/how basic science research could benefit the patients by providing alternative therapies.

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