Saturday, July 31, 2010

Week 6 - Ruiz

This week was full of in-depth discussion and editing sessions with Dr. Grant regarding my project. Following a couple iterations of revision, I am currently working on a final draft of my analysis of injectable derma l fillers and my proposed integration of nanotechnology and biomedical engineering with that field. Dr. Grant is very interested in my BME-perspective, and hopefully I can bring new engineering ideas to the table. In our talks Dr. Grant suggested that I mention some alternative therapies briefly in the introduction, such as laser resurfacing and chemical dermabrasion. After doing some background reading, I found that laser resurfacing uses a focused laser to ablate the upper layer of skin in an attempt to remove surface wrinkles, and chemical dermabrasion is a “controlled burning” off skin. It seems that these measures are very brute-force and that any small mistake can leave permanent damage. I also noticed some trends related to dermal fillers – for instance, with increased viscosity the dermal fillers become harder to inject and more painful for the patient. (The more viscous substances displace more tissue and evoke more of a pain response as a result) I also learned that normal facial movement has the potential to push dermal filler substances inward and reduce their ability to correct facial wrinkles. Additionally, I came across several papers which I would like to investigate further and incorporate into my final draft. Some of these interesting articles involve percutaneous collagen induction therapy, in vivo chondrogenesis of mesenchymal stem cells in a photopolymerized hydrogel, and biosynthetic materials used for wound healing and guided tissue regeneration applications.

Also for this week I went to the NICU (neonatal intensive care unit) for two days to go on rounds with the residents and observe the treatment protocols for the babies under observation there. It was very interesting how technical and precise all the residents must be with regards to the medication administered to each baby - every volume and concentration must be carefully documented and increased/decreased in small increments to adjust each baby’s vitals at a gradual and safe pace. Many of the babies were premature, and as such they are more at risk for serious complications following birth. One baby was one of twins, and it had had a partially resected ileum. The post-operative course involved close monitoring for infection and keeping the baby on a ventilator until it showed better vital signs. The residents also said that they would be warming up the baby slowly – but they had to be very careful because if they warm up the baby too fast it may cause coagulation complications and brain reperfusion problems. A variety of instruments and devices were used to monitor and treat the babies, and there was a lot of information to keep track of for each patient. Although each baby requires different procedures and treatments, there were a few common treatments applied across several patients: phototherapy to combat hyperbilirubinemia, constant positive air pressure (CPAP) for breathing, incubation in highly controlled chambers, and total parenteral nutrition (TPN). One of the most interesting things about these baby patients is that they cannot communicate as adult patients do – they can only cry and that gives us minimal insight. Instead, doctors must rely exclusively on diagnostic measurements such as ECGs, stool samples, x-rays, feeding patterns, and increases in weight. From these readouts, physicians are able to diagnose and successfully treat the babies in the NICU.

I also attended more office procedures (i.e. scar removal/modification, botox injections, nipple reconstruction, steroid injections for wounds that are not healing properly, etc.) and I was able to observe several follow-up consults for patients who underwent surgeries in the first few weeks of my summer immersion experience. It was really great to see the follow-up patients so that I could get an idea of how well they were healing and what kind of rules/restrictions they had to deal with. For instance, the fleur de lis abdominoplasty patient is healing well, but she had to use drains for 2 weeks to remove excess fluid collecting in her abdomen as a result of the body’s healing processes. For her second post-op meeting with Dr. Grant, she was finally allowed to have them removed, which made her extremely happy. The C-section patient is also healing well, and her scar is barely visible now! I am impressed at how fast patients can heal, especially after learning how invasive these surgeries can be.

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