This week, I continued reviewing fluid dynamics text books and reading papers about modeling flow in a parallel plate flow chamber in order to begin analyzing a design modification for chambers used to study stem cell differentiation under shear stress. I learned that I should not have taken photographs of the chambers I am working with since they are not commercially available, and I switched to documenting an earlier model of the chambers. After speaking with researchers, I have a better understanding of which aspects of the design make it difficult to use, and I hope to address these concerns by proposing a new design that could expand the scope of the research being done with these chambers.
Toward the end of the week, I began working on a simplified bioreactor design based on a paper published in Science a few weeks ago. The original paper used a decellularized lung as a scaffold on which to grow cells from a mouse that served as a transplant recipient. Due to time constraints, I will not be able to test the bioreactor with decellularized/recellularized lungs from mice, but I will be able to test it with the intact tissue under cyclic stretch. If successful, this bioreactor could be used for further genetic studies and provide a system for expanded work on stem cell differentiation under stress.
In just a few days, I have been exposed to more animal research than ever before. I have been fortunate to learn more about features of mouse anatomy as well as healing responses that are absent in humans. This knowledge will likely be useful as I progress in my PhD research.
The week ended with literature searches, a brief study of anatomy, and the realization that very few people are capable of threading a catheter into the pulmonary vein of a mouse's heart.
Wednesday, July 21, 2010
Week Five: Research, Research, Research
The main focus of this week was Research. The week started with a research presentation at a morning Spine conference in the Neurosurgery department. Dr. Vamsi Vijay Nagineni presented the clinical findings of Dr. Hartl's surgeries with actifuse. We then discussed the demographic data I had begun to add to the revision case database; however, as of right now, no trends can be readily seen. We then took a look at the XLIF patient data I had collected. Although at first glance, only 8 patients could be included in our study design, Dr. Hartl is optimistic that this may be enough for an abstract and poster presentation at the Society for Minimally Invasive Spine Surgery (SMISS) conference. The first parameters to be calculated would be VAS leg pain and back pain scores pre-op, post op, and in follow up, which I learned were a staple when evaluating data of this sort. Additionally, I would later have to contact Dr. Gebhard to determine how to measure angle of correction with MRI scans, as another set of data. I set about performing these calculations this week, as well as double checking the database for patients I may have missed. Additionally, I looked into the SMISS conference abstract information, and set about writing the abstract when not analyzing data.
On tuesday afternoon, I attended my first Spine Case Conference. In these conferences, the doctors, residents, and fellows from neurosurgery attend to discuss interesting patient cases and get second opinions about treatment routes. Vendors, social workers, physical therapists, and radiology staff also attend these conferences to lend their expertise to the diagnoses. The case conference really demonstrated the interdisciplinary nature of treatment at NYP, a concept espoused by biomedical engineering at Cornell as well.
Besides research, I also attended the first of a two part tutorial on MRI. The class was organized by Mitch Cooper and Dr. Michelle Ann Cerilles of Dr. Yi Wand's imaging lab. The curriculum is set up into 12 exercises and in this first session, we performed exercises 1 -3. These included learning how perform a phantom scan as a calibration tool for the MRI, learning about MRI safety and how to prepare a patient to receive an MRI, and performing MRI scans of the knee. These lessons can be found at www.learnmri.org; however, performing them in person was much more valuable then just reading through the exercises. We were also introduced to MRI terminology and were taught how to differentiate between tissues in the MRI scan, at least in the knee. The second lesson, schedule for next week, will include MRI imaging of the brain and abdomen.
Looking ahead, there are only two weeks left and so much more to do. My research project takes up a good deal of my time, but next week will be a busy one. Dr. Frayer has helped to set up shadowing in the ER and a chance to see an open heart surgery. The second MRI class should also be quite interesting. I look forward to the chance to squeeze in as much as I can out of what is left of immersion term, and maybe get an abstract as well.
On tuesday afternoon, I attended my first Spine Case Conference. In these conferences, the doctors, residents, and fellows from neurosurgery attend to discuss interesting patient cases and get second opinions about treatment routes. Vendors, social workers, physical therapists, and radiology staff also attend these conferences to lend their expertise to the diagnoses. The case conference really demonstrated the interdisciplinary nature of treatment at NYP, a concept espoused by biomedical engineering at Cornell as well.
Besides research, I also attended the first of a two part tutorial on MRI. The class was organized by Mitch Cooper and Dr. Michelle Ann Cerilles of Dr. Yi Wand's imaging lab. The curriculum is set up into 12 exercises and in this first session, we performed exercises 1 -3. These included learning how perform a phantom scan as a calibration tool for the MRI, learning about MRI safety and how to prepare a patient to receive an MRI, and performing MRI scans of the knee. These lessons can be found at www.learnmri.org; however, performing them in person was much more valuable then just reading through the exercises. We were also introduced to MRI terminology and were taught how to differentiate between tissues in the MRI scan, at least in the knee. The second lesson, schedule for next week, will include MRI imaging of the brain and abdomen.
Looking ahead, there are only two weeks left and so much more to do. My research project takes up a good deal of my time, but next week will be a busy one. Dr. Frayer has helped to set up shadowing in the ER and a chance to see an open heart surgery. The second MRI class should also be quite interesting. I look forward to the chance to squeeze in as much as I can out of what is left of immersion term, and maybe get an abstract as well.
Tuesday, July 20, 2010
Week 5 -Yue
Research Project:
I spent most of my week working on my research project. Dr. Gakhar and I have successfully narrowed our prostate cancer cell line candidates from five to two (PC3 and MDA-PCa-2b) since they both highly express E-selectin ligand and exert my favorite “rolling” motion on functionalized E-selectin surfaces, which would allow us to capture them under flow condition. We then optimized the antibody concentration (anti-PSMA and anti-EpCAM) so that once the E-selectin on the surface stops the cancer cells temporarily during the flow and causes them to roll (due to weak adhesion between the ligand-receptor interaction), the antibodies coated on the surface could capture (form firm adhesion with) the cells of interest. I’m very happy to see that the project is moving forward and I hope to finish as much as I can while I’m here.
Surgery:
Bilateral Maxillary Le Fort I Osteotomy, sagittal split osteotomies, anterior mandibular horizontal osteotomy/Genioplasty
On Thursday, I observed a very interesting cosmetic facial surgery performed by Drs. Neugarten and Sachs. Dr. Neugarten’s previous case got delayed so the surgery was pushed to 4pm although originally scheduled at 1pm. While I was waiting, I was introduced to two of the residents that were involved in this case and the circulating nurse, Natalie. The patient had incorrectly positioned jaw, which affects her chewing, function, speech, long-term oral health, and appearance. Prior to the initiation of treatment, she received a thorough examination with facial measurements, photographs, x-rays, and dental impressions. The doctors then personalized the course of treatment for her based on the results of the examination and consultations. Natalie encouraged me to hold the patient’s hand while general anesthesia was given to her, which is supposed to provide some level of comfort for the patient.
Procedures performed:
Maxillary Le Fort I Osteotomy involves separating the maxilla and the palate from the skull above the roots of the upper teeth through an incision inside the upper lip. It is performed to straighten or realign the upper jaw, often to bring the middle of the face forward.
Sagittal Split Osteotomy: back of the jaw is split bilaterally in the region of wisdom teeth, which allows the lower jaw to be pushed back with adequate bone contact for healing.
I look forward to spending next Friday in the ER and making progress on my research project in the coming week.
I spent most of my week working on my research project. Dr. Gakhar and I have successfully narrowed our prostate cancer cell line candidates from five to two (PC3 and MDA-PCa-2b) since they both highly express E-selectin ligand and exert my favorite “rolling” motion on functionalized E-selectin surfaces, which would allow us to capture them under flow condition. We then optimized the antibody concentration (anti-PSMA and anti-EpCAM) so that once the E-selectin on the surface stops the cancer cells temporarily during the flow and causes them to roll (due to weak adhesion between the ligand-receptor interaction), the antibodies coated on the surface could capture (form firm adhesion with) the cells of interest. I’m very happy to see that the project is moving forward and I hope to finish as much as I can while I’m here.
Surgery:
Bilateral Maxillary Le Fort I Osteotomy, sagittal split osteotomies, anterior mandibular horizontal osteotomy/Genioplasty
On Thursday, I observed a very interesting cosmetic facial surgery performed by Drs. Neugarten and Sachs. Dr. Neugarten’s previous case got delayed so the surgery was pushed to 4pm although originally scheduled at 1pm. While I was waiting, I was introduced to two of the residents that were involved in this case and the circulating nurse, Natalie. The patient had incorrectly positioned jaw, which affects her chewing, function, speech, long-term oral health, and appearance. Prior to the initiation of treatment, she received a thorough examination with facial measurements, photographs, x-rays, and dental impressions. The doctors then personalized the course of treatment for her based on the results of the examination and consultations. Natalie encouraged me to hold the patient’s hand while general anesthesia was given to her, which is supposed to provide some level of comfort for the patient.
Procedures performed:
Maxillary Le Fort I Osteotomy involves separating the maxilla and the palate from the skull above the roots of the upper teeth through an incision inside the upper lip. It is performed to straighten or realign the upper jaw, often to bring the middle of the face forward.
Sagittal Split Osteotomy: back of the jaw is split bilaterally in the region of wisdom teeth, which allows the lower jaw to be pushed back with adequate bone contact for healing.
I look forward to spending next Friday in the ER and making progress on my research project in the coming week.
Summer Immersion Week 5
During this week I was able to make some progress with my summer project and experience another area of the hospital outside of neurology.
During this week I was able to observe a cardiothoracic surgery with Dr. Girardi. The procedure was for an aortic valve replacement. A few years ago I took a course in tissue engineering and one unit of the course was about medical grafts, including heart valves. With this background I was able to better appreciate the nature of the material that was being grafted in place of the native heart valve that was no longer functioning. The procedure itself was invasive, it required an open sternotomy and that the patient go on bypass as the new valve was put in place. One aspect of the procedure that I found very surprising was that during the actual valve replacement, the coronary arteries of the heart are not perfused by the bypass machine. This means that throughout the procedure the muscle of the heart is not circulated with oxygenated blood. From speaking with the anesthesiologist in the OR it would seem that this is due to a plumbing issue. The location of the system to deliver oxygenated blood back to the body cannot reach the coronary arteries near the near the heart off of the aorta. Dr. Girardi was performing the procedure with one of him fellows and while suturing the new valve in place he mentioned that the tension and location of the sutures was particularly important for preventing leaks and other healing issues with the valve. Though I am not a materials science person I would think that there would be a need here for reliable means of attaching the valve that does not leak and can interface with the native tissue of the heart well.
On my project, I have been able to present the mouse data that I spoke about in my last entry. I was also able to show some meaningful trends in the data as well. With this part of the project complete I have moved on to implementing a simulation for the next kind of fitting algorithm that is going to be used for the data to recover information about the underlying composition of the voxels in the image.
I look forward to finally seeing some good results from my project and exploring the hospital more next week.
During this week I was able to observe a cardiothoracic surgery with Dr. Girardi. The procedure was for an aortic valve replacement. A few years ago I took a course in tissue engineering and one unit of the course was about medical grafts, including heart valves. With this background I was able to better appreciate the nature of the material that was being grafted in place of the native heart valve that was no longer functioning. The procedure itself was invasive, it required an open sternotomy and that the patient go on bypass as the new valve was put in place. One aspect of the procedure that I found very surprising was that during the actual valve replacement, the coronary arteries of the heart are not perfused by the bypass machine. This means that throughout the procedure the muscle of the heart is not circulated with oxygenated blood. From speaking with the anesthesiologist in the OR it would seem that this is due to a plumbing issue. The location of the system to deliver oxygenated blood back to the body cannot reach the coronary arteries near the near the heart off of the aorta. Dr. Girardi was performing the procedure with one of him fellows and while suturing the new valve in place he mentioned that the tension and location of the sutures was particularly important for preventing leaks and other healing issues with the valve. Though I am not a materials science person I would think that there would be a need here for reliable means of attaching the valve that does not leak and can interface with the native tissue of the heart well.
On my project, I have been able to present the mouse data that I spoke about in my last entry. I was also able to show some meaningful trends in the data as well. With this part of the project complete I have moved on to implementing a simulation for the next kind of fitting algorithm that is going to be used for the data to recover information about the underlying composition of the voxels in the image.
I look forward to finally seeing some good results from my project and exploring the hospital more next week.
Monday, July 19, 2010
Pathological Immersion, Week 5
I spent the majority of week 5 working on my summer project with Drs. Shin and D'alfonso (resident) in Surgical Pathology. Because I worked on the project so much this week, it seems appropriate to discuss it more completely. The study we are conducting is retroactive (as is most clinical pathology research) in that we have filtered cases from the past fifteen years based on certain criteria. There were three basic criteria that needed to be fulfilled for a case to be included in our study: 1) the patient had a needle core biopsy (NCB) in which either lobular carcinoma in situ (LCIS) or ductal carcinoma in situ (DCIS) was identified; 2) there were no invasive/infiltrative or worse-graded components to the lesion; 3) the patient had a subsequent lumpectomy or mastectomy of the same region as the NCB. To clarify, epithelial cells in breast tissue make up either ducts or lobules, which are basally lined by a basement membrane of various extracellular proteins and a layer of myoepithelial cells. An in situ carcinoma exhibits cytologic and architectural abnormalities, but the suspicious epithelial cells are confined within a basement membrane. Cancerous lesions can arise from both the ducts and lobules, and cells derived from each structure retain certain traits and profiles of gene/protein expression that allow scientists and clinicians to identify them. For example, a lesion of LCIS can grow and spread into ducts, but to the trained eyes of a pathologist, these tumor cells will appear distinctly lobular. This distinction is critical because patient care is determined by the nature, severity, and source of a tumor, and patients with LCIS are treated differently than patients with DCIS, regardless of where the in situ carcinoma has spread. The goal of our study is to evaluate the predictive capacity of LCIS and DCIS diagnosed from a NCB, which is currently the least invasive and most widely-used method to biopsy suspicious breast tissue. We are using indicators such as nuclear grade of the in situ carcinoma and association with other benign lesions to determine the likelihood that the cancer will "upgrade" (see tumor grading, Week 4). This and next week, we are reviewing the slides that I collected from the warehouse, recording the above indicators as well as many others. We will then use the pathology reports from the excisions (lumpectomies and mastectomies) to see how these biopsied lesions ultimately behaved.
This week I also began to envision a Reinhart-King/Shin collaborative side-project that I can work on when I return to Ithaca in August. My experience with the clinical aspects of breast cancer has inspired a lot of research ideas that I'm excited to pursue.
This week I also began to envision a Reinhart-King/Shin collaborative side-project that I can work on when I return to Ithaca in August. My experience with the clinical aspects of breast cancer has inspired a lot of research ideas that I'm excited to pursue.
Week 5 - Ruiz
This week I went to a guest lecture conference that was held for the new incoming plastic surgery residents. This week an attending physician from the Memorial Sloan-Kettering clinic came and gave a lecture on mandible reconstruction. I was really impressed with the depth of knowledge that a doctor needs for just this one type of procedure! The guest lecturer gave us a very thorough review, starting with an explanation of the main considerations – function, form, composition, etc. – which must be taken into account when planning this operation. He especially stressed knowing everything there is to know about the gold standard flap used for mandible reconstruction: the fibula flap. He showed us many detailed images showing us the critical anatomy of the fibula, and explained that the greatest advantage to using this flap is that it has a segmented blood supply. This unique characteristic essentially means that the fibula is a flap that can be shaped and optimized for many types of mandible reconstructions. We then went through a number of case examples in which he called upon the residents to help him plan out mandible reconstruction surgeries for each patient in each case. I really enjoyed the discussion and debate surrounding different real-world cases, in addition to connecting our anatomy knowledge of the flaps and the mandible with the reconstruction goals of the procedure.
I was also able to attend patient rounds and office patient consults with Dr. Grant. This week a diverse array of patients were seen. Some had just had a nasal reconstruction operation, some were coming in for office procedures (i.e. liposuction or facial augmentation using injectable dermal fillers), and others came for first-time consults about eyelid alteration surgeries and breast implant procedures. I am still very surprised by how expensive plastic surgery is! For instance, one Asian teenager came in wanting eyelid surgery, and she was told that having the operation to “create” more Caucasian-looking eyelids would cost about $4000. Another patient came in seeking facial augmentation to remove her wrinkles. Dr. Grant told her that he would need to use 2-3 tubes of dermal filler – with each tube costing about $750. I understand that these procedures help the patients feel better about themselves and happier in general, but I wonder how these prices got to be so high…
Another interesting aspect of my week was shadowing in the ER with Dr. Sperling. He gave me a full tour of the Emergency Department and explained the triage process and how patients were sequestered into different wings of the ER. I then paired up with one of the ER attendings to observe how they treated and diagnosed incoming patients to the ER. I never really realized how much problem-solving is involved with ER diagnostics! One of the attending physicians told me that “we always assume that the patient has a very serious/dangerous condition until proven otherwise.” In narrowing down the possible conditions, a lot of the discussion, lab tests, and diagnostics in the ER are used as forms of evidence that the ER doctors must then gather, organize, interpret, and integrate into one final diagnosis. This was a very different (but equally interesting) kind of clinic compared to the plastic surgery patient consults that I’ve observed with Dr. Grant!
In my spare time this week I have been working hard analyzing the literature and current perspectives on injectable dermal fillers for my research project. In the middle of the week I drafted up an outline for my review/ analysis and discussed the pros and cons of it with Dr. Grant. I have come up with a few theories on how nanotechnology and biomedical engineering can enhance the field of dermal fillers, and in the next week I plan to flesh out these ideas, back them up with current research findings, and hopefully finish a more polished rough draft of my review.
I was also able to attend patient rounds and office patient consults with Dr. Grant. This week a diverse array of patients were seen. Some had just had a nasal reconstruction operation, some were coming in for office procedures (i.e. liposuction or facial augmentation using injectable dermal fillers), and others came for first-time consults about eyelid alteration surgeries and breast implant procedures. I am still very surprised by how expensive plastic surgery is! For instance, one Asian teenager came in wanting eyelid surgery, and she was told that having the operation to “create” more Caucasian-looking eyelids would cost about $4000. Another patient came in seeking facial augmentation to remove her wrinkles. Dr. Grant told her that he would need to use 2-3 tubes of dermal filler – with each tube costing about $750. I understand that these procedures help the patients feel better about themselves and happier in general, but I wonder how these prices got to be so high…
Another interesting aspect of my week was shadowing in the ER with Dr. Sperling. He gave me a full tour of the Emergency Department and explained the triage process and how patients were sequestered into different wings of the ER. I then paired up with one of the ER attendings to observe how they treated and diagnosed incoming patients to the ER. I never really realized how much problem-solving is involved with ER diagnostics! One of the attending physicians told me that “we always assume that the patient has a very serious/dangerous condition until proven otherwise.” In narrowing down the possible conditions, a lot of the discussion, lab tests, and diagnostics in the ER are used as forms of evidence that the ER doctors must then gather, organize, interpret, and integrate into one final diagnosis. This was a very different (but equally interesting) kind of clinic compared to the plastic surgery patient consults that I’ve observed with Dr. Grant!
In my spare time this week I have been working hard analyzing the literature and current perspectives on injectable dermal fillers for my research project. In the middle of the week I drafted up an outline for my review/ analysis and discussed the pros and cons of it with Dr. Grant. I have come up with a few theories on how nanotechnology and biomedical engineering can enhance the field of dermal fillers, and in the next week I plan to flesh out these ideas, back them up with current research findings, and hopefully finish a more polished rough draft of my review.
Katie - week 5
This week was filled with a variety of activities, which kept the days very interesting. I had the opportunity to attend the center for skeletal dysplasia, led by Dr. Raggio on the 3rd floor of HSS. Here, they see patients with a variety of skeletal dysplasias, including osteogenesis imperfecta and achondrogenesis (the two most popular that are dealt with at this center). It is a fun environment that involves a large number of people. Throughout the day, each patient meets with some or all of the following, depending on their needs: orthopedic surgeon, social worker, nutritionalist, geneticist, and genetic counselor. The team works really well together, and it is obvious how much they care for each of the patients. As those with OI or Achon have to deal with the disabilities and issues their entire lives, the doctors usual develop very long-term relationships with them.
As my research at Cornell relates to mechanical sensitivity of bone and the pathways involved in bone development and maintenance, I am intrigued by all things related to bone. Recently, I had read a novel where the main character had osteogenesis imperfecta, and so I was ecstatic to be able to see patients in real life. OI is characterized by small stature, bowed bones, and low bone mineral density, usually due to a mutation in the gene that codes for collagen type I. There are many types of OI (at least 8), and the research is still growing, as type VIII was just identified earlier this year. Some of the types are fatal, while others only mildly inhibit growth. One of the most interesting things I saw with OI patients was that one child had a bone density score of -8.5! This means that her bone density is 8.5 standard deviations below the normal for her age and gender. To be considered osteoporotic, one's bone density must be -2.5 or lower, and so this -8.5 is tremendous. Dr. Raggio says it might be one of the lowest if not the lowest bond density score she has ever seen. This causes a huge increase in fracture risk, and so great precautions must be taken to protect the skeleton through diet, and to try and strengthen the bones while at the same time not overworking them.
Achondroplasia is the most common form of dwarfism, and is charactized by an enlarged forehead, short stature, trident hands, among other symptoms. It is caused by an autosomal dominant mutation in the gene coding for fibroblast growth factor receptor, which results in problems with cartilage growth plate differentiation and deficient endochondral growth.
Also this week, I was able to shadow Dr. Sperling in the ER, an experience I was really looking forward to. To start off the day, Dr. Sperling gave us a quick tour of the whole ER department. We got to see where patients came in and how they decided the severity of the symptoms. Some patients are sent over to Urgent Care, while others stay in the ER department, with some accelerated due to severity (i.e. chest pains). It was interesting to get a quick overview of the infrastructure. During the day, I did not get to see any sever trauma cases (good news for the patients) but was able to shadow doctors on a number of different cases. One case was a woman who comes in twice a week to get her bandage on a wound replaced and is probably addicted to pain medication. I was impressed with the way the doctors handled her with such a professional and kind manner. Dr. Sperling explained to me that, by law, they must treat everyone who walks in the doors, and I admire them for treating everyone with respect.
One interesting case I saw was a woman who began suffering from a seizure all of a sudden. I was surprised at the disorganization of the process. From watching medical drama on television, I was made to think that any time a crisis arises, it is handled in a hectic but completely efficient way. In this instance, the janitor was the one who alerted the doctors to the seizure, and the nurses were flustered because at first they could not get a straight answer as to the patient's name so that they could administer the correct medicine, and then they were unsure if the patient already had an IV intact. Luckily, they were able to act quick enough to get the seizure under control.
Also this week, I made significant progress on my knee implant retrieval study. I have now analyzed all 38 of the implants, both articular and backside surfaces, ten areas on each surface, 7 modes of wear for each area. Next, I will be getting the data from the mobile bearing implants to which we are comparing our implants so that we can begin to compare the results. I am very interested to see the results of hours spent looking through a dissecting microscope!
As my research at Cornell relates to mechanical sensitivity of bone and the pathways involved in bone development and maintenance, I am intrigued by all things related to bone. Recently, I had read a novel where the main character had osteogenesis imperfecta, and so I was ecstatic to be able to see patients in real life. OI is characterized by small stature, bowed bones, and low bone mineral density, usually due to a mutation in the gene that codes for collagen type I. There are many types of OI (at least 8), and the research is still growing, as type VIII was just identified earlier this year. Some of the types are fatal, while others only mildly inhibit growth. One of the most interesting things I saw with OI patients was that one child had a bone density score of -8.5! This means that her bone density is 8.5 standard deviations below the normal for her age and gender. To be considered osteoporotic, one's bone density must be -2.5 or lower, and so this -8.5 is tremendous. Dr. Raggio says it might be one of the lowest if not the lowest bond density score she has ever seen. This causes a huge increase in fracture risk, and so great precautions must be taken to protect the skeleton through diet, and to try and strengthen the bones while at the same time not overworking them.
Achondroplasia is the most common form of dwarfism, and is charactized by an enlarged forehead, short stature, trident hands, among other symptoms. It is caused by an autosomal dominant mutation in the gene coding for fibroblast growth factor receptor, which results in problems with cartilage growth plate differentiation and deficient endochondral growth.
Also this week, I was able to shadow Dr. Sperling in the ER, an experience I was really looking forward to. To start off the day, Dr. Sperling gave us a quick tour of the whole ER department. We got to see where patients came in and how they decided the severity of the symptoms. Some patients are sent over to Urgent Care, while others stay in the ER department, with some accelerated due to severity (i.e. chest pains). It was interesting to get a quick overview of the infrastructure. During the day, I did not get to see any sever trauma cases (good news for the patients) but was able to shadow doctors on a number of different cases. One case was a woman who comes in twice a week to get her bandage on a wound replaced and is probably addicted to pain medication. I was impressed with the way the doctors handled her with such a professional and kind manner. Dr. Sperling explained to me that, by law, they must treat everyone who walks in the doors, and I admire them for treating everyone with respect.
One interesting case I saw was a woman who began suffering from a seizure all of a sudden. I was surprised at the disorganization of the process. From watching medical drama on television, I was made to think that any time a crisis arises, it is handled in a hectic but completely efficient way. In this instance, the janitor was the one who alerted the doctors to the seizure, and the nurses were flustered because at first they could not get a straight answer as to the patient's name so that they could administer the correct medicine, and then they were unsure if the patient already had an IV intact. Luckily, they were able to act quick enough to get the seizure under control.
Also this week, I made significant progress on my knee implant retrieval study. I have now analyzed all 38 of the implants, both articular and backside surfaces, ten areas on each surface, 7 modes of wear for each area. Next, I will be getting the data from the mobile bearing implants to which we are comparing our implants so that we can begin to compare the results. I am very interested to see the results of hours spent looking through a dissecting microscope!
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