week 5 07/19/21

 Week 5


Going into the second last week of my stay at the summer immersion program, I have been, again, shadowing doctors in various departments outside of international radiology to obtain a more diverse experience. This week I have had the opportunity to work with Dr. Himanshu Nagar in radiation oncology, Dr. Eugene Shostak in interventional pulmonology, and Dr. Angela Kadenhe-Chiweshe in paediatric surgery.


One of Dr. Nagar's specializations is in treating prostate cancer. For these patients who need to undergo radiation therapies, one of the complications after radiation is damage to the rectum, which is located very close to the prostate. To lower the risk of radiation damage to the rectum, Dr. Nagar used a FDA-approved hydrogel product, SpaceOAR™, to space out the rectum and the prostate. This hydrogel consists of a cartridge of PEG powders mixed with trilysine buffer solution and a second cartridge of salt buffer solution. When these two cartridges are injected together through a Y-connector, across a long needle which extends into the prostate midline region, the hydrogel is delivered and it will crosslink in-situ via chemical reactions in about 10 seconds. SpaceOAR™ has proven to exceed the minimally acceptable clinical success rate in reducing radiation to the rectum. This product is also quite similar in design to DuraSeal®, which is another PEG-based hydrogel approved for use as a dural sealant. Although these two products were both formulated based on a relatively straight-forward first-generation hydrogel chemistry, they still had a long route before obtaining federal approvals in the last decade or so. Nowadays, during the surgeries which I have observed, these hydrogel products were used quite frequently. I truly look forward to seeing more innovative biomedical designs being transitioned from bench-top ideas to clinically approved products in the future.


Another truly beneficial biomedical innovation which I observed this week was with the navigational bronchoscopy that Dr. Shostak conducted for lung biopsy procedures. Navigational bronchoscopy utilizes a software which can 3D reconstruct a "map" of the lung and airways from the patient's CT scan. The software also allows the surgeon to select the desired location of biopsy, and then calculates an optimal path for the surgeon. During the procedure, the airway of the patient, who was lying on a board emitting electromagnetic signals, was calibrated to the "map" through a process called registration. Thereafter, the software can superimpose the virtual lung roadmap and update the location of the probe tip in real time to guide the surgeon to the desired location for taking biopsy samples.


On Friday, I was fortunate enough to witness one of Dr. Chiweshe's paediatric surgeries. The patient was a 12-months old infant who was suspected of having malrotation, a condition which describes a spectrum of abnormal twisting of the intestine. The patient was presented with severe malnutrition and constant vomiting after feeding. Malrotation usually is a developmental disorder which happens early in pregnancy and may lead to volvulus, which would cause severe blockage of the intestine. For patients with malrotation, a surgery called Ladd procedure can be performed to straighten out the intestines. This would also reduce the incidence of intestinal twisting happening again later in life. A gastrostomy tube was also placed in this patient through the skin into the stomach, such that nutritions can later be delivered directly to the stomach to help the patient quickly recover from the malnutrition state.   


         

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