Tuesday, August 7, 2007

Final Week of Summer Immersion...Tear

So the final week of the program was unfortunately spent mostly working on my presentation which I had to give on Thursday. However, I did get to observe two more cranioplasty cases which were awesome as usual. Dr. Spinelli, the main plastic surgeon that works on these cases is becoming acclimated to my presence in the OR now. As such, he showed me some of the facial/cranial skeletal anatomy, such as the maxilla, zygomatic arches, orbital floor, and probably some others I don’t remember. One of the cases was kind of sad; it was a two-year-old girl that was born lacking the proper fusion of her skull. Dr. Spinelli had previously operated on her several times in the past, reconstructing various parts of her cranium; however, this time he was simply adding a titanium mesh and his favorite Medpor hydroxyapatite bone cement to cover the final remaining area lacking skull bone. When the girl finally awoke she couldn’t stop crying and looked terribly unhappy. Poor girl…at least, her brain will be somewhat more protected now.

Anyway, as I showed in my presentation my research project basically consisted of a literature review and case study analysis to form the foundation for a prospective investigation of Dr. Grant’s. He wants to assess the effect short pulsed electromagnetic fields have on post-op breast augmentation patients. I won’t go into everything that I presented on; however, some of the more interesting findings were as follows. First, was a meta-analysis of over 30 years and 50 clinical trials on both bone and soft tissue revealing that ALL studies were methodologically flawed…awesome. I’m glad published research is so well reviewed…and carried out for that matter. Some of the flaws were huge, too – like no control groups or errors in the protocols. Honestly, I thought that was outrageous. Nonetheless, these were studies from years ago, and a lot of the newer studies are much better designed. Several of the better, more recent articles showed that in vitro and in vivo PEMF stimulated the synthesis and upregulation of various growth factors, such as, platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and transforming growth factor (TGF). These growth factors then act to induce cellular proliferation, angiogenesis, stimulation of an immune response, deposition of ECM and wound contraction. In other words, they aid in wound healing and in turn should also help reduce pain in human subjects by speeding up the healing process. The chart below illustrates an increase in tensile strength of rat wounds treated with PEMF for 21 days post-op as compared to the negative controls. Signal I, II, III, and IV are simply varying doses of PEMF; whereas the "Sham" is the negative control.

A company called Ivivi Technologies in Northvale, NJ manufactures devices named SofPulse that utilize this PEMF technology. The company collaborates with Columbia University to study the effects and applications of PEMF, hence, why Dr. Grant is interested in it pursuing this further. The device is essentially a small electrical device that rapidly turns on and off sending current through a circular coil as shown below.

The electric field induces a magnetic field and the device is laid on the wounded area, applying the desired PEMF therapy directly onto the patient’s wounds. It’s a non-invasive therapy that allegedly reduces pain and speeds along the healing process, allowing for an earlier discharge, and thus, cutting costs, too…that is if it actually works. A cool idea. But, it just looks so bogus to me. Anyway, the company has just released news that they have an IRB-approved, randomized, double-blind, placebo-controlled clinical trial on 30 ischemic cardiomyopathy patients (decreased blood flow to the heart) who are not candidates for surgical procedures. If it works in these cases, that would be absolutely great…it could reduce the number of many invasive, difficult cardiac surgeries. Personally, I think the biggest obstacle with this technology will be convincing the general population that a stupid wire with a flashy LED on it will actually save you…

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