The bionic pancreas data

July 2, 2014- Interviewed by Steven E. Greer, MD

The New England Journal of Medicine recently published the early clinical data on the “bionic pancreas” being developed by engineers at Boston University and medical doctors at Massachusetts General hospital. We interviewed Ed Damiano, PhD, the lead biomedical engineer, and Steven Russell, MD PhD, the lead endocrinologist. In Part 1, they review the clinical data.

The research was funded by the NIH and not a medical device or drug company. The researchers selected the components based on merit. They chose the Dexcom G4 Platinum continuous glucose sensor and a Tandem Diabetes t:slim pump, and used software that ran on a standard Apple iPhone 4S.

In Part 2, the team discusses the details of the pivotal study, that could be concluded by 2016, allowing for an FDA approval by 2017. Industry partners yet to be determined would be involved. However, the final marketed product will not require any particular smartphone to be used by the patient.

 

Reliable gun violence statistics

February 12, 2013 By Steven E. Greer, MD

In the wake of the Newtown, Connecticut massacre of 20 first graders and six brave adults, the debate over gun control is the main topic of the news. Consequently, both sides of the debate are using statistics to support their arguments. However, gun violence statistics are quite often inappropriately cited by untrained “pundits” or lobbyists.

A summary of some of the most important evidence and data: Read more »

Brian Kopell, MD: The skull repair and rehab ahead for Rep. Giffords

January 21, 2011

Rep. Gabrielle Giffords is now in a rehab facility. We asked a neurosurgeon, Brian Kopell, assistant professor of neurosurgery at the  Medical College of Wisconsin and practices at Froedtert Hospital, some questions about the reconstruction of her calvaria and her prognosis.

Q1: What have you gleaned from news reports that indicate Rep. Giffords is doing well in terms of higher function?

The main indicator that her recovery has been going well is the rapidity of her improvement.  Her transfer to a rehabilitation facility today indicates that she has achieved a level of motor and cognitive function that is at minimum interactive with her environment.  The reports that she has been tracking her visitors with her vision also indicates a significant level of awareness.  Most interestingly, she has been reported to have been playing with an iPad, certainly demonstrating complex cognitive and motor skills.

That being said, it is a bit curious given the rapidity of her improvement that she underwent tracheostomy.  Generally speaking, this is a procedure done either due to a) significant upper airway/facial injury or b) severe mental status depression where the patient cannot protect their airway.  There has been nothing in the media reports to support either of these scenarios.  Furthermore, there has been no explicit media reports of her writing notes to communicate.  Certainly if she is able to “play” with an iPad she could write simple notes indicating that her language networks are still relatively intact.

Q2: What does her skull look like now? How do they protect the brain?

Based on media reports, Giffords underwent a decompressive craniectomy during her initial operative management of her GSW.  This is a procedure where the surgeons leave the bone flap out to be replaced at a later date should the patient survive the injury.  This is done, quite simply, to allow for brain swelling.  GSW’s, especially high velocity GSW’s,  typically damage the brain in 2 steps.  The initial damage occurs due to the trajectory of the bullet through the brain.  The deceleration of the bullet in the brain causes a pressure wave that damages surrounding brain tissue.  As this damaged brain tissue reacts to this wave, a second stage of damage and swelling commences.  It is often this stage that proves fatal for the patient.  By leaving out the bone flap, the damaged brain can swell without obstruction and consequent loss of blood flow.

Her head looks quite distorted right now; it is probably why the media will not see Ms. Giffords for a while.  Generally,  patients with cranial defects are given helmets to wear in order to protect the essentially un protected brain.

Q3: Where now is the section of the calvaria that was removed When/how will they replace it?

Typically, surgeons do one of two things with the bone flap.  Some make a subcutaneous pouch in the abdomen an place it there.  It is a sterile environment.  Others place it in a sterile refrigeration unit in the hospital specially designed to house such specimens.

We typically replace the bone flap 2-6 months after injury depending on circumstance and patient recovery.  It is a simple procedure in which the old scalp incision is reopened and the bone flap is affixed over the defect with a variety of fixation methods (I use small titanium plates).  Depending on the time elapsed, there can be some significant remodeling of the calvarial defect that requires some drilling of the bone flap in order to make a good cosmetic result.

Should an infection develop, the old bone flap would need to be removed.  In this case, a high-resolution CT can be obtained and a 3D reconstruction of the defect can be modeled.  This information can be used to develop a custom acrylic implant with CAD modeling techniques.

Chris Attinger, MD: revascularization techniques for lower limb salvage

Christopher Attinger, MD, of Georgetown University Medical Center briefly discusses revascularization techniques for lower limb salvage.

Chris Attinger, MD: Wound care devices

Christopher Attinger, MD, Director of the Georgetown Medical Center for wound healing, discusses new medical devices used for debriding wounds in the OR and devices used to facilitate wound healing. Devices discussed include KCI’s VAC, The Versajet by Smith and Nephew, hyperbaric oxygen chambers by Perry, and others.

Medical companies that can help prevent amputations in Haiti

January 19, 2010 The Healthcare Channel

The conditions in Haiti are still deplorable and U.S. medical aid is surprisingly less advanced than other countries assisting with the disaster relief. ABC News reported that the mobile Israeli medial team has better MASH-like tents and operating rooms than the U.S. teams. Medical supplies are scarce and surgeries are performed with make-shift saws and being sterilized by drinking alcohol, etc. What type of medical supplies would make the biggest difference right now?

Next to water and food shortages, wound complications are the most critical problem developing. Tens of thousands of people have open fractures and crush injuries leading to gangrene, sepsis, amputations, or death. Kinetic Concepts (KCI) of Texas has what might be the most important medical device for treating these wounds: The VAC.

The VAC (vacuum assisted closure) uses negative pressure wound therapy. A special dressing consists of a sponge over the wound that is sealed with adhesive plastic coating making it airtight. A flexible tube exits the dressing and is connected to a vacuum pump that creates a negative pressure, or suction, over the wound.

Many open fractures that were once thought treatable only by reconstructive surgery can be VAC’d instead and the limbs salvaged. The VAC can also treat actively infected wounds and reduce the bacterial count even in cases of osteomyelitus.

The VAC system is fairly simple to set up and one pump can be hooked up to multiple wounds. The equipment is portable and could be delivered within a day to Haiti. Medical relief staff could be trained on proper usage within an hour.

Other companies offer negative pressure wound care as well. Smith and Nephew offers the Blue Sky Renasys system, and Medela offers Invia system.

In addition to negative pressure devices, SNN and KCI make a variety of other advanced wound care. Wound irrigation systems and standard dressings are also needed to treat the open fractures.

Johnson and Johnson’s Ethicon division has an extensive portfolio of products that could help in Haiti now, such as suture, dressings, and other surgical supplies. Also, JNJ’s drug division can offer antibiotics.

Stryker’s orthopedic surgery tools could assist with the surgeries to treat the fractures or amputations. The division that makes operating room equipment would be valuable as well.

Although wound care and limb salvage is one of the highest priorities, dozens of other medical device companies could contribute useful products to Haiti. Abbott’s infant nutrition division has essential food for the starving babies. Baxter, Hospira, and Covidien make many of the necessary routine supplies taken for granted in this country, such as needles, syringes, intravenous fluid sets, drugs, etc.

At the time of this report, it is unclear whether any of these companies will be donating their services and products to the Haiti relief effort.

Chris Attinger, MD: a tour of the Georgetown wound care center

Chris Attinger, MD of Georgetown Medical center gives a walking tour of the Center for Wound Healing and Hyperbaric Oxygen, which he founded. This is a very unique center due in large part to Dr. Attinger’s diverse surgical training in vascular and plastic surgery. Dr. Attinger’s ability to perform below-the-knee revascularization is crucial for the high rate of limb salvaged achieved at his wound care center. The center is also unique in having almost all of the therapies and diagnostic tools in-house. We took a tour.

Chris Attinger, MD: Lower limb salvage

Christopher Attinger, MD, of Georgetown University Medical Center, gives an overview of the multidisciplinary approached used by his wound care center to salvage lower limbs with chronic wounds and prevent amputation. This approach has allowed his center to post dramatically higher salvage rates that the United States averages.