Work Experience

                         

Today I learned how a gall bladder and quadrant of breast with lymph's glands of the underarms                                                           look like. I also saw a part of a colon and a huge cyst on an ovary. 
I saw how a tumour looks like in the breast and i lean red that when the lymph nodes are swallowed it means that the tumour infiltrates there, they have swallowed due to its presence. The tumour appeared hard when touching it, its colour was white/grey, and its shape was irregular and was infiltrating the surrounding. 

I asked my sister to have a look at my blog and she criticised the fact that using a scalpel was the best experience of my life, adding that I was insensitive towards patients. Actually, I cannot change it because it was the best experience. I am aware of the fact that people are in pain but to undertake the pain doctors have to love their jobs, and I loved using a scalpel because it allowed me to see what was inside, to analyse the organ and look for a cure. Moreover, at the moment I took the scalpel I became cold, rational, all my attention was focused on the instructions of the analyst and the organ in font of me.  

Attending this work experience is teaching me many aspects of the world of medicine, and step by step it is introducing me in the painful aspects of it. I asked to be present on the day in which they will inform the patient of the possible metastasis. 

Work Experience

                     
                                         

Today was the best day of my life....I used a SCALPEL!!!! 
I, personally, cut organs and help analysts to analyse the pieces. I have been under examination and i was given an uterus to take care of, so i opened it and cut into pieces to be analysed.

So I took three pieces of the uterus to be examined, these are:
1) Sample of the myoma present in the uterus;
2) Sample of the ovaries and attached;
3) Sample of the cervix.

I left them into formalin to then me dehydrated into different concentrations of alcohol. Afterwards, I will put them into paraffin, and as the tissues had been dehydrated they easily absorb the paraffin, which will wax them so to be cut into thin slices and put them into slide to analyse them under microscope.

When i held the scalpel it was like all the anxieties and fears of not being able disappeared as soon as i got the scalp in my hands. My heart beat stabilised and i normally fallowed the instructions of the analyst. It was the best experience of my life. 
I saw two fetus, one of 1 months and the other of days. It was sad seeing a life without future. Therefore, a doctor there told me, Giulia do not worry think that he or she does not have to encounter school, teenager problems and life in general. They are little angels leaving this world, and to believers, to go to somewhere better. 

Medicine is a huge world were all pieces are in order, and when something takes place and changes this order i want to be able to put all the things back in order. Medicine is challenge, I love challenges... and today I love my uterus and my scalpel!!!!!!!!!!!!!!!!

Work Experience at Hospital

                         
For the first time in my life, today, i was able to touch an organ which had undertaken visible changes in its structure. It was an uterus.

It was my first day of work experience in hospital, in a reality of the South of Italy, which is everything but pleasant, due to the low healthcare condition. The department where I had applied is Pathological Anatomy. The reason why I chose to begin with this department is because, though i had not seen a human body before, i wanted to start where all end. Where analysis and diagnosis are made.

I was able to see doctors analysing tissues belong to people who were still alive thanks to the prompt surgery. I saw an uterus of 16 kg...it was really impressing!!!! However, other organs belonged to dead people which are useful source for research.

I really liked the fact that in this department the help done by machines is quite limited, whereas in many other medical departments machines became fundamental, it seems moderns doctors depend on them.

Patients coming to this department had on their faces "hope", and what shocked me was that i asked a question to one of the analysts and it was: "do you have a favourite case?" he gave a positive answer. Therefore i asked: "could you take me through it, please?", and he said i do not remember it.
To another i asked why he chose medicine and he said because it was fashionable in my years.

I also heard them saying that dead people are the best to treat because they do not annoy you.

I made my reflections....... I am still thinking. Yes, each of us is different, each of us has a different story. Many people won't have the same level of culture, but doctors are there not to judge them but to heal them, give the correct amount of information they need. They are scared and need to be insured that someone is taking all the responsibilities to do the best he/she can to save a life.

I, also, was able to look at slides under microscopes. That was fascinating!!!
The intestines are amazing under microscope as well as the trachea... Medicine is a fascinating world.

I realised this work experience is making my will to undertake medical studies even stronger.

Hemispherectomy

After reading the Ben Carson's book, I became interested in hemispherectomy, as in the 1980s he reintroduced this procedure of removing part of the brain in children.

Therefore, as an As student I, in my little, made some researches concerning it. 

Hemispherectomy is the removal of one part of the brain which has been damaged due to illnesses, such as epilepsy. It was introduced in 1988 by Frederic Goltz on cats, and the first surgery on humans was made in 1923 by Walter Dandy. However, the outcomes of this procedure were not successful. It was just after that the Prof. Ben Carson has reintroduced it again that hemispherectomy has become known again, in the 1980s.

Patients who undertake this operation are those who suffer from really debating illnesses, for instance: Hemiplegia, Rasmussen's syndrome, Epilepsy at an advanced state and people who has experienced visual problems. 

Although, it can be practised on both adult and children, hemispherectomy had more successes on children, due to the fact that their brain has generally got more neuroplasticity, allowing the neurones in the part of the hemisphere which has not been taken out to differentiate into neurones of the lost hemisphere, therefore making able the child to function normally. 

However not every patient is then able to recover at 100%, in fact many patients end up with mental, language, movement, humour, and retardation problems, which are usually present even before the surgery. 

Moreover, some people will not be able to talk properly due to the left hemisphere lost. 

Over all, hemispherectomy is a dangerous procedure which can lead to irreversible and permanent damages, but if done it in time on children it can save many life at it has been proved that 52% became seizure free, 9% experienced only rare seizure, a further 30% had >75% reduction in seizure frequency and 9% experienced <75% reduction in seizure, no improvement 6%*.

In conclusion, I have been fascinated by the fact that, though we take out a part of the brain, not just in children as it has been shown by Prof Ben Carson who made hemispherectomy on a patient of 21 years old, that if the brain has been damaged for a long time the other part of the brain will take over it, differienciating neurones in the healthy hemisphere as they were part of the damaged one so to make the individual able to have a normal life. 

*http://brain.oxfordjournals.org

The Ben Carson Story

I always been in interested in neuroscience, therefore the majority of my reading tend to be orientated to the mistery of neurology....

Recently I came across the autobiography of a neurosurgeon, Ben Carson, who is remarkably identify as "The Gifted Hand", in so far he has given children a second chance of life.
Although his family background would not have allowed him to have such a  profitable future, his mother encouraged him to put all his energy into studies fully understanding his talents and therefore utilising them as God would have wanted him to do.

Following many sacrifices and difficulties he has grown stronger, as he was able to understand his weaknesses and improve himself through God help.

Dr. Carson majored in psychology at Yale and graduated from the University of Michigan School of Medicine. He completed both internship and residency in neurological surgery at The Johns Hopkins Medical Institutions. He also worked in Western Australia.
Nowadays he is the Director of Paediatric Neurosurgery at the Johns Hopkins, and he is internationally renowned physician.

When I bought his book I didn't know how useful it would have been for my life. I understood that many times we don't achieve our goals for two reasons: either we do not believe in ourselves or we are victims of laziness.
I would like to cite some passage of his book which has given me strength and made me understand that life is amazing because it is a challenge. It is up to us to understand when we have to give up something or focus more energy on achieving a goals. These are:

1. "If anyone can do it, you can do it better", by Sonya Carson;
2. "God won't put you into a situation if he cannot take you out of it", Ben Carson;
3. After the death of a little girl named Jennifer, he said: "Despite my grief over Jennifer and the days it took for me to throw it off, I do not believe in remaining emotionally detached from patients. I work with and operate on human beings, all creatures of God, people in pain who need help. I do not know how I can work on a girl's brain- how I can her her life in my hands- and yet not become involved. I feel particularly strong attachments to children who seem so defenceless and who have not had the chance to live a full life." 
4. "Think Big", which stands for: 

• T= Talent and Time;
• H= Hope and Honesty (and I would add Honesty and Conscience are the keys for a good             prospective of life);
• I= Insight;
• N= Nice;
• K= Knowledge;
• B= Books;
• I= In- Depth Learning;
• G= God

The point that made me think the most what the third one. I have always been wandering how surgeon can operate on humans and yet when something goes wrong, go home and live their life as anything had happened. I was scared that I might not have this attitude. However, after reading his citation, I understood that there are no patterns to be followed in the life of a surgeon. But the only thing which would make surgeons go ahead is that fact that we had done everything they could to save a life, and that a new life is waiting to be saved, therefore no negative feelings are allowed. I believe that working in honesty and conscience is the key of life, in anything I do I tend to apply the rules of "Think Big"...

To conclude, everything in life happens for a definite reason and each step toward our future is defined by our will to succeed. Personally, I learned that determination can die soon if we do not have goals and challenges to achieve, therefore I am ready to undertake a long course of medicine, aware of difficulties....but actually what is easy in life?

JQ1

JQ1

By Jay Bradley and Jun Qi.

Content Research.

Cancer research is basic research into cancer in order to identify cause and develop strategies for prevention, diagnosis, treatments and cure. 

These simple words put together give a concrete sense of what researchers are doing to fight against this dreadful illness which is cause of many loss each year. 

What I notice, is that we can easily describe the hard work that oncologists are making to provide us with cures, but actually behind a formulation of a drug there is suffering, genius and just after a certain period of time they will probably get satisfaction.

I am currently an AS student who one day has been so lucky as I was able to find an impressive lecture, given by Dr. James E. Bradner of the Department of Medical Oncology of the Dana-Farber Cancer Institute, which has changed my all approach to the medical world. Though, I found it really complicated to understand the chemical formula at first, Dr. Bradner explained it so easily so that with followed researches I have been able to analyse it fully.

Dr. Bardner's Medical Department has found a way to stop the growth of cancer cells as well as make them forget their own nature, being cancer. He based his research more on a rare but devastating cancer known as NUT midline carcinoma (NMC). 

"If you can switch off a cancer cell's growth gene, the cell will die. Alternatively, switching on a tissue gene can cause a cancer cell to become a more normal tissue cell". These were his words on which his research has been based on.

He started focusing on the following three points:

1. Transcription factors;
2. Chromatin modifying enzymes;
3. Histone binding molecules.

They discovered that the BET protein BRD4, with two bromodomains, is implicated in the formation of NMC. Therefore, what happens is a change in the BRD4-NUT protein which modifies the MYC, transforming a normal cell into a cancer cell.

Our cells have a memory, hence the first thing done by these group  of doctors was to disable the two types of proteins responsible for transcription, and so they did. However, they had to work out more about how to disable BRD4-NUT from being cancer. They discovered that benzodiazepine (C₁₆H₁₃CIN₂O)  is active against BRD4, hence using this as guide they started to arrange chemical formulae so to find an inhibitor for such a protein. Strikingly, they did. Dr. Bradner and Dr. Jun Qi, PhD, found an inhibitor for the reader of the protein BRD4-NUT, entitled JQ1 staying for Qi. 

In addition to this sensational discover, Dr. Bradner's Medical Department instead of giving the chemical formula to pharmaceutical factories secretly, they have sent it to all their friends as well as putting it on the internet, accompanied by their personal contacts for all people who may have suggestions to improve the formula itself. 

In addition to this sensational discover, Dr. Bradner's Medical Department instead of giving the chemical formula to pharmaceutical factories secretly, they have sent it to all their friends as well as putting it on the internet, accompanied by their personal contacts for all people who may have suggestions to improve the formula itself. 

Many experiments have been done on mice giving optimum results. However, the Chemical formula has not been applied into a drug yet. Therefore, they are currently working on JQ2.

Here, in relatively 'simple' words, there is the explanation of a cure that has a high percentage of cure for people who are hit by NUT, and it has been tested that JQ1 is also effective in Leukaemia.

After having listened to Dr Bradner talking, I, in my little, became more involved in the world of medicine which is affiscinated but at the same time so hard, so that I understood that determination, strength, positivity and a huge sense of will power is required not only for studying 6 years, which I would say requires just patience, but also to face the daily problems that doctors are subjected to. Studying, in medicine and especially in the field of research has no end. But a little discover has a reflection not just for your personal satisfaction but for all people who without researchers would have been without chances of life. Hence, a doctor does is work for passion, devotion and love, looking forward to new discovers that can make solution to the hardest proofs of life, illnesses.

SOURCE: 'TED TALK' http://www.ted.com/talks/jay_bradner_open_source_cancer_research.html

Here there are some pictures showing how BRD4 works...