Human Anatomy at Colby

Cody Eaton: My Experience in Human A&P

February 14th, 2014 · Comments Off on Cody Eaton: My Experience in Human A&P

Cody Eaton

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Class Blogpost

           Coming from a family in which both parents had a medical background, I grew up hearing anatomical and physiological terms in my daily life. In my junior year, I chose to shadow doctors, PA’s, and NP’s in the ER at Goodall Hospital in Sanford, Maine for the month of January. This experience was beneficial for several reasons including exposure to various occupations and paths in the healthcare field, but left me wanting more. Now that I have taken Anatomy and Physiology with Dr. Klepach, I am even more well equipped to navigate the increasingly complicated medical world in the future.
There were many experiences in this class that I was quite interested in, including the trip to Boston to attend the Body Worlds Vital exhibit, and the guest lecture from CDC Maine State epidemiologist Dr. Stephen Sears. Both of these very unique experiences taught me a lot about medicine and about the human body. Dr. Sears’ talk especially left me with a general feeling that I knew exactly what I want to do after Colby. His discussion of how the CDC uses experimental data and information gathering techniques to analyze possible epidemics was particularly interesting to me, primarily because I like the noble idea of keeping the public safe. As such, following the talk, I was more confident in my plans for the future. I now know undoubtedly that I want to work in healthcare, and now I just need to decide which path I want to take.

Additionally, the class afforded me an elevated level of insight because of the holistic progression of ideas that I have been able to study at Colby now that I am a senior. In other words, the class helped me connect some of the concepts that I had begun to explore in previous classes such as genetics and mammalian physiology. Concepts such as homeostasis and calcium regulation, which pervade many academic areas, were explored in this class and this helped me to create a broader schema regarding biological concepts.

The Grand Rounds experience was worthwhile as well. Thoroughly studying a particular case study provided me with a firm understanding of one medical concept, especially when I was responsible for understanding the anatomy and physiology that directly relates to treatment of rectal adenocarcinoma. By preparing a presentation about such a complicated topic, it was a necessity to understand the basic concepts behind the complex ones (e.g. anatomy of the colon to understand partial colectomy and ileostomy). Ileostomy is inevitably an important concept for someone who is interested in healthcare, due to the number of patients that will have one in their lifetime.

Overall, the class helped me with several anatomy and physiology ideas and concepts that I have learned over the years. Concepts such as distribution of muscles on the body, how the nervous system coordinates with the bones and muscles to move the body and send sensory input back to the central nervous system, and the circulation of blood in the body were explored throughout the month of January through activities, lectures, and laboratory. Not only did we have focused class time on these concepts, but Dr. Klepach also helped cement the concepts in our minds by providing us with a metabolic lab at the Athletic Center. This activity involved doing various exercises and analyzing spirometry parameters and heart rate before and after. Using this information, we then did a few analyses based on our own data that we obtained during the lab. This experience was good for several reasons. First, it allowed the class to learn in a context other than the normal classroom experience. It also helped to be active and learn physiological concepts at the same time, and by doing the activity ourselves it makes it almost impossible to forget some of the concepts involved.

Ultimately, this class was a very beneficial experience. In my future, I will definitely use many of the skills I have developed over the course of this month. For example, skills such as using a blood pressure cuff or a general understanding of blood pressure are life skills that impact all of our daily lives. Even though we did not have as much time exploring some of the anatomy and physiology concepts as I would have wanted, at least everything was touched upon at least once, and makes me hungry for more education. In this way, the class has served an important role in my development as a well rounded individual.

 

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Grand Rounds: 49-Year-Old Male with Adenocarcinoma of the Rectum and Novel Bacterial Therapy

January 29th, 2014 · Comments Off on Grand Rounds: 49-Year-Old Male with Adenocarcinoma of the Rectum and Novel Bacterial Therapy

By: Cameron, Lizzy, & Cody

Adenocarcinoma is cancerous disease that originates in mucus-secreting glandular tissues, most commonly in the lungs, pancreas, prostate, esophagus, colon/rectum. 95% of all colorectal cancers (CRC) are adenocarcinomas. Three months prior to diagnosis, the patient (Male, 49 years) notes blood in his stool. He went to his primary physician who found his physical examination to be normal. His father had colonic polyps, and his paternal grandmother had colon cancer in her 80s. Although family history of CRC is most significant in first degree family members, his father’s history of polyps may suggest a hereditary CRC predisposition in the patient. Six weeks before the patient’s presentation at MGH, he noted decreased stool caliber, and prolonged presence of blood and mucus in his feces. He went to see a gastroenterologist who performed a colonoscopy and discovered an exophytic mass 15 cm from the anal verge and 2 polyps in the descending colon.

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At higher magnification, small infiltrating glands in desmoplastic stroma are diagnostic of moderately differentiated adenocarcinoma. The depth of invasion cannot be assessed from this small biopsy specimen.

Biopsy of the mass revealed dense stroma covered by villiform dysplastic epithelium, with stromal hypertrophy and small infiltrating glands, a characteristic that is indicative of moderately-differentiated adenocarcinoma. An axial CT image of the abdomen/pelvis revealed a rectal mass causing abrupt narrowing of the rectal lumen (3.2×3.1×6.8 cm). An MRI image showed the rectal mass extending through the muscularis propria and into the outer layer (serosa) of the colon. Ultrasonography-guided fine-needle aspiration and core biopsy of the inguinal lymph node determined that the cancer had not spread into the lymph node and was still limited to the colon (although locally advanced). Final diagnosis of the case was moderately differentiated, invasive rectal adenocarcinoma (Stage IIA).

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An axial image from the CT study with oral and intravenous contrast material that was performed at the other hospital  shows a soft-tissue density in the rectum causing abrupt narrowing of the rectal lumen

The patient’s rectal cancer is advanced, and as such the first major treatment decision is whether to resect immediately or use preoperative (neoadjuvant) chemotherapy, radiation, and/or postoperative chemoradiation. The team of doctors recommended preoperative chemoradiation therapy with fluorouracil and radiation therapy. Stage I rectal cancer is often successfully treated with resection, but advanced rectal cancer cases such as Stage II or III typically need multiple treatment modalities (e.g. radiation). Lynch syndrome is an autosomal dominant disorder, and in this case is likely the cause of his colorectal cancer. According to the Amsterdam criteria, this patient did not qualify as having lynch syndrome. However, the Bethesda guidelines, which are more sensitive to subtle cases of Lynch syndrome, did suggest Lynch syndrome. Between 50 and 70% of people with Lynch Syndrome develop colon cancer in their lifetime, and the risk of syndrome is 50% to immediate family members–making clinical diagnosis important not only for the patient but for immediate family members as well. Postoperative treatment was complicated by a Superficial femoral-vein thrombosis which was treated with a 6 month course of heparin. The take down of his ileostomy was successful, with colon function being restored. He is now alive without recurrence more than 4 years after resection, and undergoes annual endoscopic surveillance and visits his doctor biannually.

Scientists at Chonnam National University in South Korea have developed a way to selectively attach flagellar bacteria to polystyrene microbeads. The team modified Salmonella typhimurium with a selectively BSA (bovine serum albumin) pattered PS (polystyrene) microbead. S. typhimurium has been shown to aggregate around quiescent or necrotic tumors due to chemoattraction to tumor cell lysates and spheroids. The attached microbead can release the therapeutic compound inside of the tumor. The bacteria are also useful in detecting metastases and small tumors. One of the most significant challenges of chemotherapeutic treatments is the continuous, specific delivery of optimal quantities of drugs to target cells – which would allow the bacteriobot to shine in efficiency and selectivity of drug delivery. The advancement of this treatment could mean that a total colectomy may not be necessary if the cancer recurs in the colon. The treatment also could help eliminate the negative gastrointestinal issues associated with chemotherapy by reducing general cytotoxicity and negative body response to treatment.

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