Category: Department of Surgery and Cancer

“You don’t defibrillate asystole…” and other arguments with creatives

It is a favourite pastime of anyone who works in healthcare to scoff at the mistakes we see when medicine is portrayed on film. From the back-to-front chest X-ray on Scrubs to the miraculous success rates of chest compressions in soaps we love to mock. However, for the last four years I have been working with various TV programmes to try to inject a degree of realism without dampening the drama.

This started with Holby City when I helped out on set, making sure that operating scenes looked realistic and that the actors could pass off as surgeons. This was my introduction to the tension between realism and plot. Being a medical drama, Holby had the budget and resources to try and get things right, but even they couldn’t keep viewers interested if they showed a lovely routine list of day cases where nothing goes wrong!

Holby led to me being approached by Eastenders,  which was a different type of work. With 6–8 million viewers every week, this is a show with massive reach. They have a surprising number of storylines involving medicine, ranging from characters with chronic health problems, through to the massive set piece car crashes and explosions. Even with the minor stuff, when they get it wrong they face a slew of complaints from the public and charities. Often Eastenders will want me to come up with injuries or illnesses that fit a story arc. For example, they will want someone stabbed, look like they are going to die, but then get better and be out of the hospital in seven days. This is normally straightforward, apart from making sure they aren’t reusing stuff from previous years!

Working on longer running storylines is more interesting, the most exciting of which was Phil Mitchell’s liver transplant story on Eastenders. They came to me wanting a way to rejuvenate Phil, who had become a belligerent drunk who had lost his sparkle. I suggested a storyline that took him into liver failure and then showed a long climb back to health, with a liver transplant as the final redemption. However, this was a story fraught with public health issues. It was well established that when the famous liver transplant recipient and footballer George Best started drinking again organ donation rates fell. (more…)

How machine learning will transform the way we look at medical images

Medical imaging is key in today’s delivery of modern healthcare, with an immense 41 million imaging tests taking place in England in every year. Thousands upon thousands of patients safely undergo imaging procedures such as X-ray, ultrasound, and MRI every day, and the product of these tests – the images – play an essential role in informing the decisions of medical professionals and patients in nearly every area of disease.

At its core, medical imaging is the application of physics, and sometimes biochemistry, to visually represent the biology and anatomy of living humans. We have progressed from the first, blurry, x-ray in 1895, to being able to measure minute changes in oxygenation within the brain; whilst major technological advancements continue to be made every year.  In the field of medical imaging, these techniques are applied to expand our understanding of the human body and disease in research settings, but much of this technology does not actually make it into every day clinical practice. For me, this has been the drive to move from a career in sonography into clinical research: to implement novel technology and investigate how it can be used to improve patient care.

One of these advancements is the use of image analysis technology to obtain more information from medical images. There has always been an interest in the use of computers to analyse medical images as computers are not biased by optical illusions or experience like human readers are. In image analysis, an image is no longer considered as visual, but rather as digital information. Each pixel contains a value representing biophysical properties, and you can write a program that finds a specific pattern or feature across the image that can represent disease. However, this process is time-consuming, and a single feature probably doesn’t represent a disease very accurately. (more…)

Would you give the gift of a kidney to a stranger in need?

 

As far as generous Christmas presents go, donating your kidney seems for many at the extreme end. However, for a few lucky kidney disease patients, this is the gift of a lifetime. Known as unspecified or non-directed altruistic kidney donation, this form of live organ donation is on the rise, and could potentially wipe the waiting list if more stepped forward. I met Frank Dor, a consultant transplant surgeon and Head of Transplantation at Imperial College Healthcare NHS Trust, who has carried out hundreds live organ donations.

The waiting game

Frank receives a phone call notifying him that a kidney from a deceased donor has been allocated to one of the recipients at Imperial. This single kidney is in high-demand as there are around 5,000 people on the UK NHS Blood and Transplant (NHSBT) waiting list for a kidney; some waiting for up to five years. Unfortunately, a few hundred of these will die in the meantime for lack of one.

These patients have chronic kidney disease, meaning they have lost their kidney function so dialysis three times per week becomes the norm. However, life on dialysis is debilitating, difficult and time-consuming. “Dialysis is merely a way of keeping people alive, it’s just a temporary measure that can never fully replace the kidney function,” Frank tells me. “Eventually patients on the waiting list get to a point where they start to lose hope and stop making plans for the future”.

The long-term solution is receiving a kidney transplantation, of which there are two types – living and deceased. Transplantation provides patients with the opportunity for a longer and better quality of life, with patients typically gaining 10-20 years of life compared to dialysis. However, the odds for receiving one are not favourable: there are 1,500 patients on dialysis in Imperial College Healthcare NHS Trust but only around 200 of those get transplanted every year. There is a huge gap between supply and demand nationally and internationally. (more…)

How a little Mo effort can make a big difference

It’s that time of the year again, when men grow moustaches around the globe. It all started in 2003, when two guys in Australia had the idea to make moustache-growing fashionable again. For a greater cause, they made this campaign about men’s health and established the Movember Foundation. As you may know, the campaign became an international phenomenon, attracting over 300,000 participants in more than 20 countries in 2016.

The Movember Foundation is now a global charity with one mission: “Stop men dying too young”. To achieve this, they are raising awareness and funds for three issues affecting men’s health; prostate cancer, testicular cancer and mental health. Here in the UK, the Movember Foundation has been working together with Prostate Cancer UK – the only charity that exists solely for prostate cancer – investing over £21 million in prostate cancer research between 2012 and 2015.

The prostate is a male-specific organ that sits just beneath the bladder and surrounds the urethra – this location is the reason so many symptoms of prostate disease affect the ability to urinate. Prostate cancer occurs when cells in the prostate grow and divide out of control. In the UK, prostate cancer is the most common cancer amongst men and expected to affect 1 in 8 men during their lifetime. The word ‘cancer’ sounds frightening, but it needn’t be for all cases of prostate cancer. When diagnosed at the earliest stage, virtually all men survive beyond 5 years. However, when diagnosed at the latest stage (advanced prostate cancer) only 30% of men survive beyond 5 years, indicating early detection is key. (more…)

The Pathology Museum’s top treasures

Tucked away in Charing Cross Hospital is Imperial’s best-kept secret: The Pathology Museum. Housing a 2,500-strong collection of anatomical specimens, the Pathology Museum contains some rare and unique artefacts dating from 1888, including the first hysterectomy performed in England.

Carefully curated by the Human Anatomy Unit (HAU), the specimens are grouped together based on organ systems, creating a well-arranged display of human pathology. The museum’s primary function is to help educate medical and biomedical students to diagnose diseases. The museum also hosts a number of conference and short courses in pathology for experienced professionals.

The collection incorporates specimens from across the Faculty of Medicine’s founding medical schools, there are an astonishing 4,000 further specimens not on display. This vast archive provides a snapshot of the historical foundations of the medical school. (more…)

Think peach: the true symbol of breast cancer awareness

It’s that time of year once again: Instagram and Twitter will adopt a light shade of pink, companies will adorn their products with the ubiquitous pink ribbon, all to remind us of Breast Cancer Awareness Month. To a breast cancer scientist such as myself, October always brings out ambiguous emotions. On one side, it serves as a reminder of all the great research and results that we have achieved. Statistics show that things are getting better for many women, as mortality rates have halved in the last 20 years. October also prompts many of us to remember that there is nothing better than prevention when talking about breast cancer. Early screening measures have revolutionised outcomes for women; it’s very likely that almost 50% of the lives that were saved depended on catching the cancer earlier.

The other major breakthrough was the development of targeted therapies for the most common molecular subtype of breast cancer (luminal subtypes) accounting for 70% of all new breast cancers. Years of rigorous clinical trials with these drugs have helped reduce the number of women that develop secondary disease (metastatic) – the consequence of the primary breast cancer cells spreading to other organs. This is where my ambivalence stems from; far too many women still have their breast cancer relapse. Outside of the beautiful pink narrative which Samantha King – author of Pink Ribbons, Inc: Breast Cancer and the Politics of Philanthropy – called “the tyranny of cheerfulness”, breast cancer remains the second largest cause of cancer-related deaths in women. (more…)

One small step in wearable tech: one giant leap in osteoarthritis detection and management

When deciding what to do in life, it was clear that I wanted to help people live better, however becoming a doctor wasn’t for me. I found my way through studying biomedical engineering, which developed my passion for the biomechanics of human movement. I see this as a means to understanding the underlying mechanisms of musculoskeletal disease. Through detailed assessment of patients’ movement function we can understand the implications of disease progression and propose solutions to mitigate the developing disorders. To a curious mind like mine, this is a fascinating way to achieve my aspirations. The idea of being able to find explanations as to why things happen to our bodies is amazing and the fact that it can improve people’s quality of life makes it all the more satisfying.

Debilitating disease

I joined Imperial as a research associate in the Musculoskeletal Medical Engineering Centre. As a postdoc researcher in the centre, my goals are to tackle ways that could improve symptoms as well as gain a better understanding of knee osteoarthritis development. Osteoarthritis (OA) – the most common form of joint disease – is a disabling musculoskeletal disorder that can affect our joint function. OA progression is slow and if measures are not taken, joint replacement will eventually be necessary. Joint replacements are costly, invasive and have a limited lifespan that may not last for the duration of patients’ lifetime. Moreover, patients’ satisfaction after surgery is poor, calling for early management strategies. (more…)

How to PREPARE for surgery and speed your recovery

PREPARE for surgery

All types of surgery require preparation and, afterwards, recovery time. But according to the oesophago-gastric cancer team at Imperial College Healthcare NHS Trust, undergoing major surgery is like running a marathon. The PREPARE for Surgery programme, designed by the team, ‘trains’ patients for surgery based on their individual needs. It looks at different factors important to focus on before and after a procedure, including physical activity, diet, psychological wellbeing and medication management. Here clinical nurse specialist Venetia Wynter-Blyth explains how the programme helps patients adopt the good habits needed to aid their recovery.

The PREPARE for Surgery programme is all about treating a patient holistically and looking at the whole picture. We know when someone is due to have surgery, the psychological side of preparation is just as important as the physical side; so we work hard as a team to strike the right balance and have a positive impact on our patients’ post-operative outcome.

Once we know someone is going to have surgery for oesophago-gastric cancer, we invite them to our PREPARE clinic. We assess every patient in clinic and establish their ‘baseline’ measurements. This gives us a benchmark to improve on over the four to six weeks it takes to complete the programme, and prior to the patient’s surgery. Our surgical team makes sure they schedule procedures with enough time for patients to benefit fully from PREPARE. (more…)

The magic of crystallography

Light micrograph (LM) of Insulin crystals
Light micrograph of insulin crystals.

Originally published in the Imperial Magazine in June 2017, Professor Naomi Chayen explains why, when it comes to medicine, crystals may indeed have magical properties.

To grow a crystal used to be considered a kind of magic. Perhaps that’s because crystals are so beautiful: it is easy to understand why so many people are fascinated by them and believe that they bring good fortune, or have healing powers. And yes, they do have powers. Crystallise a substance – a protein, for example – and you can understand its structure. We prize diamonds for their beauty: I prize protein crystals for their potential power to unlock new treatments, in everything from cancer to diabetes. They are my diamonds.

My own involvement with crystallography was a happy accident. I was encouraged into the field by one of its great pioneers, Professor David Blow. At that time, growing a crystal was regarded as more of an art than a science. There was a sense that one had to have ‘green fingers’, like a gardener: knowing the basic components of success but also using some kind of indefinable sixth sense.

I became fascinated with them. I wanted to bring scientific fundamentals to the process and create crystallisation methods that would work all over the world, from Kathmandu to Tokyo. Of course, crystallisation is not new. In 1914, Max von Laue won a Nobel Prize for his discovery that X-rays could be diffracted by crystals, making it possible to work out their structure. In those early days, there was a great rush to crystallise as many things as possible. Any substances that were simple to crystallise, were crystallised. (more…)