Case Study 3: Drug development

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Case Study 3 Drug development Scientific method

• Whats in your stomach?

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• Phase II of the NoPain clinical trials requires a
  placebo group, whereas phase I does not. Explain
  why.
• Because the focus of phase 1 is safety whereas
  the focus of phase II is effect. Placebos are
  used to guard against psychosomatic effects

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• Phase I of the NoPain trials uses only 50
  subjects. Why couldnt MedPharm save money by
  limiting phases II and III to 50 subjects?
• To get statistically accurate data regarding
  demographics.

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• 3. Would you classify NoPain as a palliative,
  active, or preventative treatment for cancer?
  Explain.
• NoPain is a Palliative drug, used to alleviate
  symptoms after the disease has started

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• What would you tell someone complaining about the
  cost of pills being 1.50 per dose?
• Follow up question. Is this question biased in
  defense of the drug companies and medical
  profession as a whole?

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• How would you sterlize non sterilized cotton
  swabs? What are suitable and non-suitable
  techniques?
• Autoclave ruins cotton
• Dry heat might ignite cotton
• UV light maybe
• Chemicals maybe, just dip swabs in alcohol
• Filtration pressure would tear up cotton

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• Which of the following treatments may be employed
  in treating cancer?
• Immunotherapy
• Chemotherapy
• Radiotherapy
• All of them
• Quick poll Everyone write down 1. the top 3 most
  famous people you know who have died of cancer 2.
  top 3 cancer survivors. Pass it in quick.

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• 7. How do you as a physician explain how a
  patient recovering from surgery has developed a
  nosocomial lung infection?
• What does nosocomial mean?
• Hospital acquired.

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• How can a doctor administer both rapid and
  prolonged doses of antibiotics to a patient?
• Intravenous rapid
• Oral, transdermal patch, probably oral for a
  couple of weeks.
• What happens if you quit your antibiotics before
  the weeks are up?

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• Why is the use of international units important
  to medicine?
• Communication

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• The word root gastro means stomach. what is the
  difference between
• Gastrotomy
• Gastrectomy
• Gastroscopy
• Gastrocentesis
• Gastroclysis

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Gastrotomy incision into stomach

• Surgeons spend like 500 on a pair of scissors
• Ill tell you this dont google image incision

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Gastrectomy cut out stomach (excision)
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Gastroscopy examine interior of stomach

• A 48-year-old male psychiatric inpatient
  presented with dysphagia and a history of
  swallowing two rings and a wristwatch. Chest
  X-rays confirmed a wristwatch and two rings in
  the distal oesophagus. An otolaryngologist
  performed rigid oesophagoscopy, but the watch
  migrated into the stomach. A flexible gastroscopy
  was performed and a Casio digital wristwatch,
  displaying the correct time, and two signet rings
  were identified in the stomach and removed using
  a snare. The patient recovered and has not
  represented.

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Gastrocentesis Puncture stomach

• direct-puncture technique following gastropexy
  Two gastropexy sutures are placed at about 2 cm
  spacing in the diaphanoscopy-positive region.
  Puncture of the abdominal wall with a gastropexy
  applicator for gastroscopic detection of both
  cannulas in the stomach
• Gastropexy attaching stomach to abdominal wall
  or diaphragm. E.C. for why.
• Cannula Tube

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Gastroclysis irrigation of stomach

• I understand if you couldnt find much about
  this.
• I dont think anyone calls it Gastroclysis or
  gastroclisis either, but heres a weird story
  where its used

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Bezoars

• rare causes of gastrointestinal obstruction.
• originate in the stomach,
• mainly in psych. patients who chew and swallow
  their hair, vegetable fibres, persimmon fibres,
  or tablets/semi liquid masses of drugs
  (pharmacobezoar). Industrial materials including
  wood trashes, polystyrene have been reported as
  the rare causes of bezoar formation
• This is a case of a strange suicide attmept

Vegetable fiber bezoar
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• A 37 year old housewife
• previous history of marital conflict
• brought to emergency room in Iran
• The patient was presented with ingestion of 450
  grams of saluted plaster for suicidal attempt.
• ate the plaster 7 hrs before. The main complaints
  of the patient were vague epigastric pain, nausea
  and vomiting.

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• 2 unsuccessful suicidal attempts before.
• No therapy.
• She neither smoked nor was an alcoholic, or drug
  addict. Why does this matter? Risk factors.
• hemodynamically stable
• not cooperative.
• There were no signs of trauma and burning on
  head and neck. Chest and abdominal physical exams
  were normal except for a bulging in upper abdomen
  and a palpable hard mass filling the epigasteric
  and left upper quadrant area. Laboratory tests
  were normal.

What method of imaging is this? Radiography
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• So the mass was hard and they couldnt irrigate
  so she went to surgery
• They pull out that ?
• The mucosa was intact. After saline irrigation,
  stomach was repaired in two layers. Nasogastric
  tube was inserted.
• Liquid diet was started on the 4th day and she
  was discharged after seven days.

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• They checked on her 6 months later and shes okay
• Dont say if shes still married
• How bad do things have to be for you to eat a
  pound of plaster?
• How do you handle that as a doctor?
• How does the patients history impact this case?
  What if the patient had no records, how would
  things be different?
• Bezoars are also a kind of goat