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WJOMI awards the 2018 Certificates of Outstanding Contribution to Medicine.
Bad news is the fact that time is running too fast. Good news is that each year brings novel things, twists and turns for the journal, but in the positive sense. That’s my impression at the end of this year.
There were some positive aspects to our journal during this calendar year. First of all, we have been officially accepted to be indexed in Polska Bibliografia Lekarska (pol. Polish Medical Bibliography). Secondly, we have submitted the necessary history and information and underwent Index Copernicus evaluation to receive our first Index Copernicus ranking in ICI Journals Master List 2017 database achieving the result of ICV = 88.5.
Last year, the World Journal of Medical Images, Videos and Cases had the privilege to begin awarding our colleagues with the Prize for Outstanding Contribution to Medicine. These are our colleagues who have contributed to medicine in a significant way, and who give special input to the field of medicine in a way that many of us consider as our daily jobs. What makes them special? Well, they were noticed by other doctors or patients or community members as persons who really help in those daily routines, everyday trials and tribulations. Without doubt, these persons deserve a round of applause as the most inspiring doctors, philosophers, philanthropists and foremost, as kind human souls. These guys don’t look for prizes and often are surprised by the fact that we have not only noticed their work, but also, that it is so important for us to recognize them on a national and international level.
The choice is always tough and we would like our readers to also draw some conclusions from these awards. Hence the journal’s title is World Journal of Medical Images, Videos and Cases, we would like to motivate our readers to contact us with proposals of names of professionals who would fit the profile of the candidate for Outstanding Contribution to Medicine Award for the future years. Do send us e-mails with name proposals and a paragraph or two, motivating your choice. In your motivation, please tell us something more about the candidate and do send us their affiliation. You may send the proposals to our e-mail address at: email@example.com
Now, this year’s candidates, unlike last year’s, are Polish. We have decided to nominate two renowned medical doctors as this year’s laureates. These doctors all deserve a special nomination for their work, one being an excellent microsurgeon and another an anaesthetist with passion for new technologies. Ladies and Gentlemen, let me introduce the 2018 World Journal of Medical Images, Videos and Cases laureates of the Outstanding Contribution to Medicine Award:
Dr Grandys is a dedicated medical doctor and an experienced specialist of anaesthetics and intensive care medicine at the Paediatric University Hospital in Cracow, but in his free time he is also an electronics expert and a self-made 3D-printed prosthetist . To the general public he is best known as the doctor who can print new hands. He also knows his fellow laureate - Associate Prof. Chrapusta from his past. Figure 1 and 2 show both 2018 diplomas.
Figure 1. Outstanding Contribution to Medicine Award Diploma presented to Associate Prof. Anna Chrapusta in 2018.
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Figure 2. Outstanding Contribution to Medicine Award Diploma presented to Dr Krzysztof Grandys in 2018.
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Below, please read the transcript of the interviews, which took place on October 29 and 24, 2018, respectively.
Interview with Associate Professor Anna Chrapusta
Piotr Kochan: – Last week I visited Dr Grandys, also this year's laureate for his 3D-prosthetic printing. He mentioned he remembers you when you were a really young doctor working in Prokocim. So, my first question to you is the same as I asked him, i.e. what inspired you to perform such precise microsurgeries and become a plastic surgeon?
Anna Chrapusta: – My great inspiration was my work in University Children’s Hospital in Prokocim, especially between 1993 and 2000. Above-mentioned time points sum up early beginning of my experience. Since the 3rd year of studies, thanks to very high grades, I’d been employed by Prof. Grochowski as a student-academic assistant in the Department of Paediatric Surgery in contemporary Polish-American Children’s Hospital, present University Children’s Hospital. While working in Prokocim I’ve met my first and major surgical teachers and mentors: Maria and Tadeusz Łyczakowscy and my great chief Prof. Jacek Puchała.
Tadeusz Łyczakowski was a pioneer of paediatric microsurgery in Poland. He was trained under the most renowned surgeons in Canada, including Prof. Daniel, about whom I always talk to future specialists of plastic surgery, giving lectures on the history of microsurgery. Prof. Grochowski recruited Doctor Łyczakowski who introduced many latest microsurgical techniques to Poland. Back then, I was so fascinated by what I saw in plastic surgery, that I didn't realize that the topics that fascinated me most included surgery of congenital hand deformities, which became the topic of my Ph.D. thesis as well as micro- and reconstructive surgery, and treatment of burns, done by that whole team of my masters - turned out to be the quintessence of plastic surgery. So, thinking that my fascination is paediatric surgery, in fact I wasn’t right, and years later I realized that my true love, from the very beginning, is plastic surgery. I can’t forget about craniofacial surgery, like Apert syndrome, trigonocephaly and scaphocephaly, and that, except from Dr Łyczakowski, I’ve learned from Prof. Scott Bartlett from Philadelphia.
– Flowing swiftly to my second question. Was your mentor Prof. Puchała?
– As described before, I had 3 major masters. My masters from microsurgery and reconstructive plastic surgery, including replantation, were Maria Łyczakowska and Tadeusz Łyczakowski. They gave me my first microsurgical instruments that allowed me to begin my microsurgical training during medical studies. I’d started to perform microsurgical anastomosis with the use of a microscope being on the 4th year of university. It was standing in the atrium of an operating theatre and was easily accessible for everyone willing to do training. But in those days, I had no competition among my colleges in such advanced surgical skills and microscope was waiting just for me. I did arterial and venal anastomosis on obtained specimens and available tissues. It used to be my afternoon training. The most precious devices helpful in surgery are loupes. Before I got my own loupes, doctor Łyczakowska had lend me her own. So, I was making progress and developed as a young surgeon under the eye of these two doctors.
They left the hospital just after I finished my first grade of specialisation from paediatric surgery. I focused on congenital hand deformities I learned during the time of my medical school years and a year later I obtained the doctoral degree from this topic. Professor Jan Grochowski was the supervisor of my thesis, however a great contribution to this project was done by my next mentor, Prof. Jacek Puchała.
– How do you manage to stare into the microscope ocular for so long during a surgical procedure?
– It gets better with age and experience.
– I must admit I also look into the microscope, in slightly different way observing even smaller microbes. How do you do it for many hours at a time?
– In the surgery of adult patients the majority of microsurgical procedures require magnification of 2.5, that’s why loupes are the most useful. The diameter of vessels, nerves or tendons in an adult hand is much bigger than in children. For the preparation of tissues, I use loupes and I need a microscope only for selected parts of the procedure like anastomosis of the vessels at the level of fingers or reconstruction of the nerve with cable graft. Besides, most other tasks and surgical manoeuvres I am able to perform much quicker nowadays in comparison to the past. Another problem is the difference in difficulty of paediatric and adult’s surgery. Identification of structures in children, e.g. during fingers replantation, is incomparably more complicated than in adults. In general, microsurgical procedures in children are much, much more difficult. Replantations of fingers in youngest children are some of the most technically demanding procedures. In such cases we are working on structures much smaller than 1 mm, even 0.4-0.5 mm of the external diameter. This level of microsurgery has its own name called "super microsurgery". This term is dedicated to diameters smaller than 0.8 mm.
– So, going more into micrometres?
– Do you remember your first patient?
– Yes, in fact it was my first replantation, which turned out to be unsuccessful. It was done on a young Romani girl who did not speak Polish. Dr Łyczakowski allowed me and my colleague, Radek, to perform the replantation. I was 29 years old. I did the identification of vessels and nerves and the microsurgical reconstruction using the microscope. In fact, it was my first replantation, and for many years the only one unsuccessful.
Figure 3. A. Amputation of the upper limb at the height of the elbow joint by a conveyor belt through a twisting mechanism. B. Status post replantation.
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– And what is the vital time to perform a replantation?
– Taking under consideration fingers it may be even 24h. But it needs to be a cold, not warm ischemia and such a finger should be stored in the temperature of + 4°C. In case of higher amputations, i.e. wrist, forearm, arm, this time is much shorter. It would be good for the patient to be on the operating theatre in 6-8h since the incident, so that revascularization can be performed within 12h. An example of replantation is shown in Figure 3, above.
– What are the challenges ahead of you? What would you still want to do?
– Oh, there are so many of them. In many directions.
–What about replantations?
– It's mainly a matter of expanding our spectrum of activity onto paediatric cases. This will be extremely difficult, because the team of young microsurgeons I trained does not realize how difficult are replantations in children. They are young, ambitious and talented doctors who will definitely want to continue to learn the trade secret of this difficult discipline from me.
– What about other fields? The things that you dream about?
– To be able to do paediatric cranio-facial surgery and burn surgery in Cracow again. For that purpose, I fought, visited, talked, convinced, showed photographs to many important persons, politicians of different options, because these people rotate a lot, to get enough money to raise a building, which is now built. It should be ready by February next year. In May we should move and open new wards: paediatric plastic surgery and paediatric burn unit.
– Are we talking about what's being built in Prokocim?
– No. I have nothing to do with Prokocim since I quit there. Nobody has convinced me otherwise, since. I'm talking about the new building in front of Rydygier's Hospital (Figure 4).
Figure 4. Rydygier's Specialist Hospital is currently the building housing the Departments headed by Prof. Chrapusta (Photo: P. Kochan).
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As you will drive towards the hospital you can see the new building (Figure 5). I need to offer to patients the possibility to treat everybody that requires plastic surgery or burns treatment, independent of the age. This is one of my initiatives, where I was the co-author of the project. This will be the largest centre in Poland (Figure 5), offering the full spectrum of burn care and plastic surgery – Małopolskie Centrum Leczenia i Rehabilitacji Oparzeń oraz Chirurgii Plastycznej i Replantacyjnej wraz z Oddziałem Intensywnej Opieki Medycznej dla Dzieci (eng. Lesser Poland Centre for Treatment and Rehabilitation of Burns as well as Plastic and Replantational Surgery together with an Intensive Care Unit for Children).
Figure 5. The new building of Małopolskie Centrum Oparzeniowo-Plastyczne is almost ready. It’s located next to the main building of Rydygier’s Hospital. Photos by Piotr Kochan.
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– What are the biggest obstacles you encounter in Polish healthcare system?
– Well it's a system which has recently destroyed many perfectly worked-out algorithms of care, which does not allow to get the money for the patients that were treated, especially in emergency situations. The situation, which took place this year between January and July, where we did not receive money for replantations and burn patient care, is unacceptable. We would have to prolong patient queues for another year and not perform replantations, and admit only a given number of burn patients for treatment, and then close the wards, or treat our patients with old methods and less effective drugs - which we don't do - and the media continuously show our successes. All these procedures and treatments are very costly. We will either go back to ineffective methods to save money or close our ward to patients - but then surely, I won't be a part of it in public health care - or the government will find a solution and think of something to improve that situation so that centres which have been financed, will receive better financing, but also per patient. It's not enough to give someone money for the building and the equipment. Somebody forgot to make sure, that there is also financing of the patient's treatment. We don't want money for the patients we will not treat. We want to make sure we will receive money for any patient who will come to us for a successful procedure from any place in Poland. The only limitation should be the technical capabilities. We are not currently able to admit more burn patients, because the National Health Fund (NFZ) limits are set to so many patients and given amount of funds per month.
– Up to not long ago a patient had to stay in a hospital for 7 days for them to pay out?
– It's still the case. Let the patient stay for 7 days, but if a patient gets burned and we admit such a patient to our ward, let them pay for it! – And for some of my last questions. My dad, who passed away not so long ago, was a trauma surgeon, my mom an anaesthetist. How do you deal with everyday stress as a surgeon? Is there some safety valve, or some special extracurricular interests?
– If I have time, it's sport.
– Some specific discipline?
– Skiing - and I can't wait to ski again.
– Me too.
– On weekends, if I possible - there's always the gym, if I have time during the week, then gym again. The free time is very limited. Besides of my normal work I also work afternoons. I have my own private practice and many patients. As you realize, plastic surgery is also aesthetic surgery, and this is the work which is done beyond public healthcare. So, of course, there I have more and more work each year. Therefore, each moment that I can spend with my family, the three of us, is precious.
– And the last question. How do you manage to be a renowned surgeon and a parent at the same time?
– I manage with the help of grandparents. The institution of grandparentship is absolutely irreplaceable. If it weren't for my parents, I wouldn't be able to operate as I can, and I would be able to function the way I do.
– Completely true. We also take our kids to Podhale to their grandma.
– Where in Podhale?
– To Nowy Targ. That's the city I lived and grew up in before we moved overseas.
– Well, I'm from Limanowa.
– Thanks very much for the interview. It was a pleasure talking to you.
Assistant Prof. Chrapusta is shown in Figure 6.
Figure 6. Associate Prof. Anna Chrapusta. Photograph as above by ACh&AZ - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=64001892
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Interview with Dr Krzysztof Grandys
Piotr Kochan: – I remember that the first time I came in contact with advanced medical technology was in the 80’s when I saw the movie "Empire Strikes Back" of the Star Wars Trilogy...
Krzysztof Grandys: – You mean when Luke lost his hand.
– Exactly, when the dark character Darth Vader cuts off his hand and at the end of the film, we see a new prosthesis being installed.
– Bionic prosthesis.
– And a medical droid regulates and tests its sensitivity to touch. Now, what was your inspiration for printing prostheses? – No, it wasn’t Vader. It’s a rather coincidental reason for the fact that before I became a doctor, I also completed an electronics degree. It was always some technical interests for me. I once stumbled upon a device which is known as the 3D-printer when I read about a machine called RepRap, which self-replicates itself, I always somehow wanted to have it, but it was rather expensive. Finally, I could afford it and I started playing around with it. But printing toys gets boring after a while so I started looking for medical uses of 3D-printers. I found many various applications and at that time I did not focus on one. Then I stumbled upon a Japanese project called exiii bionic prosthesis, made with a 3D-printer with cheap and generally available materials and electronic components, which according to Japanese sources costs $300-400. In Poland the cost is around 2000 PLN. So, comparing this to the cheapest bionic prostheses which cost around 40 000-50 000 PLN, it shows you the possibilities. In fact, the cost is incomparable. I tried to print it out, but my abilities as a printing expert were too small to meet the criteria. So, in my case, it didn’t work. But I got interested and I started digging deeper and deeper in the topic and I came across the projects by e-NABLE – Enabling the Future. It’s an American organization which is soon to be celebrating its 6 years of existence, which makes simple, mechanical 3D-prostheses generally for children, with the assumption that the kids should get it free of charge. So, it seemed simple, I didn’t make it with exiii, so why not try with this project. So, I printed such a prosthesis, it turned out OK, it worked. So now the question – whom should I give it to? It looks nice on a shelf, but I don’t need it. So, I attended a conference by Printed Health in Cracow, which is an organization promoting such technologies all over Poland. This time it took place on ASP (pol. Akademia Sztuk Pięknych – Academy of Fine Arts) and I made some contacts during the conference and met a parent who was interested in such prosthesis for his child. So, I gave the prosthesis to the kid. And after some time, word got around – that maybe I could make a similar prosthesis for their colleague, since he also has a child in need. So, I said, why not, I’ll make it again. And 2.5 years later I have printed 60 or 70 prostheses overall, can’t remember the exact number.
– Please tell me something more technical about the prosthesis. How is it fixed to the limb or the stump?
– Very easily. Velcros, rubber pads, it has nothing to do with the professional fixtures of real prostheses, with special silicone moulded inserts. It’s fixed easily, with Velcro pads or stripes, but nothing too complex. The idea is simple – it needs to be cheap, very cheap. So, for such a short simple prosthesis the cost is around 100 PLN, or even less, but a longer one which reaches the upper arm is approx. 200-300 PLN. As compared to even the cosmetic prosthesis, which costs several thousand zloty, this is really inexpensive, the cost is incomparable. But the fact is, it doesn’t look like a cosmetic prosthesis, it doesn’t look like real hand. It’s colourful, it looks robotic and the children are excited about it (Figure 7).
Figure 7. One of the pink prosthesis printed by Dr Grandys for a paediatric female patient.
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– I still have a question about the prosthesis? Are all the components printed and how are they joined together, by springs, rubbers, etc?
– Here also, the main characteristic is simplicity and availability of components. In 95% it's printed. Non-printed elements include rubbers, monofilament line, screws, sometimes leather which may be used in some fixtures, sponge (Figure 8).
Figure 8. Despite being inexpensive and robust, joined by rubbers and monofilament strings, the 3D-printed prosthesis has an attractive, robot-like design. Photo - courtesy of Krzystof Grandys.
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– So, no springs, rather rubbers?
– The springs are not used by many people. It's a question of technology and access to it. So, it's more common for rubbers to be used and the funny thing is that one of the most popular models uses dental rubbers meant for braces. Not only it's commonly available but it's extremely cheap and using a few rubbers and the monofilament line - sets the prosthetic fingers in motion. As to the bionic prostheses, since you will probably ask about it - yes, I want to do it. I want to make exiii, a bit for my own satisfaction and also for the fact I am educated in that field. I simply like that prosthesis.
– So, treating it like kind of a challenge?
– If you visit the Japanese website (http://exiii-hackberry.com/), you will like it too. It's really great and there is a demand for it. I would have at least 2 patients who would need it, like now. But on the other hand, I don't have full access to new technologies. I could do it on the printers I have, but it's not what is needed. I would need a more advanced 3D printer for it. I'm in the process of talking to one company located in Cracow which is a producer of SLS (Selective Laser Sintering) printers. I'm hoping they could print it in a kind of gentlemen’s exchange.
– When did you print your first prosthesis and how different was it from the currently printed prostheses?
– Two years ago. It did not differ much from the current models.
– So not that long ago...
– Yes (laughing), it was somewhere in the beginning of 2016. First was Printed Health, in 2017 a foundation was started . A bit of pressure from my colleagues who wanted to help, some people gave the printing materials, others wanted to sponsor a printer, so to make matters clearer from the financial and fiscal point of view - a foundation was established in August last year .
– What's the name of the foundation?
– e-NABLE Polska. It's not a charity yet so we don't have the ability to collect 1% of tax from people. It needs to function for two years .
– And the next question which you did mention already, i.e. is there any hopes for printing other body parts?
– It may be possible but probably not via the foundation since it was established for other purposes. I wouldn't want the persons who formed the foundation to be multitasking, although it has some possibilities, like medical printouts or development of new medical technologies. But it's not the target. If we were to do that, we'd probably split those activities. And currently we are here getting ready for spatial visualization and modelling, both computer generated and physically printed, of such devices for orthopaedics, for neurosurgery, for cardiology on a rather hospital-based approach. We will see what time will bring, but right now it's up to getting the technological know-how: seeing what may be done and what can't be done, how certain things may be done, and whether it's feasible to do it. There are many ideas, but the reality shows that certain things are not possible to be done, others may be done but they have no sense in the end, or some other people do it better. So, there are such thoughts, what will come of them - we will see.
– And what about lower limbs?
– No, no lower limbs. The general purpose of e-NABLE is to print hands using a 3D-printer in a cheap, user friendly, hobby-like fashion, rather not professional equipment. So, legs would not withstand the forces or be strong enough to support the whole body. A leg is kind of specific. At the moment there are no instructions for 3D-printing of a complete leg, as a whole. On the other hand, there are advanced works for printing some elements such as funnel, covers, but elements such as joints - nobody makes them that way. There is one project from Colombia for a paediatric leg, quite interesting, but it has age limitations up to 7-8 years of life. The designers themselves warn that it's a concept, so special attention should be payed to it, only a few copies were made so far.
– So, in general it's something for the future? When the printing materials become stronger?
– I don't think so. Why? Because by rule, e-NABLE is an amateur organization, cooperating with many universities and many specialists. So, it's a movement based largely on voluntary activities, on good will...
– Just like our WJOMI journal...
– It's a movement to mobilize the local communities, so that those good activities are done by colleagues for colleagues. For example, a school in Dobczyce has made a prosthesis for a child living in a neighbouring village, OK, maybe it wasn't the best prosthesis made - but it was a lot of fun for all the children involved when they did it. I also convinced a school in Tarnobrzeg do print another prosthesis for a girl from the same city. I grew up in Tarnobrzeg since I'm close to that city. Another offer came up in Częstochowa, where my family comes from, but the child was too small, so for now we gave up on that project (Figure 9 shows the 3D-printed prosthesis being used).
Figure 9. Young patient demonstrating a blue 3D-printed prosthesis in action, while eating a bun. Photo - courtesy of Krzystof Grandys.
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– The optimal age for such paediatric 3D-printed prosthesis is above 3 years-old, optimally 4-5 years of age. It's not a good idea earlier on, owing to many reasons.
– How much time does it take to print such a prosthesis?
– It's a difficult question.
– I.e. from the design to implementation?
– Designs are free of charge and are available in the Internet. So, one needs to adjust the size and some smaller changes, especially if there is some special recipient. If the recipient has rather a common malformation which would not require redesigning, resizing, etc., the project would take 1-2h to design, the printing itself up to 1-2 days. It would all depend how big the project is, what kind of parameters are to be set and how many 3D-printers we have. One, two or three printers or more would shorten the time. The hand assembly takes approximately 2-3h. The process is not that painstaking. Problems start if it's some atypical project. I had a few projects like that recently, that did not fit into the e-NABLE profile, and that couldn't be done but we were able to do it, rather atypical.
– What were they?
– According to e-NABLE, the wrist or the elbow joint needs to be mobile. And I had two children patients who had no elbows. It's not that they have amputations around the humerus, but they suffer from ankylosis of the elbow and have a small part of the forearm with one or two fingers somewhere in the middle. It's hard to say what fingers these are but we were able to use these fingers and scan them. One of the kids is from Cracow and the other one is from Warsaw. For these kids I also made special handlebar adapters for a bicycle. Like all kids, they also wanted to ride bicycles or push scooters and with such short limbs it was very difficult, in an unnatural crouching position, and they needed better support for such bicycles. And in such kids with stiff elbows, it's really difficult to design something effective, which I succeeded in those two patients. One of the kids, Madzia, already hit the road and the other one, Ksawery, is planning to pick his up, and I'm sure he finally will. Hopefully not too late, since his hand will grow and the prosthesis won't be the right size and won't fit anymore (Figure 10).
Figure 10. Dr Krzysztof Grandys demonstrating one of the colourful 3D-printed paediatric prosthesis with bicycle handlebar adapters. Photo - courtesy of Krzystof Grandys.
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– And this precedes my next question. The group of patients these prostheses are dedicated to, are they mostly trauma patients or patients with congenital defects?
– So far there was one post-traumatic patient I recall, a boy from around Rabka Zdrój or more closely, Nowy Targ. He was making kiełbasa (Polish smoked sausage) with his grandma and the meat grinding machine pulled his hand in and he lost his fingers. The prosthesis was a moderate success, maybe the project was not the best selection for such injury and his parents are not that interested anymore, so I never force people. Most are congenital defects in children, post-traumatic patients are rare, but I had a few other post-traumatic patients too. Also adult patients, one after trauma, the other one with congenital defect. Two more post-traumatic projects are currently in wait for me to have more time to take care of them. Children are always my top priority and the post-traumatic adults always fall back to the end of the queue. And for the last 6 months it's been just that.
– How long is the queue?
– It's long, too long (laughing). I can only tell you that currently when it comes to kids, three are urgently waiting for theirs, and the list is closed-off by three adults. The printing is not what I do full time, I have to earn money, so I work here in the paediatric hospital, and this work swallows you completely. Therefore, it takes me 2-3 weeks to prepare a model. It's difficult for me to dedicate more time to it, there are also other activities at home which need to be attended to. Also, this new 3D-printing project we are planning to start takes a lot of time, there are plenty of things that need planning and discussion, many people need extra convincing, especially orthopaedic surgeons.
– An what is the patient you especially remember? For example, I remember my first patients that died, like a motorcyclist that the family was waiting outside, or a young girl with acute leukaemia with systemic fungal infection. Is there such a patient for you?
– It's been too many such patients for me. I have a very good defensive mechanism, a really strong mechanism of repression to finally forget about these things. But there are 2 groups of patients: (i) first written in the book of miracles, with at least two such patients; (ii) and there are children with overwhelming circumstances when you come to think of it. But luckily it doesn't have much to do with e-NABLE prostheses.
– So, the second group has to do with your specialty (Anaesthetics and Intensive Care) and your line of work?
– Yes, with that you see too many of such patients, some very horrible cases.
– Well my mom is an anaesthetist so I guess I know what you mean.
– Yes, and I feel sorry for you.
– And my dad was a surgeon, but he passed away. These guys tend to live even shorter lives.
– You’re right, the doctor population is getting older. Me myself I was one of the first ones to live to see the 4 stents implanted into my coronary vessels. The cardiologists were laughing I wanted to make the headlines and front page of a newspaper as another doctor who died at work. It really is a hard and stressful job. Some doctors worry more than others, and I'm probably one of them.
– I guess everyone that's human will sooner or later get touched by such work.
– You come to a point when some cases will definitely have an impact on your life.
– And one of my last questions. You probably saw many new technologies in science-fiction films, which finally may end-up in real life. And I'm not only talking from the medical point of view, but also other technologies, like holographic images, touch screens or other miraculous advances. From the medical point of view, we see such advanced medical pods, which patients enter and are operated on, incurables are treated, etc. What sort of future medical technologies fascinate you as a doctor? What are the medical technologies you would like to see still during your lifetime, something that excites you very much?
– When it comes to medical technologies, I don't believe the medical pods will be a reality soon.
– I personally give them another 500 years. I think there was too much hope, that we as doctors misplaced in nanotechnology at the turn of the new millennium, as for it be able to remove neoplasms and inflammatory foci in our bodies. It's simply not yet as advanced as we had hope for it to be.
– The nanotechnologies will become a reality sometime further in the future. For sure microelectronics and microrobotics will be the future - even if you look at that simple microcapsule which passed through our digestive tract. For sure the electronics and IT will be evolving more and more around medicine, and it has extraordinary potential.
– And number 1 future technology for you?
– I would love to see a real robot on a street. Furthermore, I am into virtual and augmented reality, which is a mixture of real world and fiction and what may be done with such technology from the medical point of view. How you could, for example, explore the inside of a patient's body and how helpful such technologies may be in planning of surgical procedures. You may be surprised, but it's already being done in some medical centres, also in Cracow there is a company which is trying to start it up. At the Cracow's AGH University of Science and Technology there are such ongoing projects on virtual reality and medical imaging. But my hope is to see it not in the university lab of Prof. John Doe, but in an operating theatre, and to see how it functions in real life. Whether I will live to see it, I don't know. Taking into account the Polish medical system - probably not.
– So, what is it like to make or design modern technologies in Polish reality? What are the most important obstacles that you as a doctor see?
– Just what Napoleon said: "Money, money, money". This is the primary factor.
– And what about the Polish mentality?
– If you have money, you can do many things, irrespective of resistance of some groups of people. And mentality is a totally separate issue. In my opinion the medical society in Poland is strongly conservative and is very much afraid of novelties and not only because it's novel and not described yet, and that there is no EBM - but is afraid of new things overall. There is a great deal of scepticism: "If I learned to do it in such a way, why should I change it?". This is a major obstacle. Especially with older professionals and researchers. Younger generations are much more open-minded and have broader horizons, the older generations are definitely more conservative. To give an example with some of my colleagues. The old head of a befriended department was unwilling to work on a 3D-printed project. When he was replaced with a much younger colleague - he asked me why haven't we started cooperating yet. A completely different outlook on certain things. It's a big problem. But then again, it's hard to say whether it's only our problem, Cracow's problem, a national problem or a more global problem. I think the greatest advances will not be made directly in medicine but in medical technologies, and also pharmacology, medical techniques. Oh yes, I now remembered. There is actually something I would love to see with my own eyes before I die. A technological project known as bioprinting. I.e. printing with living cells, especially of tissues and organs. For me, this is the future. In my opinion, without offending anyone, current transplantology is a dead end. There is an ethical problem, complicated surgeries, risk of rejection and drugs that need to be taken by recipients for the rest of their lives, and all very costly. Something completely different would be to culture patient's own cells which could be printed into an organ or tissue and then implanted and would match the patient perfectly. That's the future. Bioprinting is growing explosively, with tremendous funding. Not in our country, although I know some efforts are done in Silesia.
– So, something quite similar to organ cloning?
– Similar but not the same. Tests are most advanced on liver tissue and blood vessels. Yes, we are able to print blood vessels. And if we have blood vessels, we will have everything else, because that's the framework. So, this is actually something I am still hoping to see in my lifetime. Few years ago, I read an article where a British company announced it will have a kidney ready within 5 years. But so far, no more news on that. So, I personally don't think they will be ready so fast. But it would be great! There are many people with renal insufficiency that could benefit from such technology - and having your own kidney vs. transplanted kidney - it tells it all.
– So many technologies to discover, space travel and sending humans to Mars. Many medical discoveries ahead of us. It all seems so interesting to learn.
– I always laugh at my colleagues who say about advances in medicine. There are no advances in medicine (laughing). I always tell them it's in actual fact advances in technologies, not medicine, and medicine always gets the best of technological discoveries. If a surgeon needs to cut a hole, he uses a scalpel, but nowadays he may choose to use a more sophisticated scalpel (e.g. laser, electric, harmonic, argon plasma or PlasmaJet).
– Now coming back to your childhood. What inspired you to be interested in technologies? Was it the literature like Lem, or interest in technological hobbies, like building models?
– Models, oh yes. As a child I always had technical interests. I was interested in putting things apart and putting them back together. To brake and fix things, probably I broke more stuff than I repaired, as a curious kid. How is it made, the typical children's questions, how does it function? Modelling, both plastic models and flying models was on my path since many boys my age liked it, we made grenades from Maggie bottles, various rockets.
– Nowadays, I observed a different trend among younger generations, if you look into the Internet. They enjoy destroying things simply for the fun of breaking it, but it has nothing to do with curiosity on how it's made.
– Well, curiosity needs some brain effort and if you simply destroy something, it doesn't. Besides, young people nowadays know, that parents will buy them new stuff.
– People don't respect and care for goods anymore.
– True. There are different patterns shown in the media nowadays. Media promote lack of responsibility for one's actions and that generates a chain reaction, with lack of respect for people. But that's a topic for another discussion and it makes me mad.
– Well it was a pleasure talking to you, thank you.
– Pleasure was all mine and thank you for the prize.
Well, this year we have awarded real passionate people. Even when talking to them during the interviews, I felt their strong motivation, and after a while they opened up to talk about their interesting work, which to them is routine, but to us it is very, very special. One doctor replants limbs, the second one helps those that can’t have them replanted. Big thanks from the Editor-in-Chief must go to all those who have believed in our journal and supported WJOMI during this and the previous years.
 Anna Chrapusta. Wikipedia. Access valid on: 15 December 2018: https://pl.wikipedia.org/wiki/Anna_Chrapusta
 Postępowanie awansowe - ANNA MARTA CHRAPUSTA. Centralna Komisja ds. Stopni i Tytułów. Access valid on: 15 December 2018: http://www.ck.gov.pl/promotion/id/14416/type/l.html
 e-NABLE Polska. Access valid on: 15 December 2018: http://e-nable.pl
To both awardees for finding time in their busy schedules for ad hoc interviews. To Anna Kochan for the transcript rewriting.
Conflict of interest: none declared
To cite this article: Kochan P. WJOMI awards the 2018 Certificates of Outstanding Contribution to Medicine. World J Med Images Videos Cases 2018; 4:e58-74.
Published on: 31 December 2018
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