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GASTROENTEROLOGY

By Robin Hart,2014-06-12 07:42
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GASTROENTEROLOGY

Ping Chen 陳炳元 12 June 2012 421777422.doc

    This past summer I traveled to Szczecin, Poland for research exchange through the International Federation of Medical Students Association (IFMSA)’s SCORE (standing committee on research exchange) program. My contract was for a four-week program, from Monday, 3 July 2006 to Friday, 28 July 2006.

    First, I should give a short history of how I was accepted to the program. In September 2005, we were first notified of the exchange opportunity from the local officers on research exchange (LORE) here at Kaohsiung Medical University. We attended an introductory meeting, during which the officers explained what SCORE was, how we could apply, and how we would be judged to decide who would be able to go. First, there was a simple application form that we had to complete noting our prior research experiences and any previous affiliation with IFMSA. In addition, we had to take the TOEFL and each had interviews to test our English communication skills. With all this information, the officers tallied our scores (TOEFL, 35%; Interview, 30%; Research Experience, 15%; Others, 20%) and the top eight students were permitted to attend the program.

    After this initial acceptance into the program, we had to complete an official application form for IFMSA, designating the top three research projects that we would like to pursue. At this time we were also required to submit the NT$12,500 registration fee. This took place near the end of November 2005. In April 2006, I was notified that my first three choices were not available and was asked to choose three more. A few weeks later I was notified that I had been assigned to the project, “Evaluation of oral probiotics in the treatment of inflammatory bowel diseases (IBD).” at the Pomeranian Academy of Medicine in Szczecin, Poland.

    At the beginning of June 2006, I started to contact the LORE in Szczecin to gather some information about my housing, meals and work arrangements. She was very polite in answering my many questions. I then notified her about my precise travel details as to when I would arrive Szczecin so that she could arrange for someone to receive me.

    And so my travels began…

    I left Taiwan on 22 June 2006 for Paris, France where I spent 3 nights. Then I traveled to London, also for 3 nights. From there I flew to Germany where I also spent 3 nights, before taking a train from Dresden to Szczecin, Poland, which is located very close to the German border in the northwest corner of the country. I arrived at the station around 20:00 on Sunday, 2 July 2006 and was received by two local students from the medical university. From there, I was taken to the dormitory where I would sleep for the 4 weeks during my exchange. At the time of my arrival there were already five other students there (2 from Portugal, 2 from Hungary and 1 from Slovakia). [By the end of my program, there had come four more students (2 from Turkey, 1 from Brazil and 1 from Macedonia)]. All the nine other students in Szczecin were there on SCOPE (standing committee on professional exchange), which is similar to a clerkship.

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Ping Chen 陳炳元 12 June 2012 421777422.doc

    My first day at the hospital was on Tuesday, 4

    July 2006. I met my mentor, Doctor Wojciech Marlicz,

    of the gastroenterology department. He showed me

    around the clinic as well as the various other

    departments in the hospital. There were about 50

    beds for in-patients, and one main waiting area for

    out-patients mainly in the clinic waiting for either

    endoscopy and/or colonoscopy procedures.

    Above is one of the endoscopy/colonoscopy rooms.

    The research project I was assigned was a clinical one, in which we were to determine the efficacy of probiotics (益生菌) in treating (not just in the general prevention) of inflammatory bowel diseases (發炎性腸道疾病). However, since my professor had also just taken the case, the project was in its early stages of patient screening for inclusion into the clinical study. Since I did not know how to speak Polish, it was thus very difficult for me to assist in this procedure. As a result, I actually spent the majority of my exchange following my doctor while he made rounds and performed endoscopies (內視鏡)/colonoscopies (大腸鏡).

    A typical day at the hospital clinic was as follows. At 8:30 every morning, there would be a group meeting during general management/procedural issues were discussed as well as daily numbers of in-patients, who was on 24-hour call, etc. After the meeting, most of the doctors would head to the endoscopy/colonoscopy room to begin on the day’s patients. A typical day would last until about 13:00, during which about 20 patients would be seen. These would be rotated through four or five doctors (one of which was my mentor), several of which were specialized in certain procedures such as endoscopic ultrasound (EUS, 內視鏡超音波) or more

    complicated surgical maneuvers.

    After the several weeks in the clinic, I became familiar with the many different appearances of common findings, ranging from gastritis (胃炎) and duodenitis (十二指腸炎) to

    peptic ulcers (胃潰瘍) and gastric cancers (胃癌), mainly in the form of adenocarcinomas (ACC,

    腺癌). In addition, I also saw many different esophageal diseases such as cancers (食道癌), ACC

    and SCC (鱗狀細胞癌) and varices (食道靜脈曲張), most easily visualized using ultrasound

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Ping Chen 陳炳元 12 June 2012 421777422.doc

    endoscopy. EUS was also very assistive in visualizing both acute and chronic forms of pancreatitis

    (胰臟炎).

    Visualization of the GI system from the other end also provided a very good learning experience. I was able to see multiple cases of colonic polyps (腸息肉), diverticulosis (憩室症) and ulcerative colitis (UC, 潰瘍性

    結腸炎). During these examinations, all found polyps were removed, with some ranging as large as 1.5~2.0 cm!! (see photo at right).

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Ping Chen 陳炳元 12 June 2012 421777422.doc

    In addition to the comparatively simple polypectomy procedures (息肉切除術), I also got to

    witness several more advanced procedures such as argon plasma coagulation (APC, 氬等離子電

    凝技術), a more modern form of thermocoagulation.

    One of the more interesting procedures I got to see was percutaneous endoscopic gastrostomy (PEG, 經皮膚內視鏡胃造口術) performed on a ninety year old lady because she was no longer capable of feeding herself and a more permanent solution was required.

    Besides all of these endoscopic and colonoscopic procedures, I also went on rounds with my mentor to visit the many in-patients. The majority in the ward were liver cirrhosis (肝硬化)

    patients with very typical appearances: heavily jaundiced (黃疸), peripheral pitting edema (凹陷性

    水腫) with ascites (腹水), spider telangiectasia (蛛形毛細管擴張) due to portal hypertension,

    asterixis (撲性震動) related to hepatic encephalopathy (肝性腦病), Dupuytren’s contracture (

    皮特倫氏攣縮), palmar erythemia (掌紅斑), and terry’s nails (特里氏指甲).

    One time, my mentor even allowed me to perform a large-volume paracentesis (大容;

    腹膜穿;術). I only performed the initial steps of sterilization, anesthesia, and needle insertion. I was later informed that 6.8L of fluid had been withdrawn from the patient’s abdominal cavity.

    The four weeks spent in the clinic were very

    worthwhile for me indeed, having been able to see

    many procedures and clinical manifestations that are

    otherwise merely words in a medical textbook. I was

    also extremely lucky that my mentor was very nice; he

    always spent the extra time to translate from Polish to

    English so that I would understand everything that

    was going on. This is a photo of the doctor and I

    taken a few days before I left.

    In addition to the days spent in the clinic, I was able to travel with the other students in

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Ping Chen 陳炳元 12 June 2012 421777422.doc

    the group to various places throughout Poland. During the three weekends we were there, we visited Gdansk (on the Baltic Sea in the north) and Malbork, Poznań and Wrocław in the east, and

    Kraków and surrounding cities Oświęcim and Wieliczka in the south. After my four weeks there, I

    traveled alone throughout various other places in Central and Eastern Europe, from Warszawa, Poland to Budapest, Hungary to Bratislava, Slovakia to Sofia, Bulgaria to Beograd, Serbia to Sarajevo, Bosnia and Hervegovina to the Croatian coast and Montenegro ending up in Ljubljana, Slovenia before returning to Germany, then France, and after a final three nights in Seoul, South Korea, home to Taiwan.

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