The Making of a Mindset: The Basic Sciences Year II

By | March 10, 2015

Adenocarcinoma of the pancreas is a disease causing severe abdominal and back pain, which we used to treat quite commonly here at Schlesinger Pain Centers.  Recent advances in chemotherapy have substantially decreased the number of patients suffering from such severe pain. This microscopic slide shows many of the important histopathological features of cancer, both aberrant cellular features such as pleomorphic nuclei, aneuploidy and frequent mitotic figures, as well as architectural abnormalities such as irregular and fused glands as well as cells growing in amorphous sheets.  It is the combination of these abnormal features that allows us to make the diagnosis of cancer and attach to it a poor prognosis.

Adenocarcinoma of the pancreas is a disease capable of causing severe abdominal and back pain, which we used to treat quite commonly here at Schlesinger Pain Centers. Recent advances in chemotherapy have substantially decreased the number of patients suffering from such severe pain.
This microscopic slide shows many of the important histopathological features of cancer, both aberrant cellular features such as pleomorphic nuclei, binucleated cells and frequent mitotic figures, as well as architectural abnormalities such as irregular and fused glands as well as cells growing in amorphous sheets. It is the combination of these abnormal features that allows us to make the diagnosis of cancer and attach to it a poor prognosis.

 

If the first year was the study of what is normal the second years is the study of abnormality and perversion. Pathology is the study of abnormal anatomy, both gross and microscopic as well as the aberrations of normal function[1] that result. Always implicitly asked is the same question, why does a particular anatomic derangement lead to this particular abnormality of function as opposed to something different. Look at the structure that is diseased or distorted and you should be able to understand the symptomatology. Pharmacology is the study of the effects of drugs on normal and abnormal tissues, which can also be thought of abnormal biochemistry. Even here we hear the unchanging mantra, “Form defines function”, but the form is molecular. What normal body chemicals does the drug mimic and does drug enhance or inhibit function. The other major classes of the second year seem to impact less on my clinical practice that those already mentioned. When I was a medical student, microbiology was primarily the study of bacteriology[2] because our understanding of viruses was so limited at that time. Even now our knowledge of viruses and how they cause chronic pain syndromes is far from complete and therapy even more limited. The other major course of the second year that has had less impact on my clinical practice than I would have thought was Neurosciences, a yearlong class in both neuroanatomy and neurophysiology. Here again the problem was the primitive state of our knowledge. While much had been learned about the function of individual nerve cells and very primitive networks, the clinically relevant neuroanatomy and neurophysiology that we studied back in the 1970s was little different from that described in the late 19th century. A minor class that has had a lasting influence on me and my medical practice, here at Schlesinger Pain Centers for two reasons was medical genetics. The first reason to study genetics, to identify the inheritable basis for the diseases we treat is still in its infancy. The second and in my opinion the more important lesson is the contribution that socio-genetic dislocations make to the diseases we treat, as can be seen in my cavemen series of blogs.

[1] Pathophysiology

[2] It turns out that bacterial infections rarely cause chronic pain and disease.


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