Medical Miracles

 

by Devin Greaney and Terre Gorham

From the MEMPHIS DOWNTOWNER October, 2008

 

 

 

TOC: Memphis has produced a lot of genius, from world-changing music  

legends to globe-impacting entrepreneurs. Add medical innovators to  

the list.

 

 

 

With its headquarters in Memphis's biotech district, Luminetx Corp.  

made waves in 2004 with its creation of the VeinViewer Imaging  

System. Those hard-to-find blood vessels zigzagging through the  

network of our circulatory systems became easy to quickly spot for  

immediate access to life-saving injections. And as incredible as this  

invention is, Luminetx is hardly alone in Memphis medical innovation.  

The inventions created by Memphians have made dramatic impacts felt  

around the world in treating the sick and injured.

 

 

 

Here are just a few ...

 

 

 

Sam Splint

 

The most well-known resident of 1408 Rayner Street in Memphis was  

George “Machine Gun Kelly” Barnes, who was captured in Memphis  

there in 1933. But perhaps it should be better known as the childhood  

home of Dr. Sam Scheinberg. Never heard of him? He just might have  

helped you.

 

As an Army medic in Vietnam from 1968 to 1969, he saw the need for a  

better splint for broken bones. One case that sticks in his mind  

involved a soldier who arrived via helicopter for treatment. “He had  

a burn and a broken arm,” Scheinberg remembers. “They had put a  

plastic inflatable splint on his arm. As the altitude changed, his  

hand went numb, and I had to take the splint off. It took the skin  

off his arm, too. It made me sick to my stomach, and the feeling  

comes back even now.”

 

A splint is a simple device used to stabilize bone fractures and  

breaks while preventing further injury. It requires something that  

maintains its shape in order to hold a broken bone in place and keep  

the broken pieces from moving within the limb. The difficulty is that  

different bones come in different sizes and shapes.

 

Around 1971, Dr. Scheinberg experienced his Aha! moment. While  

watching TV after 24 hours of surgery, he began to mindlessly bend an  

aluminum gum wrapper around his little finger. When the wrapper  

became firm and supportive, Scheinberg realized this concept could be  

used to create a splint in the same way bending a piece of paper just  

right can make a dustpan for sweeping.

 

In 1976 at the American Academy of Orthopedic Surgeons, Scheinberg  

presented his idea for a splint that could be used on almost any  

injured part of the body. The following year, he patented a thin  

strip of aluminum sandwiched between two layers of closed-cell foam  

as the Sam Splint. The mechanics has to do with the physics of curved  

surfaces: A flat thin sheet of soft metal is flimsy and weak, but  

when curved in cross-section, that same structure becomes amazingly  

rigid and strong.

 

Scheinberg, busy with his orthopedic practice, set the idea aside  

until 1984 when his wife, Cherrie, literally chased him around their  

house until he agreed to finish what he started. Scheinberg describes  

it as the luckiest 10 minutes of nagging in his life. The first new  

prototype was created in their kitchen and packaged in an Oreo cookie  

wrapper.

 

Twenty-three years and many millions of splints later, the Sam Splint  

has become the standard for hospitals, athletic trainers,  

outdoorsmen, paramedics, safety engineers, and militaries around the  

world. “We sell almost everywhere on the planet,” Scheinberg says  

from his ranch on the Oregon coast. And sales go beyond the planet,  

too. NASA has even used the device on the Space Shuttle.

 

  By the way, don’t bother looking for Machine Gun Kelly’s buried  

loot at Scheinberg's former home on Rayner. Sam and his friends  

already checked.

 

<<SAM Medical Products, 800-818-4726, sammedical.com>>

 

 

 

Fast Pellets

 

The work of two University of Memphis research professors is enough  

to have even an orange-blooded University of Tennessee fan cheer for  

these Tigers.

 

 

 

About three years ago, Dr. Warren Haggard, professor in the  

biomedical engineering department, was at  an Academy of Orthopedic  

Surgeons meeting. There, he heard of the Orthopedic Trauma Research  

Program initiated by the Department of Defense. One item on the  

agenda was a grant program offered for research to discover a way to  

reduce infections from combat-inflicted wounds. He applied for and  

received a grant. Shortly afterward, he and fellow professor Dr. Joel  

Bumgardner went to work.

 

 

 

Germs have long been a killer in warfare, but research in recent  

years shows further evidence of the critical importance of treating  

the silent killer. A 1993 battle in Somalia brought home that need.  

“In the <<Black Hawk Down>> battle, researchers followed the  

progress of the troops," Haggard says. "They found that about 25  

percent of those soldiers' wounds became infected because of a delay  

in treatment. They also found that if a wound became infected, it  

added about six weeks to recovery time."

 

 

 

“If you’re caught in a battle and get wounded by an IED or other  

high-energy weapon, you have a very large wound with a lot of tissue  

gone,” says Bumgardner. “One problem is that you lose some of your  

body's ability to fight infections. Your skin is gone, which is a  

very effective barrier against infections. Your blood and vascular  

system is also damaged, so you can’t get your body’s wound-healing  

cells to the site to fight infection and initiate the healing  

process. This is a very nice site for germs to set up household.”

 

 

 

The idea sounded simple enough: release antiseptic directly at the  

wound site. “We started playing around with the chemistry of calcium  

sulfate to try to get it to degrade in a quick way,” Haggard says.  

The plaster of paris–like compound already had many other medical  

uses, but this application would be entirely different. “We wanted  

something that could be applied to the wound, would release a  

therapeutic agent like an antibiotic, kill the bugs, and quickly  

degrade.”

 

 

 

With the help of research associate Kelly Richelsoph and graduate  

student Stephanie Jackson, the scientists created pellets about 4 to  

5 millimeters in diameter that contained the antibiotic amikacin. Now  

in the testing phase, so far so good.

 

 

 

“The military is very interested,” Haggard says. “They have done  

pre-clinical studies simulating an injury. They placed bacteria in  

the wound, but the bacteria had a special gene that made them  

luminescent so the scientists could easily see where the bacteria  

were. They surgical-treated and rinsed out all of the wounds like  

they normally do. But to some wounds, they added the calcium sulfate  

pellets with antibiotic in the wound. Within 24 hours, the pellets  

were gone, and at 48 hours, the wounds had 1,000 times fewer bacteria  

in comparison to the wounds that were just surgical treated and  

washed out.

 

 

 

Battlefields are not the only places where such an application could  

save lives, of course. “You can take this approach domestically,"  

Haggard says. “In the hospital, we have resistant organisms that  

take up residence. We are hoping we can use this approach there, too.”

 

 

 

<<678-3733, memphis.edu/research>>

 

 

 

MicroDex Robot

 

What is the best way for an experienced surgeon and a design engineer  

to work together on improving surgical technology? Dr. Steve Charles  

has an idea: Just have them inhabit the same body.

 

 

 

After graduating in engineering, Charles went to medical school. "I  

decided to design medical instruments as well as be a surgeon," he  

remembers. But operations on brain tumors, certain aneurysms,  

cervical spine problems, and functional neurosurgery for pain and  

seizure disorders require very high dexterity that can challenge even  

the best of free-hand surgeons. Worse, many difficult health  

situations are classified inoperable because of the extreme precision  

requirements and, therefore, the improbability for success.

 

 

 

As a young medical student in 1965, Charles — now a board-certified  

ophthalmologist and clinical professor at the University of  

Tennessee — saw this dilemma firsthand. Ten years later, he had a  

personal stake in addressing it.

 

 

 

“The first thought that hit me in med school was that microsurgery  

is absolutely fascinating," Charles remembers. "But there’s no  

reason a human being should be able to move their hands at 20  

microns" — a distance of 20 millionth of a meter.  “Why would we  

be able to move our hands with 20 times greater precision than the  

naked eye can see? It hit me that we need a microscope for our hands.”

 

 

 

That thought simmered on the back burner until 1975. Charles was in  

Memphis in his first year of practice as an ophthalmologist when a  

call came from his mother that his father had a brain tumor. His  

father's parting words were: Steve, you need to take your engineering  

skills to neurosurgeons to help people like me.

 

 

 

So Charles invented his own class of robots with a new technology  

called “dexterity enhancement." MicroDex provides a small robotic  

mechanism that is attached to a stereotaxic (precision positioning)  

framework.

 

 

 

“Gravity disappears, so a heavy drill is no longer heavy,” Charles  

says. “Velocity is controlled, and we can set up ‘no fly zones.’  

We can confine our work to a certain area. It will give a barrier to  

your hand like an invisible teacher holding your hand saying,  

‘don’t go there.’ We have the ability to scale motion. You can  

set it so your hand moves an inch and the instrument moves half an  

inch or an eighth of an inch.”

 

 

 

It's nothing but smooth motion and flow of force and torque. “It  

can’t have gears," says Charles, who is also founder and chairman of  

MicroDexterity Systems, a medical device company building a family of  

medical robots, and the Charles Retina Institute. "It can’t have  

cable drives; it can’t be heavy. We had to build a system that  

allowed it to move incredibly smoothly but could also tell it to stop  

immediately. The system must have high-fidelity tactile feedback.”

 

 

 

The technology is awaiting approval, and when approved, will be used  

for knee surgery, spine surgery, and neurosurgery, a strange  

application for an ophthalmologist, but that engineering background  

combined with medical training makes it a natural fit.

 

 

 

“Bryant Gumbel wanted to interview me to do a show on medical  

entrepreneurs,” he remembers. “I told him I’m not interested.  

It’s about helping people, not being an entrepreneur. I’m a  

physician and an engineer, and the charge of both fields is to do  

things that help people. I promised my dad that I would do this.”

 

 

 

  <<Charles Retina Institute, 6401 Poplar, Suite 190, 767-4499,  

charles-retina.com>>

 

 

 

 

 

Medical Education Research Institute (MERI)

 

At Medtronic’s Memphis office, a wall of about 70 patents issued to  

Dr. Kevin Foley is displayed. “It’s impressive,” says Elizabeth  

Ostric, MERI's executive director. It’s so impressive, that it's a  

little like visiting Graceland and seeing the wall of Elvis's gold  

records.

 

 

 

But perhaps Foley's greatest invention is not a procedure nor an  

instrument but rather a contribution to patient care by creating a  

way in which doctors are trained. Continuing education for surgeons,  

residents, and students — more than 5,000 per year from around the  

world — learn minimally invasive surgical techniques on deceased  

human donors at MERI, a 27,000-square-foot medical instructional  

facility that provides critical hands-on practice to surgeons in  

preparation for giving care to their living patients.

 

 

 

The original idea of MERI came from the military — when Foley came  

to Memphis from Walter Reed Army Institute of Research in Silver  

Spring, MD, the largest and most diverse biomedical research  

laboratory operated by the Department of Defense.

 

 

 

"The military has many dedicated people who donate their lives to the  

service of the country," Ostric explains. "They practice new surgical  

techniques and improve current surgical techniques and tools with the  

support of these generous anatomic donors. Foley — with support from  

Semmes-Murphy Neurologic and Spine Institute, Methodist Le Bonheur  

Healthcare, and Baptist Memorial Health Care — brought that  

philosophy to Memphis in 1992."

 

 

 

The classroom resembles an OR for 10 patients, with spaces where a  

faculty surgeon — surrounded by several student surgeons and MERI  

staff — learns how to perform a new minimally invasive procedure,  

such as working with a new knee product or properly inserting spine  

implants.

 

 

 

“In the past couple of decades, the pace of medical innovation has  

quickened,” Foley says. “The things you learned in med school  

don’t remain current as long as they might have in the past. New  

techniques have been developed to improve medical care that you may  

never have been exposed to while you were learning.”

 

 

 

MERI also provides a means for companies to perform groundbreaking  

research that includes surgeon-led new designs for medical devices,  

and testing prototypes prior to seeking FDA approval.

 

 

 

“Think of MERI as a school for post-graduate, practical hands-on  

training,” Foley says. “A company that has a new procedure or  

device might approach MERI and ask to put on a course teaching how to  

use the device. We have in Memphis a long history of medical device  

development. Many of the innovations are driven by device companies.  

It interfaces very nicely with Memphis’s drive to be a real  

biotechnology center nationally and internationally.”

 

 

 

  MERI, a nonprofit, is the largest hands-on training center of its  

kind — anywhere. "We have been approached to franchise the MERI,"  

says Foley. "I explained that this is not a business. But we have  

helped other institutions follow the model so there are some other  

similar teaching centers elsewhere. It’s exciting to develop new  

things but it’s more exciting to see them actually help the patient.  

It’s very rewarding to teach fellow physicians. If you do something  

yourself, you can affect patients. But if you teach a hundred  

physicians, you can affect thousands of patients.”

 

 

 

<<MERI, 44 S. Cleveland, 722-8001, meri.org. Genesis Donor Program,  

278-7841, genesislegacy.org>>