When much of the area in and around Managua, Nicaragua was destroyed by an earthquake in December 1972, humanitarians from all over the world pitched in to help the Central American country recover.

Among them were legendary baseball player Roberto Clemente and a team of volunteers, all of whom perished when the cargo airplane they were flying in crashed on New Year’s Eve 1972.

Also coming to the aid of Nicaraguans in the wake of that disaster was a fledgling organization known as Doctors Without Borders, which faced its first test as a relief agency during the Nicaraguan tragedy.

What, precisely, is Doctors Without Borders? It is an independent humanitarian non-government agency that provides various forms of medical assistance throughout the world.

Internationally, it is known as Medicines Sans Frontiers (MSF), for it was founded in Paris, France in December 1971 by a group of journalists and physicians who were of the belief that much international aid was obstructed by legal barriers and was also medically inadequate.

The simplest definition of the organization comes from a MSF promotional video: “Doctors Without Borders…provides aid to people whose survival is threatened by violence, neglect, or catastrophe, primarily due to armed conflict, epidemics, malnutrition, exclusion from health care, or natural disasters.”

In 2009, MSF was awarded the Nobel Prize for Peace. Accepting the award was MSF’s then President of International Council, Dr. James Orbinski, a Canadian physician and one of the many doctors, surgeons, and nurses who mostly comprise the medical sector of MSF.

MSF receives approximately three million dollars in fiscal assistance each year. More than 80 percent of those funds are used to finance MSF programs. The remainder goes to administrative, management, and fundraising duties and responsibilities.

More than 23,000 people work in all sorts of vocations for MSF, which has approximately 3,000 paid employees and 20,000 volunteers working across the globe.

Five of the 24 MSF offices are referred to by MSF officials as Operational Centers, or OCs, and all five are located on the European continent in Amsterdam, Barcelona, Brussels, Geneva and Paris.

Other MSF bureaus can be found in Toronto, Canada; New Delhi, India;  Rio de Janiero, Brazil; Dubai, United Arab Emirates and Taipei, Taiwan, which is the site of the first office on the Asian continent.

Interestingly, although MSF exists does work in more than 70 countries, the United States is not one of them. The reason for this is, according to the Doctors Without Borders website, is that “there are other organizations with experience serving these populations that are better placed to address these challenges.”

MSF employees and volunteers are independent of any political ideology and only once in the organization’s history – during the 1994 genocide between the Hutus and Tutsis in Rwanda – have its workers asked for military intervention.

Some of the more recent examples of MSF’s work include providing medical care for those affected by the outbreak of Ebola in the Democratic Republic of Congo earlier this year; the admittance of more than 50 people to a hospital in Yemen after they were injured while publicly demonstrating against various governmental policies in that country, and the providing of various psychotherapy services to people living with extreme pressures north of the West Bank.
Much of the world’s populace continues to have problems but MSF’s work to help people cope with their problems continues as the organization seeks to provide independent, neutral and impartial medical aid where it’s needed.

Three dimensional, or 3D, printing has had many notable software and technology advances in recent years, and one of the more notable implementations in that progression was recently engineered by a St. Petersburg surgeon.

Dr. Daniel Penello, a surgeon with Alexander Orthopedic Associates, became the first doctor to use a 3D printer to replace a finger bone after a welder named Robert Smith lost virtually all use of his middle finger when a steel beam fell on it and crushed it at work.

While Smith was making the difficult decision of what, precisely, to do with his crushed finger (i.e., leave it uncared for or have it amputated), Dr. Penello contacted Additive Orthopaedics, a 3D printing company that develops advanced orthopedic devices, to see if employees there could create the software and technology necessary to perform the first-of-its-kind procedure.

Additive Orthopaedics responded by obtaining a CT scan of Smith’s opposite uninjured middle finger from Dr. Penello. From that it manufactured a replacement part made of a surgical grade metal that contains a rough inner surface that allows it to attach firmly to the existing bone.

While Additive Orthopaedics worked its magic, Dr. Penello began the long process (five months) of gathering and mastering the precise information he needed to successfully perform the procedure.

Dr. Penello explained to a Patch.com writer that “my primary concern was our ability to develop an implant that would fit anatomically, while being strong enough to withstand the tremendous forces that it would be exposed to during any pinching, gripping, or lifting activities.”

The surgery was performed this past spring, and Dr. Penello deemed it a success as Smith is now doing physical therapy to regain complete usage of both the rejuvenated finger and his hand.

The successful surgery and the ongoing work at Additive Orthopaedics suggests 3D printing may soon impact the medical field in a far greater way, particularly in the area of custom implants, which could become more affordable through this process.

“I picture a 3D printer, sitting at the hospital, and when someone comes into the hospital with a broken wrist, someone will go to the printer and type it in,” Dr. Penello told the Tampa Bay Business Journal. “Almost like ‘Star Trek,’ where they type in what they need.”

That Dr. Penello performed the inaugural 3D printed finger bone operation – at least the first known in the United States – should not come as a surprise to anyone. In an interview in February for “Becker’s Spine Review,” he told a writer:

“I am most excited about the emerging trend of additive manufacturing (commonly known as 3D printing) in the development of patient-matched devices and superior implants. … The additive manufacturing process has the ability to develop custom implants and patient-specific jigs and targeting devices in a much more cost-effective and scalable way.”

Dr. Penello, who is board certified in both Canada and the United States, graduated from the medical school of the University of Toronto in Canada, and later worked at the Cleveland Clinic, is well known in his profession.

He has a YouTube video telling viewers of his professional experiences that includes an explanation of how his life vocation was influenced by his father “who sustained a pretty tragic injury in the right hand (that) really altered the course of his life. It led me to the career of my dreams because I love hand surgery.”

The loss of a tooth may be a bit traumatic for a five- or six-year-old child, but it’s all part of the natural growing process, one that adults usually find rather cute. There is nothing cute, however, about adults losing a tooth.

When someone past the age of seven or eight loses a tooth, it’s gone for good, and studies show that more than 178 million Americans have suffered just such a loss while more than 35 million Americans have lost not just one or two teeth but all their teeth.

Most consider tooth loss to be an aesthetic problem, and for those who lose a tooth in their smile line it is. But there are physical problems that develop as a result of tooth loss that are even more concerning.

Over time, the loss of a tooth can lead to a loss of bone in the jaw area where the missing tooth used to be, which can result in changes in a person’s facial appearance, odd shifts in the remaining teeth and a collapse in the person’s bite.

Replacement options for missing teeth include bridges and dentures, but dental implants have become the gold standard for tooth replacement because they prevent further bone loss and look and function just like natural teeth.

At Dental Specialists of North Florida, John W. Thousand IV, DDS, MSD, is a specialist in implant dentistry, which is the surgical placement into the jawbone of a screw-like post that serves as the foundation for replacement teeth, bridges or dentures.

The Right Choice

The implant itself is a titanium root-shaped body that is surgically placed into the jaw bone. A single implant supports an abutment and a crown, which creates a new tooth. Several implants can be used to support a fixed bridge or even a full denture.

Because implants require a certain amount of bone to attach to, the implant procedure always begins with an examination to determine whether the patient has enough jaw bone to adequately support an implant.

For those who don’t, a bone grafting procedure can be done in which bone from another part of the body or a special bone grafting material designed to enhance new bone growth is seated in the jawbone where the implant is expected to go.

It typically takes between four and six months for the jaw bone to heal to a point where it is strong enough to support implants. During that healing period, patients usually wear temporary, or removable, dentures or bridges.

Once the implants are placed, patients usually need between three and six months for the implants to heal to the point where they can support the abutment and the crown. As with bone grafting, patients typically wear temporary crowns or bridges during that time.

The advantages to dental implants include a more natural feel and look but they don’t end there. Because a full implant-supported upper arch doesn’t cover the palate the way traditional dentures do, they don’t negatively affect a person’s sense of taste.

Another issue associated with traditional dentures that is avoided through implant-supported dentures is the gag reflex that some patients experience because the denture extends over the back of the palate. Implants also aid the digestive process.

That process begins in the mouth with the way we chew our food. Implants allow a person to chew their naturally and properly, which is an important health factor. If certain foods are not chewed properly, some nutrients may not be absorbed into the body.

Implants even have an effect on the foods we eat. People missing teeth or those wearing bridges or traditional dentures may be prohibited from eating certain foods. That’s not the case with dentures, because their natural form eliminates all restrictions.

Positioning system makes replacement surgery more precise.

The number of Americans having hip replacement surgery has grown steadily over the past eighteen years. It’s estimated that this year, more than 300,000 people will undergo the procedure, up from 138,000 in 2000. The procedure, fortunately, has matured as well.

A recent advancement to hip replacement surgery was the release and FDA approval of a technology that helps surgeons determine the most accurate alignment of the replacement implants. This technology is the optimized positioning system or OPS™.

The inspiration behind OPS is the fact that no two people move the same way, and this can make a significant impact on the proper positioning of the hip implants. OPS is designed to account for the differences. It tailors the implant placement to each patient.

OPS factors in that no two people move the same way.

The hip joint has two essential parts, the ball and the socket. The ball of the joint is the head of the femur, or thigh bone. The socket, or acetabulum, is a concave depression in the pelvis, in which the ball sits. The ball and socket are the parts that are replaced during surgery and must be positioned appropriately for the best outcome.

To get the proper position, hip replacement surgery using OPS begins long before the procedure is performed. An extensive preoperative evaluation is first performed to determine how the patient’s femur, pelvis and spine work together during routine daily activities. This evaluation provides a specific functional simulation of the patient’s movement.

This information is essential to achieving optimum results during surgery. If the implants aren’t positioned precisely during surgery, there’s a greater risk for complications such as premature wear, implant loosening and dislocation, as well as nerve impingement.

The preoperative evaluation also includes imaging such as x-rays and CT scans to generate pictures of how the patient’s hip moves in three dimensions. The imaging captures the anatomical geometry around the person’s hip joint.

Using all of the information gathered from the preoperative evaluation, surgeons create exact 3-D models of the patients’ anatomy. They then use these models as guides to optimize implant position during the hip replacement procedure.

The preoperative evaluation is the first step in the hip replacement using OPS process. The second step is using the system during the procedure itself. During surgery, the 3-D model, which is unique to each patient, is combined with a laser guidance system. Surgeons match up the laser points to ensure the optimized plan is accurately recreated during surgery.

Need for OPS

The most common reason for needing hip replacement surgery with OPS is deterioration of the hip joint from arthritis. The most common type of arthritis is osteoarthritis, also known as “wear and tear” arthritis. Osteoarthritis generally develops with age. It’s estimated that more than 28 million Americans suffer from the disorder.

Osteoarthritis can develop in any joint in the body, but it most often affects weight-bearing joints such as knees and hips. The hip is one of the largest joints in the body, and like other joints, its surfaces are covered with a smooth cushioning material called articular cartilage. This cartilage enables the bones to slide over one another more easily.

Joints also contain another cushioning substance called synovial fluid. This fluid lubricates the joint cartilage and aids in movement. With osteoarthritis, the articular cartilage begins to wear away, and the synovial fluid begins to thin out. This results in the bones of the joint rubbing together without cushioning. Damaged bone may also start to grow. These resulting growths are called bone spurs.

All of the damage to the hip joint is degenerative; it gets worse over time. It also causes pain, swelling and other symptoms that get progressively more intense. Additional symptoms of osteoarthritis include tenderness around the hip, limited range of motion, a grating sensation with movement and difficulty walking.

The doctor can generally diagnose osteoarthritis through a complete history and physical exam. The doctor will confirm the findings with an x-ray of the patient’s hip.

Treatment for osteoarthritis generally begins with lifestyle modifications, such as switching from high-impact activities to lower-impact activities and losing weight. Other conservative treatments include doing physical therapy, using support such as a cane when walking and taking anti-inflammatory and/or pain medications.

If conservative treatments fail to relieve symptoms, the doctor may suggest surgery. Surgical options include hip resurfacing and total hip replacement.