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Face Transplants
For Disfigured Patients
Patients with
severe burns to their face have been treated with skin transplants
in order to help them cope with common body functions which the
average person takes for granted, like opening and closing of eyelids
or breathing. Patients have to undergo numerous skin grafts, where
skin is transplanted from other body areas. The process can take
years, as multiple surgeries are needed. Facial skin is also more
tender and pliable, making it different from the type of skin in
other areas of the body, and plastic surgeons are working to make
the facial appearance of the patient less mask-like. The journey
to recovery becomes a long and difficult one, which can be likened
to an emotional roller coaster: there is surgery and the time to
heal, after which more surgery is required.
The possibility of a face transplant sounded like a futuristic item
till a short time ago, but French doctors have used new techniques
to restore the facial features of a 38-year-old
woman, whose face had been mauled by a dog. The partial
transplant was done using the mouth, nose and chin of a brain dead
donor.
Maria Siemionow, the director of plastic-surgery research at the
Cleveland Clinic states, that facial transplant can only be considered
as a treatment for severely disfigured patients who have exhausted
all conventional options. The procedure itself remains controversial
and risky. It involves harvesting the face from a brain-dead brain-dead
organ donor in a 4 to 6 hour surgery. In the following 10 to 15
hour procedure the face is draped over the bones and muscles of
the recipient. Following surgery the transplant patients needs to
take medication to prevent the rejection of the transplant. Even
though the risk is not any different than the risk, which goes along
with a kidney transplant, there is the possibility of transplant
rejection and of side effects from immunosuppressants. Patients,
who take this medication that will cost about $2000 per month, are
more susceptible to infection, cancer, metabolic disorders, and
liver and kidney damage. The psychological impact on the patient
will also be significant, as there could be a feeling of having
a different identity. Dr. James Zins, chairman for plastic surgery
at the Cleveland Clinic, insists that there are no races to be won
and the approach to this new option should be methodical and slow.
Not all potential candidates for the surgery are willing to take
the risk of life-long immuno-suppressants and it is only a consideration
for physical as well as psychologically suitable patients who are
willing to take the risk of receiving a new face after devastating
accidents.
December
12, 2005 issue of Newsweek, pages 60-61.
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Prevent
Foot Problems In Diabetics
Diabetes has
reached epidemic proportions in North America. Two million Canadians
(about 20 million in the US) have diabetes, and the number is expected
to rise dramatically. At one time or another about 15-20% of patients
with diabetes will need hospitalization with a diabetic foot complication.
The conditions, which are of concern, are diabetic foot ulcers,
severe infection and peripheral ischemia. Health budgets are stretched,
as the cost of treating a single foot ulcer has been estimated at
$2,183, so the total cost over the lifetime of current diabetics
will exceed $650 million (about 6.5 billion $ in the US). Foot ulcers
appear like a small item considering the fact that the need for
amputation of a lower extremity is the next severe problem that
can arise. The average patient who undergoes a below knee amputation
will spend 84 days in hospital and another 38 days in rehabilitation.
To prevent the development of foot ulcers, it is important to screen
diabetic patients for predisposing factors like the loss of protective
sensation in the feet (diabetic neuropathy) as well as structural
changes resulting in areas of increased pressure. A study conducted
in southwestern Ontario found that only 15% of patients with type
2 diabetes were screened to identify those at risk for foot ulcers.
Screening is the first step, after which a podiatrist will have
to take over. Footwear prescribed by a podiatrist can be an avenue
of prevention, but ongoing podiatric care as well. The small number
of diabetic foot screenings shows that podiatric medicine has not
been used as a tool to recognize and treat diabetic foot problems.
The proactive approach of seeking the input of a podiatrist early
will translate into significant benefits for the patient with type
2 diabetes.
Parkhurst
Exchange, December 2005, page 162
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Colon
Cancer Associated with H. Pylori
The prevalence
of Helicobacter pylori has been identified as a risk for the development
of stomach cancer. Infection with this microbe has come under more
scrutiny, as patients who are seropositive to H. pylori are more
likely to develop colorectal cancer than those patients who are
seronegative.
Dr. Akio Inui
from Kagoshima University in Japan has investigated the relationship
of this microbe in the development of colon cancer by analyzing
data from 332 patients who were screened by virtual colonoscopy
(high-resolution colonoscopy) and serological testing for H. pylori.
Of the patient group 42 % with H. pylori antibodies had tubular
adenomas (precancerous colon cancer lesions) but only 19% of the
negative group had colonic cancers. The researchers concluded that
more investigations and long-term prospective studies are needed
to explore the biological basis of Helicobacter infection and colon
cancer. In the meantime it is important to eradicate infection in
order to prevent stomach and colon cancers.
Int.
J. Cancer 2005; 117: 1058-1059
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Plastic Surgery For Men
Makeover TV
shows are very common, but it is usually women who are featured
in them.
The fact that males are not talking as much about makeovers, Botox,
Restylane and face lifts does not mean that cosmetic surgery is
a topic only reserved for women. In 2004 1.2 million procedures
were performed on men according to statistics from the American
Society of Plastic Surgeons. The number of surgical procedures rose
by 16% from 2000, and in 2004 there was also a 43% increase in minimally
invasive treatments for men.
The reasons for this shift of attention may have several reasons.
Men feel that there is more pressure on them to look vibrant, youthful
and energetic. There is a lot more exposure of plastic surgery in
the news media. Information about cosmetic surgery is also disseminated
on the Internet.
An executive who has experience and skills and looks tired and old
may be at a disadvantage on the career ladder, observes Dr. Lorne
Tarshis, a Toronto plastic surgeon. If drooping eyelids convey the
look of defeat and tiredness, it is not likely a reflection of how
the patient really feels. As a result, men in this category will
often opt for a blepharoplasty. Women are more willing to talk about
plastic surgery to their doctor. Men are more reluctant than women
to go to the doctor's office and ask about procedures. They are
more likely to get their information on the net and walk into the
office of the plastic surgeon with their minds made up. Dr. Arie
Benchetrit, a plastic surgeon from Pointe Claire, Quebec finds that
men are more pragmatic, whereas women are more open to discuss options.
Men are looking for "natural" results, meaning in this
case, that they want to look great but they don't want people to
know why they look great. As a result they prefer less dramatic
procedures. It does not mean that men are less nervous or anxious
about their appearance than women, but mostly they won't talk about
it, because admitting vulnerability in a competitive context goes
against male culture.
Dr. A. Carruthers from Vancouver reports that some patients with
facial wasting as a result of HIV benefit from cosmetic fillers
like restylane and silicone oil. Some of them were well enough to
work. Their condition was stable, they felt fine, but they were
sent home and told to go on disability because they looked too sick
to be seen in the workplace. "Getting their faces back"
had an immense emotional impact on those patients, who no longer
felt stigmatized.
Dr. Carruthers reported that in the past cosmetic surgery was looked
at with skepticism. When Sigmund Freud heard that someone wanted
to undergo a cosmetic procedure, he responded by prescribing psychoanalysis.
But times have changed. Cosmetic procedures are more about well
being, and the word "vain" is a four-letter word.
The Medical
Post, December 20, 2005, page 31
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Combination
Of Drugs Helps Rheumatoid Arthritis
Several treatment
options have become available to patients suffering from rheumatoid
arthritis, but side effects can be a problem. Corticosteroids are
still needed, and methotrexate has been added. While anti-tumor-necrosis
factor therapy (TNF alpha antibody) is a very beneficial form of
treatment, there are patients who fail to respond or have toxicity
to these therapy forms.
Dr. Stanley Cohen, a clinical professor of internal medicine at
the University of Texas Southwestern Medical School in Dallas investigated
520 patients who had not adequately responded to methotrexate and
anti-TNF therapy. The patients received the genetically engineered
monoclonal antibody, rituximab (Rituxan), which so far has been
used to treat Hodgkin's lymphoma. It was found to be highly effective
for active rheumatoid arthritis when given with methorexate in patients
who experienced an inadequate response to anti-TNF therapies.
The patients were randomly selected and received either a single
dose of 1000mg rituximab or placebo on days one and fifteen. All
patients received a corticosteroid prior to the infusion. They also
took a short course of oral corticosteroids between the two injections.
For the patients on rituxmab, the medication proved beneficial.
It was also well tolerated. Statistically 51% of the patients on
rituximab had at least a 20% improvement on the swollen and painful
joints and at least 20% improvement in 3 to 5 other criteria, like
general well being, disability or laboratory tests of C-reactive
protein.
Only 18% of the placebo group showed any improvement. It was also
noted that the effects of this one-time treatment could last up
to 15 months.
As good as the current medication is, there are treatment failures.
Dr. David Karp, chief of Rheumatic diseases at the same university
but not involved with this study finds the development very valuable.
He concludes that becomes important in this area to personalize
the treatment plan. The future is to look at the patients' blood
or gene makeup and prescribe specific therapies directed at their
particular problem.
The
Medical Post, December 20, 2005, page 33
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