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Thursday, December 18, 2008

A team of eight transplant surgeons in Cleveland Clinic in Ohio, USA, led by reconstructive surgeon Dr. Maria Siemionow, age 58, have successfully performed the first almost total face transplant in the US, and the fourth globally, on a woman so horribly disfigured due to trauma, that cost her an eye. Two weeks ago Dr. Siemionow, in a 23-hour marathon surgery, replaced 80 percent of her face, by transplanting or grafting bone, nerve, blood vessels, muscles and skin harvested from a female donor’s cadaver.

The Clinic surgeons, in Wednesday’s news conference, described the details of the transplant but upon request, the team did not publish her name, age and cause of injury nor the donor’s identity. The patient’s family desired the reason for her transplant to remain confidential. The Los Angeles Times reported that the patient “had no upper jaw, nose, cheeks or lower eyelids and was unable to eat, talk, smile, smell or breathe on her own.” The clinic’s dermatology and plastic surgery chair, Francis Papay, described the nine hours phase of the procedure: “We transferred the skin, all the facial muscles in the upper face and mid-face, the upper lip, all of the nose, most of the sinuses around the nose, the upper jaw including the teeth, the facial nerve.” Thereafter, another team spent three hours sewing the woman’s blood vessels to that of the donor’s face to restore blood circulation, making the graft a success.

The New York Times reported that “three partial face transplants have been performed since 2005, two in France and one in China, all using facial tissue from a dead donor with permission from their families.” “Only the forehead, upper eyelids, lower lip, lower teeth and jaw are hers, the rest of her face comes from a cadaver; she could not eat on her own or breathe without a hole in her windpipe. About 77 square inches of tissue were transplanted from the donor,” it further described the details of the medical marvel. The patient, however, must take lifetime immunosuppressive drugs, also called antirejection drugs, which do not guarantee success. The transplant team said that in case of failure, it would replace the part with a skin graft taken from her own body.

Dr. Bohdan Pomahac, a Brigham and Women’s Hospital surgeon praised the recent medical development. “There are patients who can benefit tremendously from this. It’s great that it happened,” he said.

Leading bioethicist Arthur Caplan of the University of Pennsylvania withheld judgment on the Cleveland transplant amid grave concerns on the post-operation results. “The biggest ethical problem is dealing with failure — if your face rejects. It would be a living hell. If your face is falling off and you can’t eat and you can’t breathe and you’re suffering in a terrible manner that can’t be reversed, you need to put on the table assistance in dying. There are patients who can benefit tremendously from this. It’s great that it happened,” he said.

Dr Alex Clarke, of the Royal Free Hospital had praised the Clinic for its contribution to medicine. “It is a real step forward for people who have severe disfigurement and this operation has been done by a team who have really prepared and worked towards this for a number of years. These transplants have proven that the technical difficulties can be overcome and psychologically the patients are doing well. They have all have reacted positively and have begun to do things they were not able to before. All the things people thought were barriers to this kind of operations have been overcome,” she said.

The first partial face transplant surgery on a living human was performed on Isabelle Dinoire on November 27 2005, when she was 38, by Professor Bernard Devauchelle, assisted by Professor Jean-Michel Dubernard in Amiens, France. Her Labrador dog mauled her in May 2005. A triangle of face tissue including the nose and mouth was taken from a brain-dead female donor and grafted onto the patient. Scientists elsewhere have performed scalp and ear transplants. However, the claim is the first for a mouth and nose transplant. Experts say the mouth and nose are the most difficult parts of the face to transplant.

In 2004, the same Cleveland Clinic, became the first institution to approve this surgery and test it on cadavers. In October 2006, surgeon Peter Butler at London‘s Royal Free Hospital in the UK was given permission by the NHS ethics board to carry out a full face transplant. His team will select four adult patients (children cannot be selected due to concerns over consent), with operations being carried out at six month intervals. In March 2008, the treatment of 30-year-old neurofibromatosis victim Pascal Coler of France ended after having received what his doctors call the worlds first successful full face transplant.

Ethical concerns, psychological impact, problems relating to immunosuppression and consequences of technical failure have prevented teams from performing face transplant operations in the past, even though it has been technically possible to carry out such procedures for years.

Mr Iain Hutchison, of Barts and the London Hospital, warned of several problems with face transplants, such as blood vessels in the donated tissue clotting and immunosuppressants failing or increasing the patient’s risk of cancer. He also pointed out ethical issues with the fact that the procedure requires a “beating heart donor”. The transplant is carried out while the donor is brain dead, but still alive by use of a ventilator.

According to Stephen Wigmore, chair of British Transplantation Society’s ethics committee, it is unknown to what extent facial expressions will function in the long term. He said that it is not certain whether a patient could be left worse off in the case of a face transplant failing.

Mr Michael Earley, a member of the Royal College of Surgeon‘s facial transplantation working party, commented that if successful, the transplant would be “a major breakthrough in facial reconstruction” and “a major step forward for the facially disfigured.”

In Wednesday’s conference, Siemionow said “we know that there are so many patients there in their homes where they are hiding from society because they are afraid to walk to the grocery stores, they are afraid to go the the street.” “Our patient was called names and was humiliated. We very much hope that for this very special group of patients there is a hope that someday they will be able to go comfortably from their houses and enjoy the things we take for granted,” she added.

In response to the medical breakthrough, a British medical group led by Royal Free Hospital’s lead surgeon Dr Peter Butler, said they will finish the world’s first full face transplant within a year. “We hope to make an announcement about a full-face operation in the next 12 months. This latest operation shows how facial transplantation can help a particular group of the most severely facially injured people. These are people who would otherwise live a terrible twilight life, shut away from public gaze,” he said.

Wednesday, September 3, 2008

United States hard rock band Great White has filed a settlement offer of US$1 million to families of victims of the Station nightclub fire. 100 people died including band guitarist Ty Longley and over 200 were injured in the February 2003 disaster in Rhode Island.

The fire started when band manager Daniel Bichele ignited pyrotechnics towards the beginning of a concert by Great White at the club. Cheap packing foam had been used as soundproofing material to surround the stage, and this ignited. Great White were never charged, but Bichele was given a 15-year sentence with 11 of those suspended in 2006 for 100 counts of involuntary manslaughter, to which he pleaded guilty. He was paroled in March this year.

The settlement offer would need to be approved by each of the over 300 plaintiffs, as well as the federal judge. It would add to $175 million already offered by dozens of defendants in the case. No money has been handed out to any of the claimants as yet, and a law professor from Duke University has been hired to develop a formula that will determine how much each party is entitled to.

The fire was the fourth-deadliest nightclub fire in US history.

Sunday, January 10, 2010

Chinese officials have said that their country’s exports surged last December to edge out Germany as the world’s biggest exporter.

The official Xinhua news agency reported today that figures from the General Administration for Customs showed that exports jumped 17.7% in December from a year earlier. Over the whole of 2009 total Chinese exports reached US$1.2 trillion, above Germany’s forecast $1.17 trillion.

Huang Guohua, a statistics official with the customs administration, said the December exports rebound was an important turning point for China’s export sector. He commented that the jump was an indication that exporters have emerged from their downslide.

“We can say that China’s export enterprises have completely emerged from their all-time low in exports,” he said.

However, although China overtook Germany in exports, China’s total foreign trade — both exports and imports — fell 13.9% last year.

Monday, April 6, 2009

Over 1,600 volunteers registered to help build approximately 65,000 of the 500,000 sandbags to create dikes 20.5 feet (6 metres) high to protect the City of Winnipeg, Manitoba in the war against the Red River of the North flood.

700 volunteers answered at the rural municipality of St. Andrews alone. Once sandbags are filled for West St. Paul, St. Andrews, and Selkirk, then frozen culverts must be cleared.

The height of the river is expected to be Thursday, and predictions are that it will be less than Flood of the Century of 1997. There is no precipitation in the forecast, and snow in the province should be melted by the end of the week.

“The fear right now is we have to get that ice out of the river. The Amphibex [Excavators] are still working and breaking the ice apart, and everyday we buy with the warm weather and the current, it is thinning the ice down a bit, so when it does start to move, the better chance it’ll move right out into the lake,” said Paul Guyder, the emergency coordinator for the RMs of St. Andrews and St. Clements.

“I feel that we’ve done everything humanly possible to get ready,” said Gary Doer, Premier of Manitoba, “But … there are fallibilities with human behaviour. We can take every preventative measure as human beings possible and we can still get Mother Nature proving again she is superior.”

Communities with ring diking will partially or fully close their dikes at the beginning of the week. Provincial officials are considering opening the Red River Floodway gates around mid-week before ice is fully melted.

Ice jams could cause flooding within the city, however opening the gates could spare neighbourhood flooding when the river rises to the estimated 6.3 meters (20.7 feet) height. The province does have back up plans for dealing with ice jams within the city if they do occur. The unpredictability of ice jams and the ensuing water level rise may cause neighbourhood flooding. The city is raising dikes where the river has jammed with ice in the past such as on tight curves and past bridges. Likewise there are excavators and backhoes positioned at these points.

Vulnerable neighbourhoods on the river banks have been reinforced with sandbag dikes at vulnerable areas from the massive volunteer effort over the weekend. Guyader feels no more extra volunteers are needed, however volunteers are still being asked to leave their names and number in case of unpredicted need. Existing personnel will assess roads, and help with clean up.

Approximately 400 of the 800 people who evacuated the Roseau River Anishinabe First Nation have returned to their homes.

Former Premier, Dufferin Roblin, brought forward the floodway as a protection for Winnipeg residents and economy following the 1950 Red River Flood. The Red River floodway, “Duff’s Ditch” was finally finished in 1968, and its floodway gates have been opened 20 times saving Winnipeg from an estimated CA$10 billion in damages. The floodway expansion began in 2005 at a price of $665 million.

Polish and Chinese experts have come to survey the Red River Floodway, and Dennis Walaker, mayor of Fargo, North Dakota recognises the need for Red River flood defences down river. “Every town that you drive by from the Canadian line up to Winnipeg is either elevated or ring-diked,” said Walaker.

Wednesday, January 28, 2009

Marvin Schur, a 93-year-old man from Bay City, Michigan has died after the electric company limited his electric use due to his failure to pay over US$1,000 in past-due payments.

Bay City Electric Light & Power installed a power-limiting device on his home on January 13. The device would limit the amount of power the resident uses and would essentially shut it off if that limit is reached, or if the resident fails to pay the outstanding bill within 10 days of installation. In order for the electricity to be turned back on, the limiter must be reset by pushing a button.

Bay City power says that a warning, indicating that the power was to be turned off and a limiter installed, had been placed on Schur’s front door. Despite that, the company says that they are now “looking at our website and possibly doing an automated phone message. We obviously need to get the word out.”

The autopsy performed on Schur’s body concluded that he had died “a slow, painful death” caused by hypothermia. Dr. Kanu Virani, who performed the autopsy, explained: “Hypothermia shuts the whole system down, slowly. It’s not easy to die from hypothermia without first realizing your fingers and toes feel like they’re burning.”

It was less than 32 degrees Fahrenheit (0 Centigrade) in Schur’s home when neighbors found Schur dead on January 17. Virani commented that it was his first time performing an autopsy on a body in which “the person froze to death indoors.”

“His furnace was not running – the insides of his windows were full of ice the morning we found him,” said George A. Pauwels Jr., who was with his wife when they found Schur’s body.

In Michigan it is illegal for a utility company to disconnect power to any home between November 1 and March 31 when a resident is over the age of 65. Limiters are also not supposed to be used during that time frame. However, municipally-owned electric utilities like the one in Bay City, are not regulated by the state. The Michigan state attorney general’s office has launched an investigation into the incident.

Residents around Schur’s home say he was hard of hearing, and the city states that the device’s function and operation were never explained to him. When word of the story got around, people from all over the United States began to call the city in anger.

“I’ve taken calls from Canada, Massachusetts, Texas, New York, Alabama – and that’s just the ones I can think of off the top of my head,” said Melody Roth of the city’s administrative office, who also added that people from all over are “calling all city departments, not just our office.”

Schur has no known children, and his wife had died several years prior to the incident.

Thursday, February 10, 2011

Calgary city council voted 10 to 3 on Wednesday to stop fluoridating their water supply. This overturns a previous plebiscite from 1989 to add the fluoride in an attempt to reduce tooth decay.

Opponents of water fluoridation claim that there could be unknown health effects of fluoride, and question its effectiveness in preventing tooth decay. They also claim that individuals should be able to decide for themselves whether or not to use fluoride. However, Alberta Health Services maintains that current evidence shows that fluoride is both safe, and beneficial to dental health.

It is estimated that no longer fluoridating the water supply could save Calgary’s city council C$750 thousand (€550 thousand) annually, as well as cutting a C$6 million (€4.3 million) upgrade to the fluoridation system.