Health Newsletter:January 2006
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Contents |
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.
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
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
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
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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