Delaine's General Health Blog

Delaine Griffin

By Denise Mann
HealthDay Reporter

WEDNESDAY, Dec. 28 (HealthDay News) -- Full face transplants were once the stuff of science fiction, but not anymore.

So far, 18 such transplants have been done worldwide, and U.S. surgeons describe the intricate procedures in the Dec. 28 online edition of the New England Journal of Medicine.

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The article details the stories of three face transplants that were performed at Boston's Brigham & Women's Hospital in 201l, including the much-publicized case of Charla Nash, who lost most of her face in a chimpanzee attack.

While some technical challenges remain, surgeons say they are getting better and better at performing face transplants.

"We don't know how common or rare this operation will be, but it is here to stay," said Dr. Bohdan Pomahac, the director of the plastic surgery transplantation program at Brigham & Women's. He was the lead surgeon on all three cases described in the journal report.

These lengthy and complex surgeries are reserved for individuals with severe facial deformities, but as techniques and technology improve, transplants could become an option for patients with lesser degrees of facial deformity.

Who's a candidate? According to the doctors, prospective recipients first undergo extensive medical and psychological evaluation. If they are deemed to be appropriate candidates, surgeons then begin their search for suitable donors and start to plan the surgery.

Each operation is unique and can take more than 20 hours to complete. In general, surgeons will first remove any non-viable or injured tissue from the face transplant recipient. The healthy tissue, once procured from suitable donor, is then attached. This is not a simple task -- surgeons must restore blood flow, reattach nerves, muscles and bony structures, and then reconnect each layer of the new face.

Even so, "the hardest part is the recovery of the donor face," Pomahac said. After the transplant is complete, surgeons must be on the lookout for any signs of rejection and other side effects, such as infection. These risks are highest during the first 24 hours after surgery. "There can be clotting in the vessels that are re-connected, and we use high doses of immune suppression for a first couple of days so the patient is more susceptible to infection," he explained.

In the beginning, the patient's new face is swollen and has no motion. "Most of the swelling goes down in six weeks and then you regain motor function in three to six months," he said. Many of these patients are eating within a few days. "They get better and better each time we see them," he said.

Unlike in the movies, the patient does not wake up with the face of the donor, Pomahac stressed. Instead, the new face is more of a hybrid between donor and recipient. "It is surprisingly easy to get used to," he said. "They have new faces, but they still have a way of speaking and have the same body language."

Another study author , Dr. Daniel S. Alam, is the head of the section of facial aesthetic and reconstructive surgery in the Head and Neck Institute at the Cleveland Clinic in Ohio. He said the new article is important because it is the first time face transplants have been reported as a series of cases.

Alam was involved with Nash's surgery, and also performed the first U.S. face transplant -- on gunshot victim Connie Culp, in December of 2008.

"Five years ago, we didn't know if this could be done. Full face transplants can be done technically, they can be done safely and patients can get a lasting benefit," he said. The new study's publication marks "the end of the first chapter and now we need Chapter Two, to see who is the right patient and work toward making the surgery better and better," Alam said.

That remains a work in progress. "Surgeons have been taking gall bladders out for years [for example], but we are extremely early in our learning curve for face transplants," he said.

Another expert agreed.

"Face transplants are here to stay," said Dr. Edwin F. Williams III, a facial plastic surgeon in Albany, N.Y., and vice president of public affairs at the American Academy of Facial Plastic and Reconstructive Surgery.

However, he added, "we really need to move forward carefully and they won't be something that happen in every small town and city."

SOURCES: Edwin F. Williams III, M.D., facial plastic surgeon, Albany, N.Y., vice president, public affairs, American Academy of Facial Plastic and Reconstructive Surgery; Daniel S. Alam, M.D., head, section of facial aesthetic and reconstructive surgery, Head and Neck Institute, Cleveland Clinic, Ohio; Bohdan Pomahac, M.D., director, plastic surgery transplantation program, Brigham &Women's Hospital, Boston; Dec. 28, 2011, New England Journal of Medicine, online

Source: http://www.medicinenet.com/guide.asp?s=rss&k=DailyHealth&a=153138

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Delaine Griffin

By Stephen Robinson, 22 December 2011

Andrew Lansley: we must get better value for every pound spent

A DH report found that while the NHS was on course to meet its �20 billion efficiency savings target by 2015, PCTs stand to make even deeper cuts in the next six months than they have done so far in 2011.

Health secretary Andrew Lansley insisted the austerity drive 'does not mean cutting services'.

PCTs must average savings of �5bn per year by 2015 to meet the �20bn Quality, Innovation, Productivity and Prevention (QIPP) goal.

The report by the NHS deputy chief executive David Flory said PCTs had estimated they would save �5.9 billion from their spending in 2011/12.

Trusts have saved �2.5bn in the first six months of the year. But the rate of saving must increase further if the �5.9bn estimate is to be met.

The report, which covered the period July-September 2011, said: 'Whilst the NHS has reported a significant saving in the first six months of the financial year, it will need to continue with this focus, delivering further savings, whilst driving up quality, to achieve the forecast �3.4 billion savings in the second half of the year.'

Primary care is set for even deeper cuts. Of planned savings worth �214m in primary care, including dental, pharmacy and ophthalmic, just �97 have been made in the first six months of this year.

The report found further evidence of the squeeze occurring on GP referrals, as reported by GP in September when concerns were raised about the pressure on the profession to reduce use of diagnostic scans.

Mr Flory's report said: 'We have noted a reduction in GP written referrals into the acute sector, which is a positive indication of active GP engagement with QIPP and demonstrates a focus on referral practices to begin to shape service delivery for the future.'

The DH said quality of services had been maintained or improved despite the cuts. MRSA and C. difficile infections in hospital settings continued to fall, at 33% and 16% lower respectively than the same period in 2010.

On announcing the report, Mr Flory said: 'The NHS is in the early stages of its plans to deliver up to �20bn of efficiency savings by 2014/15 whilst maintaining or improving quality. The results from the second quarter of 2011/12 are encouraging, showing the NHS continues to deliver strongly for patients while maintaining a healthy financial position.'

Health secretary Andrew Lansley said: 'We know that despite the increase in funding, the NHS needs to save up to �20 billion from within its budget to meet these future challenges. Where the NHS can do things better and save money to reinvest in patient care, it must do so.'

He added: 'We are absolutely clear that this does not mean cutting services - this means getting better value for every pound spent in the NHS so that it can continue to improve and deliver better services for patients every day.'

Source: http://www.gponline.com/channel/news/article/1110332/pcts-ratchet-cuts-meet-efficiency-drive/

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Delaine Griffin

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WEDNESDAY, Dec. 28 (HealthDay News) -- A new examination of the origin of syphilis supports the theory that the sexually transmitted disease was carried to Europe aboard Christopher Columbus' ships as they sailed home from the New World.

The disease was not spread through sexual contact at the time, but adapted to survive once it got to Europe, Emory University researchers say.

"Syphilis has been around for 500 years," study co-leader Molly Zuckerman, a former Emory graduate student who is now an assistant professor at Mississippi State University, said in an Emory news release. "People started debating where it came from shortly afterwards, and they haven't stopped since. It was one of the first global diseases, and understanding where it came from and how it spread may help us combat diseases today."

After analyzing skeletal evidence in 54 published reports, the researchers found that syphilis did not exist in Europe until after Columbus' historic voyage to the New World in 1492. They said that most of the skeletal material lacked characteristics that would meet standard diagnostic criteria for chronic syphilis, such as small holes on the skull and long bones.

It appears that skeletons previously considered evidence of syphilis in Europe before Columbus' trip were dated incorrectly because of seafood consumption, which would have altered the collagen levels of the skeletons, the researchers said.

Their appraisal is published in the Yearbook of Physical Anthropology.

"This is the first time that all 54 of these cases have been evaluated systematically," said study co-author George Armelagos, an anthropologist at Emory, in the news release. "The evidence keeps accumulating that a progenitor of syphilis came from the New World with Columbus' crew and rapidly evolved into the venereal disease that remains with us today."

The researchers suggested someone sailing with Columbus brought Treponema -- the bacteria that causes syphilis -- to Europe. This type of bacteria also causes other diseases that are spread through skin-to-skin or oral contact in tropical climates. Their theory is that the bacteria mutated into the sexually transmitted form to survive in the cooler and more sanitary conditions of Europe.

"In reality, it appears that venereal syphilis was the byproduct of two different populations meeting and exchanging a pathogen," Zuckerman said. "It was an adaptive event, the natural selection of a disease, independent of morality or blame."

The researchers said more study is needed to confirm their findings. "The origin of syphilis is a fascinating, compelling question," Zuckerman said. "The current evidence is pretty definitive, but we shouldn't close the book and say we're done with the subject. The great thing about science is constantly being able to understand things in a new light."

-- Mary Elizabeth Dallas

SOURCE: Emory University, news release, Dec. 20, 2011

Source: http://www.medicinenet.com/guide.asp?s=rss&a=153126&k=Womens_Health_General

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Delaine Griffin