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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.

Sunday, July 30, 2006

Australian Prime Minister John Howard was mobbed by protesters in Perth, Western Australia on Saturday, angry at the stance he has taken on the recent conflicts in the Middle East.

Leaving a Liberal party conference at the Hyatt Regency Hotel in the West Australian capital, Howard was mobbed by 200 protestors angry at his support for Israel and the Australian government’s lack of action.

Protestors kicked, punched and threw projectiles at the Prime Minister’s vehicle as police struggled to keep the angry mob under control. One protestor managed to break off the Australian flag attached to the front of Mr Howard’s vehicle.

Protestors, demanding a cease fire in the Middle East, chanted “we want peace” and handed out flyers proclaiming “Cluster bombs are used by Israel to burn our families in Lebanon. Is this fair?”

Police were taken by surprise at the speed by which the protest escalated into violence. “We were surprised by the approach. It was supposed to be a peaceful demonstration,” one officer said. “It had been peaceful up to that point.”

Police arrested two men and charged them with disorderly conduct.

Prior to the protest, Mr Howard told his party conference that two things must happen before peace can be realised in the middle east:

“The first is that there must be conditional acceptance throughout the entire Arab world, without exception, of Israel’s right to exist in peace and stability behind secure and internationally recognised boundaries.”

“The entire Arab world, including Hezbollah, Iran and Syria, must give up forever the idea that the Israelis can be driven from their land.”

“The second condition is that there has to be a equally unconditional acceptance, including on behalf of the Israelis, of the need and the justice of an independent Palestinian state.”

“There has to be a two-state solution.”

Sunday, June 17, 2007

The National Transportation Safety Board (NTSB), the agency responsible for investigating transportation accidents in the United States, released updates on three major investigations on June 14.

The NTSB, well known publicly for its involvement in the investigation of aviation incidents which involve harm or loss of human life, is also an agency that oversees the transportation of refined petroleum and gas products, chemicals and minerals.

The agency determined the cause of a natural gas pipeline explosion that killed six. It also detailed the cause of an accidental release of 204,000 gallons of anhydrous ammonia from a pipeline in an environmentally sensitive area, and released preliminary information involving two commercial aircraft coming within 30-50 feet of each other on a runway.

In the gas explosion disaster, the towing vessel Miss Megan, which was of specifications that did not require inspection by the United States Coast Guard, was being operated in the West Cote Blanche Bay oil field in Louisiana by Central Boat Rentals on behalf of Athena Construction on October 12, 2006. The Miss Megan was pushing barge IBR 234, which was tied along the starboard side of barge Athena 106, en route to a pile-driving location. Athena Construction did not require its crews to pin mooring spuds (vertical steel shafts extending through wells in the bottom of the boat and used for mooring) securely in place on its barges and consequently this had not been done. During the journey, the aft spud on the Athena 106 released from its fully raised position. The spud dropped into the water and struck a submerged, high-pressure natural gas pipeline. The resulting gas released ignited and created a fireball that engulfed the towing vessel and both barges. The master of the towing vessel and four barge workers were killed. The Miss Megan deckhand and one barge worker survived. One barge worker is officially listed as missing.

The NTSB blames Athena Construction for the disaster, citing in the final report that Athena Construction’s manual contained no procedures mandating the use of the safety devices on the spud winch except during electrical work. It was found that if the Athena 106 crew had used the steel pins to secure the retracted spuds during their transit, a pin would have prevented the aft spud from accidentally deploying. Furthermore, the spud would have remained locked in its lifted position regardless of whether the winch brake mechanism, the spud’s supporting cable, or a piece of connecting hardware had failed.

The NTSB also found that contributing to the accident was the failure of Central Boat Rentals to require, and the Miss Megan master to ensure, that the barge spuds were securely pinned before getting under way. The Board noted that investigators found no evidence that the Miss Megan master or deckhand checked whether the spuds had been properly secured before the tow began. While Central Boat Rentals had a health and safety manual and trained its crews, the written procedures did not specifically warn masters about the need to secure spuds or other barge equipment before navigating. The NTSB stated that the company’s crew should have been trained to identify potential safety hazards on vessels under their control.

NTSB Chairman Mark Rosenker said of the investigation’s results, “Having more rigorous requirements in place could have prevented this accident from occurring. Not only do these regulations need to be put in place but it is imperative that they are enforced and adhered to.”

The NTSB has made a number of safety recommendations as a result of this accident and the subsequent investigation. Recommendations were made to Athena Construction and Central Boat Rentals to develop procedures and train the employees of its barges to use the securing pins to hold spuds safely in place before transiting from one site to another.

The most major of the other recommendations are:

To the Occupational Safety and Health Administration:

• Direct the Maritime Advisory Committee for Occupational Safety and Health to issue the following documents document to the maritime industry: (1) a fact sheet regarding the accident, and (2) a guidance document regarding the need to secure the gear on barges, including spud pins, before the barges are moved, and detailing any changes to your memorandum of understanding with the Coast Guard.

To the U. S. Coast Guard

• Finalize and implement the new towing vessel inspection regulations and require the establishment of safety management systems appropriate for the characteristics, methods of operation, and nature of service of towing vessels.
• Review and update your memorandum of understanding with the Occupational Safety and Health Administration to specifically address your respective oversight roles on vessels that are not subject to Coast Guard inspection.

The NTSB also released the result of its investigation into an environmental disaster in Kansas on October 27, 2004 in which 204,000 gallons (4,858 barrels) of anhydrous ammonia was spilled from a ruptured pipeline in Kingman into an environmentally sensitive area. Chemicals from the pipeline entered a nearby stream and killed more than 25,000 fish, including some fish from threatened species.

The incident reached the scale that it did due to operator error after the initial rupture. The 8 5/8-inch diameter steel pipeline, which was operated by Enterprise Products Operating L.P., burst at 11:15 a.m. in an agricultural area about 6 miles east of Kingman, Kansas. A drop in pipeline pressure, indicating abnormal conditions or a possible compromise in pipeline integrity, set off alarms displayed on the computerized pipeline monitoring system. Shortly after the first alarm the pipeline controller, in an attempt to remedy the low pressure, increased the flow of anhydrous ammonia into the affected section of pipeline. A total of 33 minutes elapsed between the time when the first alarm indicated a problem with the pipeline and the initiation of a shutdown.

In its initial report to the National Response Center (NRC), the pipeline operator’s accident reporting contractor reported a release of at least 20 gallons of ammonia, telling the NRC that an updated estimate of material released would be reported at a later time. No such report was ever made. Because of the inaccurate report, the arrival of representatives from the Environmental Protection Agency was delayed by a full day, affecting the oversight of the environmental damage mitigation efforts.

The cause of the rupture itself was determined to be a pipe gouge created by heavy equipment damage to the pipeline during construction in 1973 or subsequent excavation activity at an unknown time that initiated metal fatigue cracking and led to the eventual rupture of the pipeline.

“We are very fortunate that such highly toxic chemicals of the size and scope involved in this accident were not released in a populated area,” commented Rosenker. “Had this same quantity of ammonia been released near a town or city, the results could have been catastrophic.”

As a result of this accident, the NTSB made the following safety recommendations:

To the Pipeline and Hazardous Materials Safety Administration:

• Require that a pipeline operator must have a procedure to calculate and provide a reasonable initial estimate of released product in the telephonic report to the National Response Center.
• Require that a pipeline operator must provide an additional telephonic report to the National Response Center if significant new information becomes available during the emergency response.
• Require an operator to revise its pipeline risk assessment plan whenever it has failed to consider one of more risk factors that can affect pipeline integrity.

To Enterprise Products Operating L.P.:

• Provide initial and recurrent training for all controllers that includes simulator or noncomputerized simulations of abnormal operating conditions that indicate pipeline leaks.

“The severity of this release of dangerous chemicals into the community could have been prevented,” said Rosenker. “The safety recommendations that we have made, if acted upon, will reduce the likelihood of this type of accident happening again.”

As well as concluding their investigation of the above accidents, the NTSB also released preliminary information regarding a serious runway incursion at San Francisco International Airport between two commercial aircraft on May 26, 2007.

At about 1:30 p.m. the tower air traffic controller cleared SkyWest Airlines flight 5741, an Embraer 120 arriving from Modesto, California, to land on runway 28R. Forgetting about the arrival airplane, the same controller then cleared Republic Airlines flight 4912, an Embraer 170 departing for Los Angeles, to take off from runway 1L, which intersects runway 28R.

After the SkyWest airliner touched down, the Airport Movement Area Safety System (AMASS) alerted and the air traffic controller transmitted “Hold, Hold, Hold” to the SkyWest flight crew in an attempt to stop the aircraft short of runway 1L. The SkyWest crew applied maximum braking that resulted in the airplane stopping in the middle of runway 1L. As this was occurring, the captain of Republic Airlines flight 4912 took control of the aircraft from the first officer, realized the aircraft was traveling too fast to stop, and initiated an immediate takeoff. According to the crew of SkyWest 5741, the Republic Airlines aircraft overflew theirs by 30 to 50 feet. The Federal Aviation Administration has categorized the incident as an operational error.

The NTSB sent an investigator to San Francisco, who collected radar data, recorded air traffic control communications, and flight crew statements, and interviewed air traffic control personnel prior to the NTSB making the preliminary release.

Saturday, March 1, 2008

Wikinews held an exclusive interview with Max Riekse, one of the candidates for the Constitution Party nomination for the 2008 United States presidential election.

Riekse is a retired decorated United States Lieutenant Colonel in the United States Army who served in both the Vietnam War and the Iraq War. He is also a former public school teacher and Assistant Professor of Military Science at Western Michigan University. He has a B.A. in Political Science and International Relations from the University of South Florida as well as two M.A.s, one in Political Science and International Relations, the other in Eductaion and History. Both are from Western Michigan University.

We asked him if he thinks he has a good shot at winning the Constitution Party nomination and ultimately the presidency. He replied, “I will give it my best shot because I think I can do better then all previous Constitution Party presidential candidates….As to being in the White House in 2009, realistically, its a long shot; but so was Abe Lincoln in the new Republican Party.”

When asked about America’s public school system he said, “Local school boards and the people they are responsible to are the best judge of what is needed; this with state oversight, will help boost public school quality & education.”

Riekse is running for president because he has been “very tired of our Republican and Democratic choices for president for many years. With a population of some 300 million people to draw from, I would think we could do much, much better then we have been doing in regards to having a choice for president.”

Sunday, August 21, 2005

A robotic system at Stanford Medical Center was used to perform a laparoscopic gastric bypass surgery successfully with a theoretically similar rate of complications to that seen in standard operations. However, as there were only 10 people in the experimental group (and another 10 in the control group), this is not a statistically significant sample.

If this surgical procedure is as successful in large-scale studies, it may lead the way for the use of robotic surgery in even more delicate procedures, such as heart surgery. Note that this is not a fully automated system, as a human doctor controls the operation via remote control. Laparoscopic gastric bypass surgery is a treatment for obesity.

There were concerns that doctors, in the future, might only be trained in the remote control procedure. Ronald G. Latimer, M.D., of Santa Barbara, CA, warned “The fact that surgeons may have to open the patient or might actually need to revert to standard laparoscopic techniques demands that this basic training be a requirement before a robot is purchased. Robots do malfunction, so a backup system is imperative. We should not be seduced to buy this instrument to train surgeons if they are not able to do the primary operations themselves.”

There are precedents for just such a problem occurring. A previous “new technology”, the electrocardiogram (ECG), has lead to a lack of basic education on the older technology, the stethoscope. As a result, many heart conditions now go undiagnosed, especially in children and others who rarely undergo an ECG procedure.