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Md.
Surgeons Remove Donated Kidney Through
Surgeons removed a woman's kidney through her vagina so she
could give it to her ailing niece, an unusual operation they
hope will encourage others to donate because it reduces pain,
scarring and recovery time. Doctors at Johns Hopkins University
School of Medicine said donor Kimberly Johnson, 48, and her
niece, Jennifer Gilbert, 23, were both doing well following
operations Thursday.
"It was easier than childbirth," said Johnson, who has
three children.
Transvaginal kidney removals have been done before to
remove cancerous or nonfunctioning kidneys, and other diseased
organs have also been removed through mouths and other orifices.
Many donated kidneys are removed laparoscopically, through small
keyhole incisions.
But hospital officials think this may be the first time a
donor kidney was removed through the vagina.
The operation left three pea-size scars on the Lexington
Park woman's abdomen, one hidden in her navel. Surgeons hope the
procedure will lead more women to become donors, said Dr. Robert
Montgomery, chief of the transplant division at Johns Hopkins,
who led the team that performed the surgery.
Johnson said the operation was less painful than gall
bladder surgery and she is recovering more quickly than
Gilbert's father, who gave his daughter a kidney 12 years ago.
Gilbert, of Baltimore, needed the first transplant because
repeated infections had destroyed the kidneys she was born with.
She needed the second after she began suffering chronic
rejection.
Johnson, an assistant sales manager for a St. Mary's County
newspaper, said she was able to get out of bed Thursday night,
the same day the kidney was removed.
Quicker recovery and less pain are the key benefits of the
new technique, said Montgomery and Dr. Anthony Kalloo, the
director of the Division of Gastroenterology at Johns Hopkins
and a pioneer of the method of using natural orifices for organ
removal.
Kalloo said more than 300 such surgeries have been
performed worldwide, mostly gall bladder and appendix removal
through the mouth, anus and vagina. Kalloo said there has been
some resistance in the medical community because of concerns,
for example, that stomach acid could leak into the abdominal
cavity in operations where organs were removed through the
mouth.
Dr. Jihad Kaouk, a urologist and director of the Cleveland
Clinic's Center for Laparoscopic and Robotic Surgery, is among
those concerned about contamination. He was not involved in
Johnson's surgery.
"There is the risk of infection having the kidney passing
through a contaminated area and then going to another patient
who is immunocompromised," Kaouk said. "That is the concern we
have and we would like to monitor the outcome in that regard."
In Johnson's case, Montgomery said a plastic bag placed
into her abdominal cavity through a tiny incision protected the
donated kidney from contamination by bacteria and other
organisms in her vagina. Johnson was chosen because she has had
a hysterectomy, which made the operation easier, but the
procedure could be used without affecting women's ability to
give birth, he said.
More than 78,000 people are on the national waiting list to
receive kidneys from deceased donors. The need is increasing as
diabetes and obesity rise, threatening to further lengthen a
wait that can last years. In 2007, more than a third of the
16,629 kidneys transplanted in the U.S. came from living donors,
according to the United Network for Organ Sharing.
Montgomery
said the number of living donor transplants has tripled since
laparoscopic removal debuted in 1995, providing an alternative
to so-called "shark bite" abdominal incisions. He hopes advances
such as the vaginal removal will continue the increase.
"We think she'll be probably back to her normal activities
within a week or two," the transplant surgeon said. Recovery
from laproscopic surgery typically takes several weeks. "So,
that greatly reduces the inconvenience of donating and we're
hoping that will encourage more people to donate."###
Doctors
Test Latest Attempt At Artificial Liver
There's help for failing kidneys and failing hearts. But
there's no fix for a dying liver. Doctors are trying to change
that at a few hospitals around the country, testing a machine
packed with human liver cells as a last-ditch chance to survive
sudden liver failure.
The experiment is the latest in a decades-long quest for an
artificial liver, a device that could temporarily take over some
of the liver's jobs much like dialysis helps kidneys work and
cardiac pumps squeeze a flabby heart.
Unlike those organs, a damaged liver sometimes regenerates
if it has enough recovery time. If it's too far gone, a
transplant is the only option but a dying liver starts a fast
chain reaction where kidneys shut down, bleeding begins and
patients fall into a coma, often too sick to try a transplant
even if an organ could be found soon enough.
The goal: To help such patients stabilize enough for a
transplant, or even to avoid one.
"It doesn't replace a liver," cautions Dr. Todd Frederick
of California Pacific Medical Center.
But, "if we could buy some time while the liver is
recovering, that potentially would be a great advance," says Dr.
Lena Napolitano of the University of Michigan, who like
Frederick is helping test the ELAD, or "extracorporeal liver
assist device."
Elizabeth Blaj of San Diego credits the machine with doing
just that.
"I believe that machine kept me alive for five days," says
Blaj, 40, whose doctors at the Scripps Clinic expected her to
die before a liver arrived for emergency transplant last
October.
"I'm just eternally grateful," she said.
The problem: Previous attempts have seemed promising, too,
only to fizzle later. A Mayo Clinic review last year found half
a dozen different methods under development but none yet proven
to reduce death. In fact, the maker of an earlier version of the
ELAD went bankrupt in the midst of a 2002 study that gave some
hints the device might help at least sometimes.
Early on, scientists focused on just one of the organ's
jobs, to filter poisons out of blood. One such filter is sold
today to help treat drug overdoses.
But a liver does more than filter. It also creates a stew
of different chemicals crucial for such things as metabolism and
blood-clotting. So scientists are trying to add living liver
cells from pigs or people to filtering machines in hopes of
better mimicking the full organ.
The first pig cell-powered machine failed to win Food and
Drug Administration approval despite some tentative evidence
that it improved outcomes.
Now enter the ELAD, powered by human liver cells. It "comes
closer to replacing the amount of liver" people need, says Dr.
Robert Brown of New York-Presbyterian Hospital and Columbia
University, who has helped test most of the devices to date.
Proving whether the machine makes a difference is tough:
Doctors have to choose patients sick enough to benefit but not
so sick "that a little bit of liver won't do the trick," Brown
says.
There are nearly 28,000 deaths a year in the U.S. from
liver disease, and fewer than 6,000 liver transplants. Eligible
for the experiment are a subgroup: People with conditions slowly
damaging their livers, such as hepatitis or cirrhosis, when
something an infection, often abruptly pushes them over the
edge into full-fledged liver failure. About half die.
The FDA is asking if three to 10 days of ELAD liver support
improves 30-day survival over the similarly ill who get today's
standard supportive care. Among the safety issues to get close
scrutiny: The device's cells initially were derived from a liver
tumor and are encased to ensure none of those cells enter a
patient's body. Doctors also will ask if any benefit is big
enough to cover what could be a $30,000 price tag.
Manufacturer Vital Therapies Inc. says that among the first
49 patients it studied in China, where liver failure is more
rampant, 85 percent given ELAD therapy survived short-term
compared with half of patients given regular care.
In the U.S., the study just began in October, too soon for
any conclusions. But Michigan's Napolitano notes that kidney
dialysis had a similarly rocky start in tests of the dying
before doctors could determine how it best worked and use it on
the less sick an ultimate goal for whatever artificial liver
scientists eventually develop.
"It's a challenging technology to test. It's a very
challenging cohort of patients because they're so sick," agrees
Dr. Winfred Williams of Massachusetts General Hospital. But he's
testing ELAD again because of a 2002 patient, Kevin Fitzmaurice
of Boston who started emerging from a five-day coma after a day
of the liver-supporting therapy.
"The nurses fairly accosted me at the door to say he was
waking up," Williams recalls, and a few days later Fitzmaurice
was stable enough to transplant. "Had he not gotten onto the
ELAD support, he would not have survived."
Now 55, Fitzmaurice says his donated liver is doing
great###
Dutch
report 3rd Death From Human Form Of Mad Cow
A third person has died in the Netherlands from variant
Creutzfeldt-Jakob Disease, the human form of mad cow disease,
the National Institute for Public Health and the Environment (RIVM)
said.
The RIVM said late on Monday the patient died at the
beginning of January and investigations were underway to assess
whether other people could have been infected, although the
chances were small.
Two other deaths from the human form of the disease were
confirmed in the Netherlands in 2005 and 2006.
Mad cow disease, or bovine spongiform encephalopathy (BSE),
is a fatal brain disease in cattle, and it is believed humans
can contract a fatal variation of it by eating infected parts of
animals suffering from the disease.
It first emerged in Britain in the 1980s and has been found
in herds in several European and other countries. Scientists
believe it is transmitted through infected meat and bone meal
fed to cattle.
The European Union banned the use of animal and bone meal
in animal feed in 2001 in order to prevent the spread of mad cow
disease and vCJD.###
Mental
Illness Alone Is No Trigger For Violence
A new large study challenges the idea that mental illness
alone is a leading cause of violence. Researchers instead blame
a combination of factors, specifically substance abuse and a
history of violent acts, that drives up the danger when combined
with mental illness in what they call an "intricate link."
People with serious mental illness, without other big risk
factors, are no more violent than most people, according to the
study of more than 34,000 U.S. adults. The research was released
Monday in Archives of General Psychiatry.
"Mental illness can provide the knee-jerk explanation for
the Virginia Tech shootings," but it's not a strong predictor of
violence by itself, said lead author Eric Elbogen of the
University of North Carolina at Chapel Hill School of Medicine.
Elbogen compiled a "top 10" list of things that predict
violent behavior, based on the analysis.
Younger age topped the list. History of violence came next,
followed by male gender, history of juvenile detention, divorce
or separation in the past year, history of physical abuse,
parental criminal history and unemployment in the past year.
Rounding out the list were severe mental illness with substance
abuse and being a crime victim in the past year.
After the 2007 Virginia Tech killings by a student ordered
to get psychiatric treatment, some states considered laws adding
mental health questions to background checks for gun buyers or
denying weapons to people who've been involuntarily committed
for mental health treatment.
The new research, which bolsters other similar findings,
raises questions about such laws, experts said. Such legislation
may be both ineffective and discourage people who need help from
getting treatment.
"We are being misled by our own fears," said Columbia
University psychiatry professor Dr. Paul Appelbaum, who wasn't
involved in the new study. "We ought to be concerned about
providing good treatment and helping people lead fulfilling
lives, not obsessed with protecting ourselves from phantom
threats that appear to be unrelated to mental illness."
U.S. systems to treat mental illness and substance abuse
are separate, uncoordinated and could do a better job treating
people with both problems, Appelbaum said.
For the new study, the researchers analyzed data from the
National Epidemiologic Survey on Alcohol and Related Conditions.
The original survey in 2001-2002 involved more than 43,000
face-to-face interviews with a representative sample of American
adults. Three years later, many of the same people, more than
34,000, were interviewed again.
Questions about violence in both interviews included:
_"Ever use a weapon like a stick, knife or gun in a fight?"
_"Ever hit someone so hard that you injured them or they
had to see a doctor?"
_"Ever start a fire on purpose to destroy someone's
property or just to see it burn?"
_"Ever force someone to have sex with you against their
will?"
From the responses, the researchers determined what
elements raised the risk of violent behavior.
There were 3,089 people deemed to have severe mental
illness schizophrenia, bipolar disorder and major depression
but no history of either violence or substance abuse. They
reported very few violent acts, about 50, between interviews.
But when mental illness was combined with a history of
violence and a history of substance abuse, as in about 1,600
people, the risk of future violence increased by a factor of 10.
The relationship between mental illness and violence is
there, "but it's not as strong as people think," Elbogen said.
Predicting who will act violently is complex, said John
Monahan, a psychologist at University of Virginia's law school,
who has done similar research but was not involved in the new
study.
"It is true that our crystal balls are very murky," Monahan
said. "The vast majority of violence that occurs in American
society has absolutely nothing to do with mental illness."
The large national survey, conducted by the National
Institute on Alcohol Abuse and Alcoholism, included people
living in shelters, hotels and group homes, as well as houses
and apartments, but it didn't include people living in
hospitals, jails or prisons.
Rosanna Esposito of the nonprofit Treatment Advocacy Center
in Arlington, Va., applauded the study but pointed out the
researchers weren't able to analyze whether the subjects were in
psychiatric treatment or not. Medication for serious mental
illness can reduce the risk of violence, she said..###
Study
Finds One-third Of Us Kids Take Vitamins
About a third of U.S. children and teens take vitamins,
even though most of those taking the pills are healthy, active
kids who probably don't need them, a new study suggests.
Youngsters who could benefit the most from vitamins kids in
fair or poor health with the worst eating habits were the least
likely to take them, researchers reported.
The survey of parents of children aged 2 to 17 was done
from 1999-2004. The results show a decline in vitamin use from
the 1970s when roughly half of all American children took
vitamins, the study's lead author said.
The study highlights a question doctors often get from
parents: Should I give my kids vitamins?
Stacy Fournier, of Gainesville, Fla., says it's often on
her mind even though her daughter is a great eater.
"I probably bring it up every other time we visit the
pediatrician because it is looming on my mind and I want to make
sure that she's healthy," said Fournier, whose daughter is
almost 3.
For now, Fournier has heeded her doctor's advice against
it, but she still wonders, "Why not? It can't hurt."
The study's lead author, Dr. Ulfat Shaikh, a pediatrician
at the University of California-Davis Children's Hospital in
Sacramento, says taking daily multivitamins in the dose
recommended on the label probably is harmless. However, they
often aren't needed for healthy children with a varied diet, she
said.
Shaikh said kids in the study "who had the ideal profile
higher dietary fiber intake, higher milk intake, lower total fat
and cholesterol intake, lower computer use, greater physical
activity, lower obesity, kids that had insurance coverage, had
good health care access, whose parents said that they were in
good health these kinds of kids were the highest users."
She noted that vitamin and mineral supplements aren't
cheap. A bottle of 100 multivitamin-mineral tablets for kids can
cost around $10, depending on the brand. Almost $2 billion is
spent on them annually.
Also, some parents and teens may mistakenly think taking a
daily pill will make up for a lousy diet, Shaikh said.
Pediatricians generally agree that the best source for vitamins
and minerals is a varied diet that includes fresh fruit,
vegetables and fiber not pills.###
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