A new face for the transplant field

by Shannon MacKay on May 1, 2014

facetransplant

Image shows a computer illustration of the first near-full face transplant.

Face transplants were first introduced in 2005, when surgeons in France took a gamble and performed the first partial face transplant. The first transplant patient’s name was Isabelle Dinoire and she was 38 years old. Dinoire had her nose, lips, chin and parts of her cheeks removed after having been bitten by her dog earlier that year. This operation involved transplanting facial parts from a recently deceased 46-year-old woman. Dinoire reported being “very satisfied” with the surgery and her subsequent progress (The Guardian, 2012). Later, in 2010, the first full face transplant was performed in Spain. A Spaniard named Oscar had accidentally shot himself, resulting in his inability to breathe or eat on his own. Oscar underwent a 24-hour operation in which doctors removed an entire face, “including jaw, nose, cheekbones, muscles, teeth ad eyelids, from a donor and placed it mask-like on Oscar” (The Guardian, 2012). These two surgeries sparked the beginning of a whole new area in the transplant field of medicine. Many after have attempted to achieve the same success and build upon this foundation.

Now, about 10 years after the first facial transplant, 30 face transplant surgeries have been performed all over the world, including: China, United States, Spain, France, Belgium, Turkey and Poland. Recently, the “first comprehensive review of every transplant reported” has been created (Altman, 2014). This report has dispelled any legal and ethical questions regarding the procedures of these facial transplants. Additionally, it affirms that while the operation is risky and expensive, the procedure itself is generally “safe and feasible” (Altman, 2014). Candidates for face transplant surgery must be carefully selected to avoid unnecessary complications. Although there are risks associated with transplants, as there are with any surgery, they can also “ease or erase the grotesque deformities that leave them subject to taunts, discrimination, isolation and serious depression” (Altman, 2014).

In a recap of procedural results, post-transplant patients have been found to “regain their ability to eat, drink, speak more intelligibly, smell, smile and blink” (Altman, 2014). Furthermore, only three out of the thirty surgeries have ultimately resulted in the death of the patient, none of which occurred in the United States. At first the idea of a face transplant, or places someone’s face on another individual, was quite alarming. This technique, however, has proved much more successful and effective than conventional facial reconstruction. Also, “contrary to such fears, no recipient physically resembles the stranger who gave it” (Altman, 2014). According to Dr. Eduardo D. Rodriguez of NYU Langone Medical Center, “it is not as if you would recognize the donor walking down the street” (Altman, 2014).

The over arching reason for these surgical successes appears to be the strong effort to ensure patients stick to post-surgical procedures and precautions. Surgeons need candidates who “would be motivated to stick to an anti-rejection regimen and who had a strong social support system” (Altman, 2014). Working collectively as a surgical team on the many processes involved in a full face transplant also seems to be another component in the success of the surgeries. “One team removes the face and underlying tissues from a donor, while a second team removes the damaged portions of the recipient’s face” (Altman, 2014). The next steps, including arterial and nerve ending connection, must be performed cohesively and quickly, requiring a strong team to perform this procedure.

The leaders in face transplants so far have been the French, who have performed 10 face transplant surgeries. Specifically, Dr. Laurent Lantieri, a French surgeon, has performed seven face transplants. The United States and Turkey follow with the second highest numbers of transplants at seven. This large European “dominance” appears to stem from European national health plans funding the procedure, whereas in the United States private institutions and government grants fund the procedure. The United States may want to consider adopting policies similar to those of the European countries if we want to stay competitive in this matter.

All competition aside, these medical successes have given rise to ethical inquiries and a wish for regulation. Some prominent ethical questions include: “ How long should a severely disfigured individual wait after receiving other therapy before getting a face plant?” and “What should be the youngest age of eligibility?” (Altman, 2014). These ethical questions are soon to be answered as the medical field and government receive continuing pressure from this topic.

Going forward, special attention must continue to be observed during patient selection. By doing this, doctors will be able to have more successful surgeries and establish a more standard procedure for face transplants. Furthermore, legislative and ethical concerns will be addressed as more surgeries occur. This will give more background and evidence towards ideas about this topic. As for right now, face transplantation is a new great procedure that will continue to change the lives of many people, as it eventually becomes a standard technique.

 

References

 

Altman, L. K. (2014). An about-face on a risky transplant. The New York Times. Retrieved from http://www.nytimes.com/2014/04/29/health/an-about-face-on-a-risky-transplant.html?ref=science&_r=0

 

Guardian News. (2012). Face transplants – a short history. The Guardian. Retrieved from http://www.theguardian.com/science/2012/mar/28/face-transplants-history

 

Madrigal, M. (2009). [Image of person pre and post face transplant]. First near-full face transplant a success, so far. The Wired. Retrieved from http://www.wired.com/2009/02/facetransplant/


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Antibiotic Problems

by Vassilis Ragoussis on April 30, 2014

Antibiotic resistance has always been a huge concern for doctors and people all over the world, and now that problem has become a reality. This problem is caused when antibiotics are ineffective in killing or controlling bacterial growth. This causes the problem that the bacteria can continue to multiply and are hence seen as resistant. The widespread and carefree use of antibiotics has unfortunately caused this problem. This resistance causes increased healthcare costs and problems in treatment, leading to many people having to take a “cocktail” of antibiotics.

The two ways in which bacteria become resistant are as such: the mutation of genetic material, and getting the resistance from a similar bacterium. The mutation of genetic material entails an impulsive change to genetic material within the bacterium. Each different mutation that occurs can express a different sort of resistance. For example, it can lead to the bacteria to excrete chemicals that render the antibiotic ineffective. Another way the resistance can occur is by affecting the way the antibiotic works.

Some antibiotics work by stopping important molecules from binding to ribosomes where protein synthesis happens. So the mutation in the bacterium can stop this process by removing the target that the antibiotic affects.

The other way resistance occurs is by acquiring certain genes through conjugation from other bacterium. This can happen vertically when new generations of bacterium inherit the resistance. Or horizontally where the bacteria share the mutations with other such bacteria.

The more people use antibiotics the higher the chance that these mutations are realized and allowed to take effect. It is without surprise that antibiotic resistance poses a huge threat to hospitals and medical advancement. The more the mutations and resistance spread the less likely we will be able to control and prevent the spread of bacterial disease.

To combat this, doctors should be very careful in how they prescribe the antibiotic, and the patient should carefully follow the prescription instructions of taking them. A lot of patients stop taking the antibiotic when they start feeling better, however the drugs must be continued to ensure all the bacterium are either stopped or killed. If you stop the cycle of antibiotics early, some bacterium may remain. The bacterium that remains could be resistant and hence multiply and cause devastating problems, including severe problems and further illness.

Along with this, new strains of mutant bacteria can evolve where there is simply no way of treating it. This increases the chance of death in patients with infections. In Europe, 25,000 people die a year from bacterium that are resistant to drugs.

This number will only continue to rise if we do not combat the problem of overusing antibiotics. We should potentially limit antibiotic use and regularly monitor those who do.

Further complications include economic problems too. The cost of healthcare will increase dramatically as doctors and healthcare systems have to find new antibiotics that work. The increase in price of research will further increase the price of medicines meaning that a lot of the population will not be able to afford buying drugs to combat any illnesses they have.

 

References:

 

http://www.tufts.edu/med/apua/about_issue/about_antibioticres.shtml

 


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Thumbnail image for Banning Blu

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Stop A-Salting Your Food

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