Wardens

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Obviously this surgery has implications for autotransplantation for numerous organs, but this seems like an extraordinary opportunity for otolaryngologists in the states. How commonly do thoracic surgeons opperate on the trachea outside of lung transplant? I'm not sure if this is typically their terrain or ours, but I foresee a new turf war developing here.

Pioneering Stem Cell Surgery Announced
By ALAN COWELL
Published: November 19, 2008

PARIS -- Physicians at four European universities have completed what they say is the first successful transplant of a human windpipe using a patient’s own stem cells to fashion an organ and prevent its rejection by her immune system, according to an article in the British medical journal The Lancet. One of the physicians said the surgery could herald a “new age in surgical care.”

The transplant operation was performed on the patient, Claudia Castillo, in June in Barcelona, Spain, to alleviate an acute shortage of breath caused by a failing airway following severe tuberculosis. It followed weeks of preparation carried out at the universities of Barcelona, Spain, Bristol, England and Padua and Milan in Italy.

News of the procedure coincided with speculation that President-elect Barack Obama may reverse the Bush Administration’s restrictions on stem cell research, which has been contentious in some European countries, too. Anthony Hollander, a professor at Bristol University, said ethical concerns relating to embryonic stem cell research had not surfaced in the latest procedure because it had used only the patient’s own stem cells. “This was not embryonic stem cell research,” he said in a telephone interview.

Ms. Castillo, 30, was hospitalized in March with her windpipe so badly damaged by tuberculosis that she was unable to walk more than a few steps at a time, according to a statement from Bristol University.

“The only conventional option remaining was a major operation to remove her left lung which carries a risk of complications and a high mortality rate,” Bristol University said.

The surgery represented what the university called “pioneering work.”

“We are terribly excited by these results,” said Prof. Paolo Macchiarini of the University of Barcelona, who performed the operation. “Just four days after transplantation the graft was almost indistinguishable from adjacent normal bronchi.”

Moreover, two months after the surgery, lung function tests on Ms. Castillo “were all at the better end of the normal range for a young woman,” the Bristol University statement said.

Martin Birchall, a professor at the university, said the transplant showed “the very real potential for adult stem cells and tissue engineering to radically improve their ability to treat patients with serious diseases. We believe this success has proved that we are on the verge of a new age in surgical care.”

The Bristol University statement said a segment of trachea, roughly three inches long, was taken from a 51-year-old donor who had died of a cerebral hemorrhage. Using a new technique developed in Padua University, the trachea was stripped of its donor’s cells over a six-week period “so that no donor cells remained,” the statement said.

At the same time, at Bristol University, stem cells removed from Ms. Castillo’s bone marrow, were grown into “a large population” and used to “seed” the donated windpipe using a new technique developed in Milan to incubate cells.

Four days after the seeding, the graft was used to replace Ms. Castillo’s damaged windpipe.

Normally after transplants there is a high risk of rejection because the recipient’s immune system reacts against the foreign organ. Most transplant patients, thus, use immunosuppressant drugs to prevent rejection.

“The patient has not developed antibodies to her graft, despite not taking any immunosuppressive drugs,” the statement from Bristol University said
 

resxn

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Seriously? A turf war?

Turf wars develop over lucrative relatively easy surgeries, not over complex, multidisciplinary procedures.

ENT's rarely operate on the trachea (from an external approach anyway) much below the subglottis and cardiothoracic guys rarely travel above the subglottis, many not even that high. This is not and will not be a turf war--it will be the next coolest thing in select Ivory Towers, that's it.

in my humble opinion.
 

Wardens

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Yeah, since I'm not practicing yet I guess I'm not familiar with "turf wars" per se. I had seen some research from the otolaryngology department at Case where they've been working on creating an artificial trachea, so I figured the two fields might be competing at least in research to some extent. It's still a cool procedure in which some ENT ivory tower in the States could become involved.
 
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Neuropathia

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“The only conventional option remaining was a major operation to remove her left lung which carries a risk of complications and a high mortality rate,” Bristol University said.

Can anybody explain that to me? How would the removal of her left lung have helped her if the problem was in the trachea?
 

resxn

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My guess is that the constriction which extended from the trachea into the primary bronchi was so severe that it prevented mucociliary clearance which caused pooling and secondary infection of the lung leading ultimately to recurrent empyemas and other lung badness. Additionally, the changes in the pulmonary inspiratory effort certainly could lead to negative pressure pulmonary edema resulting in the same thing. Overall, this could also lead to pulmonary hypertension with shunting, R-sided heart failure, etc, etc. Without correcting the stenosis, pneumonectomy was the only other reasonable option for what sounds to be end-stage organ failure.

That's just a guess based on what's been revealed in the media.
 
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