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Liver Transplantation: Challenging Controversies and Topics grew out of a need I perceived within the fields of transplant hepatology and liver transplantation. Liver transplantation has rightly gained recognition as an established therapy for end-stage liver disease. Few would argue that liver transplantation is one of the few truly lifesaving and life-altering treatments within medicine and surgery. Not many realize that 20 years passed from the time of the first human liver transplantation in 1963 to its acceptance as therapy by the 1983 NIH Consensus Conference on Liver Transplantation. In 2008, 25 years will have passed since the 1983 NIH conference-a mere 25 years for a field that has provided patients hope, doctors options, and to some the "gift of life. " Many issues in liver transplantation involve indications, patient selection, and outcomes after transplantation-these are standard topics, covered by textbooks of hepatology and transplantation. In contrast, the field of liver tra- plantation is young, evolving, dynamic, and issues and decisions are often controversial. Thus, Dr. Trotter and I, as well as our colleagues at the University of Colorado, felt that a text with a different focus was required, one that highlighted controversy and challenged dogma. Out of this perceived need emerged Liver Transplantation: Challenging Controversies and Topics. To meet the transplant community's need for emerging information about liver transplantation, Dr. Larry Chan, Dr. Igal Kam, and I initiated the Controversies in Transplantation Conference.
The replacement of a diseased organ by a healthy one is a medical dream that has become a reality for thousands. Once considered experimental and highly risky, human tissue and organ transplantation is today's successful therapy for disorders affecting the heart, liver, kidney, pancreas, eyes, ears, and bone marrow. Combining advanced techniques in surgery, immunology, infectious diseases, cardiology, nephrology, psychiatry, and nursing, organ transplantation is at the forefront of medical science. Despite the advances in transplantation, the literature available to a potential transplant recipient is scant. This book, written by members of the transplant team at the Massachusetts General Hospital in collaboration with a medical journalist, is expressly created for patients and their families, the lay public, and allied health personnel. The authors present a history of human organ transplantation, a review of transplant immunology and anti-rejection drugs, a survey of the national donor organ network, a characterization of the hospital transplant team, and the process of harvesting donor organs. They also discuss the realities of surgery and recovery, potential complications, and hints for transplant recipients and their families on how to cope with the stresses of illness, the wait for a donor organ, and the transplant operation itself. In providing a picture of what to expect from an organ transplant, the authors include case studies of patients' experiences before and following transplantation, and they depict how patients and their families interact with the hospital's medical team. A s a result, this book aims to offer a sympathetic and unsensationalized guide for the more than 20,000 patients each day who await an organ transplant - and for those who are intimately involved with the patient's successful recovery.
Transplant and oncology patients present a challenge to the infectious disease specialist because many of the entities that infect them are hard to diagnose.? Chemotherapy may further complicate the situation, since it may contraindicate a biopsy or interfere with antibiotic therapy. This issue of Infectious Disease Clinics provides specific information on several entities with the purpose of helping physicians to best treat these difficult infections.
This text is designed to provide a comprehensive and state-of-the-art overview of the major issues specific to technological advances the field trauma, critical care and many aspects of surgical science and practice. Care of these patients and clinical conditions can be quite complex, and materials have been collected from the most current, evidence-based resources. The sections of the text have been structured to review the overall scope of issues dealing with trauma, critical care and surgery, including cardiothoracic surgery, vascular surgery, urology, gynecology and obstetrics, fetal surgery and orthopedics. This volume represents the most comprehensive textbook covering a wide range of topics and technological advances including genomics and nanotechnologies that affect patients' care and surgeons' practice daily. The multidisciplinary authorship includes experts from all aspects of trauma, surgery and critical care. The volume highlights the dramatic changes in the field including hand held devices and smart phones used in daily medical and surgical practice, complex computers in the critical care units around the world, and robotics performing complex surgical procedures and tissue engineering. Technological Advances in Surgery, Trauma and Critical Care provides a comprehensive, state-of-the art review of this field, and will serve as a valuable resource for clinicians, surgeons and researchers with an interest in trauma, critical care, and all the specialties of surgery. It provides a concise yet comprehensive summary of the current status of the field that will help guide patient management and stimulate investigative efforts.
Lung transplantation (LT) is the only definitive treatment for many forms of end-stage pulmonary diseases. However, its success is limited by several factors including organ infection/disease, acute rejection and chronic allograft dysfunction. Progresses made in patient selection, surgical techniques as well as in therapeutic management (immunosuppressive regimes) have led to a growing increase in the one-year survival rates up to 75%, however, the 5-year survival rate following LT remains only approximately 50%. This book presents research in the study of lung transplantation, including primary graft dysfunction in lung transplantation; the impact of viral pathogens in lung transplant patients; neurologic complications of lung transplantation; intensive care management of the lung transplantation patient and the surgical issues facing lung transplant surgeons.
Heart transplantation remains one of the major scientific achievements of twentieth century medicine. During the past four decades, it has evolved from an unproven experimental surgical technique to the most effective form of therapy for refractory end-stage heart disease. It has captured the public's imagination and expanded our understanding of fundamental immunologic mechanisms that are responsible for cellular and humorally-mediated immunity. Despite its successes, many clinical and scientific problems remain. One or more bouts of acute cellular or humoral (vascular) rejection will occur in over 75% of transplant recipients despite current immunosuppressive strategies. Further, rejection directly results in approximately 20% of post-transplant deaths and is believed to play a major role in the development of late allograft dysfunction and coronary vasculopathy. This book by international experts in the fields of transplantation medicine, immunobiology and cardiac imaging provides the reader with an up-to-date, consise summary of the latest developments in the diagnosis and treatment of acute cardiac rejection. It is axiomatic that a more complete understanding of the pathogenic processes involved in rejection will ultimately lead to its prevention. This volume will be useful to transplant cardiologists, cardiovascular surgeons, cardiac pathologists and transplant scientists who seek to prolong the lifespan and improve the quality of life of their transplant recipients.
More than any other altruistic gesture, blood and organ donation
exemplifies the true spirit of self-sacrifice. Donors literally
give of themselves for no reward so that the life of an
individual--often anonymous--may be spared. But as the demand for
blood and organs has grown, the value of a system that depends
solely on gifts has been called into question, and the possibility
has surfaced that donors might be supplemented or replaced by paid
This work provides a one-of- a-kind volume that includes all aspects of heart transplantation from its historic beginning to its current day standards which now make the procedure a long-term treatment option for heart failure patients. The subjects covered include technical aspects of the procurement and implant procedures, as well as the medical nuances of pre-operative preparation and post-transplant immunosuppression management; the current day multi-disciplinary make up of the transplant team along with information on the keys to building and running a successful transplant program; regulatory standards and listing policies and the impact of the growing mechanical circulatory support technologies on the transplant field; and emerging technologies and future possibilities. All chapters are written by experts in the field and include the most up-to-date peer reviewed studies and clinical guidelines. This book gives an ever-changing reference that will become the text of choice for those beginning or continuing their transplant careers.
This book introduces transplantation in rodents as useful tools used in studying transplant immunobiology. Several solid organs (kidney, heart, liver) transplant models in rodents are described in this book. It can help surgical quality and save surgical time. The first part of the book provides a review of rodent transplant tolerance induction, the role of gender and body-weight in rodent transplantation, surgical instruments and organ preservation solutions. In the second part of the book, various organ-transplantation techniques in rodents are discussed in individual chapters. This book presents uniform surgical procedures in mouse and rats, which produce comparable data, efficiently enhancing the translational research from bench to non-human primates and beyond. It will be of great value to transplant researchers, research fellows and clinicians in many surgical specialties.
Difference between tissue specific stem cells and embryonic stem cells is explained. The advantages of the latter are included. The application of human pluripotent stem cells, mesenchymal stem cells, and hematopoietic stem cells in cancer therapy and tissue/organ regeneration is detailed. Role of neural cancer stem cells in brain tumors, including their role in brain tumor therapy and the role of CD133 stem cell antigen in glioma patients, is emphasized. Therapeutic role of bone marrow-derived stem cells in myocardial infarction and the role of mesenchymal stem cells in orthopedics are explained. Transplantation of umbilical cord hematopoietic stem cells and allogeneic hematopoietic stem cell transplantation followed by graft-versus-host disease are presented. Role of cancer stem cells specifically in glioblastoma and medulloblastoma is included. It is also emphasized that CD133 is an appropriate stem cell marker for gliomas. Targeting of cancer cells is also explained.
Despite the significant decline in heart disease mortaht>' rates over the last 25 years, heart failure has remained a significant problem. We are now confronted with large numbers of terminally ill patients for whom conventional therapies for heart failure have been exhausted and for whom repeated hospital visits are necessary. There now is a major thrust towards a management strategy which embraces a comprehensive approach including vigorous preventive measures and earlier surgical interventions. This book outlines the major surgical options for the treatment of heart failure and brings together a very broad base of opinions with contributions from several outstanding individuals. With the improved knowledge and techniques to control rejection, transplantation has become the central pillar in the surgical management of this group of patients. Unfortunately, because of limited donor supply the teclmique cannot be applied to large numbers of patients. A great deal of excitement, however, exists in the potential for xenotransplantation as a supplement to homotransplantation. The use of cardiac assist devices has become a reality with several hundred LVADS and BiVADS implanted throughout the world and cardiac replacement with total artificial hearts continues to be used successfully as a bridge to transplantation. We are on the thieshold of the broad application of assist devices to provide prolonged relief of heart failure and restore patients to an ambulatoiy home environment and hopefully return to the work force in significant numbers.
An ever-increasing demand for organs, with over 100,000 people on waiting lists, has driven a relentless search for new sources of organs. In 1995 the American Medical Association supported taking organs from anencephalic infants, children born without brains. In 1999 the Chinese government began removing organs from members of the politically outcast religious group Falun Gong, making a lucrative profit from sales to foreigners. Recently in Belgium physicians have euthanised a patient by removing her organs.The search for fresh organs began much earlier, in 1968, when death was redefined, so that well-preserved organs could be removed from brain-dead individuals. The early 1990s saw the introduction of donation after cardiac death, in which organs are taken from individuals whose hearts could still be resuscitated. Over the past two decades various countries have attempted markets in the sale of organs.Each of these sources of organs raises ethical concerns. Is brain death truly death, or by taking the heart of the brain-dead individual do we thereby kill him? When a person's heart stops beating is it permissible to prepare his organs for transplantation, even though we could choose to resuscitate him? Can we take organs from an infant without a brain? If a woman no longer wishes to live, can she donate her organs to others in an act of beneficent suicide? Is a market in organs acceptable?These questions and others are thoughtfully probed in this collection of essays, which features articles from theologians, philosophers, physicians, biomedicial ethicists, and an attorney.
Xenotransplantation could have an impact on at least three aspects of medicine. The first is as a means of overcoming a severe shortage of human donor organs for the treatment of organ failure. The second aspect relates to the possibility that a xenogeneic organ would not be susceptible to infection by a "human" virus and thus the xenograft might resist injury caused by such viruses. The third and, as of yet, unexplored aspect relates to a means of delivering genes for therapeutic purposes thus overcoming some of the limitations of "conventional" gene therapy.
Hematopoietic stem cell transplantation (HSCT) is currently utilized as a treatment option for a variety of life-threatening conditions affecting children and young adults including leukemia, lymphoma, neuroblastoma, brain tumors, inherited immune deficiency syndromes, blood disorders, and inherited metabolic diseases. This expertly written reference provides current information on methods and outcomes in a wide range of pediatric diseases, using a variety of HSCT approaches. It guides the pediatric professional in the proper execution and understanding of HSCT, and provides illustrative discussions of the hematopoietic and immune systems, clear outlines of current chemotherapy regimens, and expert guidance on each phase of stem cell transplantation and management, including patient evaluation and recovery.
This is the first surgical atlas demonstrating preparatory steps by photographs These operations are shown: organ donation (liver-kidney, liver-pancreas-kidney, kidney), orthotopic liver transplantation, segmental liver transplantation (preparation of a left liver graft, preparation of a left lateral liver graft, split liver preparation), living-related liver donation, heterotopic liver transplantation, pancreas transplantation, kidney transplantation. The photographs explain each important preparatory step, as well as potential variants and possible pitfalls. For each operation a checklist for preoperative preparation and postoperative care is included to allow a quick survey of the pre- and postoperative periods. "The book clearly explains all details of surgical technique and anatomy. The authors have restricted the text to a minimum so that the reader can gain a clearer understanding of the anatomy as each procedure develops...With the increasing number of organ transplantations ...more and more general surgeons have to be involved in organ donation...This atlas is recommended for all transplant surgeons and should be available to all general units where organ donation occurs." Transplant International, 4/96
The handbook provides concise descriptions of diseases affecting the liver, biliary tree and pancreas, including their management. Interventional procedures and operative techniques form a substantial part of the text and these are accompanied by clear diagrams to aid the reader. The handbook is designed to be portable, enabling the trainee to quickly access information in the operating theatre or clinic without having to resort to larger texts.
In a rare and intimate story, Michael McCarthy carries the reader through a personal account of courage and survival in the face of tragedy. A tale of ordinary men and women placed in an extraordinary real-life nightmare, it involves a life-and-death decision, a long-shot development of the world's first artificial skin, and a horribly burned victim restored to life.
In Drugs and the Liver: High Risk patients and Transplantation, leading physicians, hepatologists, pharmacologists, pathologists and transplant surgeons discuss the most recent advances in the field of liver disease and their treatment. Attention is focused on epidemiology, the diagnosis of disease (clinical chemistry, histopathology, medical imaging analysis), prognosis, prediction, and clinical management. Pathogenesis of diseases such as liver cirrhosis following viral disease or alcohol abuse are discussed at length, and special attention is dedicated to high risk patients (children, fulminant hepatitis). The other major topics include terminal liver failure, for which transplantation is now routine. The latter is discussed in depth, starting from the organ donor management, organ evaluation and preservation, new surgical techniques, post-transplant patient follow-up including side effects of immunosuppression, and reports of the latest drugs used to prevent rejection.
This issue of Clinics in Chest Medicine, guest edited by Robert Kotloff, focuses on the topics of Lung Transplantation. Articles include: Candidate Selection, Timing of Listing, and Choice of Procedure for Lung Transplantation; Lung Allocation in the United States, Selection and Management of the Lung Donor; Novel Approaches to Expanding the Lung Donor Pool: Donation After Cardiac Death and Ex Vivo Conditioning; Extracorporeal Life Support as a Bridge to Lung Transplantation; Survival and Quality of Life of Patients Undergoing Lung Transplant; Primary Graft Dysfunction; Acute Allograft Rejection: Cellular and Humoral Processes, and more!
Progress in the development of surgical implant materials has been hindered by the lack of basic information on the nature of the tissues, organs and systems being repaired or replaced. Materials' properties of living systems, whose study has been conducted largely under the rubric of tissue mechanics, has tended to be more descriptive than quantitative. In the early days of the modern surgical implant era, this deficiency was not critical. However, as implants continue to improve and both longer service life and higher reliability are sought, the inability to predict the behavior of implanted manufactured materials has revealed the relative lack of knowledge of the materials properties of the supporting or host system, either in health or disease. Such a situation is unacceptable in more conventional engineering practice: the success of new designs for aeronautical and marine applications depends exquisitely upon a detailed, disciplined and quantitative knowledge of service environments, including the properties of materials which will be encountered and interacted with. Thus the knowledge of the myriad physical properties of ocean ice makes possible the design and development of icebreakers without the need for trial and error. In contrast, the development period for a new surgical implant, incorporating new materials, may well exceed a decade and even then only short term performance predictions can be made.
Therapeutic immunosuppression has very broad applications in clinical medicine, ranging from prevention and treatment of organ and bone marrow transplant rejection, management of various autoimmune disorders (e.g., rheumatoid arthritis), skin disease, and asthma. Whereas traditionally only a small repertoire of immunosuppressive agents was available for clinical use, recent discoveries have significantly increased the number of approved agents, resulting in numerous trials to further evaluate their potential. In addition, products of the biotechnology industry - monoclonal antibodies, cytokines, cytokine antagonists, and other products of genetic engineering that target key molecular pathways in disease pathogenesis - have either already made, or are on the verge of making an important impact on treatment. There is also considerable interest in the potential of cell-based therapies (particularly hematopoietic stem and dendritic cell therapy) of allo- and autoimmunity. Important recent advances in the immunotherapy of allergic diseases are also covered in this book. Gene therapy offers considerable promise for suppressing pathogenic processes in either transplantation or autoimmune disorders. The possibility of combining these important new advances to maximize benefit to the patient, and to minimize possible untoward effects (which are also given extensive coverage in this book), is one of the most exciting challenges of contemporary medicine. This volume is intended both for practising physicians and surgeons and for biomedical scientists at the graduate/postdoctoral levels, and is designed to provide the theory behind these various approaches to immunosuppression, and to provide state-of-the-art reviews of current developments in each area. Each chapter is contributed by one or more experts in the field. There was a need to bring this information together in a single volume, as much of the key recent developments have been dispersed throughout the biomedical literature, largely in specialized journals. Since, as in the past, important developments in immunosuppressive therapy in one branch of medicine (i.e. transplantation) are likely to benefit another (e.g., dermatology, rheumatology, gastroenterology), cross-disciplinary coverage of the mechanistic basis of the various therapeutic strategies in a single volume is likely to convey the potential of advances in therapy in the most coherent manner possible.
Transplantation Surgery uniquely covers all aspects of this rapidly expanding field in one volume. The book gives a clear description of the current status of transplant surgery for trainees sitting surgery exit examinations. The book will also be of interest to transplant surgeons, physicians and nephrologists who have an interest in this field. It opens with an introductory chapter on the history of transplantation and the basic science of immunobiology, and then examines the practice of transplantation in each major system. No other book covers the breadth of this topic in a single volume. Each contributor to Transplantation Surgery is an internationally recognised expert. Nadey S Hakim is Consultant Surgeon and Surgical Director of the Transplant Unit based at St Mary's Hospital, London, UK. Gabriel M Danovitch is Medical Director of the Kidney Transplant Program, Center for the Health Sciences, Los Angeles, California, USA. Both have been personally involved in many of the major developments in transplantation.Transplantation Surgery is the first volume to appear with the Springer Specialist Surgery Series (edited by Professor John S P Lumley, St Bartholomew's Hospital, London)
Advances in Abdominal Surgery 2002 contains papers from a group of Italian academic surgeons who contribute to a national research program entitled Progress in Abdominal Surgery'. The research is supported by the Italian Ministry of the University. The primary objective of the group is to combine experimental and clinical approaches in the study of several surgical abdominal diseases. The authors of the individual chapters were requested to present an update in their own fields of research. This volume summarizes several important updates in abdominal surgery and pathophysiology. The contributions are grouped into six sections, namely Surgical Infection, Hepatobiliary and Pancreatic and Splenic Surgery, Colorectal Surgery, Fecal Incontinence, Minimally-Invasive Surgery, and Transplantation.
In the late 1980s, a promising new treatment for breast cancer
emerged: high-dose chemotherapy with autologous bone marrow
transplantation or HDC/ABMT. By the 1990s, it had burst upon the
oncology scene and disseminated rapidly before having been
carefully evaluated. By the time published studies showed that the
procedure was ineffective, more than 30,000 women had received the
treatment, shortening their lives and adding to their suffering.
This book tells of the rise and demise of HDC/ABMT for metastatic
and early stage breast cancer, and fully explores the story's
implications, which go well beyond the immediate procedure, and
beyond breast cancer, to how we in the United States evaluate other
medical procedures, especially life-saving ones.
This volume is based on a very successful meeting on organ transplantation that was held in Kuwait in 1990 under the auspices of the Middle East Society for Organ Transplantation. An international group of organ transplant experts attended this conference and their contributions and deliberations have been recent1y updated to produce this definitive and authoritative summary of current clinic al practice in organ transplantation. The initial chapters appropriately focus on the immunology of organ trans- plantation with special emphasis on the initial events in the induction of alloreactivity, the mechanisms of rejection, and the potential for tolerance induction. A strong emphasis is placed on the diagnosis of rejection by cellular analysis. The section on immunosuppression deals with several new areas of clinical therapy. The section on renal transplantation is unique in several respects, the long-term results from various countries, including the Middle East, are summarized, the use of living unrelated donors and of ABO incom- patible donors - all strategies to maximize organ availability - are presented.
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