Here is the amazing story of how a man with cancer of the trachea (and no other remaining treatment options) was treated with a tracheal transplant created from “scratch” in the tissue engineering lab, using the patient’s own stem cells. Very exciting, cool stuff, reported today in the Wall Street Journal.************

Cancer Patient Saved With Lab-Grown Windpipe

By GAUTAM NAIK, Wall Street Journal

Doctors have replaced the cancer-stricken windpipe of a patient with an organ made in a lab, a landmark achievement for regenerative medicine. The patient no longer has cancer and is expected to have a normal life expectancy, doctors said.

“He was condemned to die,” said Paolo Macchiarini, a professor of regenerative surgery who carried out the procedure at Sweden’s Karolinska University Hospital. “We now plan to discharge him [Friday].”

The transplantation of a lab-made and permanent windpipe had never been successfully done before the June 9 procedure.

Photo: The lab-grown tracheal implant immediately before it was placed into the patient. The 36-year-old man who received the organ is now free from cancer.

The researchers haven’t yet published the details in a scientific journal.

The patient’s speedy recovery marks another milestone in the quest to make fresh body parts for transplantation or to treat disease. More immediately, it offers a possible treatment option for thousands of patients who suffer from tracheal cancer or other dangerous conditions affecting the windpipe.

“It’s yet another demonstration that what was once considered hype [in the field of tissue engineering] is becoming a life-changing moment for patients,” said Alan Russell, director of the McGowan Institute for Regenerative Medicine in Pittsburgh, who wasn’t involved in the latest operation.

In a notable advance in organ transplants, surgeons at UC Davis Medical Center have restored the voice of a woman who couldn’t speak on her own through a transplant of the larynx, thyroid and trachea.

In 2006, researchers disclosed how they had implanted lab-grown bladders into children and teens with spina bifida, a birth defect. And in 2008, members of a team that included Dr. Macchiarini said they had given a patient a new windpipe made partly from her own cells, and partly from “scaffolding” material taken from a cadaver.

The latest experiment shows that a fully functioning windpipe can be manufactured entirely in the lab without the need for a cadaver.

“It makes all the difference,” said Dr. Macchiarini. “If the patient has a malignant tumor in the windpipe, you can’t wait months for a donor to come along.”

The patient in this case is a 36-year-old Eritrean man, a father of two studying geology in Iceland. Surgery and radiation treatments failed to stem a cancerous growth in his windpipe.

When the tumor reached about six centimeters in length it almost completely blocked the trachea, or windpipe, making it hard for the patient to breathe.

With no suitable donor windpipe available, the final option was to try to build one from scratch. Dr. Macchiarini had good reason to feel emboldened: He had successfully transplanted cadaver-based windpipes in 10 patients.

A windpipe is a hollow tube made up of respiratory cells that sit atop a scaffold of various tissues, such as cartilage and muscle cells. As a first step, a team led by Alexander Seifalian of University College London used plastic materials and nanotechnology to make an artificial version of the scaffold in the lab. It was closely modeled on the shape and size of the Eritrean man’s windpipe.

Meanwhile, researchers at Harvard Bioscience Inc. of Holliston, Mass., made a bioreactor—a shoe-box-size device similar to a spinning rotisserie machine. The artificial scaffold was placed on the bioreactor; then, stem cells extracted from the patient’s bone marrow were dripped onto the revolving scaffold for two days.

With the patient on the surgery table, Dr. Macchiarini and colleagues then added chemicals to the stem cells, persuading them to differentiate into tissue—such as bony cells—that make up the windpipe.

About 48 hours after the transplant, imaging and other studies showed appropriate cells in the process of populating the artificial windpipe—which had begun to function like a natural one.

There was no rejection by the patient’s immune system, because the cells used to seed the artificial windpipe came from the patient’s own body.

When traveling, I’ve often wondered why the TSA agents don’t wear the little dosimetry badges that all medical and dental personnel who work around X-rays wear on their lapels. It’s a standard safety precaution in the industry, another method of ensuring that medical personnel aren’t inadvertently getting exposed to too much radiation at work.

Well, here’s an article from TIME magazine on this very topic. It turns out that a few TSA agents in Boston have developed various cancers, and they’re wondering if it’s linked to their X-ray screening equipment. If they had been wearing dosimetry badges, they would have known if X-ray leakage was a problem!

The TIME magazine report also implies that the X-ray based machines may not have been as rigorously tested for safety as some might like…


When the FDA re-approved silicone breast implants for general use, back in November of 2006, one of the conditions was that the two major manufacturers and the FDA would co-operate to do some ongoing follow-up studies about implant safety and effectiveness. Now, approximately 5 years later, the FDA has released an update, discussing the first installment of this data.

In a nutshell: it confirms what we knew 5 years ago. Implants, when used correctly, are safe devices…but they’re not perfect.

The report says the same things we tell patients at their consultations for breast augmentation

1) Implants don’t last forever. They get old, become brittle, and eventually need to be replaced. This means more surgery, at some point in the future.

2) They can get in the way of mammograms. Other imaging techniques, like MRI and ultrasound, are very helpful in examining the implant and hard-to-see breast tissue.

3) The implants can get hard, due to capsular contracture, in a minority of patients. This is still the most frustrating, unsolved problem of breast implant surgery, long-term.

And these issues are also true for saline filled implants, as well.

Good news: the FDA study continued to find no linkage at all between silicone gel implants and breast cancer, or between silicone gel breast implants and auto-immune diseases, such as lupus, scleroderma or rheumatoid arthritis.

The FDA website has much more details. Their consumer page is here.

This week, the FDA announced a series of changes that will affect how sunscreens are labelled. This is a good thing for consumers: the manufacturers will have to be very clear about whether the product products against UVA rays, or the more typical UVB. Misleading terms like “sunblock” and “waterproof” are going to be eliminated. Just so you know: there is no sunscreen yet invented that is totally waterproof, or is a 100% sunblock. These are BS marketing terms.

Under the new labeling system, which takes effect in 2012, the key feature to look for on the label will be the term “broad spectrum”. If you see this, then you are getting both UVA and UVB protection, which is what you want. Here’s an example of how the new labels might look – there’s much more useful information.

Here’s more details, directly from the FDA website….

Q. What are the main points of the new FDA sunscreen rule?

A. The new final rule includes the following requirements:

Broad Spectrum designation. Sunscreens that pass FDA’s broad spectrum test procedure, which measures a product’s UVA protection relative to its UVB protection, may be labeled as “Broad Spectrum SPF [value]” on the front label. For Broad Spectrum sunscreens, SPF values also indicate the amount or magnitude of overall protection. Broad Spectrum SPF products with SPF values higher than 15 provide greater protection and may claim additional uses, as described in the next bullet.

Use claims. Only Broad Spectrum sunscreens with an SPF value of 15 or higher can claim to reduce the risk of skin cancer and early skin aging if used as directed with other sun protection measures. Non-Broad Spectrum sunscreens and Broad Spectrum sunscreens with an SPF value between 2 and 14 can only claim to help prevent sunburn.

“Waterproof, “sweatproof” or “sunblock” claims. Manufacturers cannot label sunscreens as “waterproof” or “sweatproof,” or identify their products as “sunblocks,” because these claims overstate their effectiveness. Sunscreens also cannot claim to provide sun protection for more than 2 hours without reapplication or to provide protection immediately after application (for example– “instant protection”) without submitting data to support these claims and obtaining FDA approval.
Water resistance claims. Water resistance claims on the front label must indicate whether the sunscreen remains effective for 40 minutes or 80 minutes while swimming or sweating, based on standard testing. Sunscreens that are not water resistant must include a direction instructing consumers to use a water resistant sunscreen if swimming or sweating.

Drug Facts. All sunscreens must include standard “Drug Facts” information on the back and/or side of the container.

Sunscreen lotions will also no longer be able to advertise that they carry an SPF, or sun protection factor, of greater than 50.

Photo credits:,

Source: Dermatology Times E-News

A new study reveals dramatic results for an experimental drug designed to attack a melanoma tumor’s genetic trigger in patients with advanced disease.

About half of melanoma patients’ tumors carry a mutation of the BRAF gene, which causes skin cells to reproduce out of control. The experimental drug, called PLX4032 or vemurafenib, reverses the effects of that mutation. The new study, led by Paul Chapman, M.D., of New York’s Memorial Sloan-Kettering Cancer Center, involved 675 patients with advanced, inoperable melanoma with the BRAF gene mutation. The patients were treated either with dacarbazine, the standard chemotherapy drug, or with PLX4032.

Investigators report that after three months, PLX4032 was so obviously effective that the study was stopped so that dacarbazine patients could switch to the new drug. Study results show that PLX4032 shrank tumors significantly in nearly half the patients, reduced by two-thirds the risk that the disease would progress, and decreased the chance of fatality by 63 percent.

Side effects included skin rashes and joint pain, but researchers report that the effects tended to be far less severe than those caused by standard chemotherapy.

“This is really a huge step toward personalized care in melanoma. This is the first successful melanoma treatment tailored to patients who carry a specific gene mutation in their tumor”, said Dr. Chapman.

More bizarre parenting, this time from the UK. Plastic-surgery obsessed mom gives daughter a voucher for breast augmentation…but she’s only SEVEN.

Here’s the story, from the Daily Mail:


She made the headlines last year when she confessed to teaching her then six-year-old daughter Poppy to pole dance. And now Sarah Burge is back in the spotlight again – for all the wrong reasons. The 50-year-old mother – a self-confessed plastic surgery addict known as The Human Barbie – has boasted that she gave a £6,000 breast enlargement voucher to her daughter for her seventh birthday. Miss Burge, who has spent more than £500,000 on her own surgical enhancements and wants to make her daughter into a glamour model, said Poppy ‘squealed with delight’ when she was given the voucher.

Appropriate? Sarah Burge has given her daughter a £6,000 boob job voucher for her seventh birthday She said: ‘Poppy begged me for a boob job, so I gave her the voucher so she can have it after she’s 16, when it’s legal. ‘If she develops naturally big boobs, she can have something else done with it.’ The voucher was part of a £12,000 ‘exotic pamper party’ that Miss Burge organised to mark her daughter’s birthday.

As well as the breast enlargement voucher, Miss Burge bought her daughter thousands of pounds worth of gifts, including a £250 computer, a £450 pink Swarovski crystal ring and necklace set and the promise of a £4,000 spa break. The main event though, was the breast enlargement voucher. Poppy says: ‘I wanted a new computer, a holiday and a voucher for surgery. When I got it all, it was a dream come true. All my friends were jealous. ‘I can’t wait to be like Mummy with big boobs. They’re pretty.’

Editor’s note: Have you heard the term “Age appropriate”, Ms. Burge? This is absurd….and all sorts of messed up!

With a name like the SPY system, you might think that “Q”, from the James Bond series, would be introducing the technology with a clipped “Pay attention, 007”.

Not the case here, though. Despite the neat moniker, the SPY system is a Canadian-made tool to help surgeons figure out whether tissue is getting the correct amount of blood flow. Using a new twist on a time-honored idea, the system uses a laser to make an intravenous dye called ICG light up, combined with a fancy scanner to enhance the images (shown above) for easy use. In real time, the surgeon can actually watch the dye flow into the flap in the artery, light up the tissue, and return back in the vein, so he/she can feel confident about the condition of the flap. The scanner is a small, mobile unit, perfect for use in the OR or the ICU, which is a big improvement over the clunky, X-ray based angiogram equipment of the past.

In plastic surgery, this gadget comes in very handy for assessing whether microsurgical or pedicle flaps, such as those used in breast reconstruction, are working properly. Clinical testing, done largely here in Florida at the Cleveland Clinic, has shown that the SPY system really gives the surgeon an accurate way to assess the blood flow, with a 95% correlation between imaging and the patient’s clinical course.

Impression: Cool stuff that works! Breast reconstruction surgeons should check this out.


The drug Aromasin appears to cut the odds of breast cancer by 65 percent in high-risk postmenopausal women, new research has found. Unlike other anti-estrogen drugs like tamoxifen, Aromasin doesn’t seem to have an increased risk of uterine cancer or blood clots.Aromasin, an aromatase inhibitor, is currently approved for early breast cancer patients, but is not FDA approved as a preventative medication. Currently, the medication costs $300-400 per month, but will soon be available in generic form. Hopefully, the price will drop.

The new placebo-controlled study, conducted by Canada’s NCIC Clinical Trials Group with partial support from Pfizer, involved 4,560 women from Canada, the U.S., France and Spain with a median age of 62.5 years. The women were all post-menopausal and had at least one other risk factor for breast cancer.

After three years, researchers observed 11 invasive breast cancers in the women receiving Aromasin, compared with 32 in the group receiving the placebo, for a 65% reduction. There were also fewer precancerous lesions in the group receiving the drug.

“This may add another potential drug for these women,” said Dr. Jennifer Litton, a breast medical oncologist with the University of Texas M.D. Anderson Cancer Center in Houston. “Hot flashes, joint stiffness were more pronounced but it [Aromasin] doesn’t have the blood clot and uterine cancer risk.”

A murder-suicide in a parking garage at Florida Hospital in Orlando left a doctor and the gunman dead today, police said.

The doctor was identified as 41-year-old Dmitriy Nikitin, a skilled transplant surgeon. The gunman, allegedly a disgruntled patient, killed himself after shooting the surgeon several times in the chest.

Officers closed off the hospital garage after being called about 5:10 p.m. to the facility at 601 E. Rollins. St. Jones said that the shooting happened near the elevators on the first floor of the garage, which is used by employees and patients’ families.

“The Florida Hospital family is deeply saddened by the tragic event Thursday evening which has taken two lives, one of whom is Dr. Dmitriy A. Nikitin, a respected and talented multi-organ transplant surgeon,” Florida Hospital said in a statement released tonight. “At this time, we ask for your sympathy as we and the family of Dr. Nikitin grieve for our loss.”

The Orlando Fire Department said it took the shooting victims to Orlando Regional Medical Center in critical condition. Both victims died, despite heroic resuscitation measures.

According to his profile on the Florida Hospital website, Nikitin was “board certified in general surgery specializing in multi-organ abdominal transplant surgery. He completed his Transplantation Surgery Fellowship at Baylor University Medical Center in Dallas, Texas and his General Surgery Residency at Drexel University College of Medicine in Philadelphia, Pennsylvania.” He had no malpractice claims.

Nikitin completed his residency in anesthesia and intensive care in Omsk, Russia, the profile said. In addition to English, he spoke Russian, Ukrainian and Spanish.

Nikitin was also an assistant professor at the University of Central Florida’s College of Medicine, according to the school’s website.

source: Orlando Sentinel

Here’s a cool product I checked out in Boston: 3-D imaging for patients, without an expensive, dedicated multi-camera system.

Swiss software company Crisalix has been working on this for several years, and now they are at the stage where they are offering a commercial product, designed to help patients thinking about breast augmentation surgery. Simply upload 3 standard digital photos, 1 taken face on, and two taken from the lateral (side) position to their secure & protected server, add in some measurements, place some digital markers on selected topographical landmarks, and five minutes later – they send you a 3-D reconstruction image.

Then, using their morphing software, they can show you how the image would change with an implant placed there, and even demonstrate how it might look in a swimsuit or in a shirt! They have all the dimensions for commonly used saline and silicone implants, and can show what a subglandular, dual-plane, or submuscular implant might look like. I checked this out in Boston, and the images look pretty good – close to what I would expect in a clinical situation.

They charge $50 for this service – so it’s a fair question if patients would be willing to pay extra for this, or not. (Let me know what you think, people!)

Imaging companies like Canfield Imaging and Axis Three have also had 3D imaging systems like this – but they were expensive, costing in the range of $20,000 – $40,000. The dedicated cameras were moderately large, and required a room dedicated to the equipment. This new software from Crisalix doesn’t have these drawbacks. However, it doesn’t work on ptotic (droopy) or large (D+) breasts as yet – these will apparently be addressed in a future software upgrade. It also may not be quite as good as the Canfield system for patients with a lot of chest wall (ribcage) deformities.

We’ll be trying out the new Crisalix software. If you are interested in having a 3D image of your breast and torso made, let us know during your breast augmentation consultation.

Plastic Surgery In Florida