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Archive for November, 2013

Mayo Clinic's Fifty Years of Kidney Transplants – Part IV

Posted on November 25th, 2013 by Admin

Pioneers of Kidney Transplantation at Mayo Clinic

James H. DeWeerd, M.D.

The first transplant of a kidney took place in Saint Marys Hospital on Nov. 25, 1963. Surgeons George A. Hallenbeck, M.D., and James DeWeerd, M.D., headed a medical team that performed the first transplant, placing a kidney in a female patient. The patient’s half-sister was the donor. Mayo’s operation reflected a common theme in the early development of transplant medicine. The donor providing the kidney was a close relative of the recipient. That was important at the time to minimize rejection of the organ by the recipient’s body.

George A. Hallenbeck, M.D.

George Hallenbeck, M.D., had acquired a deep knowledge of physiology and an interest in experimental surgeries before he stood at that operating table. Dr. Hallenbeck also designed Mayo’s initial kidney transplant program. Once it began, he was named to direct Mayo’s Section of Tissue and Organ Transplantation. He subsequently headed the surgical teams for more than 40 kidney transplants.

Dr. Hallenbeck was among Mayo’s most accomplished surgeons and researchers. Besides a medical degree, he held a doctorate in physiology with specialty work in gastric secretions. During World War II, Dr. Hallenbeck worked on the physiology of acceleration for Mayo, and served on the U.S. Army’s development team for the famed “G-suit.” It was created to protect fighter pilots from blackouts under extreme flight conditions.

Frank C. Mann, M.D.

Frank C. Mann, M.D., and his Mayo Clinic laboratory were probing the science of kidney transplants in the 1920s, decades before surgeons performed the first patient operations. A surgical resident working with the laboratory drew several insights from the failure of transplanted kidneys. Carl S. Williamson, M.D., was among the early scientists to recognize a “blood-borne” factor that needed to be overcome to prevent rejections. In later remarks, Dr. Mann observed: “The successful transplantation of a healthy organ for a diseased one awaits the discovery of those biologic factors which prevent the survival of tissues of one individual when transplanted into the body of another individual.” Dr. Mann and his associates also pioneered surgical techniques for kidneys. Among them was the method developed by Dr. Williamson, which was used in the first kidney transplants on humans. Dr. Mann came to Mayo Clinic in 1914 as director of experimental medicine and retired in 1952.

Mayo Clinic – Fifty Years of Kidney Transplants – Part III

Posted on November 25th, 2013 by Admin

The Numbers, for the Record

Candidates on waiting list for kidneys for transplant (national) - Approximately 97,000

Kidney Transplants at Mayo Clinic

Mayo Clinic - Number of Kidney Transplants (as of June 30, 2013)

Rochester ( since 1963) - 4,822

Arizona (since 1999) -  1,974

Florida (since 2000) -  1,186

Kidney transplant patients at Mayo Clinic are cared for after surgery at special houses. The first, on the Rochester, Minn., campus was called the Gift of Life Transplant House.

Rochester businessman Ed Pompeian knew the personal difficulties of kidney transplants as he worked to create the Gift of Life Transplant House. He had undergone two transplants.

Pompeian envisioned a home-away-from-home atmosphere, to be shared by patients who needed a place to stay while at Mayo Clinic for transplant surgeries. The Gift of Life Transplant House opened in Rochester, Minn., in December 1984. In the past three decades it has expanded into the nation’s largest transplant house program with 84 rooms in two complexes.

A patient may be accompanied by one caregiver. The house offers common facilities that encourage interaction and support among guests. There is a minimal fee for staying at the house, easing the financial burdens on patients.

Similar residences at Mayo campuses in Florida and Arizona also welcome transplant patients.

 

 

 

 

Mayo Clinic and 50 Years of Kidney Transplants – Part II

Posted on November 25th, 2013 by Admin

[Editor's note: We recently looked at benchmarks in kidney transplant history. Today more on the kidney and why it's so important.]

The Kidney’s Critical Role

The kidney’s well-being is essential for the rest of the body. It acts as the main filtering system for wastes and the major factor in excreting them from the body.

With each heartbeat, about one-fifth of the blood supply floods into the kidney. The organ contains enormous numbers of “nephrons’’ containing microscopic tubes. They are sized precisely to strain undesirable waste chemicals from the blood stream.

Each human has two kidneys and easily can survive with a single one. But various genetic diseases, infections or poisons can destroy the nephrons in both kidneys.

Once the kidneys are incapacitated, the damage is life- threatening. Doctors today can offer two main treatments to patients with terminal renal disease – transplantation or dialysis.

Although individual cases differ, Mayo Clinic doctors tend to favor transplants because of better and longer-lasting results. Kidney transplants can be performed at almost any age.

Medical Advances that Made a Difference Over 50 Years

Kidney transplant surgeries are possible due to ongoing, significant biomedical advances. Perhaps the single most important advance involves preventing the recipient’s immune system from rejecting the donated kidney.

Immunosuppressant drugs

• Prednisone – a steroid used in the early days of transplantation and still used today

• Azathioprine – introduced in 1968

• Cyclosporine – approved in 1983 and in wide use today

Blood treatments

Doctors today can “precondition” the recipient’s blood to remove antibodies that would trigger rejection of a donated kidney.

Antibiotics, antimicrobial and related medicines – These drugs help ward off infections in patients with weakened immune systems.

Surgical techniques

Laparoscopy has greatly reduced the size of incisions and shortened recovery times for kidney donors. Mayo surgeons first started using the technique in 1999. It’s sometimes called “bellybutton surgery.” The surgeon inserts a long instrument with a camera through narrow holes in the donor’s abdomen, snips away a healthy kidney and recovers it through another small opening. Previously, the operation involved a much larger incision on one side of the donor’s back.

Fifty Years of Kidney Transplants at Mayo Clinic

Posted on November 25th, 2013 by Admin

Fifty years ago, the prognosis for a patient with kidney failure was threatening to grim.

Transplants of kidneys from one person to another were not mainstream medicine. In fact, a transplant was so extraordinary that TIME magazine described the treatment as “the most daring of all.”

Kidney transplants still are serious operations today. But, since Mayo Clinic’s first transplant in 1963, the surgeries have become accepted medical practice. In many cases, transplantation now is the treatment of choice for patients whose kidneys are failing. It often is preferred over chronic “hemodialysis,” which relies on an artificial kidney outside the patient’s body to filter the blood and prolong life.

Mayo transplant teams have used advances in surgical techniques, drugs that suppress rejection and, of course, experience with thousands of patients to change a “daring” operation into a safe procedure.

Today at Mayo Clinic, a kidney transplant patient has a 98 percent chance of surviving one year; furthermore, the chance of surviving 10 years is in the mid-70 percent range. Continued progress in the field is accelerating the survival rate.

Timeline
1963 – First kidney transplant by Mayo Clinic surgeons, performed at Saint Marys Hospital.

1967 – First Mayo kidney transplant using organ from deceased donor.

1987 – First multiple-organ transplants involving kidneys. One paired a pancreas with a kidney and the other involved a liver.

1994 – Kidney transplants for children relocated to the newly opened Mayo Eugenio Litta Children’s Hospital.

1999 – Mayo Clinic surgeons acquire a kidney from a donor by laparoscopy for the first time. Mayo Rochester records its 2,000th kidney transplant. Mayo Clinic in Arizona begins transplanting kidneys.

2000 – Mayo Clinic opens The William J. von Liebig Transplant Center, a specialty clinic for organ transplants, in the 10th floor of the Charlton Building. Mayo Clinic in Florida starts a kidney transplant program.

2004 – Mayo Clinic reaches a milestone of 3,000 kidney transplants.

2013 – Mayo Clinic in Arizona completes its 2,000th kidney transplant.

2013 – Mayo Clinic celebrates 50 years of kidney transplants with more than 4,800 procedures.

 

Detecting and Treating Cancer Recurrence in Time

Posted on November 22nd, 2013 by Admin

A Mayo Clinic laboratory study has revealed a possible mechanism to stop recurrence of cancer in mice. The approach, involving screening and a second-line treatment, prevented cancer from coming back in most of the mice in the study in which recurrence would have happened. The findings appear in Nature Medicine.

It’s been long known that cancer tumors change their appearance or phenotype, as well as their genomic characteristics, to avoid the natural immune response from the host body. A collaborative international team led by Richard Vile, Ph.D., Mayo Clinic molecular medicine researcher, attempted to detect or anticipate that shift and then initiate a “pre-emptive strike” before the tumor fully evolves, thus preventing a relapse.

The researchers say the findings may lead to new methods of early cancer detection and “appropriately timed, highly targeted treatment of tumor recurrence irrespective of tumor type or initial treatment.”

The research was supported by the Richard M. Schulze Family Foundation, Mayo Clinic, Cancer Research UK, the National Institutes of Health, and a grant from Terry and Judith Paul.

Other collaborators in the research are: Timothy Kottke, Nicolas Boisgerault, Ph.D., Rosa Maria Diaz Ph.D, Diana Rommelfanger-Konkol Ph.D, Jose Pulido, M.D., Jill Thompson, Debabrata Mukhopadhyay, Ph.D., of Mayo Clinic; Oliver Donnelly, M.D., Alan Melcher, M.D. Ph.D., and Peter Selby, M.D. Ph.D., of Cancer Research UK; Roger Kaspar, Ph.D., TransDerm, Santa Cruz; Matt Coffey, Ph.D., Oncolytics Biotech, Calgary; Hardev Pandha, M.D. Ph.D., University of Surrey; Kevin Harrington, M.D. Ph.D., The Institute of Cancer Research, London.

 

 

 

 

Reducing the Panic of Fecal Incontinence

Posted on November 12th, 2013 by Admin

From Mayo Clinic's Discovery's Edge magazine

Imagine the distress of waiting in a stalled checkout line, the bathrooms located at the back of the store, when your bowels begin to rumble and you have the uncontrollable urge to go. For those with fecal incontinence, panic ensues with the very thought of being caught unprepared at moments like these.

Mayo Clinic gastroenterologist Dr. Adil Bharucha has heard too many stories from his patients, mainly women over 40, about the panic created by the inability to control bowel movements, causing stool to leak unexpectedly from the rectum. In the worst cases, fecal incontinence can lead to a complete loss of bowel control.

Since one in 10 women experiences this embarrassing condition and since the prevalence increases with age, fecal incontinence was once thought to be the results of trauma during childbirth.  Dr. Bharucha discovered, however, that rectal urgency and diarrhea, rather than obstetric trauma, are the main risk factors for fecal incontinence among women

Adil Bharucha, M.D.

He also knew he needed better diagnostic tools to identify and assess anorectal function if he hoped to help women suffering from fecal incontinence. With that goal, he set about building an extensive network of collaborators both within Mayo Clinic and externally to develop new diagnostic tests and devices. This work has led him to collaborating widely across the institution to improve care for the patient.

The work of Dr. Bharucha and his research colleagues has earned international acclaim for Mayo Clinic's gastrointestinal motility clinic, the first center nationwide to introduce high resolution anorectal manometry into clinical practice; and to develop normal values and a system with which to classify patients with defecatory disorders, including fecal incontinence. It now offers a panel of tests to assess rectal stiffness, sphincter strength and urgency. This comprehensive approach provides an array of sophisticated diagnostic tools to help researchers zero in on the cause for fecal incontinence in each patient.

"Most of my collaborators had never considered working in my field," Dr. Bharucha says. "I am very grateful for their enthusiasm and expertise once they understood how common and distressing these disorders are. People say that the beauty of collaborating is that you work with smarter people. In my case, it's really true."

And, as a result, many women are also grateful to Dr. Bharucha for seeking new answers and new tests with his colleagues for this all too common and embarrassing condition.

Mayo Clinic's Genomic Study on Prostate Cancer

Posted on November 6th, 2013 by Admin

Certain types of "hard to treat" prostate cancer present an unanswerable challenge for physicians. That's a nicely worded sentence for very bad news for the patient. After hormone treatment yields no response, the patient usually has two years or less to live. Surgery isn't possible because the tumor cannot be shrunk. The reality of the condition underscores the urgency of a new study at Mayo Clinic's Center for Individualized Medicine that uses the genomic information of the patient's tumor to find possible solutions, such as more targeted drugs. For more details on the study or to learn how you might participate, check the news release Mayo issued today.

 

Regenerating Heart Tissue Through Stem Cell Therapy

Posted on November 6th, 2013 by Admin

From the pages of Mayo Clinic's Discovery's Edge --

Two years after a heart attack left him too exhausted to even tend his garden, Miroslav Dlacic is now able to walk again without becoming worn out.  An international team of Mayo Clinic doctors and researchers, led by André Terzic, M.D., Ph.D., director of Mayo Clinic’s Center for Regenerative Medicine, helped Dlacic reclaim his life by discovering a way to regenerate heart tissue through stem-cell therapy.

For decades, treating cardiac patients has typically involved managing heart damage with medication. It’s a bit like driving a car without fixing a sluggish engine; you manage the consequences as best you can and learn to live with them. But in collaboration with European colleagues, Mayo Clinic researchers have discovered a revolutionary means of repairing a damaged heart—of actually fixing the machine.

Dr. Andre Terzic

“It’s a paradigm shift,” says Dr. Terzic. “We are moving from traditional medicine, which addresses the symptoms of disease, to being legitimately able to cure disease.”

In this breakthrough process, stem cells are harvested from a cardiac patient’s bone marrow. They undergo a laboratory treatment that guides them to become cardiac cells. The treated cells are then injected into the patient’s heart in an effort to grow healthy heart tissue. The study is the first successful demonstration in human beings of the feasibility and safety of transforming adult stem cells into cardiac cells.

“We guide the stem cells to become something useful, in this case, cardioprogenitors,” Dr. Terzic explains.

This discovery has implications for millions of people. Cardiovascular disease is the leading cause of death worldwide. In the U.S. alone, about 5.8 million people have heart failure, and the number is growing. Beyond heart failure, the Mayo research also is a milestone in the emerging field of regenerative medicine, which seeks to go beyond palliative treatments to fully heal damaged tissue and organs.

 Mayo Clinic is uniquely positioned to pursue this complex therapy. In addition to its global reach, Mayo Clinic has its Center for Regenerative Medicine at the forefront of efforts to develop reparative solutions for a range of conditions.

“With the cardiopoiresis research, we have shown that regenerative medicine can really work,” Dr. Terzic says. “We are now actively working on regenerative medicine in the areas of diabetes, liver and lung disease, neurologic disorders, and orthopedic surgery.”

 To read the full story about Dr. Terzic's research into regenerative medicine, visit Discovery's Edge, Mayo Clinic's research magazine, at http://www.mayo.edu/research/discoverys-edge/regenerating-heart-tissue-stem-cell-therapy.