AMPUTATION ONLINE MAGAZINE
MARCH 15, 2001
Volume 6 Issue No.2
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CONTENTS
POV Editorial
WEB Site of the Month
Top News Story - Hand Reattachment and Removal
Business - Hangers face class action lawsuit as CEO Quits
New Technologies and Developments - Artifical skin & Russian "smart" leg
Prevention and Awareness - Promising therapy found for flesh-eating disease
From Around the World - Canada's War Amps support Viagra Program, Earthquake survivors count the cost
POV - EDITORIAL
It's that time of year again when many amps across North America are considering the annual Amputee Coalition of America as an event to attend in June.
For those who don't know, the ACA Convention is the worlds largest gathering of amputees on the planet, 3 - 4 days of motivation, education and commaraderie the likes of which you will not find elsewhere.
This year's event is in Kansas City, centrally located in the geographical centre of the USA, should provide an unique opportunity for those geographically challenged by west or east event in the past.
However, one apparently insurmountable barrier for some people is the presence of devotees at the ACA event. Most of realise that devotees are part of life, some of us believe the less the better, but we at least knowledge they exist and not all bad people.
This year I won't be attending the ACA event. Not solely due to the presence of devotees, but it sure does not help the situation. Can the ACA deal with the devotee issue ? Apparently not - the ACA continue to ignore the problem, no debates, no discussion just a general lack of action and activity.
Surely the ACA must realise their growth and reputation as an organisation capable of a million members has to act positively and decisively on this issue. Already we have seen good people leave the ACA for the ACA's inactivity and ineffectiveness when conflicts arise, good people that the ACA need. We also see people not attending the annual event for the same reasons.
This is a most unfortunate chain of events. All amputees need to go to the ACA event at least once in their lifetime, it truly is an awe inspiring few days. Yet, with the dark shadow of a devotee presence, how can the ACA truly call itself an amputee organisation ?
Ian Gregson
Editor and Publisher
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WEB SITE OF THE MONTH
The Amputee hockey site is an American site for those of us fortunate enough to be able to skate. Mainly for BK's and arm amps the site is a meeting point for all interested in the game of ice hockey.
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TOP NEWS STORY - YOU WIN SOME YOU LOSE SOME....
Doctors cut off transplant hand
February 3, 2001
Web posted at: 12:17 PM EST (1717 GMT)
LONDON, England -- The world's first hand transplant patient has had his new limb amputated after telling doctors to cut if off. New Zealander Clint Hallam was given the hand in a pioneering operation in France in 1998 but said his body had now rejected it. Surgeons insist he failed to follow the recommended course of treatment after surgery. Hallam said that for the first year his new hand, which had previously belonged to a motorcyclist killed in an accident, had functioned well. But since then there had been constant "pockets of rejection" that have covered it in scabs. Microsurgeon Professor Earl Owen -- from the team that transplanted the hand -- said it was removed, at Hallam's request, in a short operation at an undisclosed London hospital on Friday night. He said Hallam had failed to stay in regular contact with his doctors. Hallam denies that the rejection was sparked by his failure to take his medication.
"At the time that the rejection started I was under a strict regime. The doctors were monitoring almost on a daily basis what medication I was taking," he told the BBC.
He insisted that he only gave up taking the medicine several months later so that his body could recover from a bout of flu.
"I'm convinced that there has come a stage with the number of rejections that I have experienced that my body or my mind has said, `Enough is enough'," he said.
He added he was sure there were drugs that he could take that would make his transplanted hand look as good as the one he was born with, but there were no guarantees the new hand would ever be "functionally useful."
Professor Owen said in a statement that Hallam left the care of his doctors in January 1999, three months after the operation, and disappeared for over two months.
"We know he voluntarily went without drugs for weeks at a time over the two years and failed to follow the plan he willingly agreed to before the actual transplant was performed," it said.
"This frustrated our attempts to treat him optimally making it inevitable that irreversible rejection would intervene necessitating an eventual amputation in the interests of his own health."
Hand transplant patient doing well
February 19, 2001
Web posted at: 2:25 p.m. EST (1925 GMT)
By Elizabeth Cohen
CNN Medical Correspondent
LOUISVILLE, Kentucky (CNN) -- Jerry Fisher, the second recipient of a hand transplant in the United States, will see his new hand Monday afternoon for the first time and begin physical therapy Wednesday or Thursday, his doctors said..
"Jerry has only seen the tips of his fingers sticking out of the dressing," said Dr. Warren Breidenbach, the hand surgeon who led the 13-hour procedure Friday night and Saturday morning. "Now we'll uncover that and take a look at the wounds."
Breidenbach said Fisher is doing "extremely well" and has passed the most critical period -- the first 48 hours after the surgery -- when there's the highest risk that a blood clot could cut off circulation to the hand. "With each 24-hour period that goes by, the likelihood of that taking place goes down quite a bit," he added.
Fisher is expected to be in the hospital for another 5-8 days and then will stay in Louisville for three months before moving back home to Michigan. He'll have to take immunosuppressive drugs every day for the rest of his life to prevent his body from rejecting the new hand.
Dr. Darla Granger, the lead transplant surgeon on the team, said she feels more confident now about the effectiveness of those drugs compared to two years ago when the team did the same surgery on Matthew Scott -- the first hand transplant in the United States and the second in the world.
"Now [Fisher] is the ninth in the world and the same immunosuppressive regimen has been done with all," Granger said. "When compliant with that regimen, we've had very good results."
The recipient of the world's first hand transplant, done in France in 1998, had to have his hand amputated two weeks ago because he didn't take the drugs.
The Louisville doctors had a rigorous screening process for patients, including evaluations by psychiatrists and social workers.
"This is an experimental, investigational procedure," said Breidenbach. "We discussed the pros and cons of everything -- from a patient's blood pressure to his family life."
As part of the evaluation, doctors explained to Fisher the risks of the procedure, which include high blood pressure, liver and kidney dysfunction, increased risk of certain cancers, diabetes, and death due to the immonosuppressants he will be taking for the rest of his life.
"I was impressed by how motivated and intelligent he was. He could truly understand the risk," Dr. Granger said. "That's what made me comfortable as a physician to go ahead with it."
Fisher, who's right-handed, lost his left hand in a Fourth of July fireworks accident in 1996.
"Anytime he would try to do something he couldn't do it because he didn't have the hand, he was very disappointed," Fisher's wife, Sonya said at the news conference. "As soon as we heard about Matt Scott he knew he wanted a chance to do this."
Surgeons perform second hand transplant in U.S.
February 17, 2001
Web posted at: 7:58 p.m. EST (0058 GMT)
LOUISVILLE, Kentucky (CNN) -- In a 13-hour operation overnight, a team of 18 surgeons and five anesthesiologists gave a 36-year-old gutter installer a new hand, making him the second person in the United States and the third in the world to receive such a transplant.
Jerry Fisher, a father of three from Jackson, Michigan, had the hand attached at Jewish Hospital in Louisville, Kentucky.
"This went very smoothly. It took us 13 hours," said Dr. Warren Breidenbach, a hand surgeon on the transplant team. "The patient is now in recovery and is actually back on the floor. And really, I can't be more pleased with the way things turned out."
The surgery began at 8:12 p.m. Friday and ended at 9:10 a.m. Saturday, a hospital spokeswoman said. The surgery went well, said hospital president Douglas Shaw, and Fisher was taken to a recovery room in stable condition.
"He left the operating room in good condition and alert and was actually joking with members of the surgical team," Shaw told CNN.
He will likely be moved to a regular patient room within several hours, Shaw said. In four days, a physical therapist and brace specialist will begin bracing his hand and working with it, Shaw said. Fisher will likely remain hospitalized for seven to 10 days and remain in the Louisville area for therapy for the next three months, Mackovic said.
Fisher lost his hand July 4, 1996, when a firecracker, a three-inch mortar, exploded in his hand. After the accident, his left nondominant hand was amputated at the wrist. Since then, Fisher has been using a hook in place of his missing hand. The donor hand came from a man who was declared brain dead. Fisher will have to take anti-rejection drugs for the rest of his life. In order to be selected, Fisher underwent physical and psychological testing, Mackovic said. Fisher, who is self-employed, installs seamless gutters. Hand surgeons, anesthesiologists and transplant experts from Kleinert, Kutz and Associates and the University of Louisville made up the transplant team.
Before undergoing the surgery, Fisher talked with Matthew Scott, who became the first person in the country to undergo the surgery two years ago. Scott remains healthy and continues to gain motion and function in his new hand, while incorporating it into everyday activities, the hospital said. Scott can rotate his wrist and move his fingers to perform various tasks.
The first hand transplant was done in France in 1998. Clint Hallam, 50, who had lost his hand in prison, failed to follow the anti-rejection drug regimen. Last week, the hand was amputated.
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BUSINESS NEWS
01-30-01 01:28:24 PM Hanger sees Q4 revenue shortfall, says CFO leaves
NEW YORK, Jan 30 (Reuters) - Hanger Orthopedic Group Inc. (HGR.N) on Tuesday said its fourth quarter revenues are seen down 5 percent, or $5 million, and that its Chief Financial Officer Richard A. Stein has left the company to pursue "other opportunities."
The Bethesda, Md.-based company also said it was undertaking certain steps to cut costs as it more closely matches cashflow with its debt obligations. Hanger, which specializes in orthotics and prosthetics services, said it has engaged search firm Korn-Ferry to look for candidates for the chief financial officer position.
The company's shares fell 24 cents, or 13.8 percent, to $1.50, above a year low of 93.75 cents and below a 52-week high of $6.3750.
Hanger Orthopedic Group, Inc. and Otto Bock Orthopedic Industry, Inc. Have Terminated Their Discussions About Sale By Hanger of its Manufacturing Division to Otto Bock Orthopedic Industry, Inc.; Hanger Pursuing Organizational Efficiencies
Friday, December 22, 2000 10:46 AM
BETHESDA, Md., Dec. 22 /PRNewswire/ -- Hanger Orthopedic Group, Inc. (NYSE: HGR, news, msgs) announced today that the proposed sale of its manufacturing division, Seattle Orthopedic Group, Inc., to Otto Bock Orthopedic Industry, Inc. will not be consummated due to the proposed buyer's inability to obtain financing on terms acceptable to it for the proposed purchase. Hanger had previously announced a possible sale of the division for approximately $75 million, the net proceeds of approximately $53 million would have been used to reduce bank indebtedness. Hanger presently plans to retain ownership of its manufacturing division and expects it to continue to make a positive contribution to Hanger and the operations of its patient-care centers.
In another development, Hanger has implemented a realignment of the branches in its patient care operations which will reduce annual expenses by approximately $8 million.
Headquartered in Bethesda, Maryland, Hanger is the only national public company specializing exclusively in practice management for orthotics and prosthetics ("O&P"). The Company now provides O&P services in 627 patient- care centers located in 44 states and the District of Columbia and is the largest distributor of O&P supplies and components in the country. Hanger also is engaged in the manufacture and distribution of components and finished patient-care products to the O&P industry, and through its OPNET program, provides O&P services to over 1,000 managed care programs.
Certain statements included in this press release are forward looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Please refer to the Company's SEC filings for factors that could cause actual results to differ materially from the Company's expectations.
12-04-2000 10:16:29 AM Schatz Nobel Announces That It Has Named Hanger Orthopedic Group And Others in a Class Action
HARTFORD, Conn., Dec. 4 /PRNewswire/ -- On November 28, 2000, a class action complaint (the "Complaint") was filed in the United States District Court for the District of Maryland on behalf of all purchasers of the common stock of Hanger Orthopedic Group, Inc. (NYSE: HGR) ("Hanger") from November 8, 1999 through and including January 6, 2000, inclusive (the "Class Period").
Plaintiff is represented by the law firm of Schatz Nobel, P.C., which has significant experience prosecuting class actions on behalf of investors. If you wish to discuss this action or have any questions concerning this notice or your rights or interests with respect to these matters, please contact attorneys Andrew M. Schatz, Jeffrey S. Nobel, Patrick A. Klingman, or Robert W. Cassot, at (800) 797-5499, or by e-mail at SN06106@aol.com. For more information about Schatz Nobel, P.C., please visit our website at www.snlaw.net.
The Complaint alleges that during the Class Period, Hanger and certain of its officers (collectively, the "Defendants") violated Sections 10(b) and 20(a) of the Securities Exchange Act of 1934 by, among other things, knowingly or recklessly making material misrepresentations concerning (i) Hanger's financial results for the quarter ended September 30, 1999 and (ii) the progress of Hanger's efforts to integrate the recently-acquired operations of Novacare Orthotics Prosthetics, Inc. The Complaint further alleges that by making these material misrepresentations, the Defendants artificially inflated the price of Hanger common stock during the Class Period. Plaintiff seek to recover damages on behalf of all class members.
If you purchased Hanger common stock (NYSE: HGR) during the Class Period and wish to act as lead plaintiff, you may move the Court to serve in that capacity not later than February 2, 2001. If you wish to discuss your rights as lead plaintiff or as a class member, please call Schatz Nobel, P.C. toll-free at (800) 797-5499, or by e-mail at SN06106@aol.com.
CONTACT: Andrew M. Schatz
Jeffrey S. Nobel
Patrick A. Klingman
Robert W. Cassot
Tel.: (800) 797-5499
Website: www.snlaw.net.
e-mail: SN06106@aol.com.
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RELATED TECHNOLOGICAL DEVELOPMENTS
Experts developing hi-tech prosthetic 'smart' leg
NEW YORK (Reuters Health) - The US government, private industry, and about 120 former Russian nuclear scientists are working together on a project to research, design and develop an advanced "smart leg."
Relying on an intricate combination of microprocessors, hydraulic joints and electric motors, the leg will simulate a human gait on a wide range of terrain. Researchers plan to have the new prosthetic device available for use within 2 years.
"This is the third of three projects on prosthetics we've undertaken with the Russians, starting with a prosthetic foot which has now reached the stage of being worn by soldiers who lost a foot in Chechnya," said Neil Singer, a spokesperson for the US Department of Energy's (DOE) Sandia National Laboratory. Based in Albuquerque, New Mexico, Sandia is a government-funded lab owned by the Sandia Corporation, a division of the Lockheed Martin Company.
"This is a unique arrangement, where you have the resources of two defense labs with their state-of-the-art equipment joining forces with American private industry to make prosthetic devices that will be ahead of their time," Singer told Reuters Health. "We have supercomputers and the most advanced labs in the world, and for a relatively small allocation of material and effort you get a relatively large humanitarian outcome that can help people."
Singer added that the work being done by both Sandia and the Russians based in the Chelyabinsk 70 nuclear weapons lab is addressing a currently unmet need.
Many of the people who suffer from loss of limbs are in third world countries--those who lost their limbs from land mines--and the economies of those countries are not strong enough to fund a research base.
The focus of the project is the development of an "active" prosthetic technology, using sensors at strategic points along the leg to reduce the amount of strain and energy the user needs to walk on irregular terrain while minimizing the risk of falling.
Researchers are also working on a new regularly self-adjusting socket for the leg to fit into--one that would reduce pressure sores resulting from the rubbing of the prosthetic against the amputee's contact limb.
The joint American-Russian effort is being funded by the DOE's Initiatives for Proliferation Prevention, which puts scientists who had formerly been involved in the nuclear arms race to work on humanitarian projects.
Scientists develop artificial 'skin'
The plastic might one day be used for making artificial organs
A self-repairing plastic "skin" has been developed and tested by US scientists. The smart type of plastic, which automatically knits together when cracked or broken, could one day be used to make artificial organs.
The material contains microcapsules filled with a special healing agent. Like human skin, it bleeds and heals itself, offering a potential breakthrough in vital materials used in surgical implants. It could also prove useful for making rocket and spacecraft components, which cannot be repaired once they are in use.
Plastics are normally susceptible to cracking caused by vibration, bending, and heat. Often the damage is deep within a structure, where it is difficult to detect and repair. But in fracture tests, the new self-healing plastic regained 75% of its original strength. Scott White, a member of the University of Illinois team that developed the "skin", said: "When the material cracks, the microcapsules rupture and release the healing agent into the damaged region through capillary action."
The scientists are now trying to modify the plastic so that it is suitable for commercial use.
They believe the technology could revolutionise the plastics industry, with satellites, rocket motors and prosthetic organs prime candidates for treatment.
The research is reported in the journal Nature.
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PREVENTATION AND AWARENESS
Promising therapy found for flesh-eating disease
TORONTO - Canadian doctors are reporting great gains in treating people with so-called flesh-eating disease. They're not touting a cure or promising preventative medicine. But they are saving lives -- and limbs.
Flesh-eating disease, or necrotizing fasciitis, is caused by a deadly strain of Group A streptococcus bacteria that also cause toxic shock syndrome. The bacteria travel so quickly through the body that doctors have long thought the best way to stop them is to begin an intense round of antibiotics and amputate the area affected if needed.
Now a new therapy called intravenous immunoglobin (IVIG) may help to reduce death rates from the disease. Researchers at Toronto's Mount Sinai Hospital are reporting the first study that shows the treatment reduces death.
The study found that of 32 patients with the disease who received antibiotics and other standard therapy, only 34 per cent survived. But of 21 patients who also got IVIG, 67 per cent survived-- nearly double the rate.
The doctors who treated Quebec Premier Lucien Bouchard in 1995 were among the first to try the treatment. Although he lost a leg, Bouchard probably owes his life to the experimental therapy.
IVIG is made of human antibodies that work by neutralizing poisons created by the bacteria that cause the immune system to attack itself.
Interestingly, it was developed in the early part of this century using antibodies from horses. The therapy worked so well, eventually the disease was nearly wiped out and the therapy forgotten.
Medicare Panel Unanimously Votes in Favor of Ambulatory Blood Pressure Monitoring
REDMOND, Wash.--(BW HealthWire)--Feb. 22, 2001--Spacelabs Medical, Inc. (Nasdaq:SLMD, news, msgs) reported today that the Medicare Coverage Advisory Committee (MCAC) Medical Devices and Prosthetics Panel met on Feb. 21, 2001, and unanimously voted in favor of the Company's petition to support the use of Ambulatory Blood Pressure Monitoring (ABPM) for suspected white coat hypertension.
The Panel also recommended that the Health Care Financing Administration (HCFA) develop guidelines for utilization. The Panel, which is comprised of outside experts, clinicians, researchers, as well as an industry and consumer representative, heard testimony from a number of patients who have benefited clinically from ABPM and medical luminaries. Substantial evidence presented by Spacelabs was also considered.
Hypertension affects approximately 50 million people in the United States. It is estimated that approximately 20% of those diagnosed with hypertension are not actually hypertensive and present elevated blood pressure only while in the presence of a clinician. This is known as "white coat hypertension". ABPM provides 24-hour blood pressure monitoring outside of the clinical setting, thereby helping to identify white coat hypertension.
Commenting on this development, Spacelabs Vice President Gene DeFelice stated, "We are very pleased with the Panel's unanimous vote to support the coverage of ABPM for suspected white coat hypertension. We believe that decision was a result of overwhelming evidence and scientific consensus. We also believe that the increased use of ABPM for suspected white coat hypertension will improve patient care and will likely eliminate unnecessary treatment and related costs. Once the MCAC's recommendation is forwarded to HCFA, we are hopeful that HCFA will act reasonably promptly."
Spacelabs is a worldwide leader in cardiovascular monitoring, diagnostic instrumentation, clinical information systems and ambulatory blood pressure monitoring used by physicians to monitor patients' blood pressure over a 24-hour period. Spacelabs Medical Data provides ambulatory blood pressure services to clinicians and other cardiovascular services.
Forward Looking Statements: Statements in this release not based on historical fact are forward looking statements subject to uncertainty and risk including but not limited to unanticipated delays, the risk that the Panel may modify the recommendation prior to finalization, and the risk that HCFA will not adopt or may modify the unanimous Panel recommendation.
(c)Spacelabs Medical, Inc. 2001
Chinese medicine may help diabetic foot ulcers
HONG KONG (Reuters Health) -- A Chinese University team has had an 85% success rate in healing diabetic foot ulcers using a traditional Chinese medical technique, eliminating the need for amputations in some serious cases.
Dr. Ping-chung Leung and his colleagues from the Chinese University, working out of the Prince of Wales Hospital in Hong Kong, adopted the technique in 1998 from Dr. Jiu-yiu Shi of the Shanghai Hospital for Integrated Medicine. Shi's method "has an excellent record on limb salvage with diabetic ulcers", Leung told Reuters Health.
The approach, which includes removing dead tissue and the use of herbs, was studied in 30 patients in Hong Kong who had been labeled "untreatable by limited surgery" and were on the amputation list, Leung said.
"The Chinese Philosophy advocates gradual removal of necrotic ligamentous tissues, thus limiting the disturbance of local circulation and promoting healing," he told Reuters Health. The ulcers are also treated with Chinese herbs, which are believed to "improve circulation" and "improve warmth and granulation," he added.
In Shanghai, patients with diabetic ulcers treated using Shi's technique stay in the hospital for about 20 days, as staff work slowly and continuously to remove necrotic tissue. No anaesthetic is used, and Chinese herbs are used to treat infection.
But in the Hong Kong study, patients were treated on alternate days and received anaesthesia and antibiotics as needed. Leung attributes the success of the Chinese method equally to the gradual surgery and Chinese herbal preparations.
"Radical debridement of ulcer or local amputation is often complicated with extension of tissue necrosis and higher amputation. The reason why we've failed diabetic foot patients previously is that we haven't realized how far the necrotic tissue has extended beyond the ulcer... some 4 cm to 10 cm," Leung told Reuters Health.
Leung attributes the 15% amputation rate in his study to patients sustaining damage to all the arteries going into the foot, leading to extensive tissue necrosis. Some patients needed one or more toes amputated or a mid-foot amputation and undergo skin grafting 4 to 5 weeks later. Essentially, Leung noted, their weight-bearing limb is preserved so they can walk with a specially designed shoe and do not need an artificial limb.
Currently, the active ingredients of the herbal preparations are being analysed in the Chinese University laboratory. "The problem with these herbal centres (that provide the herbs in China) is that they do not do these studies themselves nor disclose the proportions of the different herbs," Leung said.
He also has plans for another study to evaluate the circulatory changes in the affected limb during treatment so that a detailed protocol for limb salvage can be determined.
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NEWS FROM AROUND THE WORLD
Doctors say Baby Erika will walk again
EDMONTON - The remarkable recovery of Erika Nordby continued on Wednesday as doctors said the little girl who almost froze to death will walk again on her own two feet.
The 13-month-old Edmonton girl suffered severe frostbite on her hands and feet and there were fears she would have to lose portions of her limbs. But on Wednesday Dr. Gary Lobay, Erika's plastic surgeon, said it appears the frostbite is healing and her feet will not have to be amputated.
"It looks like her heel pad will survive and a good part of her foot and maybe all of it," he said.
"She should be able to walk with maybe some, maybe no, or maybe minimal disability, but at least she will be able to walk on her feet."
Lobay said it's still too early to tell if Erika will lose any fingers or toes, but her prognosis is positive. "It's a wonderful thing to see a child survive a very devastating insult and particularly when they come out with what looks like an excellent prognosis," Lobay said. That prognosis remains excellent even though Erika developed a mild fever of 39 C on Wednesday, one day after being moved out of intensive care. By evening, the fever had subsided. Erika was found nearly frozen to death early last Saturday morning, after wandering outside in &endash;20 C weather wearing only a light top and pants.
Doctors say Erika's heart stopped beating for at least an hour and a half. Her toes were frozen together and her mouth was frozen shut when she was found. Her body temperature had dropped so quickly she went into a state of suspended animation, like hibernation. Doctors say that drastically reduced the amount of oxygen she needed, enabling her to survive even after her heart stopped.
Doctors are watching closely for signs of infection, and they say it may be weeks or even months before Erika can go home. Even then, Erika and her mother face some challenges at home. Leyla Nordby, 26, is a single parent with a number of other children, including one on the way. Alberta's Department of Children and Family Services is offering to place professional child care workers in the home to help care for Erika and her siblings.
War Amps defend position on Viagra for vets
SAINT JOHN, N.B. - The head of the War Amps of Canada says Saint John MP Elsie Wayne has misunderstood the group's position on Viagra for veterans. Wayne says Ottawa shouldn't be paying millions of dollars for veterans to get the sexual dysfunction treatment.
"You can go up to six but I don't see many people at 75 or 80 who are going to use their full supply"
Elsie Wayne was astonished after Ottawa announced plans to pay for up to six Viagra pills a month for veterans.
Wayne called the move unbelievable, suggesting men with an average age of 81 didn't need it. She was even more shocked when a reporter asked if it was a quality of life issue.
"Oh, glory be, for heaven's sakes, no it's not. That isn't important whatsoever," she says.
Wayne says veterans are suffering from far more serious health problems that need funding. But Cliff Chadderton, head of the War Amps, says Wayne missed the point. Chadderton says amputees often struggle with sexual problems either because the amputation damaged their sexual ability or because the loss of a limb affected their sexual confidence. Chadderton, an amputee himself, says he uses Viagra and it's a health issue.
"A healthy sex life can enhance the quality of life but also lengthen life expectancy," he says. Chadderton says the announcement is good news for the 800 surviving war amps.
As for people worried about the cost of the program, Chadderton says you need to prove the problem is war-related to get those six pills each month.
"You can go up to six but I don't see many people at 75 or 80 who are going to use their full supply, let's put it that way," he says.
Former President Bush doing well after hip replacement surgery
By Rhonda Rowland
CNN Medical Correspondent
ROCHESTER, Minnesota -- Surgery to replace Former President George Bush's left hip went well, as expected, according to a statement released by the Mayo Clinic, in Rochester, Minnesota. The surgery, which typically lasts about two hours, was completed at 7:40 a.m. EST. The former president is expected to stay at the hospital for five days.
"Hip replacement surgery is a not a minor operation, but it's very predictable," said Dr. Jorge Galante, director of the Rush Arthritis and Orthopedic Institute in Chicago, Illinois. "Patients can expect good results at least 98 percent of the time if they're in good health."
The surgery involves removing the diseased part of the hip joint and replacing it with new, artificial parts called prosthesis. The new parts fit together like a ball and socket in the femur and hip bones. The goal is to improve movement by relieving pain and improve function of the hip joint.
The Bush family has not released information regarding the cause of the former president's hip problem. The most common reason people have hip replacement surgery is the wearing down of the hip joint from osteoarthritis. Other causes include rheumatoid arthritis (inflammation of the joints), avascular necrosis (loss of bone due to poor blood supply), injury, fracture and tumors.
"Hip deterioration is not life-threatening, but can greatly effect quality of life," said Dr. Galante, who designed some of the prosthetic devices currently used in hip replacement surgery. "Life for these patients can be miserable because the pain can be terrible. Without surgery patients can become totally handicapped and experience pain day and night, which interferes with sleep. Some patients can't walk from a chair to a bed, but with surgery we can make them almost normal and take away their pain."
Walking and light activity typically begins the day after surgery.
"Then begins the rehabilitation, which plays an important and lengthy role in any successful hip replacement," said Emory University's Dr. J. Robin de Andreade. "After discharge from the hospital, patients typically undergo three weeks of intensive rehabilitation prescribed by physical therapists."
Patients can often resume driving 4 to 6 weeks after the operation and return to normal activity in 3 to 6 months.
Serious complications such as joint infection are low occurring in less than 2 percent of cases. Blood clots are the most common complication and are limited by giving patients blood thinners.
Former first lady Barbara Bush also had hip replacement surgery at the Mayo Clinic three years ago. Both the former president and first lady also have Graves' disease. Doctors say the thyroid disorder and its treatment are not related to the hip problem.
The average cost of hip replacement surgery is $25,000. A major study published in the Journal of the American Medical Association in 1996 found the operation was cost effective. It found the average lifetime savings of a hip replacement is $117,000. The difference is largely due to savings in nursing care.
Canada debates validity of male circumcision
February 26, 2001
Web posted at: 1:03 PM EST (1803 GMT)
TORONTO, Canada (Reuters) -- Canadian anti-circumcision crusaders are challenging a law protecting women against genital mutilation as a way to draw attention to much more common male circumcision.
The court challenge led by Dr. Arif Bhimji has sparked a heated debate that pits subscribers to modern human rights tenets against followers of age-old religious traditions.
"We are saying that this section is discriminatory because it provides protection to females but it does not provide the same protection to males," said Bhimji, an emergency-room physician and a Muslim who heads the anti-circumcision Association for Genital Integrity.
He argues that the section of the criminal code concerning aggravated assault violates the Canadian Charter on Rights and Freedoms, which guarantees equality between the sexes.
Male circumcision is common in North America and elsewhere for religious and cultural reasons and to help prevent urinary tract infections, sexually transmitted diseases and penile cancer. In the minor surgical operation, the foreskin is removed to prevent bacteria from developing under the fold of skin.
Yet more is at risk than most people think, said John Antonopoulos of the Montreal-based Information Center on Circumcision. "It is not a small, useless piece of skin. There is a whole world of sensations in the foreskin," he said, citing sensitive nerve connections at the end of the penis.
A mandatory practice in Islam and Judaism, circumcision was introduced to Anglo-Saxon countries at the turn of the 19th century and expanded in the 1950s as a way to improve hygiene. Experts say it was also seen as a way to control sexual urges and reduce masturbation, believed then to cause mental illness.
Since the 1970s there has been an ongoing debate over its merits and the Canadian Pediatric Society, like several medical associations in the United States, Britain and Australia, said in 1996 that newborns should not be routinely circumcised.
"There are potential complications, and it's not medically necessary," said Dr. Debra Davis, a member of the Canadian Pediatric Society. In 2 percent to 10 percent of circumcisions minor complications such as bleeding, infection and inflammation can occur and, more rarely, damage to the penis can lead to amputation, she said.
Given those concerns, she said there was a "real push" from the medical community in the mid-1980s to decrease the rate of circumcision, which fell to 60 percent from almost 90 percent in the United States and to 20 percent from 50 per cent in Canada. Davis said no new medical evidence has arisen that would justify recommending a return to circumcision. Bhimji said medical associations failed to educate professionals on this delicate matter. "As a physician, I had an obligation to make sure that we are protecting the most vulnerable in our society," he said.
"I am a Muslim, so this is something I didn't take lightly, but I came to the conclusion that just because it is a religious requirement it doesn't give us an unfettered right to cause harm to our children."
The view of most human rights, children's aid and religious groups is that, unlike female genital mutilation (FGM), male circumcision is not a deliberate attempt to injure the child.
"Male circumcision does have recognized medical benefits ... FGM in contrast was never medically accepted and all colleges (of physicians and surgeons) have banned the practice," said Carole Morency of Justice Canada.
Male circumcision cannot be compared to female genital mutilation -- often mistakenly called female circumcision -- which generally involves the complete removal of female genitalia and poses serious health risks, Morency said.
"We amended the code in 1997 to avoid any uncertainty that the criminal law in Canada does clearly prohibit the practice of FGM," she said, rejecting Bhimji's argument that the section violates the Charter's requirement of equality of treatment. The Canadian Jewish Congress immediately said it would oppose any court challenge to the law.
"Circumcision is a divine commandment. It's not an optional kind of thing and it doesn't depend on logic," CJC communications director Rubin Friedman said. If a child is not healthy, the only exception would be delaying the rite, usually performed on the eighth day following birth, he said.
Imprisoned in bone Disorder calcifies muscle, connective tissue
By Michele Dula Baum
CNN.com Health Writer
(CNN) -- At birth, short, malformed big toes are the only indication of the genetic disaster that is fibrodysplasia ossificans progressiva, or FOP.
Perhaps fewer than 2,500 people worldwide share the mystery of this disorder that slowly -- but sometimes as quickly as overnight -- immobilizes those who have it in a cage of bone.
"These people are literally imprisoned in a second skeleton," says Dr. Fred Kaplan, a University of Pennsylvania specialist in molecular orthopedics who has dedicated much of the past 10 years to finding the key to FOP. "It transforms muscles, tendons, ligaments -- connective tissues become sheathed in bone. It spans joints, locking them into place and rendering movement completely impossible."
In many ways, Ashley Kurpiel of Peachtree City, Georgia, is a typical 18-year-old. She shows off snapshots from a family vacation and proudly points out her boyfriend of 14 months, Shawn.
She is enthusiastic about starting college studies on the Internet next month, and plans to focus on a career in the computer industry. At one time, she had dreams of working with children, but the realities of her condition have made that increasingly unlikely.
"It gets to me that I can't dress myself or do my hair, but I remember that I could always be worse," she says.
Though she can still walk (the hips and knees of many FOP patients become locked by the time they are teen-agers), Kurpiel's most severe handicap was caused by a childhood misdiagnosis of infantile fibromatosis, a nonmalignant yet extremely aggressive tumor, in her right shoulder.
An irreversible choice
Doctors told her parents the tumor had spread too far to save the arm, and it was amputated, along with the shoulder joint and a portion of back and chest muscle. Ashley was not quite 3 years old at the time.
In actuality, the tumor was another early sign of FOP. "Right after the amputation, my left arm started freezing up," says Kurpiel, who can no longer lift her arm above her head, but can still write longhand and manage a keyboard.
One of the heartbreaks of the disease is that any bump or trauma -- even something as seemingly insignificant as a vaccination shot -- can trigger a flare-up. Beginning as an inflamed, red and tender swelling, flare-ups are often the first real sign of the disease.
Eventually, the swellings subside, to be replaced by new bony growth. Such ribbons and sheaths of bone form bridges across the skeletal framework, building a new frame that often contorts posture as well as immobilizing those with FOP. Some are left in a perpetual standing position, while others may freeze hunched into a forward sitting pose.
"This is catastrophic beyond belief," says Kaplan.
Kaplan and other researchers continue to make discoveries about the nature of the disorder, which seems to be linked to a particular chromosome. So far, only one family -- a father and three children -- has been identified with multiple members affected. Others are randomly scattered throughout the world. Doctors peg the odds of a child being born with FOP at one in 2 million.
Genetic clues
The mapping of the human genome is a great stride for scientists who are researching all kinds of diseases, and FOP also is yielding clues.
"What happens in FOP is children continue to make new pieces of the skeleton after birth," explains Kaplan. "The signal is not just 'make more bone.' "
Extra bone forms in a known pattern that echoes skeletal formation during fetal development. It starts at the head and neck and progresses down the trunk to the extremities, ranging from back to front.
To be able to identify a gene for FOP would truly be "the skeleton key," says the orthopedist.
Several proteins have been identified as vital for bone growth, including one called BMP4. "We know BMP4 is one of the terrorist agents that triggers new bone formation," says Kaplan. "We're working on therapies to limit the production of BMP4 in people who have FOP."
Promising research is being done in Philadelphia and elsewhere on a compound called noggin, which blocks BMP4, and an agent called squalamine, which comes from shark cartilage. Squalamine inhibits the formation of blood vessels, a vital link to bone tissue growth. Similar research is ongoing with such substances, known as anti-angiogenics, as cancer therapy, since tumors also need blood vessels in order to grow.
Locating the precise gene for FOP can have far-reaching consequences, and not only for FOP, he continued, saying, "If you can figure out how to turn it off, you can turn it on."
Unnatural bone growth
Normally, the body breaks down and grows new bone all the time, focusing and speeding the process only to repair a break before settling into the routine of maintaining a skeletal system already complete.
In FOP, this system goes on overdrive. They need an "off" switch. But an "on" switch would be just as useful to grow new bone to replace that lost by accidents, tumor removal, congenital malformation or other trauma.
"Even if the answer to FOP is only for FOP, it wouldn't in any way dissuade me from working on it," says Kaplan. "I would hope we can make a difference for these kids (and find) medications, treatment or therapy that would enable them to prevent a joint from turning into bone or restore movement to some joint already frozen."
For now, there is little medicine can offer other than education -- especially for other physicians.
"You can't keep a child in a glass box," says Kaplan, explaining that parents often say they are as fearful of the disorder stealing their children's childhood as they are of the progressive disability.
But prudence to avoid trauma makes sense. If you know that a routine inoculation can cause inflammation and bone formation, you can decline the shot.
Physicians who suspect FOP should not biopsy swellings, for instance, Kaplan says. "That can send the condition into a wild state of flare-up."
An injection for dental work "can cause the jaw to lock up within hours," he adds. One woman with FOP remembers going to sleep still able to use her left wrist, and waking up to find it frozen with the hand cocked upward. Jaws frequently lock early in life, reducing those with FOP to eating only pureed food.
Jack Wilson of Chattanooga, Tennessee, hasn't swallowed a thing since 1987. Now 45, his neck muscles are locked tightly in bone. He has a tracheotomy, and can move only a few shuffling steps with help. But he is determined to make a difference with his life for as long as he can. Before his elbows locked up, he played piano. When they began to stiffen, he taught himself guitar, and then taught others how to play. These days, he regularly visits a psychologist at a Chattanooga rehabilitation hospital for guidance in staying focused on the world outside the four walls of his basement apartment. He can still move his hands, and is an active computer correspondent, as is Kurpiel.
"The FOP association helps me be able to be in touch with other people, too," he says through perpetually clenched teeth. "And I'm thinking about getting a power wheelchair."
Life expectancy for people with FOP is "tremendously variable," says Kaplan. "The average life span is mid-40s, but it ranges from the teens to the 80s."
Those who die at midlife or younger generally succumb to respiratory complications such as severe bronchitis or pneumonia. Because of restrictive bone formation in the chest wall, lungs often cannot expand properly, making it that much harder to overcome infection.
"Generally, though, these people are quite healthy," Kaplan notes. "Perhaps there is an auto-inflammatory component because they tend to be tremendously resistant to infections. But if they happen to get a cold or respiratory infection, it's more likely to become a complicated issue."
Guarantee heating or face sack
A Russian government minister has said that regional governors who fail to guarantee adequate heating and electricity supplies in freezing temperatures should be sacked. The Minister, Sergei Shoigu, who's responsible for dealing with emergencies, issued the warning after a visit to Krasnoyarsk, in Russia's Siberia region, where thousands of people have been without heat for months and more than two million face daily blackouts. The region is suffering its harshest winter in over fifty years with temperatures regularly falling to 40 degrees below zero falling in some places to lows of minus 70. Amputations from severe frostbite are a daily occurance in the town of Irkutsk and fifty frozen corpses have been collected off the streets in recent weeks.
New protests as Siberian freeze bites
The railway is a crucial artery for Siberia Protesters in Russia's Far East have tried to block the Trans-Siberian railway in a new wave of protests over continuing power cuts. Russian Public Television reported that residents of Razdolnoye, a village in the Maritime Territory, decided to take direct action but police blocked their access to the railway line.
Some flats have no heating at all
The operation of the railway has not been disrupted, but the Razdolnoye residents said they would continue the protests until their homes were heated. Many people have not had heating, water or electricity in their homes for weeks amid one of the harshest Siberian winters in recent years. Public television reported a total of 600,000 people were affected by poor heating in the Far East territory, and 18,000 people have no heating at all. Conditions for ships entering harbour have been described as the worst in 25 years. Even people used to the harsh weather are taken by surprise. Amputation is often the only course available in cases of severe frostbite, which takes hold rapidly in temperatures as low as minus 50C.
Emergency
In Yakutia, northeastern Siberia, a state of emergency has been announced in the town of Lensk, where 16 blocks of flats and nearly 30 private houses were left without heating.
Local people are running electric heaters at full capacity to keep food from freezing indoors. Thick icefields have formed outside the port of Magadan and it is taking 10 times longer than usual for icebreakers to escort tankers and container ships into port.
The icefield now extends some 400km from the shore. No improvement is expected until a wind from the north-east carries ice out of Nagayevo Bay, but forecasters do not expect this to happen until February at the earliest.
Taleban warn of death for converts
The supreme leader of the ruling Taleban in Afghanistan, Mullah Mohamad Omar, has warned that the death penalty will be applied to any Muslim who converts to another faith.
An edict issued by Mullah Omar said strict Islamic law or Sharia would apply to any Afghan Muslim who was caught professing Christianity or Judaism. This included distributing literature and other publicity material promoting non-Islamic faiths. The Taleban, who control most of Afghanistan, follow a strict interpretation of Islam.
The decree by Mullah Omar referred to what were described as attempts by enemies of Islam to win over Muslims to Christianity and Judaism. It said that some Afghans had converted for material benefits.
"It is seen that enemies of the sacred religion of Islam are making efforts throughout the world to eliminate this pure religion."
The statement did not elaborate. However a Taleban spokesman, Abdul Hai Mutmain, said that foreigners in Afghanistan were secretly trying to convert Afghans to Christianity.
"There are programmes by some agencies inside and outside Afghanistan to do this," he said, without identifying the organisations allegedly involved.
Since taking control of 90% of Afghanistan, the Taleban have introduced Islamic punishments, including execution and amputation of limbs. They have also barred women from most jobs, and insisted that both men and women follow a strict dress code. Last month, the UN stepped up an embargo imposed on the Taleban over their refusal to hand over Saudi militant Osama bin Laden. Osama bin Laden is accused by the US of masterminding the bombings of US embassies in Africa in 1998, killing more than 200 people.
Eight-month-old Murtza Ali found alive in his mother's arms
BHUJ, India -- The discovery of a living 8-month-old baby on Monday has captured the heartbreak and the singular miracles of India's killer earthquake.
The rescue was a rare cause for hope following the earthquake, whose damage is now estimated at up to $5.5 billion. Some authorities in India said it was likely that the death toll would rise above 20,000. The number injured was more than 32,000, officials said.
"If after five days you survive it is due to exceptional luck, a cavity large enough and access to water," said Mike Thomas, a member of a British specialist rescue team.
India's prime minister acknowledged Monday that his country was ill-prepared for disasters. In the case of the miracle baby, found cradled in his mother's arms and covered in her blood, doctors said the warmth of his mother's body helped him survive three days in the ruins of a collapsed building in Bhuj's Kansara Market.
"We saw the baby in the mother's lap, we saw some movement from the baby," said R.K. Thakur, a Border Security Forces assistant commandant. "I took the baby in my hand and I found it was alive."
The boy, Murtza Ali, was rushed to a medical center, surviving relatives were found, and the child was conscious and smiling, Thakur said, adding: "It was miraculous."
There are few even partly happy endings in western India these days. Survivors complained Monday that confusion and a lack of equipment was hampering rescue efforts. Rescuers lacked cranes and bulldozers, and many units did not even have generators, making night work impossible without lights. Soldiers hunting for survivors began work at first light and stopped when the sun went down. The hope of finding many more survivors "is dwindling hour by hour, but as long as there is hope, we won't give up," said Joachim Ahrens, who represents a Swiss rescue team in Bhuj. A grim-faced prime minister Atal Bihari Vajpayee, who toured Gujarat on Monday, said he was forming a national disaster agency to ensure immediate response to emergencies.
"The country is not ready to face such disasters," Vajpayee told reporters in Ahmedabad, Gujarat's economic hub. He also announced federal grants totaling $108 million for the state.
In New Delhi on Monday, Agriculture Minister Bhaskar Barua appealed to private aid groups for field hospitals, clothing, volunteers to put up tents and prepare and distribute food, and cranes and other equipment. As recently as Sunday, Barua said it was the policy of his government not to ask for foreign aid. But he said India was thankful for the foreign help it had been offered. Some 20,000 soldiers are working throughout the state to help other rescue workers, some from overseas.
The Associated Press & Reuters contributed to this report.
U.N. urges Saudi Arabia to halt child floggings
GENEVA, Switzerland (Reuters) -- A United Nations body on Friday said Saudi Arabia's strict interpretation of Islamic Sharia law violated many basic children's rights, and urged the kingdom to halt floggings, stonings and amputations of young offenders.
The U.N. Committee on the Rights of the Child expressed concern that Saudi laws discriminated against females and non-Muslims, and called on it to bring its legislation into line with international standards.
The conclusions were issued after Saudi officials appeared for the first time before any U.N. human rights treaty monitoring body to present a report and defend their country's record, according to a U.N. spokesman.
Saudi anti-vice officials "routinely harass and assault persons under 18 for dress code infractions" according to the U.N. committee, composed of 10 independent experts.
These and other practices are incompatible with the U.N. Convention on the Rights of the Child, the committee said in a statement after a "frank dialogue" held in Geneva on January 19.
"Noting the universal values of equality and tolerance inherent in Islam, the Committee observes that narrow interpretations of Islamic texts by State authorities are impeding the enjoyment of many human rights protected under the Convention," it said.
The Committee urged Saudi Arabia to "end the imposition of corporal punishment, including flogging and other forms of cruel, inhuman or degrading treatment and punishment to persons who may have committed crimes while under 18."
The experts also urged Saudi Arabia, which is among the 191 countries to have ratified the 1991 pact, to withdraw its general reservation attached to the treaty which "potentially negates many of the Convention's provisions."
The committee said Saudi law failed to define a child and the age of majority and expressed serious concern about the possibility that the death penalty may be imposed for offences committed by those under age 18, in violation of the pact.
Abdul Wahab Attar, Saudi Arabia's ambassador to the United nations in Geneva, told the committee his country embraced Islam as a creed and way of life in which children were accorded an honorable place.
The Saudi government gave the highest priority to sustaining a high level of welfare, education and health services for youth, according to the envoy who led a 10-member delegation.
The London-based human rights group Amnesty International last year accused the Saudi justice system of being steeped in secrecy that facilitated torture, and of meting out cruel punishments including floggings and amputations.
Amnesty called on the U.N. Commission on Human Rights to condemn "gross and systematic" violations in Saudi Arabia.
But the world's largest oil exporter -- long considered "untouchable" at the 53-member state body because of its strategic and commercial interest to allies including the United States -- was not rebuked at last year's session.
Sharia law poses dilemma for aid organizations
NEW YORK (Reuters Health) -- Providing healthcare in nations that have sharia law -- where convicted criminals can be punished by amputation of a limb -- can be a dilemma for international aid organizations. Spokespersons for two such organizations say that criminal convictions under sharia law can pose difficult ethical and humanitarian concerns for medical staff and aid workers.
For example, does treating people who have just had a hand amputated as punishment indicate support for such laws? The issue is debated in the British Medical Journal for August 14th.
The Red Cross does not allow its health professionals to participate in performing amputations under sharia, or provide "the premises, the knowledge, or material for performing these amputations," according to Chief Medical Officer Pierre Perrin of the International Committee of the Red Cross, headquartered in Geneva, Switzerland.
Perrin points to the case of an Afghan surgeon under the Red Cross' employ. In 1997, the surgeon "was taken by the local authorities to a marketplace. There he amputated the hand of a person who had been convicted under sharia law." Subsequent negotiations with Afghanistan's Taliban government have since ensured that staff or hospitals linked with the Red Cross will not be involved in such acts in the future.
At issue is how healthcare professionals who are providing humanitarian aid to countries that recognize sharia can provide aid without condoning these practices, and work to end sharia without appearing to impose Western values on Islamic cultural systems.
Perrin notes that it is the policy of the Red Cross to privately (but not publicly) state its objections to amputations based on sharia, and to "call for leniency in each case." He adds that doctors have a duty to treat individuals who have undergone such amputations.
Hanna Nolan, of the medical humanitarian organization Medecins Sans Frontieres, Amsterdam, the Netherlands, comments in a separate article that corporal punishment is "increasingly interpreted as a violation of laws governing human rights." Because the types of corporal punishment allowed under sharia are a "danger to a person's health," the organization will "never be involved in corporal punishment or the preparation for it," she states.
However, she adds that once an amputation takes place, the individual "becomes a patient in need of medical care, which the organisation would supply," echoing the Red Cross' stand.
But unlike the International Committee of the Red Cross, Medecins Sans Frontieres does not "rule out the possibility of making a public statement and opposing amputations," and considers documentation and reporting of amputations part of its humanitarian role.
Aid workers rush to isolated areas of El Salvador
SAN SALVADOR - The man whose astonishing rescue from under earthquake rubble brought a ray of hope to El Salvador has died in hospital. Sergio Moreno, a 22-year-old musician, spent 31 hours buried under cinderblocks and dirt. He called for help on his cell phone and was pulled out alive. But his heart and kidneys had failed just before he was rescued. Doctors revived him and later amputated his legs, but Moreno died late Tuesday night. Moreno was the 683rd victim of Saturday's earthquake that devastated El Salvador. The 7.6 magnitude quake also killed six people in neighbouring Guatemala.
Rescue workers have given up on finding any more survivors. Aid workers are now racing to get food, water, and medicine to towns cut off from the rest of the country. The death toll is expected to rise as authorities assess the earthquake's effects in those isolated communities. Tens of thousands of people are still living outdoors. Many are afraid to go inside after four days of aftershocks.
Signs of normal life are returning to the capital of San Salvador. Banks, stores and some restaurants have reopened. But about three million people &endash; nearly half of El Salvador's population &endash; still don't have clean water.
Authorities are overwhelmed by the huge number of bodies. In shattered places like Santa Tecla where a landslide buried an entire neighbourhood, victims were buried in mass graves.
Officials there are blaming landslides on builders who removed trees to build mansions.
Copyright 2001 GB Communications
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