Ownership of and respect for the body
Philip Cheung in Public Trust in Medical Research?, 2018
The validity of the 'no property in a dead body' rule can equally be challenged on the basis of ethics and natural law. There is a duty to give decent burial and there must be a denial to anyone of a right of ownership of the dead body for commercial profit, that is the body or body parts cannot be sold. The argument over the ownership of the dead human body goes on, and appears to be a worldwide issue. The problem of ownership of the human body is clearly an insurmountable legal problem as long as the 'no property' rule exists, particularly where the system is flexible and subject to change socially. Perhaps the focus should be on the professional integrity of doctors. The shortage of donor organs is real. Perhaps there might be a strong case to support research on the manufacturing of autograft from one's own stem cells for organ transplantation.
Shifting Paradigms in Peripheral Tolerance
Richard K. Burt, Alberto M. Marmont in Stem Cell Therapy for Autoimmune Disease, 2019
Through clonal selection, the immune system is able to prepare and respond to a multitude of diverse antigens. However, since the generation of diversity is a stochastic post-germline encoded event, a critical component of the immune response must subsequently be the ability to discern between harmful and innocuous antigens in a tolerance process. Early theories, (on which the foundation of modern immunology is based) described tolerance as the ability to distinguish self from nonself. In the beginning, Ehrlich and Morgenroth realized this important aspect of the system and coined the term “horror autotoxicus” to describe the consequences of tolerance being broken and the immune system unleashing its effector function on one’s own body. 1 Burnet proposed that this educational skewing toward the recognition of only nonself occurred during a critical developmental period that began in utero and lasted through the perinatal period. 2 During this time, autoreactive lymphocytes would recognize self antigens and be deleted. If indeed self was defined during a critical developmental period, then a prediction of such a model was that “foreign” antigens introduced during this period would induce tolerance. Experiments by Billingham demonstrated that if cells from A mice were injected into B mice during the fetal period, the B mice would accept A-strain skin grafts but reject third party C-strain grafts. 3 Inversely, Triplett was able to show that by removing the pituitary anlage from tree frog larvae and then replacing the adult animals with their own pituitaries, the frogs rejected the autografts. 4 Since the pituitary was not present during the critical self education period, it was seen as foreign in the adult animal and rejected.
Switchback: using the pulmonary autograft to replace the aortic valve after the arterial switch operation
Tirone E David, Hans A Huysmans, Stephen Westaby in Stentless Bioprostheses, 1999
Aortic valve insufficiency has been described to occur following the arterial switch operation. Valve insufficiency is mild in most cases. In some patients valve repair or root reconstruction may solve the problem, but in others the valve will have to be replaced. As the number of patients surviving long term after the arterial switch operation is growing, valve insufficiency may be seen more often. In infants the ideal way to replace the aortic valve is using the pulmonary autograft. Our experience with aortic valve replacement using the pulmonary autograft (former aortic valve) in one infant with a previous arterial switch is described.
Autograft cellular composition and outcome in NHL patients: results of the prospective multicenter GOA study
Published in Leukemia & Lymphoma, 2020
Antti Turunen, Jaakko Valtola, Anu Partanen, Antti Ropponen, Outi Kuittinen, Hanne Kuitunen, Kaija Vasala, Lasse Ågren, Karri Penttilä, Leena Keskinen, Eeva-Riitta Savolainen, Marja Pyörälä, Taru Kuittinen, Tuomas Selander, Pentti Mäntymaa, Jukka Pelkonen, Esa Jantunen, Ville Varmavuo
Autologous stem cell transplantation (auto-SCT) is an established treatment option in patients with non-Hodgkin lymphoma (NHL). In this prospective multicenter study, the effect of infused blood graft cellular composition on post-transplant outcome was analyzed in 129 NHL patients. Higher graft CD34+ cell content (>2.5 × 106/kg) correlated with better progression-free survival (PFS) (p=.009) and overall survival (OS) (p=.004). Higher graft CD34+CD133+CD38– counts (>0.08 × 106/kg) were also linked with better PFS (p=.03) and OS (p=.004), and these survival benefits retained in multivariate analyses. Higher infused CD3+CD4+ cell count (>37 × 106/kg) predicted better PFS (p=.013) and OS (p=.007) in multivariate analysis. Autograft cellular composition seems to impact outcome in NHL patients. These observations regarding composition of optimal graft in autologous setting should be validated in an independent patient series or in a randomized study.
In Situ Blood Coagulum versus Sutures for Autograft Fixation after Pterygium Excision
Published in Current Eye Research, 2018
Purpose: To compare the outcomes of autograft fixation using patient’s own blood coagulum and using sutures after pterygium excision. Methods: In this prospective clinical study, 30 eyes of 30 patients with primary pterygium were randomly assigned into two groups: Group 1 (15 eyes) underwent autograft fixation with 10/0 nylon sutures and Group 2 (15 eyes) underwent autograft fixation by using in situ blood coagulum following pterygium excision. Primary outcome measure of this study was graft failure and displacement. Recurrence, the duration of surgery and patient discomfort were also evaluated. The patients were examined at day 1, day 7, month 1, month 6, and month 12. Results: Mean duration of surgery was significantly less in Group 2 (mean duration 14 ± 2 minutes) compared with Group 1 (mean duration 48 ± 2 minutes). Graft failure and displacement were more common in Group 2 (13.3%) compared with Group 1 (6.7%). Recurrence was reported equally in both groups. Patient discomfort was found significantly more in Group 1 (foreign body sensation due to sutures.) Conclusions: Autograft fixation by using in situ blood coagulum after pterygium excision is an effective technique with less patient discomfort and shorter operation time.
Posterior auricular muscle patch graft for exposed orbital implant
Published in Orbit, 2019
Catherine Y. Liu, Michael G. Sun, Scott Jones, Pete Setabutr
The purpose of this article is to describe a surgical technique to repair an exposed orbital implant by posterior auricular muscle autograft. A retrospective review was conducted of four patients with an exposed orbital implant that were treated with a posterior auricular muscle graft. Four patients received posterior auricular muscle patch graft to the exposed orbital implant. The donor site healed with minimal scarring and remained well hidden. The graft incorporated fully into surrounding orbital tissue with no recurrent exposure at average of 13 month follow-up. The posterior auricular muscle autograft is a viable technique for repairing an exposed orbital implant.
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