Stem cells used to fix breast defects
Sun, 16 Dec 2007 09:59:48 GMTBy MARILYNN MARCHIONE, AP Medical Writer
SAN ANTONIO - For the first time, doctors have used stem cells from liposuctioned fat to fix breast defects in women who have had cancerous lumps removed.
The approach is still experimental, but holds promise for millions of women left with cratered areas and breasts that look very different from each other after cancer surgery. It also might be a way to augment healthy breasts without using artificial implants.
So far, it has only been tested on about two dozen women in a study in Japan. But doctors in the United States say it has great potential.
"This is a pretty exciting topic right now in plastic surgery," said Dr. Karol Gutowski of the University of Wisconsin-Madison. "There are people all over the country working on this."
The Japanese study was reported Saturday at the San Antonio Breast Cancer Symposium. The company that developed the treatment, San Diego-based Cytori Therapeutics, plans larger studies in Europe and Japan next year.
More than 100,000 women have lumps removed each year in the United States. These operations, lumpectomies, often are done instead of mastectomies, which take the whole breast. But they often leave deformities because as much as a third of a woman's breast may be removed.
"It's almost a euphemism" to call it a lumpectomy, said Dr. Sydney Coleman, a plastic surgeon at New York University who has consulted for Cytori and is interested in the stem cell approach.
The defect "initially may not be as noticeable" but it often gets worse, especially if the woman also has radiation treatment, said Dr. Sameer Patel, a reconstructive surgeon at Fox Chase Cancer Center in Philadelphia.
"There's a growing push to try to involve the plastic surgeon particularly for this reason — to try to avoid a defect," but once one develops, options to repair it are limited, Patel said.
The implants sold today are for reconstructing breasts after mastectomies. They aren't designed to fix odd-shaped deformities from lumpectomies or radiation.
"Each one is so different, there's no little thing you can just pop in there," Gutowski explained.
Doctors can try making the other breast smaller so they match, transplanting a back muscle to boost the flawed breast, or rearranging tissue to more evenly distribute what's left. But these involve surgery and leave scars.
Mini implants of fat tissue have been tried, but they often get resorbed by the body or die and turn hard and lumpy. The recent discovery that fat cells are rich in stem cells — master cells that can replenish themselves and form other tissues in the body — renewed interest in their use.
In the Japanese study, doctors liposuctioned fat from 21 breast cancer patients' tummies, hips or thighs. Half was reserved as the main implant material; the rest was processed to extract stem cells and combined with the reserved fat. This was injected in three places around a breast defect.
Doctors think the stem cells will keep the tissue from dying and form lasting mini implants.
Eight months after treatment, "about 80 percent of the patients are satisfied" with the results, said the lead researcher, Dr. Keizo Sugimachi of Kyushu University in Fukuoka, Japan.
There was a statistically significant improvement in breast tissue thickness at one and six months after treatment.
Doctors with no role in the research say longer study is needed to see if these results last.
The treatment is expected to cost $3,000 to $5,000, said Cytori's president, Dr. Mark Hedrick. The company sees potential for cosmetic breast augmentation of healthy breasts, but for now "our plan is to focus on an unmet medical need" in cancer patients, he said.
The American Society of Plastic Surgeons says doctors must be cautious about using fat cells for cosmetic purposes until more is known. Gutowski heads a task force the society formed to study the science. Coleman is a member.
"It's got great potential not only for breast but other cosmetic and reconstructive purposes," like filling in facial defects from cancer or trauma, Gutowski said. "Imagine the aging face."
Better cosmetic treatments may encourage more women to choose lumpectomies. Some have opted for mastectomies because they are concerned about being left with a defect, especially younger women.
Laurie Rapp, a 48-year-old restaurant manager in Philadelphia, was only 32 when she had a lumpectomy, and now has mismatched breasts.
"One is so much smaller than the other one," she said. "There's quite a bit of puckering, and as I'm getting older I feel it's getting worse."
She probably would not try the stem cell treatment now, but if it had been available when she had her surgery, "I definitely would have, especially because I wasn't even married then," she said.
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On the Net:
Breast cancer meeting: http://www.sabcs.org/
National Cancer Institute: http://www.cancer.gov/
Cytori: http://www.cytoritx.com/
WHO to investigate Pakistan bird flu
Sun, 16 Dec 2007 11:22:20 GMTBy STEPHEN GRAHAM, Associated Press Writer
ISLAMABAD, Pakistan - International health experts have been dispatched to Pakistan to help investigate the cause of South Asia's first outbreak of bird flu in people and determine if the virus could have been transmitted through human contact, officials said Sunday.
Four brothers — two of whom died — and two cousins from Abbotabad, a small city about 30 miles north of Islamabad, were suspected of being infected by the H5N1 virus, said WHO spokesman Gregory Hartl in Geneva. A man and his niece from the same area who had slaughtered chickens were also suspected of having the virus.
Another person in a separate case who slaughtered poultry in nearby Mansehra, 15 miles away, also tested positive for the disease, he said.
Details surrounding the cases remained confusing, with Pakistan's Health Ministry issuing a statement Saturday saying six people had initially tested positive for the virus last month, while the WHO said eight had been reported. Hartl said the discrepancy was likely linked to a technicality since six patients had tested positive using an internationally recommended method while a less reliable test was used on the others.
Specimens were never collected from one of the brothers who died, and many of those who tested positive experienced only mild symptoms and were not hospitalized, Hartl said.
He added a team of WHO experts have been sent to Pakistan to help determine the cause. He said all four brothers were believed to have worked on a farm and poultry outbreaks had earlier been reported in the area. But one brothers, Mohammed Tariq, said only one sibling worked on the farm.
Hartl said WHO has not ruled out limited human-to-human transmission.
"We can't answer that yet," he said. "It's possible."
The H5N1 virus has killed at least 208 people worldwide, mostly in Southeast Asia and China, since it began ravaging Asian poultry stocks in late 2003. So far, most human cases have been linked to contact with sick birds.
A team from the U.S. Naval Medical Research Unit in Cairo was being dispatched to Pakistan to help with the investigation, said Dave Daigle, a spokesman for the U.S. Centers for Disease Control and Prevention in Atlanta.
Khalif Bile, WHO representative in Pakistan, told The Associated Press on Saturday that preliminary tests had been carried out. He said the WHO was encouraging the government to carry out confirmation tests in the same government laboratory and the results should be available by Tuesday.
People who came into contact with those infected in Pakistan are being monitored, the WHO said.
A brother of the two men who died in Pakistan said Saturday he had been hospitalized with flu-like symptoms. Mohammed Ishtiaq said he fell ill last month after slaughtering chickens suspected of carrying bird flu at a farm near Abbottabad.
"I was not aware that this was such a dangerous disease," said Ishtiaq, a veterinary doctor who works for a government-funded livestock program. He said he wore no protective clothing.
His two brothers did not accompany him to the farm, but visited him in a hospital, Ishtiaq told Associated Press Television News in the village of Sukur.
He identified his brothers as Mohammed Ilyas and Mohammed Idrees and said they were both studying at an agriculture college in the northwestern city of Peshawar.
It was unclear if they had other contact with poultry or another potential sources of infection.
Muqarab Khan, director general of livestock and animal husbandry in the province, said animal surveillance was under way across the province.
Poultry vaccine campaigns also have been started and all farms in the surrounding area have been closed.
Pakistan has grappled with outbreaks of bird flu in poultry for the past two years, but had previously not confirmed cases in humans.
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Associated Press reporters Margie Mason in Hanoi, Vietnam, Zarar Khan in Islamabad and Inam ur-Rahman in Sukur contributed to this report.
Girl born with 8 limbs leaves hospital
Sun, 16 Dec 2007 10:00:10 GMTBy AIJAZ RAHI, Associated Press Writer
BANGALORE, India - A 2-year-old girl who was born with four arms and four legs left a hospital in southern India on Saturday, little more than a month after surgeons successfully removed her extra limbs.
The surgeon who led more than 30 doctors in the marathon surgery said Lakshmi was making good progress and should be mobile soon.
"Lakshmi is fine and stable," chief surgeon Dr. Sharan Patil told The Associated Press. "She should face no problem in walking."
Lakshmi was born joined at the pelvis to a "parasitic twin" that stopped developing in her mother's womb. The surviving fetus absorbed the limbs, kidneys and other body parts of the undeveloped twin.
A team of more than 30 surgeons performed a 24-hour operation on Nov. 7 at the Sparsh hospital in Bangalore, the capital of southern Karnataka state. They removed the extra limbs, transplanted a kidney from the twin and reconstructed Lakshmi's pelvic area.
"Lakshmi is a hero," Patil said Saturday.
"Lakshmi, who never turned earlier, started turning after the surgery. She was even able to stand for 10 minutes on the bed holding the window grill, which is remarkable," the Press Trust of India news agency ed Patil as saying.
Lakshmi's parents said they were taking her back to their rural village in eastern Bihar state where she had been revered by some as an incarnation of the four-armed Hindu goddess she was named after.
