Faculty Bibliography

STUDY DESIGN: Consecutive case prospective radiographic and medical record review. OBJECTIVE: To define the learning curve associated with thoracoscopic spinal instrumentation by evaluating operative data and early outcomes of 1 surgeon's (B.L.) cases. SUMMARY OF BACKGROUND DATA: Thoracoscopic spinal instrumentation for the treatment of thoracic adolescent idiopathic scoliosis has emerged as an alternative to open anterior and posterior techniques. The technique is technically demanding and has been perceived as having a prohibitive learning curve. METHODS: The operative reports, charts, and surgeon's database were used to evaluate operating time, estimated blood loss, levels fused, complication rate, blood transfusions, and curve correction, among other variables. For purposes of analysis, the entire cohort was divided into 2 groups of 28 and 29 patients, respectively, and then 4 groups of 14 patients (the last group with 15) were used for comparison. RESULTS: The records of 57 patients were evaluated. No significant difference in estimated blood loss or number of levels fused was noted for either comparison (P = 0.46 and P = 0.66, respectively). There was no significant difference in blood transfusion requirements, with 7% in group 1 and 18% in group 2 (P = 0.35). Operating time was significantly less after 28 patients were operated on 6.2 +/- 1.3 hours versus 5.3 +/- 1.2 hours (P = 0.011). Percent curve correction was significantly better after 28 cases were performed, 54.4 +/- 17.9 in the former groups versus 65.7 +/- 10.4 in the latter half of cases (P = 0.005). Complications were evenly distributed throughout the series. No significant differences were observed between the 2 groups in terms of rate of complication (P = 0.50). No major complications, such as neurologic deficit or significant hemorrhage, were observed. CONCLUSIONS: The learning curve associated with thoracoscopic spinal instrumentation appears to be acceptable. Significant differences were noted in operating time and percent curve correction after 28 cases. The complication rates remained stable throughout the surgeon's experience

On June 13, somebody giving Ms. [Isabelle Dinoire]'s home as an address brought the dog to the animal shelter, but gave no indication that the dog had bitten anyone. The dog might eventually have been adopted by a new owner had it not caught a debilitating respiratory virus shortly after it arrived. It was killed two weeks later, Ms. [Jeanne-Marie Binot] said, but it was only after the story of Ms. Dinoire's transplant emerged that the shelter realized that it had taken in Ms. Dinoire's dog. At the university hospital in Amiens, Ms. Dinoire was placed under the care of Dr. [Bernard Devauchelle], the head of maxillo-facial surgery there. He quickly decided that Ms. Dinoire was a transplant candidate. Isabelle Dinoire, right, during an examination by Dr. Bernard Devauchelle, left, conducted in front of hospital staff members in Amiens, France. Ms. Dinoire has been identified as the recipient of a partial face transplant. (Photo by Amiens Hospital, via Associated Press)(pg. A14); Dr. Bernard Devauchelle, with a resin model of a human skull. (Photo by Ed Alcock for The New York Times)(pg. A1)

Dr. Maria Siemionow, director of plastic surgery research at the Cleveland Clinic, who has been preparing to perform a full face transplant, said the way the transplant was conducted appeared to conflate two experimental protocols: the transplantation of facial tissue and the infusion of stem cells from the donor's bone marrow into the patient in an attempt to prevent rejection of the new face. The French doctors said traditional surgery could not have salvaged the woman's face. Dr. Benoit Lengele, a Belgian specialist in facial injuries, and other experts had judged that reconstructive surgery would be 'very difficult, if not impossible' in the patient's case, [Jean-Michel Dubernard] said. Dubernard said the woman was approved as a candidate for a face transplant only after a thorough psychological examination by an independent expert and by mental health professionals working with the transplant teams in Amiens, France, where the operation was performed, and in Lyon, where the woman is now being monitored for rejection reactions

Dr. Maria Siemionow, director of plastic surgery research at the Cleveland Clinic, who has been preparing to perform a full face transplant, said the way the transplant was conducted appeared to conflate two experimental protocols: the transplantation of facial tissue and the infusion of stem cells from the donor's bone marrow into the patient in an attempt to prevent rejection of the new face. The French doctors said traditional surgery could not have salvaged the woman's face. Dr. Benoit Lengele, a Belgian specialist in facial injuries, and other experts had judged that reconstructive surgery would be 'very difficult, if not impossible' in the patient's case, [Jean-Michel Dubernard] said. Photos: 1. EXAMINATION: A French surgeon examines a woman who was mauled by a dog, leaving her with injuries that made it difficult to speak and eat. She became the recipient of the world's first partial face transplant (p. 10); 2. SURGERY: French surgeons perform the partial face transplant operation at Amiens hospital in northern France (p. 10)

Initially, Dr. Freedberg could not see any bacteria when he used standard chemicals to stain the stomach tissue. But the bacteria stood out when he used a silver stain. He found the bacteria in 13 of 35 patients, or 37.1 percent. So Dr. [Freedberg] wrote a paper describing his findings and The American Journal of Digestive Diseases published it in 1940. In a discussion section, published as a follow-up to Dr. Freedberg's paper, Dr. Frank D. Gorham of St. Louis said that for 10 years he had found that intramuscular injections of bismuth helped heal ulcers. Bismuth was a popular remedy. Dr. Freedberg said he was ''very upset that my findings weren't confirmed'' because it implied that his work was wrong. Also, the inability to grow the bacteria ''bothered me,'' Dr. Freedberg said, because his findings ''had to be important'' for ulcers, which were an important health problem

Shortly after the woman's injury, Dr. Bernard Devauchelle, head of face and jaw surgery at Amiens University Hospital, decided that the woman was a candidate for a partial face transplant and sent an urgent request for help in locating a donor to the French Biomedicine Agency, which oversees the allocation of organs for transplant in France. The window for a successful transplant was narrow, the doctors said, because the wound was developing scar tissue. Dr. [Jean-Michel Dubernard] said he had already injected stem cells from the donor's bone marrow into the patient in an attempt to enhance her body's tolerance of the transplanted tissue. After reviewing successful hand transplants, he theorized that cells produced by the marrow of the donor's hands were the critical element in the operation's success. He added that another ''infusion'' of the donor's bone marrow stem cells would be given to the patient on the 11th day after the transplant. The transplant did not include bone. A woman who received a partial face transplant was taken from the operation in Amiens, as shown in this image released yesterday in Lyon. (Photo by Amiens University Hospital, via Reuters)(pg. A8); A computer-generated image of the face transplant. Colors represent arteries, veins, nerves and muscles. (Photo by Edouard-Herriot and Amiens University Hospitals, via Reuters)(pg. A1)