Upper extremity and craniofacial vascularized composite allotransplantation: ethics and immunosuppression

2019 ◽  
Vol 3 (6) ◽  
pp. 681-686
Author(s):  
James Benedict ◽  
Gerard Magill
Keyword(s):  
Upper Extremity ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Vascularized Composite Allotransplantation ◽  
Medium Term ◽  
Term Survival ◽  
Ethical Concerns ◽  
History Of ◽  
Late Twentieth ◽  
Late Twentieth Century

Vascularized composite allotransplantation (VCA) is the name most often used to refer to the transplantation of anatomical units composed of multiple tissue types (skin, bone, muscle, tendon, nerves, vessels, etc.) when such transplants do not have the primary purpose of extending life, as is the case in the more familiar field of solid organ transplantation (SOT). A serious interest in VCA developed in the late twentieth century following advances in immunosuppression which had led to significant improvements in short and medium-term survival among SOT recipients. Several ethical concerns have been raised about VCA, with many being connected in one way or another to the limitations, burdens, and risks associated with immunosuppression. This article will focus on upper extremity and craniofacial VCA, beginning with a brief review of the history of VCA including reported outcomes, followed by a discussion of the range of ethical concerns, before exploring in greater detail how immunological issues inform and shape several of the ethical concerns.

scholarly journals Solid Organ Transplantation in Patients With a History of Lymphoma

2018 ◽  
Vol 14 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Philip J. Bierman
Keyword(s):  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Supporting Evidence ◽  
Solid Organ ◽  
Post Transplantation ◽  
Term Survival ◽  
Hematopoietic Stem ◽  
Lymphoma Treatment ◽  
History Of

There is an increasing number of long-term survivors of Hodgkin and non-Hodgkin lymphoma. These people may have a need for subsequent solid organ transplantation, often as a result of late effects of their lymphoma treatment. There is abundant literature demonstrating that patients with a history of lymphoma are appropriate candidates for solid organ transplantation. Long-term survival without relapse and with a functioning graft is possible. Patients with a history of post-transplantation lymphoproliferative disorders and patients who have received a prior hematopoietic stem-cell transplantation may also be candidates. Although high-level supporting evidence is not available, most guidelines recommend a waiting period of 2 to 5 years after lymphoma treatment before patients undergo solid organ transplantation. Each patient with a history of lymphoma requires a multidisciplinary approach and should be evaluated on a case-by-case basis before consideration of solid organ transplantation.

URBAN DISPLACEMENT AND LOW-INCOME COMMUNITIES: THE CASE OF THE AMERICAN CITY FROM THE LATE TWENTIETH CENTURY

2016 ◽  
Vol 10 (2) ◽  
pp. 06 ◽  
Author(s):  
Jason Knight ◽  
Mohammad Gharipour
Keyword(s):  
Urban Communities ◽  
Low Income ◽  
Urban Redevelopment ◽  
Minority Populations ◽  
The People ◽  
History Of ◽  
Late Twentieth ◽  
Cultural Connections ◽  
American Cities ◽  
Late Twentieth Century

How can urban redevelopment benefit existing low-income communities? The history of urban redevelopment is one of disruption of poor communities. Renewal historically offered benefits to the place while pushing out the people. In some cases, displacement is intentional, in others it is unintentional. Often, it is the byproduct of the quest for profits. Regardless of motives, traditional communities, defined by cultural connections, are often disrupted. Disadvantaged neighborhoods include vacant units, which diminish the community and hold back investment. In the postwar period, American cities entered into a program of urban renewal. While this program cleared blight, it also drove displacement among the cities’ poorest and was particularly hard on minority populations clustered in downtown slums. The consequences of these decisions continue to play out today. Concentration of poverty is increasing and American cities are becoming more segregated. As neighborhoods improve, poorer residents are uprooted and forced into even more distressed conditions, elsewhere. This paper examines the history of events impacting urban communities. It further reviews the successes and failures of efforts to benefit low-income communities.

The Birth of the Prophet Muhammad

2009 ◽  
Vol 26 (1) ◽  
pp. 97-99
Author(s):  
Frederick S. Colby
Keyword(s):  
Twentieth Century ◽  
Middle Eastern ◽  
Formative Period ◽  
Central Importance ◽  
Islamic Studies ◽  
Critical Scholarship ◽  
History Of ◽  
Late Twentieth ◽  
Modern Era ◽  
Late Twentieth Century

Despite the central importance of festival and devotional piety to premodernMuslims, book-length studies in this field have been relatively rare.Katz’s work, The Birth of the Prophet Muhammad, represents a tour-deforceof critical scholarship that advances the field significantly both throughits engagement with textual sources from the formative period to the presentand through its judicious use of theoretical tools to analyze this material. Asits title suggests, the work strives to explore how Muslims have alternativelypromoted and contested the commemoration of the Prophet’s birth atdifferent points in history, with a particular emphasis on how the devotionalistapproach, which was prominent in the pre-modern era, fell out of favoramong Middle Eastern Sunnis in the late twentieth century. Aimed primarilyat specialists in Middle Eastern and Islamic studies, especially scholarsof history, law, and religion, this work is recommended to anyone interestedin the history of Muslim ritual, the history of devotion to the Prophet, andthe interplay between normative and non-normative forms ofMuslim beliefand practice ...

The Myth of the Perfect Pregnancy

2019 ◽  
Author(s):  
Lara Freidenfelds
Keyword(s):  
Twentieth Century ◽  
Health Care Providers ◽  
Maternal Education ◽  
Colonial America ◽  
Care Providers ◽  
Early Nineteenth Century ◽  
Unrealistic Expectation ◽  
History Of ◽  
Late Twentieth ◽  
Late Twentieth Century

The Myth of the Perfect Pregnancy is a history of why Americans came to have the unrealistic expectation of perfect pregnancies and to mourn even very early miscarriages. The introduction explains that miscarriage is a common phenomenon and a natural part of healthy women’s childbearing: approximately 20 percent of confirmed pregnancies spontaneously miscarry, mostly in the first months of gestation. Eight topical chapters describe childbearing and pregnancy loss in colonial America; the rise of birth control from the late eighteenth century to the present; changes in parenting from the early nineteenth century to the present that increasingly focused attention on the emotional relationship between parent and child; the twentieth-century rise of prenatal care and maternal education about embryonic growth; the twentieth-century blossoming of a consumer culture that marketed baby items to pregnant women; the abortion debates from the mid-twentieth century to the present; the late twentieth-century introduction of obstetric ultrasound and its evolution into a pregnancy ritual of “meeting the baby” as early as eight weeks’ gestation; and the late twentieth-century introduction of home pregnancy testing and the identification of pregnancy as early as several days before a missed period. The conclusion offers suggestions for how women and their families, health-care providers, and the maternity care industry can better handle pregnancy and address miscarriage.

scholarly journals Cancer immunotherapy in special challenging populations: recommendations of the Advisory Committee of Spanish Melanoma Group (GEM)

2021 ◽  
Vol 9 (3) ◽  
pp. e001664
Author(s):  
Maria Gonzalez-Cao ◽  
Teresa Puertolas ◽  
Mar Riveiro ◽  
Eva Muñoz-Couselo ◽  
Carolina Ortiz ◽  
...  
Keyword(s):  
Cancer Immunotherapy ◽  
Multidisciplinary Approach ◽  
Checkpoint Inhibitors ◽  
Solid Organ Transplantation ◽  
Latent Tuberculosis ◽  
Solid Organ ◽  
Chronic Infections ◽  
Immunosuppressed Patients ◽  
History Of ◽  
Evidence Based Guidelines

Cancer immunotherapy based on the use of antibodies targeting the so-called checkpoint inhibitors, such as programmed cell death-1 receptor, its ligand, or CTLA-4, has shown durable clinical benefit and survival improvement in melanoma and other tumors. However, there are some special situations that could be a challenge for clinical management. Persons with chronic infections, such as HIV-1 or viral hepatitis, latent tuberculosis, or a history of solid organ transplantation, could be candidates for cancer immunotherapy, but their management requires a multidisciplinary approach. The Spanish Melanoma Group (GEM) panel in collaboration with experts in virology and immunology from different centers in Spain reviewed the literature and developed evidence-based guidelines for cancer immunotherapy management in patients with chronic infections and immunosuppression. These are the first clinical guidelines for cancer immunotherapy treatment in special challenging populations. Cancer immunotherapy in chronically infected or immunosuppressed patients is feasible but needs a multidisciplinary approach in order to decrease the risk of complications related to the coexistent comorbidities.

scholarly journals A case of rhabdomyolysis after atorvastatin therapy of a liver transplant recipient receiving immunosuppressive therapy with cyclosporine

2021 ◽  
Vol 13 (2) ◽  
pp. 158-164
Author(s):  
A. V. Shabunin ◽  
S. P. Loginov ◽  
P. A. Drozdov ◽  
I. V. Nesterenko ◽  
D. A. Makeev ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Drug Interactions ◽  
Liver Transplant ◽  
Immunosuppressive Therapy ◽  
Organ Transplantation ◽  
Muscle Pain ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Term Survival

Rationale. To date, liver transplantation is the most effective method of treating end-stage liver failure, and therefore this treatment has become widespread throughout the world. However, due to the improvement in the quality of transplant care and an increase in the long-term survival of patients, the development of concomitant pathology, which often requires medical treatment, is inevitably associated with a higher life expectancy of liver transplant recipients. Thus, in patients who underwent liver transplantation, there is. a significant increase in the incidence of dyslipidemia. However, a long-term immunosuppressive therapy in organ transplant patients can adversely modify the effect of the prescribed drugs, which requires careful monitoring and consideration of drug interactions.Purpose. Using a clinical example to demonstrate the importance of taking drug interactions into account in the treatment of patients after organ transplantation receiving immunosuppressive drugs.Material and methods. In the presented clinical case, a patient after orthotopic liver transplantation performed in 2005 underwent a staged treatment of cicatricial stricture of choledochal anastomosis in the S.P. Botkin City Clinical Hospital. During the following hospitalization, the patient complained of minor muscle pain when walking. At doctor's visit 3 weeks before hospitalization, a local physician prescribed therapy with atorvastatin 10 mg per day due to an increase in blood plasma cholesterol levels. The patient underwent removal of the self-expanding nitinol stent. During the follow-up examination, the patient had no evidence of an impaired bile outflow, however, muscle pain and weakness progressively increased, the rate of diuresis decreased, and in the biochemical analysis of blood there was an abrupt increase in the concentration of creatinine, aspartate aminotransferase, alanine aminotransferase. Atorvastatin was canceled, a diagnosis of acute non-traumatic rhabdomyolysis was established, treatment with hemodialysis and plasma exchange was started on 03/05/2020. The last session of renal replacement therapy was 03/30/20.Results. With the restoration of the diuresis rate, there was a spontaneous decrease in the level of creatinine to 170 μmol/L. The patient was discharged with satisfactory renal and hepatic function. The pain syndrome completely resolved. Conclusion. Drug interactions between atorvastatin and cyclosporine have resulted in acute rhabdomyolysis with life-threatening consequences. This once again confirms the importance of taking drug interactions into account when managing patients after solid organ transplantation.

EXODUCTION

2018 ◽  
Vol 4 (1) ◽  
Author(s):  
Richard Schechner
Keyword(s):  
Twentieth Century ◽  
Oral Transmission ◽  
Transmission Of Knowledge ◽  
History Of ◽  
Late Twentieth ◽  
Late Twentieth Century

This essay by Richard Schechner dedicated to a mythical figure of the theater of the late twentieth century; a work of critical reconstruction that has contributed decisively to consolidating the legacy of Grotowski, just a few months after his death. In addition to fixing some essential terms of the vocabulary, together with the contents and the periodization of the Grotowskian work (aspects that Grotowski in life were entrusted exclusively to oral transmission), the essay retraces the formation of Grotowski, the aspects linked to his character, the specific forms of his research and his transmission of knowledge, the exercise of leadership, the role of his collaborators, the sources, the mystical side, his relationship with the spirit of time, the importance (and weakness) of his opera, in the history of twentieth century theater.

Mourning Otherwise

2017 ◽  
Author(s):  
Athena Athanasiou
Keyword(s):  
Twentieth Century ◽  
Armed Conflicts ◽  
Former Yugoslavia ◽  
Central Aspect ◽  
Military Violence ◽  
History Of ◽  
Late Twentieth ◽  
A Site ◽  
Late Twentieth Century

This chapter engages the discursive conditions that made ethno-nationalist ideologies and armed conflicts of the 1990s possible and probable. Indeed, the question of how to recall the late twentieth-century history of former Yugoslavia constitutes a central aspect of the Women in Black labour of memory. The dissolution of Yugoslavia, especially the normalization of nationalist military violence in the mid-1990s, has manifested gendered norms as constitutive of nationalist discourses. Drawing on the ways in which the movement performatively brings forth an alternative public to embody the potentiality of displaced memory, this chapter argues in favor of breaking through the universalist, moralist, and humanist scripts of mourning. It seeks to make sense of the politically enabling ways in which these activists stage mourning as a site of agonistic resignification in order to interrogate the injustices and foreclosures which sustain dominant regimes of grievability, in Judith Butler’s terms.

Sign in / Sign up

Export Citation Format

Share Document