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Hand-Transplant Patients Making Progress

April 19, 1999|THOMAS H. MAUGH II

The two patients who made medical history by having hand transplants are doing well and beginning to achieve some function in their new hands, the men's doctors say. It is still not clear, however, how much use of their hands they will eventually achieve.

Clint Hallam, a 48-year-old Australian, received the first successful hand transplant in September in Lyon, France. Matthew Scott, 37, of Absecon, N.J., underwent his transplant in January at a Louisville, Ky., hospital.

The international team that operated on Hallam reported in Saturday's Lancet that the hand had not been rejected after six months, although transient symptoms of skin rejection were successfully treated. Hallam has "satisfactory" movement of the hand, has feeling in the wrist creases and can feel pressure in the middle of his palm, the team said.

Scott may be doing somewhat better. Although the operation was performed only 13 weeks ago, he was able to use the hand to throw out the first ball April 12 at the Philadelphia Phillies' home opener. He has no feeling in the hand yet, and unless he looks, he said, he can't tell whether he is holding a baseball or an apple.

Scott can pick up poker chips with his hand and was able to hoist his young son for the game with both hands. At the time of the men's surgeries, their doctors predicted that it could take as long as a year for Hallam and Scott to have feeling in their new hands, if they ever do.

Study of Brain Disease Clears Blood Products

Creutzfeld-Jackob disease, a rare and fatal brain disorder caused by an abnormal protein called a prion, is not transmitted through contaminated blood transfusions or blood products, according to a new Department of Veterans Affairs study released Sunday at a San Francisco meeting of the Society for Healthcare Epidemiology of America.

CJD has been in the news recently because of an outbreak of a related disorder, bovine spongiform encephalopathy, commonly called "mad cow disease," in Great Britain. Mad cow disease is caused by a slightly different prion.

Epidemiologist Abid Rahman and his VA colleagues studied the records of 8,000 VA hospital patients and the death certificates of 500, all of whom had received blood products or transfusions from people subsequently found to have CJD. The researchers found no evidence of CJD or of CJD-like symptoms in any of the patients.

About 60 cases of spontaneous CJD occur in California each year.

In a related development, Dr. Paul Aylin of the Imperial College of Medicine in London reported in Saturday's British Medical Journal that a careful study of butchers, farm hands and other people who come in contact with cows' blood provided no evidence of an increased risk of CJD or mad cow disease among the workers.

New Surgical Option for Farsightedness

A new experimental treatment for farsightedness is less expensive than laser surgery and more easily learned by physicians, Dr. Edward E. Manche of Stanford reported Sunday at a Seattle meeting of the American Society of Cataract and Refractive Surgery. All four of the patients treated so far now have at least 20/25 vision, he said.

About 20% of Americans suffer from farsightedness, which causes nearby objects to look blurry. The only current surgical treatment for the condition uses a laser procedure, called LASIK, to resculpt the cornea.

In the new procedure, called hyperopic radio-frequency thermokeratoplasty, surgeons heat and shrink the cornea with radio-frequency energy. After numbing the eye with an anesthetic, Manche inserts a thin probe about the thickness of a pin into the cornea and zaps the tissue with a burst of radio-frequency energy. The process is repeated until the cornea has been molded into the desired shape. The procedure takes two to five minutes.

Pain Medication Often Delayed in Emergencies

Many physicians withhold pain medication from patients in emergency situations because they mistakenly believe the drugs may affect the accuracy of their diagnoses, according to researchers from the University of Iowa.

In fact, diagnoses are more accurate if the patients are suitably medicated, Dr. Mark A. Graber reported in the March American Journal of Emergency Medicine. If the patient is unable to cooperate with the physician because of intense pain, an accurate diagnosis is less likely, he said. Pain relief also increases the sensitivity and specificity of the physical examination, and reduces the number of emergency surgeries performed.

Special Vest May Save Cardiac Arrest Patients

Physicians around the country are testing a vest that may prolong the lives of heart-disease patients who may suffer cardiac arrest. The device, which looks like a bra with small electric shock paddles inside the straps, can jolt a heart into beating again and eliminate the need for open-heart surgery to implant a defibrillator.

Electronics in the device continually monitor the patient's heartbeat. When a potentially fatal rapid heartbeat, or fibrillation, is noted, the vest gives off a series of warning alarms. If the patient fails to shut it off within 20 seconds, an electrically conductive gel is ejected under the paddles and a shock is delivered to restore normal heart rhythm. If the rhythm is not restored, the device will repeat this process up to five times at 30-second intervals.

Every year, 350,000 Americans collapse and die of cardiac arrest.

Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.

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