Transplantation

Facial transplantation is emerging as a therapeutic option for self-inflicted gunshot wounds. The self-inflicted nature of this injury raises questions about the appropriate role of self-harm in determining patient eligibility. Potential candidates for facial transplantation undergo extensive psychosocial screening. The presence of a self-inflicted gunshot wound warrants special attention to ensure that a patient is prepared to undergo a demanding procedure that poses significant risk, as well as stringent lifelong management. Herein, we explore the ethics of considering mechanism of injury in the patient selection process, referring to the precedent set forth in solid organ transplantation. We also consider the available evidence regarding outcomes of individuals transplanted for self-inflicted mechanisms of injury in both solid organ and facial transplantation. We conclude that while the presence of a self-inflicted gunshot wound is significant in the overall evaluation of the candidate, it does not on its own warrant exclusion from consideration for a facial transplantation.

BACKGROUND: Bleeding is a major intraoperative complication during surgical procedures. When conventional methods such as ligature and diathermocoagulation are ineffective for bleeding management, hemostatic agents should be used. Oxidized cellulose is one of the major hemostatic agents used worldwide. Oxidized cellulose is often left in situ after hemostasis because of its high level of reabsorption that lasts up to 8 weeks. However, 38 cases of retaining-associated complications are reported in the literature.
CASE REPORT: A 51-year-old male patient presented in our emergency department with acute abdominal pain, nausea, and vomiting. The patient had been admitted in our department for laparoscopic cholecystectomy for acute cholecystitis 25 months previously. Abdominal ultrasound and CT scan showed the presence of a cystic circular mass, with homogeneous fluid content, close to the surgical clips of the previous surgery, resembling a “neogallbladder”. Laparoscopic abdominal exploration and drainage were performed. Histological examination reported protein-based amorphous material with rare lymphocytes and macrophages. Culturing was negative for bacterial growth. The patient was discharged uneventfully on the 4 th postoperative day. The primary surgical report was evaluated with evidence of application of Gelita-Cel ® Standard for hemostatic purposes. Results of 12-month follow-up were normal.
CONCLUSIONS: Herein, we report the first case of a complication associated with the use of Gelita-Cel ® Standard. We reviewed the literature to better define the purpose and limits of oxidized cellulose use as a hemostatic agent. Despite the fundamental role of oxidized cellulose as a hemostatic agent, we provide some practical suggestions to prevent the reported severe complications and surgical overtreatments.

The essay deals with the deceased donor organ donations and, in particular, with the nature and the features of the consent which authorizes the removal from the body of a deceased person of any relevant material. The analysis is conducted through the scrutiny of the relationship that exists between the choice about to be or not an organ donor and the social interest to obtain a rapid increase of organ donation. The essay makes a comparison between the Italian and the English legal approaches to the freedom of deciding the allocations of removed organs, with a special regard to directed donations.

Summary - We aimed to measure medical students’ attitudes to organ donation and transplantation. Health care providers’
attitudes and beliefs can influence public willingness to donate organ for transplantation. What do medical students
think about organ donation as future healthcare professionals?
We conducted a cross-sectional survey among 143 medical students to evaluate their attitude toward organ donation and
transplantation at a medical faculty. We administered a 17 item questionnaire that included items on knowledge of organ
donation, attitude, beliefs and demographics.
We found 42.7% of the respondents indicated that their religion restricts donation. Students were more willing to donate
their own organs (39.9%) than those of their deceased relatives (4.2%). 85.3% of respondents believe organ donation
is important and honourable for humanity. Although cardiology, neurology, neurosurgery and reanimation specialists are
needed to determine brain death, 64.3% of students were afraid of the wrong decision on the status declared as brain
death. More than 55% of respondents want to be buried without disfigurement.
The results of our research suggest that a new medical education program is needed for better equipped future healthcare
professionals. Today’s medical students will be the first to establish a relationship with a potential donor’s family in order
to improve their attitudes towards organ donation issues.

The problems that organ transplantation poses to the Muslim mind may be summarized as follows: firstly, a muslim believes that whatever he owns or possesses has been given to him as an amānah (trust) from Alla¯h. Would it not be a breach of trust to give consent for the removal of parts of one's body, while still alive, for transplantation to benefit one's child, sibling or parent? Secondly, the Sharā'ah (Islamic Law) emphasizes the sacredness of the human body. Would it not then be an act of aggression against the human body, tantamount to its mutilation, if organs were to be removed after death for the purpose of transplantation?In this paper I attempt to illustrate how the Muslim jurists have tried to resolve the dilemma of Muslims by providing them with certain guidlines based on the original sources of Islam, namely, the Qur'n and the Prophetic tradition. In order to assist the followers of other religious traditions to grasp the gravity of the problem posed by organ transplantation to the Muslim mind, I begin by discussing the opinions of Muslim jurists on the issue of utilization of human parts. Thereafter, I touch upon the resolutions taken by the various Islamic Juridical Academies on the issue in question. Finally, I shed light upon the inclusion of organ donation in a Muslim Will and the enforceable nature of such a will

Les Mains d'Orlac, roman de Maurice Renard publié en 1920, relate l'histoire d'une double greffe de mains sur un pianiste accidenté. Nous en faisons ici une triple analyse concernant l'épistémologie implicite du discours, le travail sur le schéma corporel et la question de l'identité hybride. M. Renard est un des rares écrivains de science-fiction a avoir théorisé sa propre pratique, en montrant qu'elle repose sur un modèle hypothético-déductif où l'hypothèse provient d'une analogie, d'une généralisation ou d'un fait nouveau fictif. Ici, il s'agit de généraliser l'art de la greffe végétale au monde animal et particulièrement à l'homme. Le roman, de plus, montre une grande attention à l'appropriation sensorimotrice des mains greffées, dans un effort pour adapter son schéma corporel passé à ces mains nouvelles. Enfin, puisqu'il s'agit des mains d'un criminel un conflit identitaire oppose Orlac à elles, avant qu'on ne découvre l'innocence du condamné. On peut noter aussi le télescopage temporelle avec la première double greffes de mains réelle, accomplie en 2000 alors qu'un personnage du roman s'exclame justement : « On se croirait en l'an 2000 ! », et l'hommage rendu par le chirurgien réel – le Pr. Dubernard – à Alexis Carrel, tandis que le chirurgien du roman, le Dr Cerral, s'en inspire directement.

Regulatory T cells (Treg cells) are a small subset of immune cells that are dedicated to curbing excessive immune activation and maintaining immune homeostasis. Accordingly, deficiencies in Treg cell development or function result in uncontrolled immune responses and tissue destruction and can lead to inflammatory disorders such as graft-versus-host disease, transplant rejection and autoimmune diseases. As Treg cells deploy more than a dozen molecular mechanisms to suppress immune responses, they have potential as multifaceted adaptable smart therapeutics for treating inflammatory disorders. Indeed, early-phase clinical trials of Treg cell therapy have shown feasibility, tolerability and potential efficacy in these disease settings. In the meantime, progress in the development of chimeric antigen receptors and in genome editing (including the application of CRISPR-Cas9) over the past two decades has facilitated the genetic optimization of primary T cell therapy for cancer. These technologies are now being used to enhance the specificity and functionality of Treg cells. In this Review, we describe the key advances and prospects in designing and implementing Treg cell-based therapy in autoimmunity and transplantation.

RESUMEN:
Las investigaciones aquí desarrolladas buscan una aproximación interdisciplinaria al fenómeno de la salud y la enfermedad, así como a la naturaleza de la práctica médica en la posmodernidad. La filosofía de la medicina se inspira fundamentalmente en la actual filosofía de la ciencia, que ha abandonado la idea de una realidad objetiva o de un orden natural inmutable, reemplazándola por la representación de nuestro conocimiento, adquiriendo así uno de sus rasgos fundamentales, el carácter holístico e interpretativo. Más allá de esto –en una aproximación bioética– se busca considerar el cuerpo de las personas con enfermedades avanzadas, y con riesgo cercano de muerte, donde la presencia inminente de mutilaciones o terapias altamente invasivas, con el correspondiente decaimiento y destrucción del propio cuerpo, nos fuerzan a pensar más allá de la “dignidad”, en “la zona muda”, para enfrentarse en el tema irreductible del dolor.
Dr. Adolfo Vásquez Rocca