AdultStemCell.com

Lawrence Ebert asked:


The stem cell article by Jennifer Washburn in the April 12, 2006 issue of the Los Angeles Times mentioned Jeanne Loring, an embryologist at the Burnham Institute in La Jolla: In 1999, Loring tried to launch a company to work with stem cells, but the firm quickly collapsed when it couldn’t raise the $100,000 in upfront fees the Wisconsin foundation [WARF] charged.

Washburn’s article did not mention an earlier article by Loring and co-author Cathryn Campbell, entitled “Intellectual Property and Human Embryonic Stem Cell Research,” which appeared in 311 Science 1716 on March 24, 2006. Therein, Loring and Campbell mentioned the changing royalty fees charged by WARF in response to a “memo of understanding” (MOU) with the federal funding agency. Loring/Campbell mentioned the “SBIR paradox” as to funding of small businesses, which may be a problem, but not one associated with patent law.

Both the Washburn and Loring/Campbell articles suggested that the WARF/Thomson patents would pose a long-term threat to stem cell science. Washburn noted the position of the Foundation for Taxpayer and Consumer Rights, based in Santa Monica, which urges California’s stem cell agency to challenge the Wisconsin patents. In greater detail, the Santa Monica group stated: The stem cell institute faces a threat from a foundation associated with the University of Wisconsin [WARF], which claims that it is owed licensing fees because it holds patents on all human embryonic stem cells in the United States. John M. Simpson stated: “This is an outrageous raid on the treasury of California based on over-reaching patents. No other nation in the world recognizes them. They are blocking vital research in the United States. I call on the stem cell institute to challenge the patents’ validity.”

Neither the Washburn nor Loring/Campbell articles discuss the possible research safe harbor created in the Hatch-Waxman Act and codified at 35 USC 271(e)(1). The breadth of this safe harbor was recently affirmed in the Supreme Court decision of Merck v. Integra. Neither the Washburn nor Loring/Campbell articles discuss that patent infringement suits against states and state bodies (such as California’s CIRM) are likely to be heard in state court, not federal court, according to the Supreme Court decision in Florida Prepaid Postsecondary.

Although there may be a visceral reaction to lash out against patents perceived to be overbroad, the cautionary tale of NTP v. RIM suggests that sometimes negotiation is the better path for infringement defendants. Further, Loring/Campbell mention the possibility of an interference with Plurion, although this most likely would change only the identity of the owner of controlling patents. Separately, one recalls that the Thomson patents are about creating stem cells from blastocysts; they are not about “cloning” [SCNT] technology. To date, traditional methods for stem cell separation from blastocysts have failed wherein SCNT is involved. There may be a question of enablement as to the Thomson patents for cases involving SCNT, which is where the holy grail of patient-specific stem cell lines resides.

As a general proposition, the state taxpayers underwriting efforts such as Proposition 71 have the expectation that money will be used for research, not to litigate the patent positions of prior researchers. Extrapolating further, state funding to achieve patent positions could lead to a balkanization of research, in which entities from individual states (such as California, New Jersey, Maryland, Illinois, Connecticut) are fighting one another, rather than collaborating.

Gary P Owen asked:


Recent advances in stem cell research have shown that it is possible to reverse the effects of multiple sclerosis with stem cells being replaced. While this is still in the experimental stage some measure of success has been achieved in independent studies conducted at the Northwestern University Feinberg School of Medicine in Chicago by Dr Richard K. Burt and his colleagues.

The study involved a group of 21 patients who were all relatively young and in the relapsing-remitting phase of multiple sclerosis. Stem cells were harvested from their own bone marrow and chemicals were used to destroy all the existing immune cells within the patient’s body. Younger people were selected because they had fewer disabilities and were not responding to interferon therapy. Previous attempts at this type of therapy had only limited success so the thought was that younger healthier patients might fare better.

The theory is that the body is stripped of all the immune cells that are the cause of multiple sclerosis. Stem cells that were removed from the patient’s own bone marrow are then injected back into the blood stream. These “naïve” stem cells would then repopulate the body with cells that have not been triggered to target the myelin and no further damage would be done to the myelin sheath.

The study was conducted over a period of three years and the results were hopeful. Seventeen of the patients showed an improvement of one full point on the disability scale. Five of the patients relapsed but after further treatment went into remission. After three years none of the patients showed any signs that the disease was progressing and 16 of them were no longer suffering from relapses. Some of the patients showed signs of improvement and reported no major side effects from the treatment of multiple sclerosis with stem cells.

While these results are impressive the treatment of multiple sclerosis with stem cells is still in its infancy and much more testing needs to be done.  The specialists are waiting to see if the immune system has actually been completely reset or if it has merely been suppressed for a longer period of time. Still they are very optimistic that this type of therapy will help those patients in the relapse-remitting phase.

Peter Emerson asked:


Biotechnology and religion often do not mix. Consider some of the major biotechnological advances that have happened within the past decade. With each news report outlining the benefits of the new technology, it also touches on the opposition, often by religious groups.

Biotechnology and religion is a matter of ethics. Where do you draw the line between science and religion? Do religious groups have a right to try and intervene? Controversial sciences such as cloning and stem cell research will inevitably raise the question of ethics. Is it right for humans to try to spark life? Some say it is playing God. Others see it as important. It is hard to say whether or not biotechnology and religion really can mix.

Do you want to understand the subject of biotechnology and religion better? The best thing to do is research. Go to your library and look up the different resources on biotechnology and also on science and how it and religion have functioned over the years. It seems that each generation has a controversial science that causes the religious to question it. The generation after that looks at the new science as normal and doesn?t think of it. Will this happen to the current field of biotechnology? Will cloning become so common that most people won’t think it is strange or remarkable?

It seems that biotechnology and religion don’t necessarily need to compete with each other. Perhaps the issue of one versus the other has to do more with a lack of knowledge than ethics. I think that both sides will coexist better if they understood each other a little more and were more tolerant of their own differences. So when a new scientific advancement in the field of biotechnology comes out, instead of panicking and becoming outraged, perhaps opponents can practice a little understanding.

Kanquona Bhattacharjee asked:


Medical science is doing wonders by means of its inventions and its proper application. It has enabled mankind to show his mastery over the god. The medical professionals are curing a number of people of their diseases and giving them a new lease of life everyday. A man can change his god-gifted features wishfully with the help of science. Even gender change is no longer a matter of surprise and awe. So man is seen defying their god in a way. But still he is unable to conquer the place occupied by the almighty God; he cannot impart life to all persons who are destined die. There are many such avenues left that are to be ventured by man. So, day–by-day man is trying to reach the ultimate knowledge.

Of late, a striking invention of medical science has made man to see a ray of hope. Patients of incurable diseases have to undergo very painful process to continue their life. The patients of Thalassemia have to live on blood transfusion throughout their life. But the invention of the procedure to cure blood disorder has shown its patients a gleaming horizon.

The doctors claims that the cord blood or can be better explained as the blood collected from the umbilical cord of a woman, soon after her second delivery , can save her first thalassemic born child. This blood is collected after the umbilical cord has been severed from the new-born. The cord blood is a rich source of stem cell. These cells are found at different stages of foetal development. Stem cells are also present in several adult tissues. It has the potentials to cure almost 75 serious ailments, from blood disorder to heart and eye ailment to Type 1 diabetes. Diseases such as lupus, multiple sclerosis, Crohn’s disease, rheumatoid arthritis, to name a few, can be cured using cord blood. Stem cells form part of our blood and immune system and they help to grow other cells in our body’s system. Thus it is expected to be a cure for cancer also.

The most striking feature that has made the invention more useful is the capacity of storing the cord blood. There are banking facilities where the parents can store the blood. If the first child of a couple is suffering from a blood disorder or any other disease that stem cell can cure, and the mother is expecting her second child, she could store her cord blood. This blood has the quality to cure her first thalassemic child. Number of couples is storing their cord blood for any future need. The parents who decide to store the cord blood have to undergo a proper HLA (human leukocyte antigen) match. It is a procedure through which the immune system recognizes ‘self’ and rejects ‘non-self’ cell, then the stem cell is transplanted into the patient’s body.

There are mainly three kinds of stem cell transplantation namely adult stem cells, embryonic stem cells and cord blood cells. Here one caveat is that the stem cells taken from adult bone marrow or peripheral blood stem cells are prone to rejection while cord blood stem cells are more adaptable and acceptable. However in India, the adult stem cells are mainly collected from bone marrow. For bone marrow, a perfect 6 out of 6 HLA match is required to prevent tissue rejection. But in case of cord blood stem cells for some diseases even 2 out of 6 match will suffice, but the chance is rare as the cord blood is collected immediately after birth.

In India the banking facility is available in the cities like Mumbai, Gurgaon, Chennai, and soon Kolkata will have one. Before delivery the parents can deposit Rs. 35000/- to Rs. 40000/- ($800 to $1000) initially and have to pay 10% of the deposit annually. So people can any corner of the world can store the cord blood stem cells of their children into these banks quite easily. With rapid advancement in stem cell research, the day is not too far when we will bid adieu to all generic diseases.

Shashank Nayak asked:


The article deals with the benefits the human race can reap if embryonic stem cell research is made legal in America. When I hear that President Bush’s ideology prevents him from sanctioning embryonic stem cell research, I just wonder in which century do we live in! Embryonic stem cells are cells that are, as the name suggests are the ones derived from embroyos.

These embryos are not the ones that are fertilized in a woman’s body, but are the ones that are fertilized invitro-in an in vitro fertilization clinic-and then donated for research purposes with informed consent of the donors. As long as the embryonic stem cells in culture are grown under certain conditions, they can remain undifferentiated (unspecialized). But if cells are allowed to clump together to form embryoid bodies, they begin to differentiate spontaneously.

They can form muscle cells, nerve cells, and many other cell types. Specifically their possibility of differentiating into nerve cells is worth serious consideration. Some of us as healthy people, with a functional spinal cord may think( as President Bush certainly does) that embryonic stem cell research ultimately leads to the destruction of the human embryo involved, and is thus equal to murder of a human being.

This is the same as saying that a molecule of H2O is same as a litre of water in all respects( including the prospect of water’s ability to quench thirst). An embryo is not sentient. It does not feel like we humans do. Just think of the possibilities. People who have broken their spinal cords in accidents could walk and function normally again. Christopher Reeves would have been waking. But it is too late for him now. I sincerely hope that Bush or the president after him approves the Bill which would sanction embryonic stem cell research.

John M Campbell asked:


The carotid arteries are 2 blood vessels, one either side of the neck, that each transport blood to the brain from the heart. These arteries can become partly or totally blocked resulting in the decrease of blood flow to the brain. This condition in turn is caused by atherosclerosis, also known as hardening of the arteries. Atherosclerosis is the outcome of a build up of cholesterol and calcium on the inner lining of the arteries. These deposits are referred to as plaques, which might eventually become so thick that they totally prevent the blood flow through the arteries. Those with untreated blocked carotid arteries are statistically likely to have a stroke.

Carotid artery occlusive disease is a permanent but treatable condition. Treatment is designed to stop further blockage and stroke. If there is some blockage devoid of symptoms, treatment will probably be limited to regular checkups, with ultrasound being used to monitor the condition along with medication that will cause the blood to thin to prevent the blood cells from clotting. Even if the arteries are severely narrowed, there is no guarantee of symptoms. If the blockage is severe, surgery might be recommended to reduce the possibility of stroke.

The most usual method of surgery, carotid endarterectomy, seeks to remove the plaque from the artery. For some patients, a balloon angioplasty (the inflating of a balloon to press the plaque to the artery wall), with the placement of a stent, may be recommended. If a carotid artery is 100% blocked, then it is unlikely anything would done to clear it because the risk of stroke is too high during or post operation.

Efforts are then concentrated on keeping the opposite carotid as open as possible. A person can live a good life with only one open carotid artery. The body is smart enough to reroute blood via a complex network to the side of the brain that would normally get blood via the blocked carotid. A dietitian (check with her MD) could help you devise an eating plan that is healthy & affordable.work).

If the brain is deprived of oxygen, it stops working — with potentially catastrophic effects. If the resulting impairment is permanent, we call the event a stroke. If it is temporary, it’s called a transient ischemic attack (TIA).

Every human has 4 carotid arteries through which blood moves from heart to brain. TIAs and strokes normally begin with an increase of cholesterol plaque in the carotid arteries — the large blood vessels on either side of the neck which supply blood to the head and brain.

Eric Schultz asked:


The Democratic Party is looking to regain the White House after eight years. Whether they succeed or not will depend on their stated positions on major issued affecting the lives of all Americans. If a majority of the electorates views match the Democratic candidate’s own opinions, the chances of occupying the White House are bright. So what is the Democratic Party’s stand on major issues. Here they are.

1. Economic Issues:

Democrats favor a higher minimum wage and more regular increases in order to assist the working poor. Democrats have opposed tax cuts and incentives to oil companies, favoring a policy of developing domestic renewable energy. Democrats believe that they always provide a balanced budget. They are in favor of higher taxes on the rich and businesses and better control on government spending to keep budget deficit under control. Democrats favor affordable and quality health care and more government intervention in this area. Democrats will strengthen environmental protection laws and impose stringent sanctions on polluters. Democrats aim to provide low-cost publicly funded college education with low tuition fees and increase availability of grants and scholarships. Democratic Party is in support of a progressive tax structure and has vowed to adjust the Alternate Minimum Tax (AMT) to give permanent AMT relief for those tax payers who were never meant to pay it.

2. Social Issues:
Democratic Party supports equal opportunity for all Americans and favors affirmative action as a way to redress past discrimination. Democratic believes that discrimination against persons because of their sexual orientation is wrong, support adoption rights for same-sex couples and opposes the military’s “Don’t ask, Don’t tell” policy. Democratic Party supports easy access to women for birth control and public funding of contraception for poor women. Democratic Party strongly supports all stem cell research.

3. Foreign Policy Issues:
Democrats believe in use of military force against those responsible for attacks against the United States and a majority voted for invasion of Afghanistan, while being divided (29 for and 21 against) on attacking Iraq. Democrats usually oppose the doctrine of unilateralism and believe that the United States should act in the international arena through strong alliances and international support.

4. Legal Issues:
Democrats oppose the use of torture as an instrument of interrogation of military prisoners. Democratic Party supports the right to individual privacy and supports legal restrictions on monitoring by law enforcement agencies. Democrats believe in preventive methods of crime control and emphasize improved community policing. Democratic Party favors gun control measures and introduced Gun Control Act of 1968, the Brady Bill of 1993 and Crime Control Act of 1994.

Now you know the Democrats position on various issues of national importance affecting the common citizen’s life. Did that help you make-up your mind? Hope so.

Mike Selvon asked:


The stem cell research debate has spanned numerous decades, with presidents like George HW Bush, Ronald Reagan and George W. Bush rejecting funding science that tampered with human embryos, and presidents like Bill Clinton and Barack Obama appropriating money toward an end that justifies the means. If a primitive bundle of cells can be used to save thousands or millions of lives and alleviate suffering, then is it worth it? Or does embryonic stem cell research cross the line between man and God?

When does human life begin? This is the quintessential theological question behind embryonic stem cell research. Devout Catholics and Protestants will tell you, “Human life begins at conception, at the very moment when sperm and egg come together. Development from there on out should be left up to God and God only.” They argue the problem is that embryos are killed in the process of harvesting stem cells, therefore aborting the developing embryo.

In a speech on August 9, 2001, former President George W. Bush explained, “While we must devote enormous energy to conquering disease, it is equally important that we pay attention to the moral concerns raised by the new frontier of human embryo stem cell research. Even the most noble ends do not justify any means.” Pope Benedict XVI went so far as to say human stem cell research was “not only devoid of the light of God but also devoid of humanity.”

The Iranian position on embryonic stem cell research is that it’s a necessary and common pathway to medical discovery. According to the Koran, human life begins at Day 120, when the embryo is blessed with a soul, so the fetal stem cells being derived when the embryo is less than two weeks’ old is of little moral concern to them. In a letter to a scientist, Ayatollah Khamenei commended the pursuit of “lofty objectives,” predicting “huge humanitarian wealth.” He did, however, caution against producing identical parts of human beings, which would be considered cloning, which is rejected in Iranian culture.

Lawyers may argue either for or against stem cell research. They can argue that stem cells cannot develop into humans outside of the uterus or that these spare embryos are routinely destroyed by flushing them down the drain, incineration or leaving them out to perish; so why not use these extra embryos to save lives?

Yet they may also argue that these embryos can be adopted, rather than destroyed, or that embryonic stem cell research is senseless murder. This complex argument may become null and void if adult stem cells can be effectively harvested and reverted back to their primal state, although it may take years before the process is fully perfected.

William Phoenix asked:


In my assigned surfing of the internet I come across a variety of topics and sites. Recently, I came across something regarding stem cell research and MS. Humor me just once and read about this important issue. (I am already 48 and we still aren’t cloning headless bodies to replace organs that wear out so naturally I am concerned. I want to be writing for you people when I am 100! I mean, it is 2009 and we don’t have all the things we should have. We don’t have flying cars. We don’t have Star Trek-level medical science. We don’t even have medical science on par with “Space:1999″. But I digress…)

Everyone is aware of the controversy. Even musicians such as Dream Theater are aware of the stem cell debate: “This embryonic clay wrapped in fierce debate; Would be thrown away or otherwise discarded, Some of us believe it may hold the key to treatment of disease and secrets highly guarded”. For now let us focus on one aspect of stem cell research: the cure for MS.

Recently, scientists discovered that they can prevent and even reverse the crippling condition of MS (multiple sclerosis). Specific findings at the Northwestern University Feinberg School of Medicine in Chicago, Illinois show that “17 out of 21″ people with (the most common) relapsing-remitting MS tested had their health improve as a result of aggressive stem cell treatment.

Past studies demonstrated that stem cell treatment could stabilize the condition but it had not yet shown that the same treatment was capable of reversing the condition. The leader of this study, Richard K Burnt, observed that this treatment is undoubtedly “a feasible procedure”. It is called autologous non-myeloablative haemopoietic stem cell transplantation. Not only does the treatment appear to stave off neurological progression but it also seems to reverse neurological disability.

The procedure causes the suppression of the immune system and revitalizes it with new cells. Medical experts think the new cells reset the immune system of the patient.

A three-year follow up was done and it revealed that 81% of MS sufferers saw an improvement of one point or more on a disability scale. No patient scored lower than before the operation. A spokesperson for the MS Society, Dr. Douglas Brown, said that research is increasingly demonstrating that these cells are showing “more… potential in the treatment of MS” and that now science needs to continue to show how effective they can be.

A serious issue worth serious consideration. I know when my time comes, I just plain won’t want to go yet. If this type of research can help then I say we support it. As always, I am waiting to hear what you all have to say.

My name is Phoenix and…that’s the bottom line.

Mike Selvon asked:


Imagine a world where a new liver or kidney can be grown from your own stemcells in a Petri dish and then transplanted into your body. A knee injury, a burn or a damaged heart can be fixed with a patch that regroups with surrounding tissues and repairs itself.

Alzheimer’s and Parkinson’s would become a thing of the past, as fresh stem cells work diligently to make new connections in the brain. Imagine a world where stem cells can be implanted into spinal cords or eyes to restore full functioning in the disabled. This world is not so distant, given recent advances. There are a number of places where you can research stem cell treatments.

One place to do some research on stem cells is the California Institute for Regenerative Medicine (CIRM). Despite former President Bush’s ban on federal stem cell research funding, the rogue Californians approved a 2004 ballot initiative (Proposition 71) that set aside state funds for just that purpose.

As a result, $3 billion was appropriated to California research facilities, making the state an epicenter of stem cell news. On their site, you might like to read their comprehensive annual report, which reads much more like a magazine than a lofty scientific publication. You can read about awards, its therapy treatments, studies and stem cell research facilities at Cirm web site.

Another great place to research stem cells is Medical News Today (at Medicalnewstoday). Here you’ll read the latest articles on stem cell news adapted from press releases, reports, newspaper articles and medical journals. You can sign up for daily or weekly newsletters to keep you abreast of all trials, treatments and research being conducted. You can watch a Youtube video titled “Everything You Wanted To Know About Stem Cells.” You can learn all about “What Are Stem Cells,” in addition to looking up current news on this comprehensive site.

With the new allocation of federal stem cell research funding, a number of facilities across the country will be receiving money to research stem cell therapies. For instance, the University of Buffalo will receive $4.9 million for human stem cell research. The University of California at Irvine will receive $27.2 million to build a new stem cell research facility and the University of San Diego will get $2.8 million to improve their current facilities. It may take another 10 years to produce a widely recommended cure, but research has been promising.

Colum Fitzroy asked:


If you or a loved one are one of the millions of children and adults in the United States suffering from congestive heart failure, there is reason now to be hopeful. An effective treatment may be on the horizon, thanks to stem cell research being done by a company in Florida.

Heart failure doesn’t mean your heart stops working. It means your heart is not working as well as it should. It’s not pumping enough blood, perhaps because your heart doesn’t fill up with enough blood, or it doesn’t pump blood forcefully enough to the rest of your body. The main causes of heart failure are diabetes, high blood pressure, and coronary artery disease.

Coronary artery disease is also one of the leading causes of heart attacks, which happen when plaque blocks the flow of blood (and oxygen) to an area of the heart. This causes damage and even the death of heart tissue. In adults, it takes time to develop heart failure, sometimes many years, as the pumping action of the heart gradually weakens. Sometimes only the right side of the heart can be affected. But most of the time both sides are affected. If the right side of your heart has the condition, then your lungs won’t get enough blood. That means your lungs won’t pass along enough oxygen to your blood. You may then notice a build-up of fluid in your feet, ankles, legs, liver, abdomen, and sometimes in the veins in the neck.

If the left side of your heart is affected, then the rest of your body will not get enough oxygen from the blood. In both kinds of heart failure, you can be short of breath and tired all of the time. Sometimes, heart failure can lead to a heart attack, also known as myocardial infarction. According to the National Institutes of Health (NIH), as many as five million people in the United States suffer from heart failure, and 300,000 of these die every year.

Although there are different kinds of treatment for heart failure, no one has come up with a cure. But progress is being made. One company is exploring the use of stem cells in heart failure patients to reverse the damage (scarring) in tissue after a heart attack. The U.S. Food and Drug Administration has given the go-ahead to Sunrise, Fla.-based Bioheart, Inc. (BHRT) to begin a Phase I clinical trial for the company’s proprietary stem cell mixture to treat congestive heart failure.

Because this is a so-called Phase I trial, it will involve only a small number of patients, in this case 15. The goal of any Phase I trial is to test both the safety and effectiveness of a new drug or treatment. Bioheart’s trial will be conducted at different locations and will assess the safety and cardiovascular effects of implanting its stem cell mixture in congestive heart failure patients who have experienced a heart attack.

The mixture consists of stem cells from a patient’s own thigh muscle that have been modified to over-express a certain protein. The stem cells are injected directly into the scar tissue in the heart using a needle-tipped catheter inserted into the groin. The company hopes to prove that its stem cell mixture can grow new heart muscle within the scar tissue that will in turn be able help the repair process.

Bioheart also hopes the procedure will improve the patient’s heart function, exercise capacity, and quality of life. When it tested the stem cell mixture in earlier preclinical studies, heart function in the tested animal improved 54 percent compared to 27 percent for an earlier version of the mixture. Meanwhile, heart function in animals treated with a placebo declined by 10 percent.

According to Bioheart, the preclinical studies also showed that its stem cell product candidate enhanced blood vessel formation in damaged hearts. The company says its clinical trial will begin sometime this year. So results won’t be available for awhile. But heart failure patients have at least a ray of hope that stem cell research will someday provide a viable treatment for their debilitating condition.

Al K asked:


Ms. L wrote me:

Hello Dr. Kavokin,

I was reading some of your literature and found it to be quite informative. I have a question that perhaps you may be able to answer: If a woman’s ovarian cyst ruptures, (especially multiple cysts from PCOS) can these ruptured cysts become an infection?


Hi, MS. L

Short answer: anything can become infected. Though I do no think ruptured ovarian cyst becomes infected very often, did not hear about that. I will look more literature and probably place the answer on my website.

Sincerely,

Alex

OK. I looked the literature.

I didn’t do very extensive literature search. Should admit.
Anyway, some available books mention that ovarian cyst may become infected. However the infection is not described as the main complication in ovarian cyst rupture.

Also, I don’t remember that anybody told me otherwise. Maybe there is some specialized article that says: the condition happens in one point three percent of cases with Standard Deviation of half percent. I don’t know exact percentage. Need to look more. PubMed service did not give many abstracts on PCOS + infection.

Anyway.

So how would it look alike?

A young woman comes to ER. She is premenopausal. She complains on mild (or maybe severe) pain in her belly. ER Doctor takes history. The woman also mentions changes in her menstrual interval. Let’s say regular is 28 days. Last one was delayed.

Physician puts gloves, puts jelly on gloves. Then he puts his two fingers into the female vagina.
The other hand is on belly. Then he starts to palpate.

It is named pelvic exam. Modest name. Though in Russia it is named vaginal exam, which it is.

Is it a common type of exam? Depends. They usually send you to CT (computer tomography) scan if there is severe abdominal pain. Charge 1000. Boom.
Done.

Exclude the price. Exclude delay in reading (somebody should look and interpret what is going on). Exclude radiation. CT scan gives better picture than just poking your belly.

CT scan helps to diagnose abdominal pain of uncertain origin. You can really image what is going on. Though, there are cases when physical exam gives more clues. Physical exam must be performed always. Pelvic exam is somewhat a special one.

I remember how I performed a pelvic exam in medical school. It is actually difficult even just to insert two fingers into vagina first time.
Female Gynecologist asks me: “So, what do you feel?”
Patient goes the same, encourages me:
“What do you feel, what do you feel, do you feel it?”

I guess she felt a sort of museum artifact.
Heck, I did not feel anything.

Well. Actually I felt something – aside from uterus – something round. I would say 5 cm in diameter (would it be less I probably would not feel it at all) and semi-solid on touch. Also I saw that the patient grimaces. It is tender when I push hard.

It’s it. How to say that it was tuboovarian abscess (that it was) for sure, I don’t know.
You really need experience to perform this type of exam. Experienced gynecologist can tell almost precisely what is going on.

Let’s discuss that woman in ER. She will have tenderness on one side. Physician should be able to feel a mobile cystic mass.
(Cyst or rather cystis is Latin for bubble. Palpate is Latin for touch. It means you touch something and feel what it is).
What if the pain is severe? It often means that the cyst ruptured.
My impression is that modern ER orders CT scan right away. If you are not very sure what is going on, you will go from less expensive methods to more expensive and end up with CT anyway. Ruptured cyst causes significant pain. Here CT is indicated.

Alternatively they may order Ultrasound Exam. Transvaginal ultrasound uses the probe inserted into vagina. Ultrasound is cheaper than CT. Ultrasound visualizes cysts clearly. Though, ultrasound gives less information for excluding other pathology. Ultrasound is also safe from the radiation point of view.

In PCOS ultrasound shows increased number of small cysts in both ovaries. Usually more than five confirms the diagnosis.

Culdocentesis may give some useful information too. The name came from cul-de-sac. It’s French I guess. Cul-de-sac is one of the pouches in the pelvis. Centesis means: stick a needle and draw. These days it is considered an outdated method. But if you do not have other machines, it is very useful.

If the content is blood, the ruptured cyst was probably Corpus luteum cyst. If the content is purulent the ruptured thing was probably a tubo-ovarian abscess or other pelvic inflammatory disease (PID).
Other abnormal masses can rupture as well. Teratoma gives oily fluid, endometrioma gives “chocolate” old blood.

What is a follicle?

Female body is created for reproduction and childbearing. Oocyte is the start for a new human being in the ovaries. Several layers of specialized membranes surround an oocyte.

The membranes protect the oocyte, help in feeding and nurturing of this small cell.
One of layers has a beautiful name Zona pellucida. Pellucida means shiny in Latin.

When the oocyte matures, a small bubble (follicle) filled with special fluid is formed around.
In mid-cycle the follicle bursts and the oocyte goes first into peritoneal cavity, next into ovarian tubes (fallopian tubes). The tubes lead into uterus. Tubes, by the way, have special small hair-like things inside – fimbria. They beat in one direction. They propel the oocyte into uterus.

I remember I read somewhere that there are 11000 follicles. When a girl is born, there is no more multiplication of oocytes. After the birth the follicles sit dormant. When the female goes into her reproductive age, the follicles start to grow and mature (one by one).

Only 400 of them mature.

Yeah, it should be like this. Calculate. Average cycle is 28 days. So there are around 12 cycles a year. Women start to menstruate at 13-15 years old. The menopause is around 45-55 years. Total is 30-40 years

Multiply everything together. It should be around 400.

By the way, an interesting thought.

All those discussion about abortion and Stem Cell research.
Somewhere in nineteen century the baby was considered the baby when it was born. The church even struggled to admit anything like existence of cells etc. Rare baby actually survived beyond first year.
Heck, the hypothesis that human been consists of small cells was actually admitted widely not so long ago. Maybe hundred years ago. Then, all that research happened. People learned how the fetus is created and how it grows. Now the public idea is that fertilized oocyte is already the baby.

Have you seen any oocyte under microscope? Even a human hair near an oocyte looks like a skyscraper near a real human.

Now, if the public perception had shifted this way in several decades, shouldn’t we punish all women for that they recklessly loose 400 potential babies during lifetime. Isn’t it a crime?

Then, maybe we should punish every man for losing millions of sperms – also potential babies.
Where did this idea come from that fertilized oocyte is the baby and non-fertilized oocyte is not?
Shouldn’t we move the boundary a little bit earlier?
Need to think about that.

Anyway.

Ovarian follicle (follicle means small bubble in Latin) usually mature, rupture and release the oocyte that was in this follicle. Sometime the rupture delays. Then ovulation delayes. (Ovulation is rupture and release of the oocyte. Oocyte is the cell that eventually becomes the fetus after sperm gives the genetic material).

Normal cycle is divided into follicular phase (when the follicle grows) and luteal phase.
Luteum means yellow in Latin.

When the follicle ruptures (by the way rupture means burst or tearing), the oocyte goes out.

The cavity that left behind (remember it was small bubble) is filled with blood and special cells, producing hormones. These special cells grow in quantity and fill that cavity. These cells produce hormones that help the fertilized oocyte to attach and to grow in the uterus. Because they grow in quantity, they create a yellowish body in the ovary. It is literally yellowish. The name is Corpus Luteum (corpus=body, luteum = yellow).

This is normal cycle.

As we said, the follicle sometime doesn’t rupture (there is a bunch of reasons). A physician should sort out several different conditions. This is an abnormal cycle.
If follicle does not rupture it becomes the follicular cyst. Cyst also means bubble in Latin. There are actually plenty of different kinds of bubbles in medical Latin. Big ones and small ones. Normal and abnormal.

OK, the cyst did not rupture. Then what happens?

Well. If cyst doesn’t rupture, it usually resolves. That fluid inside the cyst is reabsorbed and the cyst collapses.

However, if the cyst ruptures, it causes acute pain. The pain comes from irritation of peritoneum (lining of peritoneal cavity) with blood and cyst content.

Why it is not painful when a regular follicle ruptures and releases the oocyte? Probably, a regular follicle is too small. In addition it doesn’t cause much bleeding.

In contrast the cyst is a really big bubble (sometime 5-10 cm in diameter). If it ruptures, it instantaneously release bunch of special fluid. Plus, there is significant bleeding because there are a lot of blood vessels around to feed.

Significant is of course relative.

For example, take 5-10-20 ml of blood from a patient vein in a hospital daily. He complains about the pain from the needle mostly.

But if you get the same 10 ml of blood into peritoneum… Wow.
You will cry. There are plenty of nerve endings. Peritoneum is too touchy-feely. Tender.

Besides, the cyst has high concentration of prostaglandins. Prostaglandins, in their turn, are mediators of inflammation. They should cause significant pain directly and indirectly.

From the other hand bleeding could be really significant. Then it becomes really dangerous.

A physician also should not miss an ectopic pregnancy. Doctor will order a pregnancy test for that. If an ectopic pregnancy starts to bleed, this is really really worrisome. It seems like your blood did not left your body. However the blood is in the abdominal cavity. It left the blood vessels. It is internal bleeding. You die quickly.

Polycystic ovarian syndrome is a little bit different animal actually. Here is some genetic predisposition.

Classically: an overweight young female presents with oligomenorrhea or amenorrhea, anovulation, acne, hirsutism, and or infertility.

What is what? Poly = many. Many, many, many men.
So PCOS means bunch of those bubbles in the ovaries. The follicles did not rupture on time, as they should. Oligo means a little. Meno is derived from menses. Rrhea means flow in Latin

So olygomenorrhea = flowing a little bit (less than it should).
A- is a prefix that means “No”. So, amenorrhea = no flow at all.
Hirsutism. I don’t remember where it came from, but means hairy or hairiness. Actually excessive hairiness.

Causes of PCOD or PCOS (disease or syndrome) are obesity, genetic predisposition and some other causes of Luteinizing hormone (LH) excess.

There is a self-amplifying cycle:

LH stimulates theca lutein cells. Theca means sort of capsule. Doesn’t really matter, just an anatomical term.
Those cells are special. They produce androstendione and testosterone. Androstendione and testosterone are actually male hormones. You know, bodybuilders use these hormones to get muscle bulk. You probably heard about those hormones. Sport doping uses testosterone.
So, athletes build their muscles and trash their liver.

Rumors say that a famous Hollywood actor used the hormones. Later he got liver transplant.
Though he always denied the use.

Anyway, female body converts androstendione into estrone (a weak estrogen). Fat cells do this. Estrone is a female hormone already.

Basically any body produces androgens (andros = man) and estrogens (female hormones). Just the proportion of those hormones makes us male or female.

The cycle happens in normal person as well.

The estrone stimulates pituitary secretion of LH.
Pituitary is a small gland in you brain. Pea Size.
It’s small, but it sooooo powerful.

Pituitary has another name – hypophysis. Hypo means down, phys means growth, so this gland is growing from below the rest of the brain. Pituitary gets bunch of connections from hypothalamus.
Hypothalamus means “below thalamus”.
These two areas of brain regulate almost all the hormone production in organism.

Higher levels in brain hierarchy regulate them.

Hypophysis gets a command. Then it produces some intermediate messengers and hormones.
The hormones go into blood and control whole body.

Hormones are like orders, like messages to the rest of the body.

Brain may give quick orders: Signals go through the nerves. It is like a phone order or cablegram.

Brain also regulates organism through the hormones. This is like a mail order.
Sort of if the brain sends letters by regular mail. The hypophysis is the Post Office in this case.

PCOS kicks in when a woman is obese. There are more fat cells to convert
androstendione to estrone. Estrone has such effect that it stimulates pituitary secretion of LH.
LH in its turn goes back to those theca lutein cells we discussed and turns them on again, to produce more androstendione, which is again converted into estrone.

Self-amplifying cycle

In addition, that increased level of testosterone causes the hirsutism (she becomes hairy like a male) and acne in female.
In a normal person this cycle is probably designed to support the development of fetus.
Estrogen helps placenta to grow. Placenta supports fetal growth.

However, in a person with PCOD the cycle is going out of normal control. In this case LH causes growth of the cysts in the ovaries.

Why?

Because the corpus luteum cyst is partially made by overgrowth of those theca lutein cells. LH stimulates theca lutein cells.

Also, women with PCOS have intolerance to glucose (sugar) and resistance to insulin.
It means there is a lot of insulin (hormone that helps to utilize glucose mainly).

However excessive insulin does not work. Either receptors to insulin do not work or something else, but the glucose is not utilized. Hence, energy inside the cells drops. Hence, a big pile of other problems mounts. As if it is Diabetes Mellitus. Diabetes is a different topic of discussion. For us, it is worthwhile to mention that people with diabetes are very much prone to any infection.

PCOS causes acanthosis nigricans also. Acantocytes are special skin cells.
Nigricans means black in Latin. That thing looks like thickened pigmented skin. When you touch it, it feels like velvet. Usually it happens in axilla, neck, below breast, in inner thigh and vulva. So, mostly all those places where skin folds.

The treatment for PCOS includes different medications: oral contraceptives, progesterone,
glucocorticoids, ketoconazole, spironolactone, cyproterone, flutamide, cimetidine, finasteride, ovarian wedge resection, laparascopic electoracutery, mechanical hair removal, etc.

All methods break the cycle of overproduction. The medications are either hormones themself or hormone-like substances that occupy receptor site and prevent regular hormone to work.

The medications act on different levels. Normal hormones have very complicated regulation. There are loops and feedbacks in the pathways.

To suppress a hormone production or action, you give similar hormone or another hormone or non-hormone at all, that goes to the feedback loop and breaks it and so on. It’s really long separate discussion.

Basically, you either decrease hormone production or shift ratio toward female hormones.

Another way, the best probably, is weight loss. No fat cells – no conversion of andrgoens etc… You can make conclusions yourself.
It’s the first line of treatment.

For a simple follicular ovarian cyst (not PCOS) doctor rules out ectopic pregnancy. Then he may send patient home and repeat pelvic exam in 6-8 weeks. Especially, if the cyst was small, less than five cm in diameter.

For larger cysts, doctor would order pelvic ultrasound.

Most follicular cyst will resolve on their own in six to eight weeks. Though, a physician may give oral contraceptives. Again, this suppresses stimulation of cyst by hormones from the hypophysis. The hormones are named gonadotropins.

If the cyst is still there after 6-8 weeks, a suspicion arises that the cyst maybe malignant. Then doctor orders other studies. CT scan. Physician may perform surgical procedures also. He looks what is this cyst really.

Corpus luteum cyst is usually not treated. However, oral contraceptives may be used.

Rupture of any kind of those cysts leads to another story. Acute pain, bleeding into peritoneum.
Sometime bleeding is very severe and is true emergency. You need also to distinguish other process in the abdomen. For example, appendicitis looks similar. You can treat mild case of non-complicated cyst rupture with just observation. Appendicitis almost always requires surgery.

There are many other problems arise. Surgeon scratches his head: what’s going on? Is this this or is this that? Here is the CT scan gives big advantage.

Now, going back to the question of Ms. L.

If the cyst was infected, I don’t’ see a reason why a ruptured cyst wouldn’t become infected.
Cyst content is very nutrient-rich. Remember? All those cells and their products are dedicated to feeding the oocyte (future baby). Should be very tasty for any bacteria.

Rupture may cause significant bleeding as well. This blood is also different from the blood in your vessels.

This blood is sitting in the pelvis, not moving, quickly clotting. Clotting prevents entry of white blood cells. “No flow” prevents entry of antibodies. Absence of flow prevents entry of other protective chemicals (complement etc).

So, it is very nutrient-rich media for bacteria growth.

They can go wild. Why not?
If a female had another pelvic infection before, that infection can flare up. In a normal person peritoneal cavity should be sterile. However, any gynecological or gastrointestinal infection may supply bacteria. Now, mix these bacteria with the content of the leaking cyst. It just destined to become infected.

Actually Ms. L later answered her own question in another e-mail. She had cysts multiple times and they became infected several times.

So, to answer the question:
Will the ruptured cyst become infected? Not necessarily. Rather not. Can it become infected?
Yes.

Simon Paisley asked:


Stem cells are currently used for treating some diseases, and offer hope of a future cure for many of today’s incurable diseases. Parents are now able to have blood or cells from the umbilical cord of their newborn child stored for the child’s future disease treatments. This article gives an overview of the process of stem cell storage.

Stem cell storage is becoming a more and more popular choice among parents of newborn children, and is relatively common in the USA. It is now becoming increasingly common in the UK. These cells have been used for bone marrow transplants since 1988. They may, in the future, offer a cure for many diseases for which there is presently no cure. Conditions and injuries such as heart disease, brain damage, deafness, blindness and diabetes. Even hair loss and missing teeth could be treatable in the future.

The idea behind storage of your child’s stem cells is that they will have a supply of compatible cell types to be used in the treatment of any disease, injury or condition that they might suffer from in the future. Obviously, this also depends on advances being made in medical procedures using these cells. If a cure for this condition has not been discovered by the time the child has developed it, then they are of no use for treatment purposes. The current range of conditions treatable with stem cells is relatively small, however, significant time and money is being put into this area of research and future cures seem to be highly likely.

The storage process begins at the birth of the child, using an umbilical cord blood collection kit supplied by the cord blood storage company. A healthcare professional (a phlebotomist, doctor, nurse etc.) collects blood from the umbilical cord using the collection kit. The process is painless for both mother and baby, and is completely harmless to both. The blood is then transported to the laboratory for processing by the technicians. In some laboratories the whole blood is frozen, but other laboratories extract the stem cells before freezing. The sample is frozen using liquid nitrogen at around minus 190 degrees Celsius, and can be stored in the storage tank at this temperature indefinitely. Some storage tanks use liquid phase nitrogen and some use vapour phase nitrogen. Vapour phase nitrogen appears to be increasingly popular as there has been some evidence of liquid phase nitrogen transferring infectious diseases from one sample to others.

Robert Wascher asked:


Congestive heart failure (CHF) is a serious and life-threatening illness that is associated with premature death. If one thinks of the heart as a pump, progressive damage to this pump’s muscle fibers results in decreased “pump efficiency,” which causes blood to, essentially, back-up within the vascular system under increased pressure. This increased back-pressure causes swelling of the entire body (edema), and particularly the lower extremities, the lungs, the liver, as well as within the heart itself. In more severe cases, CHF is associated with generalized weakness and profound shortness of breath.

The American Heart Association estimates that there are already more than 5 million Americans living with CHF, and that more than 550,000 new cases of CHF are diagnosed each year. Although mortality rates associated with CHF have improved dramatically over the past 30 years, the 5-year death rate associated with clinically significant CHF still approaches 50 percent.

As our population continues to grow older, on average, the incidence of CHF is expected to continue to rise. Although precise estimates are difficult to arrive at, the cost of caring for CHF is thought to be at least $33 billion per year in the United States alone.

There are several known major risk factors for CHF, including coronary artery disease and heart attack (myocardial infarction), uncontrolled high blood pressure (hypertension), diabetes, obesity, diseased heart valves, elevated cholesterol, and smoking. In most countries, coronary artery disease and myocardial infarction are the leading causes of CHF, and these two related risk factors account for approximately two-thirds of all CHF cases in the United States.

In adults, heart muscle fibers (cardiac myocytes) that have become damaged by chronic oxygen deprivation (myocardial ischemia) or oxygen loss (myocardial infarction) are essentially unable to regenerate themselves, and are gradually replaced by scar tissue that interferes with the heart’s pumping action. At the present time, the standard clinical management of heart injury due to ischemia or infarction includes the use of medications such as aspirin, ACE inhibitors, aldosterone antagonists, beta-blockers and nitrates. So-called “reperfusion strategies,” including coronary artery stent placement and coronary artery bypass graft (CABG) surgery may also be required in some patients. However, once the heart’s blood-pumping muscle fibers have become extensively replaced with non-contractile scar tissue (fibrosis), irreversible CHF develops, and only symptomatic management is possible at this point.

Recent animal studies, and limited clinical research studies in humans, have looked at the use of stem cell auto-transplantation into damaged hearts afflicted with CHF. Although mature cardiac myocytes cannot regenerate or reproduce following severe ischemia or infarction, primitive “pluropotential” stem cells in the bone marrow are thought to be potentially capable, under certain conditions, of metamorphosing, or differentiating, themselves into almost any type of specialized cell of the body, including cardiac myocytes. However, this transformation, from undifferentiated bone marrow stem cell into a highly differentiated and specialized cardiac muscle cell, does not occur naturally in the human body, at least not to any clinically significant degree. Therefore, as is also the case in other areas of stem cell research, the greatest challenge in this type of clinical research is in coaxing undifferentiated stem cells to morph into functional cardiac myocytes and to find a way to incorporate these new heart muscle cells into the damaged heart in such a way that they actually improve the damaged heart’s compromised pumping function. (These two challenges continue to vex clinical research into stem cell therapy, and particularly research into the use of adult patients’ own stem cells.)

Now, newly published clinical research in the Journal of the American College of Cardiology appears to have pushed the existing boundaries of so-called autologous stem cell transplantation in the treatment of CHF, and may represent a major advancement towards finding an enduring treatment, if not an eventual cure, for this increasingly common and disabling disease.

In this prospective interventional clinical study, 124 patients who had just experienced an acute myocardial infarction were evaluated with coronary angiograms, treadmill EKGs, 24-hour EKGs, and echocardiograms, among other cardiac studies. Half of this cohort of patient volunteers also underwent collection of their own (autologous) bone marrow cells, and injection of these bone marrow cells into the blocked coronary arteries that had caused these patients’ heart attacks. Both groups of patients were matched with each other in terms of baseline cardiac function and the extent of their myocardial infarctions. All 124 patients were then closely followed, at regular intervals, for 5 years. The results of this study were rather dramatic.

Within 3 months of bone marrow cell injection, significant improvement was noted in cardiac pumping efficiency (ejection fraction) of the bone marrow cell transplant patients, when compared to the patients who did not receive autologous intracardiac bone marrow cell transfusions. Moreover, on average, the total area of heart muscle death (infarction) following heart attack was 8 percent smaller in the patients who received the bone marrow cell transplants, when compared to the “control group” patients.

In the area of the “infarction zone” of the heart, a very significant 31 percent increase in cardiac contractility was observed in the patients who had undergone bone marrow cell transplant, suggesting that the infused bone marrow stem cells had actually incorporated themselves into the infarcted heart muscle, and had successfully transformed themselves into functional cardiac myocytes. When compared to the control group patients, the patients who had undergone autologous intracardiac bone marrow cell transplantation also experienced significantly improved exercise tolerance and a decreased risk of death throughout the 5-year observation period within this study. Furthermore, these highly significant improvements in cardiac function continued to remain stable and durable throughout the 5-year period of post-transplant observation of these patients. As the “treatment group” patients were infused with their own bone marrow cells, there were no episodes of rejection, and no major complications were reported with this novel treatment.

This small prospective pilot study strongly suggests that autotransplantation with stem cells contained in the bone marrow can significantly reduce the risk and extent of CHF following acute myocardial infarction. Not only does this therapy appear to be clinically effective, but it appears to be associated with a very low risk of complications, and it also side-steps the ongoing ethical debate that surrounds the use of more versatile, but more controversial, fetal stem cells.

Based upon the rather remarkable findings of this small clinical study, much larger multi-institution, prospective, randomized, controlled studies of autologous intracardiac bone marrow cell transplantation, following acute myocardial infarction, need to be performed. Fortunately, several such studies are already underway in the United States and Europe. I look forward to the long-term results of such studies, as I believe that they may have the potential to radically transform the management of coronary artery disease and acute myocardial infarction, and offer the best and most practical hope of reducing both the incidence of CHF and the mortality rate associated with CHF.

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.