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From: TSS (216-119-156-132.ipset36.wt.net)
Subject: MCG takes surgical precautions due to CJD MEDICAL/SURGICAL MISHAP (proper TSE surgical procedures NOT followed)
Date: January 13, 2005 at 9:07 am PST

-------- Original Message --------
Subject: MCG takes surgical precautions due to CJD MEDICAL/SURGICAL MISHAP (proper TSE surgical procedures NOT followed)
Date: Thu, 13 Jan 2005 10:37:51 -0600
From: "Terry S. Singeltary Sr."
Reply-To: Bovine Spongiform Encephalopathy
To: BSE-L@LISTSERV.KALIV.UNI-KARLSRUHE.DE


##################### Bovine Spongiform Encephalopathy #####################

MCG takes surgical precautions

By DAVID WAHLBERG
The Atlanta Journal-Constitution
Published on: 01/12/05
The Medical College of Georgia in Augusta temporarily shut down its
operating rooms this week to resterilize instruments because a
surgery patient last week may have had an illness similar to human
mad cow disease.

MCG officials said they were being "overly cautious" and that no one
was at risk because the patient almost certainly doesn't have the
illness, Creutzfeldt-Jakob disease. The situation comes less than
four months after Emory University told more than 500 patients that
they may have been exposed to the disease after a surgical patient
there was found to have it.


The 42-year-old man, hospitalized at MCG since shortly after
Christmas, has had headaches, rapid memory loss and difficulty moving
and speaking, said Dr. Ralph Caruana, MCG's chief medical officer.

Those are symptoms of CJD, a form of which is known to come from
infected beef. But the patient, now receiving steroid treatment, is
getting better, Caruana said. That is leading doctors to think he
doesn't have CJD, which is invariably progressive and fatal, he said.
Definitive test results are expected today or Thursday.

Monday night, MCG closed its 22 operating rooms, Caruana said. The
eight children's operating rooms reopened Tuesday morning, and the 14
adult operating rooms were expected to reopen Tuesday night.

MCG officials have not formally notified patients of the situation
because hospital officials say it is unnecessary. "We do not believe
at this time that there was any potential exposure," said Bill
Boling, the hospital's general counsel.

Creutzfeldt-Jakob disease has two main forms: variant CJD, the human
form of mad cow, and sporadic CJD. Health officials say the cause of
sporadic CJD is unknown, though some recent European studies suggest
some cases might also stem from tainted beef.

Both forms of the disease are caused by prions, abnormal proteins
that cause the brain to become spongelike. Prions, thought to be
nearly impossible to kill with heat, are difficult to remove from
surgical instruments. In cases of suspected CJD, federal guidelines
instruct hospitals to increase the sterilization of surgical
instruments, soaking them in sodium hydroxide and heating them in
autoclaves for longer periods or at higher temperatures than is
routine.

The MCG patient had unusual neurological symptoms but no obvious
diagnosis, so he underwent a brain biopsy Thursday, Caruana said. He
was not suspected to have CJD, but Caruana said the hospital applied
the enhanced sterilization measures as a precaution for the
instruments used during the biopsy.

On Monday, hospital officials interviewing operating room staff
learned that other surgical instruments had been opened during the
biopsy, though not used, Caruana said. The officials decided to
subject those instruments, and all others that later might have come
into contact with them, to the enhanced sterilization.

To do that, the officials shut down the 22 operating rooms, canceling
about 50 elective surgeries and diverting emergencies to other
hospitals. After learning that no children's instruments could have
been affected, the children's hospital was reopened. All of the adult
instruments determined to need the enhanced sterilization were
expected to have been cleaned by Tuesday night.

Caruana said MCG was convinced the patient didn't have CJD and that
business soon would return to normal. "But we felt obligated to act
as if there really was a risk," he said.

http://www.ajc.com/metro/content/metro/0105/12cjd.html


-------- Original Message --------
Subject: re--CJD medical/surgical precautions
Date: Thu, 13 Jan 2005 10:19:02 -0600
From: "Terry S. Singeltary Sr."
To: dwong@mail.mcg.edu

final transmission, please reply......

-------- Original Message --------
Subject: re--CJD medical/surgical precautions
Date: Wed, 12 Jan 2005 14:42:00 -0600
From: "Terry S. Singeltary Sr
To: dwong@mail.mcg.edu

Greetings Danielle,

my name is Terry S. Singeltary Sr. and I belong to several groups,
CJD Watch and CJD Voice. I lost my mother to hvCJD
(Heidenhain Variant Creutzfeldt Jakob disease).
anyway, we are aware of a surgical scare at your hospital from
a suspect CJD case. THE media states that ;

could you please tell us what the Definitive test was and what the findings
were ???


Thank you,

kind regards,

Terry S. Singeltary

> But the patient, now receiving steroid treatments, is getting better,
> Caruana said. That is leading doctors to think he doesnt have CJD,
> which is invariably progressive and fatal, he said. Definitive test
> results are expected today or Thursday.
>


CJD Watch

http://www.fortunecity.com/healthclub/cpr/349/part1cjd.htm

DOES not seem they are willing to discuss this.

I find this rather disturbing;

> Caruana said MCG was convinced the patient didn't have CJD and that
> business soon would return to normal. "But we felt obligated to act as
> if there really was a risk," he said.

FOR them to act as if there was really a risk, while pretending there was
not, is just more of the same old BSeee. THE medical and surgical community
must get serious about this agent, BEFORE MISHAPS like this happen, not
after. by then it's much too late and countless become exposed...

J Neurol Neurosurg Psychiatry 1994 Jun;57(6):757-8


Transmission of Creutzfeldt-Jakob disease to a chimpanzee by
electrodes contaminated during neurosurgery.

Gibbs CJ Jr, Asher DM, Kobrine A, Amyx HL, Sulima MP, Gajdusek DC.

Laboratory of Central Nervous System Studies, National Institute of
Neurological Disorders and Stroke, National Institutes of Health,
Bethesda, MD 20892.

Stereotactic multicontact electrodes used to probe the cerebral
cortex of a middle aged woman with progressive dementia were
previously implicated in the accidental transmission of
Creutzfeldt-Jakob disease (CJD) to two younger patients. The
diagnoses of CJD have been confirmed for all three cases. More than
two years after their last use in humans, after three cleanings and
repeated sterilisation in ethanol and formaldehyde vapour, the
electrodes were implanted in the cortex of a chimpanzee. Eighteen
months later the animal became ill with CJD. This finding serves to
re-emphasise the potential danger posed by reuse of instruments
contaminated with the agents of spongiform encephalopathies, even
after scrupulous attempts to clean them.

PMID: 8006664 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8006664&dopt=Abstract


Docket Management

Docket: 02N-0370 - Neurological Devices; Classification of Human Dura Mater

Comment Number: EC -1

Accepted - Volume 1


http://www.fda.gov/ohrms/dockets/dailys/03/Jan03/012403/8004be11.html


http://www.fda.gov/ohrms/dockets/dailys/03/Jan03/012403/8004bdfe.html


http://www.fda.gov/ohrms/dockets/dailys/03/Jan03/012403/8004bdfc.html

Ref: MRC/62/04

Under strict embargo until 19.00 British Time Thursday 11 November 2004

GENETIC MAKE-UP MAY DETERMINE WHAT TYPE OF CJD OCCURS WHEN HUMANS ARE

INFECTED WITH BSE

New research published today (19.00 hours Thursday 11th November) by a

team from the Medical Research Council (MRC) Prion Unit offers an

explanation about why only people with a particular genetic make-up have

so far developed vCJD. It also provides evidence that other types of

BSE-derived prion infection with a different pattern of symptoms might

occur in humans. The findings are published in the journal Science.

Variant CJD (vCJD) is the human disease thought to be caused by eating

food contaminated with the infectious agent, known as a prion,

responsible for the epidemic of BSE or mad cow disease in cattle. So

far, everyone known to have developed vCJD has been of a particular

genetic type  known as MM. Until now it has been a mystery why everyone

that has developed vCJD is of the MM type and one possibility is that

they are simply the first to develop the disease when infected with BSE,

and that people with the other genetic types1 (known as VV and MV)

infected with BSE prions will also develop vCJD, but some years later.

In a series of experiments spanning more than ten years, the MRC team

has been studying mice genetically modified so that they make human

prion proteins  which are used to model human susceptibility to BSE.

The team has now shown that mice with the human VV genetic type do

become infected when given BSE or vCJD prions, but manifest a different

form of the disease which looks quite different to vCJD and has a novel

prion strain type.

Remarkably, when these novel prions were used to infect mice of the MM

genetic type, the mice either developed a disease very like vCJD, or

else a pattern of disease that looks like so-called sporadic CJD  the

classical form of CJD. This form has been known about for many years,

is seen all over the world and has not hitherto been associated with

BSE. However, the new strain identified in the mice, being called type

5, has not been seen yet in people and we do not know what pattern of

disease it would cause. It could look like one of the forms of classical

or sporadic CJD or perhaps be yet another different variant form.

The work from the MRC team suggests that type 4 prions, the type

associated with vCJD, can only propagate themselves in people that make

the M form of the protein. It seems the V form of the protein just

cannot adopt the particular molecular shape that characterises type 4.

The studies in mice also suggest that if these prions were to pass from

person to person (for example by blood transfusion) then, depending on

the genetic type of the person becoming infected, at least three

different patterns of disease might result: type 2 (which is seen in

sporadic CJD); type 4 (which causes vCJD) or type 5 (which may cause a

new pattern of disease).

Professor John Collinge, Director of the MRC Prion Unit, which is based

at University College London, said: These mouse studies give us vital

clues about the behaviour of prions and how they appear to modify and

adapt depending on the genetic makeup of the individual they are infecting.

We always have to be cautious about making direct comparison to the

human condition, but our work strongly suggests that we can not assume

only those with one genetic profile are vulnerable to BSE infection.

At this stage it is not possible to say how this should alter estimates

of those likely to become ill, but our findings do suggest we should be

taking steps to draw up a more sophisticated system of categorizing the

disease so that we dont mistake BSE related infection for a version of

sporadic CJD.

ENDS

For more information call the MRC press office on 020 7 637 6011

Notes to Editors

1The human prion protein comes in two common forms, known as M and V.

Because everyone has two copies of this gene, there are three possible

genetic types: MM, MV and VV.

Paper - Human Prion protein v129 prevent expression of vCJD phenotype 

Science On line 11.11.04

Prions are rogue forms of one of the bodys own proteins  known as the

prion protein  which are misshapen. There are several different rogue

or misshapen forms that can infect humans, and these different types of

prions are known as strains. This is analogous to different strains of

other germs such flu virus causing influenza or strains of salmonella

causing different forms of food poisoning for example.

The strain of prion causing vCJD is known as type 4, types 1-3 cause the

different forms of sporadic or classical CJD. Each strain causes a

different pattern or type of disease. It is known that prion strains can

change or mutate when they pass between different animals.

The Medical Research Council (MRC) is a national organisation funded by

the UK tax-payer. Its business is medical research aimed at improving

human health; everyone stands to benefit from the outputs. The research

it supports and the scientists it trains meet the needs of the health

services, the pharmaceutical and other health-related industries and the

academic world. MRC has funded work which has led to some of the most

significant discoveries and achievements in medicine in the UK. About

half of the MRCs expenditure of £430 million is invested in its 40

Institutes, Units and Centres. The remaining half goes in the form of

grant support and training awards to individuals and teams in

universities and medical schools. Web site at: http://www.mrc.ac.uk

.

Send Post-Publication Peer Review to journal:

Re: RE-Monitoring the occurrence of emerging forms of Creutzfeldt-Jakob

disease in the United States

Email Terry S. Singeltary:

flounder@wt.net

I lost my mother to hvCJD (Heidenhain Variant CJD). I would like to

comment on the CDC's attempts to monitor the occurrence of emerging

forms of CJD. Asante, Collinge et al [1] have reported that BSE

transmission to the 129-methionine genotype can lead to an alternate

phenotype that is indistinguishable from type 2 PrPSc, the commonest

sporadic CJD. However, CJD and all human TSEs are not reportable

nationally. CJD and all human TSEs must be made reportable in every

state and internationally. I hope that the CDC does not continue to

expect us to still believe that the 85%+ of all CJD cases which are

sporadic are all spontaneous, without route/source. We have many TSEs in

the USA in both animal and man. CWD in deer/elk is spreading rapidly and

CWD does transmit to mink, ferret, cattle, and squirrel monkey by

intracerebral inoculation. With the known incubation periods in other

TSEs, oral transmission studies of CWD may take much longer. Every

victim/family of CJD/TSEs should be asked about route and source of this

agent. To prolong this will only spread the agent and needlessly expose

others. In light of the findings of Asante and Collinge et al, there

should be drastic measures to safeguard the medical and surgical arena

from sporadic CJDs and all human TSEs. I only ponder how many sporadic

CJDs in the USA are type 2 PrPSc?

http://www.neurology.org/cgi/eletters/60/2/176#535

Docket No. 2003N-0312 Animal Feed Safety System [TSS SUBMISSION]

http://www.fda.gov/ohrms/dockets/dockets/03n0312/03N-0312_emc-000001.txt

Terry S. Singeltary Sr.

P.O. Box 42

Bacliff, TEXAS USA 77518

######### https://listserv.kaliv.uni-karlsruhe.de/warc/bse-l.html ##########






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