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Thread: meeting with Carl C. Kao

  1. #51

    info. on Kao's book-Spinal Cord Reconstruction-Kao,C.C., Bunge,R.P., Reier,P.J.


  2. #52

    this would be another man going this month for the procedure...trying to find him

    http://www.cincypost.com/2001/jul/06/surg070601.html Silverton man hopes to patch up wounds first, then painful life
    By Ken Wilson, Post staff reporter


    Rather than accept that he will need a wheelchair the rest of his life, Gregory Perry is willing to take a chance on a surgery some medical professionals consider highly experimental.

    In February 1996, the 28-year-old Silverton man was shot twice. One bullet came within a quarter inch of his heart, the other damaged his spinal cord, leaving him paralyzed from the chest down.

    Almost 10 years earlier, Perry was stabbed 18 times by three men outside the apartment of a former girlfriend. That attack left him with nerve damage in both arms.

    ''Sometimes we get depressed thinking about what has happened,'' said Perry's mother, Linda Edwards. ''He'll say, 'Mom, I don't bother anybody, why do these things happen to me'?

    ''I'll say, 'If you would have been a drug dealer on the corner and got shot, you would have been dead ... and God wouldn't have a chance to work in your life.' ''

    Her son prefers not to dwell on the shooting. Mrs. Edwards said her son was picking up a co-worker at an apartment complex in Mount Airy when he ran into an ex-girlfriend. A confrontation followed with the woman's boyfriend, who shot Perry.

    Both son and mother stand firm in their belief spiritual intervention led them to a neurosurgeon who will perform a spinal construction surgery with nerve implantion on Perry in August.

    Perry is trying to raise $27,000 for the procedure to be performed by Dr. Carl Kao, who operates a Spinal Cord Clinic in Washington, D.C. The surgery has not been approved in the United States, so it will be done in Quito, Ecuador.

    Members of Mount Zion Baptist Church of Woodlawn have established a fund to help with medical expenses. The church, which has raised $3,000, pledged to contribute whatever money Perry can't raise by July 20.

    ''We'll chip in the rest to make sure he can have the surgery,'' said church member Gina Ruffin-Moore, who's coordinating efforts.

    ''Greg was the first person to be baptized in a wheelchair at our church,'' Ms. Ruffin-Moore said. ''He told us about how he wanted to walk again and he found this doctor who might help. He is so determined. Members did research on this doctor and decided to help.''

    Perry has sold baked goods and cookbooks to raise money while his mother held a skating party.

    Perry spent countless hours researching his condition and doctors that might help before stumbling on Dr. Kao, who's originally from Taiwan.

    ''Greg didn't want to adapt or get used to a wheelchair,'' Mrs. Edwards said. ''He wanted to walk.'' The optimum outcome of Perry's surgery would be to restore sensation to reach his mid-thighs and to walk again.


    Publication date: 07-06-01 *****************************Related story:
    It's rush-hour traffic outside. From his first-floor room in the 6700 block of Highland Avenue in Silverton, Gregory Perry can hear it humming down Montgomery Road.

    He would like to be a part of the rush, heading for a job, or just outside driving around.

    But he can't. He has a bigger job with his mind, body and spirit.

    Mr. Perry, 28, is paralyzed from his chest down because of a spinal-cord injury from a gunshot wound five years ago.

    He was attacked on the way to work Feb. 8, 1996. He doesn't remember much about the attack, except that he was shot twice, once in the chest, an inch from his heart, and another bullet entered his abdomen, damaging his spinal cord. He still has use of his arms.

    "I have blotted it out of my mind," he said. "I am 10 steps ahead of that incident."

    Six days a week for 10 hours, Mr. Perry puts himself through grueling physical therapy. It's like a full-time job for him, because he is determined to walk again.

    "I work on my entire body, mind and spirit," he said. "I refuse to live my life confined to a wheelchair."

    He is also working against a deadline to raise $30,000 by July 20 to pay for an operation he believes will help him walk again. He is scheduled to fly to Quito, Ecuador, on Aug. 13, where Dr. Carl C. Kao, a neurosurgeon who directs a spinal cord clinic in Washington, D.C., will perform reconstructive surgery through nerve implantation. This surgery has not been approved by the U.S. government.

    But it is one piece of hope Mr. Perry holds on to.

    Dr. Kao came to Cincinnati in May to meet Mr. Perry. He explained by telephone last week that the bullet through Mr. Perry's abdomen did not damage his spine, but the heat and vibration from the bullet caused a 2-inch collapse in his spinal cord.

    He said inside the collapsed spinal cord is an empty space which expands and causes nerve fibers of the spinal cord to be disrupted causing the paralysis.

    "The surgery is to implant sural nerve and schwann cells into this empty space and wrap the spinal cord," he said.

    Dr. Kao said after the implantation, the nerve fibers of the spinal cord can be reconnected and blood supply restored.

    He thinks Mr. Perry can regain sensation to the mid-thigh area, gain control of bowel and bladder functions, and walk with a pair of orthopedic boots and a walker.

    "We have done about 500 of this type of surgery and about 70 percent have been able to walk with the special boots and walker," Dr. Kao said.

    Mr. Perry is confident that he will walk again.

    "I had faith from day one," he said. "I know God would see me through."

    Before his injury, Mr. Perry was a car detailer and a perfume salesman.

    "I think this whole incident has made him strong, spiritually," said Linda Edwards, his mother. "He went back to church and was baptized in his wheelchair."

    The Mount Zion Baptist Church of Woodlawn, where Mr. Perry is a member, has set up a special fund to help pay for the procedure. Church members have raised $3,000.

    Donations can be made to: Mount Zion Baptist Church of Woodlawn Benevolence Fund, 10180 Woodlawn Blvd., Cincinnati, Ohio 45215.

    [This message was edited by Birde on August 05, 2001 at 05:09 PM.]

    [This message was edited by Birde on August 05, 2001 at 05:50 PM.]

  3. #53
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    My only question would be...are there better bridges besides the peripheral nerve? Would Neurogel be a better bridge???

    Eric Texley

  4. #54

    Eric

    Bridging the spinal cord with peripheral nerves is more complicated and more simple than most of us think.

    When the peripheral nerve is transplanted, the axons in the peripheral nerve obviously die (the nerves contain axons that have been cut off from their cell bodies) but the Schwann cells remain. In the peripheral nerve distal to the injury site, Schwann cells transform (or they may come from some other cells) into macrophage-like cells when the axons that they once myelinated die. These cells rapidly clean up the myelin debris (which may inhibit axonal growth). When the axons grow back into the area, the Schwann cells then myelinate them.

    The above is the theory underlying the beneficial effects of Schwann cells in peripheral nerve. The peripheral nerve can regenerate to some extent, although it is not as good as most people assume that it is. Most of the time only a small proportion of the peripheral nerve will regenerate.

    In the spinal cord, oligodendroglia myelinate the axons. They are very different cells. First, unlike the Schwann cell which myelinates only one axon, an oligodendroglial cell myelinates as many as 20 axons. When axons die, the oligodendroglial cells don't transform (or at least we don't think so) into macrophages. As long as there are still some axons that the oligodendroglial cell is still myelinating, the cell remains. In fact, the axons die and the myelin sheath often remains for some time. For example, if you look at a degenerating white matter tract in the spinal cord, you often see hollow myelin cylinders with no axons in them. However, if enough of the axons die, the oligodendroglial cells undergo apoptosis (programmed cell death). The degenerating white matter is invaded by macrophages that clear out the dying oligodendroglia and myelin fragments. This process is called Wallerian degeneration and often takes place many weeks after injury.

    The experience of many laboratories have shown that bridging the gap alone may not be enough. The Bunges have shown this very clearly in their model where they use bridges made of Schwann cells embedded in a biomaterial called matrigel. Matrigel was developed by Cytotherapeutics and was designed to contain all the goodies that axons love to grow on. It is probably similar to Neurogel. What they found was that axons dearly love to grow into the bridge but they were very reluctant to grow out of the bridge.

    The problem became not one of bridging the spinal cord but getting the axons to grow out of the bridge. Henreich Cheng suggested a solution to this problem by doing specific nerve bridges from white matter to gray matter, reasoning that the reason why the axons don't like to grow out of the bridge is because they don't like to go into white matter containing Nogo and other axon-growth inhibitors. In addition, he applied a growth factor called acidic fibroblast growth factor. Cheng, Cao, and Olson published a paper in 1996 reporting the first successful peripheral nerve bridging of transected rat spinal cords.

    Therefore, just throwing a peripheral nerve or some neurogel into the syrinx is unlikely to bridge the spinal cord or solve the problem of getting the axons across the injury site. On the other hand, the Schwann cells from the peripheral nerves may very well proliferate and myelinate axons in the vicinity. We have long known that transplanted Schwann cells will myelinate axons in the spinal cord. In general, because the central nervous system consider Schwann cells a part of othe peripheral nervous system, astrocytes tend to wall off the Schwann cells and keep them from migrating in the system. So, the Schwann cells will only myelinate the axons close to the transplantation site.

    One other thing... there is a great deal of work looking at other cells as potential bridging cells. These of course include the olfactory ensheathing glial cells (which sometimes have been called the Schwann cells of the CNS), radial glial cells, tanicytes, and other specialized glial cells.

    Wise.

  5. #55
    Super Moderator Sue Pendleton's Avatar
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    I understood that what Dr Mary Bunge and Naomi Kleitman are now working on is a combination of olfactory ensheathing glial cells and Schwann cells to bridge the gap. From what I read it sounded like a very, hmmmmm, not really disappointing butunexpected outcome for Dr Bunge. I'm trying to remember the article........I think they found that instead of OEGc's helping the Schwann cells along it turned out that the Schwann cells helped the OEGc's along. After so many years working dilligently on Schwann cells I imagine Dr Bunge must have wanted to throw a microscope or two at these findings.

  6. #56

    hospital in Ecuador that Kao works out of...Clinica Primavera

    http://www.clinicalaprimavera.com/ (click on Bienvenido)*** OR*** http://www.clinicalaprimavera.com/espanol/index.htm Everything is in Spanish and the English version doesn't seem to work, however if you bookmark the site and go to: http://babel.altavista.com/translate...ml&language=it and put in what you want translated (spanish to english) it will work.

    [This message was edited by Birde on August 07, 2001 at 12:51 PM.]

  7. #57

    Birde

    Thanks. I am posting a copy of the information that you provide in the Trials Forum as well, so that people don't have to scroll through so many postings to find the information. Wise.

  8. #58
    Senior Member kilgore's Avatar
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    Speaking of peripheral nerve transplants...

    "When the peripheral nerve is transplanted, the axons in the peripheral nerve obviously die..."

    I recall experiments in which live peripheral nerves (still attached to a back muscle, for example) were stuck into the spinal cord injury site and coaxed into regenerating into the cord stump. Are the axons dead in this peripheral nerve, too? Did they have much luck with this?

    How about this: graft a live peripheral nerve into each side of the injury, then cut the peripheral nerves and graft them together. If one end of peripheral nerve tissue is always connected to live tissue, it might stay alive and keep its grafting ability.

  9. #59

    Kilgore

    Sorry, I don't explain so well.

    The neurons that give rise to the axons do not live in the peripheral nerve. They are either motor axons which come from motoneurons situated in the spinal cord or sensory axons that come from dorsal root sensory ganglia that are little cluster of neurons attached to the nerve roots.

    When you cut out a section of peripheral nerve, the axons are cut off from their cell bodies. It is surprising how long they do live, however. You can isolate a nerve and the axons continue to conduct action potentials for many hours. They all eventually die. It doesn't matter how well you oxygenate or maintain the nerve segment, the axons die.

    What remains in an isolated nerve are the periaxonal support and Schwann cells. In many studies now, peripheral nerve segments support axonal growth. Although many substitute grafting material have been developed and proposed, I know of nothing that is better than peripheral nerve for supporting axonal growth.

    So, when Carl Kao transplants sural nerve segments into the spinal cord, I believe that it is a source of Schwann cells and also may provide an environment that axons like to grow in. But, as I pointed out earlier, the problem is not to get the axons to grow into the peripheral nerve segment but getting them to grow out against and all the way to their original targets.

    Wise.

  10. #60
    We met with a gentleman and his wife yesterday that had this procedure by Dr. Kao about 1 1/2 years ago. We had spoke to him on the phone a few times but he invited us to his home so we could see for ourselves his progress. He showed us his video of the operation...not the entire operation, as that was about 9 hours, just the part that the sural nerve was used to bridge the gap and the schwann cells inserted, the omentum was placed in.... Quite interesting. His level is/was T8. He is able to tell when he has to go to the bathroom, however he needs to cath still. He can get out of his wc and stand unassisted for the most part(without any boots) like to get up to the counter. He is walking with the boots and walker(which is made of steel not like here...its a heavy duty thing!) He still relys on his wc but can and does get around his home with the boots and walker...and he is not dragging his body around or swiveling to move...the legs are bending and moving. Many small scars from the procedure...back(1), stomach(1), knee pits-back of knees(2), ankles(2), upper thighs(2). They are not real big and Kao did a good job with them...not too noticable...in fact his back scar looks better than what it had looked before the procedure(from the pictures he showed us). He was happy with the progress and said that it was still early. He is 60 years old by the way. We were impressed.

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