SAGA OF THE BIOFUEL: THE PHILIPPINE EXPERIENCE

By Rudy A. Fernandez
30-May-2007 The Philippine STAR

Did you know that as early as the 1930s ethyl alcohol (ethanol) has been used as a motor fuel in the Philippines?   Studies on the use of ethanol as fuel for cars were conducted by engineers of the University of the Philippines College of Agriculture (UPCA) led by Dr. Anastacio Teodoro.

The 1929 De Sotto de Luxe Sedan used as a model ran for more than 50,000 kilometers on alcohol fuels for five years, it was reported by Dr. Fernando A. Bernardo, former dean of UPCA, who retired in 1998 as deputy director general of the Los Baños-based International Rice Research Institute.

Dr. Bernardo, also a former Education deputy minister and former president of the Visayas State College of Agriculture (VISCA, now Leyte State University), has been devoting his time writing books covering important facets of Philippine life.

His latest book-writing project, titled “Centennial Review: 100 Great Moments in UPLB’s History” (UPLB stands for UP Los Baños, which began as UPCA), reported, among other things, UPCA-generated technologies in the 1930s.

In his research for this portion of the book, Bernardo noted, “Initially, gasanol was used, which was a mixture of 50 percent alcohol, 45 percent gasoline, and 5 percent sulphuric other. The car ran at a maximum mileage of 15.8 miles/gallon.”

“With 10 percent alcohol, the car covered 17.4 denatured 193o proof ethyl alcohol mixed with gasoline exceeded the efficiency of pure gasoline by 0.7 to 16 percent.”

“Ethanol,” points out a brochure produced by the Department of Agriculture-Bureau of Agricultural Research (DA-BAR), “is a clean-burning high octane alcohol that is produced from crops like corn and sugarcane. A percentage of ethanol is combined with unleaded gasoline for fuel. This makes for lower fuel cost, increased fuel octane rating, and decreased harmful emissions.”

Bioethanol, on the other hand, is a blending of ethanol and gasoline to produce an alternative fuel called gasohol.

Scientific literature states that ethanol is extensively used as a preservative, disinfectant, solvent, and fuel and gasoline additive. Ethanol provides high-quality, low-cost octane booster for exceptional engine performance.

Records have it that ethanol has actually been used in cars since Henry Ford designed his 1908 Model T to operate on alcohol. Long stretches have been covered on ethanol-blended fuel since the 1980s.

The commonly used combinations of ethanol-gasoline are called E10 (10 percent ethanol and 90 percent gasoline) and E85 (85 percent ethanol and 15 percent gasoline).

E10 has long been in popular use in countries such as the United States, Brazil, China, and India.

In fact, one account states that several teams in international racing competitions use ethanol because of its high octane and excellent performance. About 30 percent of all automotive fuels sold in the US today are ethanol-blended.

Are ethanol-blended fuels harmful to car engines?

This is a misconception, according to those in the know. In reality, today’s cars are built to be compatible with ethanol-blended fuels and are warranted for its use.

When ethanol was introduced in the early 1900s, some cars experienced deterioration of some elastomers (rubber-like parts) and metal in fuel system components. But vehicle manufacturers immediately upgraded these components so that they are now compatible with ethanol fuels.

Best of all, since it is a reasonable fuel produced from plants, unlike petroleum-based fossil fuels that have a limited supply and are the major contributor of carbon dioxide emissions, ethanol is environment-friendly.

It has been found that ethanol is 35 percent oxygen, and adding oxygen to fuel results in more complete fuel combustion, thus reducing harmful tailpipe emissions. Ethanol displaces the use of toxic gasoline components such as benzene, which is a carcinogen (cancer-causing substance).

Moreover, it is non toxic, water-soluble, and quickly biodegradable.

During the oil crisis in the 1970s following the Middle East war, when prices of fossil-based oil consistently began going up, the Philippines again considered biofuels sourced from such crops as sugarcane, corn, cassava, and others.

But nothing or not much happened as the country continued to depend on foreign-sourced fuel.

Records, for instance, show that in 2005 the country imported 77.6 million barrels of crude and refined petroleum products valued at $411 billion (about P200 billion or roughly about one-fifth of the country’s annual budget).

It was only in 2005 that the government mustered the political will to tackle the problem by the proverbial horn, resulting in the passage of the Biofuels Act of 2005 (Republic Act 9637). RA 9637 is principally authored by Rep. Juan Miguel Zubiri of Bukidnon, a UP Los Baños alumnus who is now in the running for senator.

Under the law signed by President Gloria Macapagal-Arroyo last Jan. 12, fuels such as gasoline and diesel should be blended with one percent bioethanol (coconut methyl ester or CME) within three months of the effectivity of the law. The blend will subsequently be increased to two to five percent in two years. Within four years, a 10-percent blend will be mandated.

Full implementation of the Biofuels Act is expected to save the country at most P35 billion worth of oil imports annually.

The government sees no reason why implementation of the Biofuels Act will be delayed, with the National Biofuels Board (NBB) seeing to it that it will be so.

RA 9637 is expected to boost the development of the country’s corn, sugarcane, and coconut industries, which would be the source of raw materials in the production of bioethanol.

But considering that these crops are produced for specific purposes (corn feeds, coconut oil, and sugar), the government is also now considering alternative crops.

Now the object of research and development (R&D) activities is sweet sorghum, a special purpose sorghum with a sugar-rich stalk, almost like sugarcane, which is now being dubbed as “plant of life” because of its many uses.

As Agriculture secretary Arthur C. Yap said at the first DA-BAR-sponsored “Technology Investment Forum on Sweet Sorghum for Ethanol Production” held last January 19, “Sweet sorghum is going to be a major player in the country’s drive toward energy independence because of its many uses.”

Consider the following:

• From the sweet sorghum’s stalk can be squeezed the precious sigar-rich juice suited for ethanol production. Further, the biomass after the extraction of juice is rich in micro nutrients and minerals that can be used as forage for animals.

• Its grains can be ground into flour for the making of cookies and other snack items.

• Its leaves are also good feeds for ruminants (goats, cattle).

• Its roots are good fuelwood.

Scientists at the India-based International Crops Research Institute for the Semi-Arid Tropics (ICRISAT) have found that sweet sorghum is a viable alternative for raw material in producing ethanol.

And the good news is that it also feels at home in Philippine farms, as proven by a research done recently at the Mariano Marcos State University (MMSU) in Batac, Ilocos Norte.

A brief background of the research project:

Early in 2006, President Arroyo personally received at Malacañang from then visiting India President APJ Abdul Kalam several kilos of foundation sets of sweet sorghum developed by ICRISAT.

Subsequently, DA-BAR, MMSU, and ICRISAT embarked on a program aimed to develop and commercially utilize sweet sorghum as potential source of ethanol and decrease the country’s dependence on imported fossil fuels.

With funding from DA-BAR and the Commission on Higher Education (CHED), MMSU field-tested eight varieties, five of which have been found adapted locally.

Dr. William D. Dar, former Agriculture Secretary and now ICRISAT director general, reported during his visit to the Philippines early this year that the field tests, supervised by MMSU vice president Dr. Heraldo Layaoen, have shown encouraging results.

The average yield was 110 tons per hectare of sweet sorghum cane stalk for two cropping seasons in eight months (one main crop followed by one ratoon crop; ratoon is the outgrowth after the main stalk has been cut).

The yield of sorghum is higher with a much shorter cropping season (one season for sugarcane is 12 months compared to four months of sweet sorghum).

“It also requires less input and water compared to other bioethanol sources,” stressed Dr. Dar, who also was DA-BAR’s first director (1987).

The economics of sweet sorghum: The net income for two cropping seasons ranges from P65,000 to P72,000 per hectare.

Dr. Dar further asserted, “The commercialization and massive planting of sweet sorghum augurs well for our country, as President Arroyo recently signed into law the Biofuels Act, mandating the use of ethanol-blended gasoline and biodiesel.”

In another front, DA-BAR, ICRISAT, and UP Los Baños have also signed a memorandum of understanding (MOU) on the production and development of hybrid varieties of sweet sorghum for biofuel purposes.

The tripartite agreement - signed by DA-BAR director Nicomedes P. Eleazar, Dr. Dar, and UPLB chancellor Dr. Luis Rey Velasco - focuses on the conduct of strategic research on the development of hybrid sweet sorghum and other important crops.

Corollary to these developments, several companies, including Chinese and Australian partners, have signed a letter of intent (LOI) to set up sweet sorghum ethanol plants here.

Rusni Distilleries, the leader of the Ethanol Distilleries of India, has also tied up with a Filipino farmers’ federation for the supply of a US$9-million multi-feeds stock ethanol plant.

As reported by farmer-leader agribusinessman V.L. Sonny Domingo, the farmers will be encouraged to engage in sweet sorghum production as they will eventually own the ethanol plant. Funding will come from government agencies and financing institutions willing to help the farmers integrate their farms for the high-value crops.

“The special engineering required to consolidate the farms of agrarian beneficiaries and upland farmers will be done by Green Roots Biotech Corporation with the Kapisanan ng Magsasaka, Mangingisda, at Manggagawang Pilipinas, Inc. Both corporations recently signed an agreement for the purpose of engaging in renewable energy projects nationwide,” Domingo said in a press statement.

Most important, President Arroyo has given her blessing and full support for the commercialization of planting of sweet sorghum as a viable and sustainable source of bioethanol.

Summing up, it will be soon when a big part of the country’s energy needs will be sourced from the farm instead of being extracted from the bowels of the earth.

That time will certainly be a high point in the saga of the biofuel in the Philippines, spanning eight decades from the time it was used to propel cars in the 1930s to today’s high-priced fossil fuels.

SOURCE: SEARCA Biotechnology Information Center

College, Laguna 4031

PHILIPPINES

Tel.: +63-49-536-7136

Fax: +63-49-536-7162

Website:  http://www.bic.circa.org

e-mail: bic@agri.searca.org

Technorati Tags: biofuel, philippine biofuel

WHAT IS TESSELLATION?

Definition

A tessellation is created when a shape is repeated over and over again covering a plane without any gaps or overlaps.

Another word for a tessellation is a tiling.

A dictionary* will tell you that the word “tessellate” means to form or arrange small squares in a checkered or mosaic pattern. The word “tessellate” is derived from the Ionic version of the Greek word “tesseres,” which in English means “four.” The first tilings were made from square tiles.

A regular polygon has 3 or 4 or 5 or more sides and angles, all equal. A regular tessellation means a tessellation made up of congruent regular polygons. [Remember: Regular means that the sides of the polygon are all the same length. Congruent means that the polygons that you put together are all the same size and shape.]

Only three regular polygons tessellate in the Euclidean plane: triangles, squares or hexagons.We can’t show the entire plane, but imagine that these are pieces taken from planes that have been tiled. Here are examples of

Tessellation of triangles

Tessellation of squares

Tessellation of hexagons

When you look at these three samples you can easily notice that the squares are lined up with each other while the triangles and hexagons are not. Also, if you look at 6 triangles at a time, they form a hexagon, so the tiling of triangles and the tiling of hexagons are similar and they cannot be formed by directly lining shapes up under each other - a slide (or a glide!) is involved.

You can work out the interior measure of the angles for each of these polygons:

Shape triangle square pentagon hexagon more than six sides

Angle measure in degrees 60 90 108 120 more than 120 degrees

Since the regular polygons in a tessellation must fill the plane at each vertex, the interior angle must be an exact divisor of 360 degrees. This works for the triangle, square, and hexagon, and you can show working tessellations for these figures. For all the others, the interior angles are not exact divisors of 360 degrees, and therefore those figures cannot tile the plane.

Naming Conventions

A tessellation of squares is named “4.4.4.4“. Here’s how: choose a vertex, and then look at one of the polygons that touches that vertex. How many sides does it have?

Since it’s a square, it has four sides, and that’s where the first “4″ comes from. Now keep going around the vertex in either direction, finding the number of sides of the polygons until you get back to the polygon you started with. How many polygons did you count?

There are four polygons, and each has four sides.

For a tessellation of regular congruent hexagons, if you choose a vertex and count the sides of the polygons that touch it, you’ll see that there are three polygons and each has six sides, so this tessellation is called “6.6.6“:

A tessellation of triangles has six polygons surrounding a vertex, and each of them has three sides: “3.3.3.3.3.3“.

Semi-regular Tessellations

You can also use a variety of regular polygons to make semi-regular tessellations. A semiregular tessellation has two properties which are:

1. It is formed by regular polygons.
2. The arrangement of polygons at every vertex point is identical.

Here are the eight semi-regular tessellations:

Interestingly there are other combinations that seem like they should tile the plane because the arrangements of the regular polygons fill the space around a point. For example:

If you try tiling the plane with these units of tessellation you will find that they cannot be extended infinitely. Fun is to try this yourself.

1. Hold down on one of the images and copy it to the clipboard.
2. Open a paint program.
3. Paste the image.
4. Now continue to paste and position and see if you can tessellate it.

---

There are an infinite number of tessellations that can be made of patterns that do not have the same combination of angles at every vertex point. There are also tessellations made of polygons that do not share common edges and vertices. You can learn more by following the links listed in Other Tessellation Links and Related Sites.

Michael South has contributed some thoughts to the discussion.

*Steven Schwartzman’s The Words of Mathematics (1994, The Mathematical Association of America) says:

tessellate (verb), tessellation (noun): from Latin tessera “a square tablet” or “a die used for gambling.” Latin tessera may have been borrowed from Greek tessares, meaning “four,” since a square tile has four sides. The diminutive of tessera was tessella, a small, square piece of stone or a cubical tile used in mosaics. Since a mosaic extends over a given area without leaving any region uncovered, the geometric meaning of the word tessellate is “to cover the plane with a pattern in such a way as to leave no region uncovered.” By extension, space or hyperspace may also be tessellated.

Technorati Tags: geometry, mathematics, plane, shape, tessellation

St. Mary Magdalene

Feast day: July 22

“Wherefore  I say to thee, her sins, many as they are, shall be forgiven her, because she has loved much . . .” (Luke 7:47)

From the moment of her conversion, St. Mary Magdalen was exceptionally favored by Our Lord. After most of His friends had deserted Him, she stood at the foot of the Cross, assisted at His burial and was the first recorded witness of the Resurrection. Only the Blessed Mother would have seen her Son first, although the New Testament does not mention such an appearance.

In Sons of the Church, Rene Bazin describes this beautiful woman who acquired the name of Magdalen “from her property in the pleasure-loving city of Magdala.”

“Rich, graceful, sought after, frequenting the lax court of Herod Antipas, she found lovers, and threw public opinion to the winds. Associating herself with what was non-Jewish, Roman and hellenic, she became an object of scandal. She gave sumptuous feasts. Sellers of precious stuffs and costly furniture, pedlars, who came from Arabia selling spices, knew her. Her name was mentioned with a shrug of the shoulders; yet when she passed she was looked at with curiosity and admiration. She was the abode of seven devils.”

How did such a woman ever come to know Jesus? Like so many others she went, out of curiosity, to see and hear Him one day. She did not yet realize that it was God’s grace drawing her to Him. The words she heard that day were meant especially for her. St. Vincent Ferrer says, “… At once Magdalen is stirred to the depths of her soul. Her head sinks beneath the weight of shame and repentance. Tears pour down her cheeks. Her heart is conquered.” The seven devils had been cast out but there was not yet peace. Although she knew she was unworthy, she had to see Jesus again and be assured of His forgiveness.

She was afraid to approach Him but her now pure and perfected love drove her to make a bold public repentance. What a tremendous flow of grace had to be surging through this woman of shameful reputation that she could expose herself to contempt by coming openly to Jesus. Our Lord had accepted an invitation to dine with a certain Pharisee called Simon and the house was overflowing with highly respected guests. Mary Magdalen dared not approach Jesus face to face but she made her way, unnoticed, through the gathering. Coming up behind Him, she suddenly attracted attention. What on earth was she doing? With her tears, she began to wash the Saviour’s feet; with her hair, she dried, then respectfully kissed them. Lastly, she anointed them with her costly perfume.

In Butler’s Lives of the Saints, the symbolism of this act is expressed with beautiful poignancy: “She now defaces or consecrates to penance whatever had formerly been an instrument of sin; her eyes, which had been full of dangerous charms, are now converted into fountains of tears to cleanse the stains of her soul; and her hair, once dressed in tresses and curls to ensnare souls, now hangs loose and dishevelled, and serves for a towel to wipe Our Lord’s feet, which she kisses with her lips and scents with her perfumes, formerly the incentives of vice.”

Thus, St. Mary Magdalen began her new life, leaving forever her past in Magdala, on the west shore of Galilee. She followed Our Lord nearly everywhere. When she was not ministering to Him, she lived at Bethany  with  her sister, Martha, and her brother, Lazarus. The family was a noble one and, according to trustworthy tradition, possessed a great deal of property. St. Bonaventure, in his Meditations, tells us that Jesus spent most of His time with this family during the days preceding His Passion. Our Lady also stayed there and St. Mary Magdalen was her constant companion.

Shortly before the Passover, Magdalen, divining that Jesus was soon to die, desired to offer Him a most precious ointment. She did so, according to the text of St. Matthew, by pouring it on His head. Some of the disciples complained that she was being wasteful, that the ointment could have been sold for the benefit of the poor. “But Jesus perceiving it, said to them, ‘Why do you trouble the woman? She has done me a good turn. For the poor you have always with you, but you do not always have me. For in pouring this ointment on my body, she has done it for my burial. Amen I say to you, wherever in the whole world this gospel is preached, this also that she has done shall be told in memory of her’.”  (Matthew 26:10-13)

St. Mary Magdalen remained as close as possible to Jesus throughout His Passion and Death, only leaving the sepulchre in order to obey the Commandment of the Sabbath.

In the accounts relating to Our Lord’s Resurrection one of the most thrilling passages anticipates the moment of Magdalen’s recognition of Him.  “Jesus said to her, Woman, why art thou weeping? Whom dost thou seek? She, thinking that he was the gardener, said to him, Sir, if thou hast removed him, tell where thou hast laid him and I will take him away. Jesus said to her, Mary! Turning, she said to him, Rabboni!” (John 20:15-16)

Following Pentecost and the early days of persecution of the infant Church, the faithful were scattered. According to French tradition, St. Mary Magdalen, along with her family and others, were driven out and put to sea by the Jews. It was approximately 42 A.D. when they landed on the shores of Provence. Magdalen was instrumental in converting the people of Marseilles where Lazarus became the first bishop. She then followed St. Maximin to Aix where he became bishop. Magdalen retired to a cell where she prayed and meditated, longing for total separation from the world.

Rev. P. M. Sicard, Doctor of Theology, describes her last years in Vol. II of St. Mary Magdalen. “The angels of God, in response to the desires and supplications of Mary Magdalen, bore her from Aix to the mountain, to the entrance of the cave which was henceforth to be her dwelling.” The last thirty years of her life were thus spent in solitude in this hill cave. Called La Sainte-Baume, it denotes Holy Cave in the Provencal language. Seven times daily, the angels took her up to the summit of the mountain to pray. This  elevation  of the contemplative is mentioned in the Roman Breviary. Since her surroundings were desolate, she was  sustained  “not by earthly food,” says St. Antoninus, “but by that which came from heaven.”

When the day of her death approached, Magdalen had the angels carry her to Aix and the oratory of St. Maximin where the Bishop gave her Communion. She died in thanksgiving.

According to the Catholic Encyclopedia, her body was laid in an oratory constructed “at Villa Lata, afterwards called St. Maximin.” This reference states that ”History is silent about these relics till 745, when, according to the chronicler Sigebert, they were removed to Vezelay through fear of the Saracens.” There is no record of their return but in the thirteenth century, “the shrine was found intact, with an inscription stating why they were hidden.” The relics were discovered during the construction of a Dominican convent at La Sainte-Baume by Charles II, King of Naples.

Butler’s Lives relates that this king, who then governed Provence, became devoted to St. Mary Magdalen. He founded the Church of St. Maximin’s upon the spot of discovery and assisted at the solemn translation of her relics in 1279. The head of the saint is set in a gold case decorated with diamonds and surmounted by the royal crown of Charles II. It remains, along with other relics, in the subterraneous chapel.

A few miles from St. Maximin’s, towards Marseilles is the solitary Dominican convent of La Sainte-Baume where pilgrims pay homage to the glorious Model of Penitents.

HEART TRANSPLANT

Heart Transplant Surgery

Alternative names

Cardiac transplant; Transplant - heart

Definition

Heart transplantation is a surgical procedure to remove a damaged or diseased heart and replace it with a healthy donor heart.

Description

Heart transplant is the fourth most common transplant operation in the U.S., with over 2,200 cases per year. Cornea, kidney and liver transplants are the most common. A healthy heart is obtained from a donor who is brain dead but on life-support. The healthy heart is put into a special solution that preserves the organ.

The patient is put into a deep sleep with general anesthesia, and a cut is made through the breast bone. The patient’s blood is circulated through a heart-lung bypass machine to keep the blood oxygen-rich. The patient’s diseased heart is removed and the donor heart is stitched in place. The heart-lung machine is disconnected. Blood flows through the transplanted heart.

Indications

A heart transplant may be recommended for:

Heart failure caused by

* Coronary artery disease

* Cardiomyopathy (disease of the heart muscle)

* Heart valve disease with congestive heart failure

* Severe heart disease  present at birth

* Life-threatening abnormal heart beats that do not respond to other therapy

Heart transplant surgery is not recommended for patients who have:

* Kidney, lung, or liver disease

* Insulin-dependent diabetes with poor function of other organs

* Other types of blood vessel disease of the neck and leg

* Other life-threatening diseases

Risks

Risks for any anesthesia are:

* Reactions to medications

* Problems breathing

Risks for any surgery are:

* Bleeding

* Infection

Heart transplants carry major risks. There is a greater risk of infection because of the drugs that must be taken to prevent transplant rejection. Call your doctor if there are signs of infection (redness, drainage, fever) or if there is a general worsening of health.

Expectations after surgery

Heart transplant prolongs the life of a patient who would otherwise die. About 80% of heart transplants are alive 2 years after the operation. The main problem, as with other transplants, is graft rejection. If rejection can be controlled, the patient’s survival can be increased to over 10 years.

Drugs that prevent transplant rejection must be taken for the rest of the patient’s life. Normal activities can resume as soon as the patient feels well enough and after consulting with the doctor. However, vigorous physical activities should be avoided.

The major problems are the same for all major organ transplants:

* Finding a donor

* Fighting the rejection effect

* The cost of the surgery

* Avoiding infection

* Avoiding blocked blood vessels in the transplanted organ

Finding a donor can be difficult. In heart transplantation, the healthy heart must come from a person who recently died or is on life-support and is brain dead. This is different than a kidney transplant, because a kidney may be donated by a living person.

Timing is very important because there is no good way to keep a donor heart alive for long periods of time. A person in need of a heart transplant may be kept alive on artificial heart devices for longer and longer periods of time. However, artificial hearts also have major risks. While some of these devices are fully approved, others are still considered experimental.

Fighting rejection is an ongoing process. The body’s immune system considers the transplanted organ an infection and fights it. For this reason, organ transplant patients must take drugs such as cyclosporine and corticosteroids that suppress the body’s immune response. The downside of these drugs is that they weaken the body’s natural defense against infection.

Convalescence

The recovery period is about 6 weeks. The patient must move the legs often to reduce the risk of deep venous thrombosis. The stitches or clips are removed about 1 week after surgery.

History

There are several mentions of heart transplantation in ancient mythology and biblical reference, but it was the pioneering work of Alexis Carrel at the beginning of the 20th century that made organ transplants a real possibility.

The next reported heart transplantations were those of Mann at the Mayo Clinic in 1933. These dog heart transplants were able to function until the onset of rejection at eight days.

After these experiments, there was a 20-year period without progress until the late 1940s. S.V.P. Demikhov, a Russian surgeon, then initiated a series of ingenious experiments on the technical feasibility of both intra thoracic heart transplants as well as heart lung transplantation, although his work was not reported in the West until 1962.

With the advent of techniques for successful heart surgery in the 1950s, major attention was finally given to heart transplantation.

Various experiments using either hypothermia (low temperature) and circulatory arrest or the early cardiopulmonary bypass machines permitted a number of ingenious laboratory studies to be performed.

The currently-used surgical technique for heart transplantation originated with the work of Lower & Shumway in 1959, but the first human heart transplantation was performed by Christian Barnard in Cape town, South Africa, in December 1967.

This transplant triggered a great amount of interest at other centres around the world, with 170 transplants by 65 surgical teams performed between December 1967 and March 1971. However, with only 15 per cent of patients surviving a year after the procedure, enthusiasm for heart transplantation waned by the end of 1971.

Widespread application of heart transplantation depended on development of better immunosuppressive therapy. This came with the discovery of the drug Cyclosporin.

The rapid development and introduction of this compound to clinical transplantation resulted in superior results. Later on many drugs and methods were used in heart transplantation, including FK506, ATG, OKT3, MMS and body radiation.

FAQ

Why do I need a heart transplant?

Candidates for heart transplantation should have terminal heart failure, and a life expectancy of less than 12 months.

Sometimes the heart is irreversibly damaged by long-lasting heart disease or viral infection. In general, indications for heart transplantation are:

1. Cardiomyopathy (acute or chronic disease of the heart muscle)
2. Coronary artery disease
3. Valvuler heart disease
4. Re-transplantation
5. Complex forms of congenital heart defects

Can anybody go through heart transplantation?

No. The criteria for recipient selection according to Papworth Hospital in Cambridge is as following:

1. End-stage heart disease with life expectancy limited to 6-12 months.
2. Age of less than 55 years for coronary arteries disease; less than 60 years for cardiomyopathy
3. Absence of irreversible hepatic or renal failure
4. Absence of active infection
5. Absence of recent pulmonary infection
6. Psychosocial stability
7. There is no lower age limit to heart transplantation

When can’t you do a heart transplant?

There are absolute and relative contraindications to heart transplantation.

1. Absolute contraindications:
   • active infection
   • untreated malignancy
   • coexisting systemic illness likely to limit survival
   • severe and irreversible major organ dysfunction
   • fixed elevated pulmonary vascular resistance
2. Relative contraindications:
   • advanced age
   • recent or unresolved pulmonary infection
   • active peptic ulceration
   • marked peripheral or cerebrovascular disease
   • mental illness

How long can I expect to live after heart transplantation?

The longest survival after heart transplantation is 24 years. The survival rate has improved dramatically during the last 10 years.

Heart transplants performed with 1, 5, and 10 year survival figures are now approaching 90%, 70%, and 50%, respectively.

What are the criteria in donor selection?

Donor selection is critically important if early postoperative problems are to be avoided.

Potential donors will be certified as brain dead if two separate brain stem function tests show no activity. Most donors have had head injuries or an intra cerebral bleeding, gunshot wound, brain tumour, or liver failure.

Ideal criteria for the donor include the following:

• age (<45 years for male, <50 years for females)
• weight (within 25 per cent of the recipient’s weight)
• ABO compatibility
• no evidence of heart injury (normal ECG, normal chest X-ray)
• no evidence of active infection (HIV, hepatitis B, or bacterial)
• no malignancy apart from brain tumours.

What are the most common complications expected after heart transplantation?

There are many complications associated with heart surgery in general, but the most important complications in heart transplantation are divided into two groups:

• Early complications:
  1. donor organ dysfunction
  2. acute rejection
  3. renal failure
  4. arrhythmia (abnormal heart beat)
  5. bleeding
  6. infection
• Late complications:
  1. infection
  2. accelerated coronary athrosclerosis (coronary disease)
  3. chronic rejection
  4. hypertension (high blood pressure)
  5. malignancy (cancer)

What are the causes of donor heart dysfunction?

Ventricular dysfunction is often present as a result of the adverse effects of brain death on the heart; and the ischemic period during storage and transplant.

Right ventricular failure may occur because the unprepared right ventricle of the donor has to perform work against the recipient’s pulmonary vascular resistance which may be elevated. Lack of reflex sympathetic enervation may diminish the heart ability to compensate for any reduction in function.

What are the causes of renal failure after heart transplantation?

Renal failure usually is caused by:

1. effects of Cardiopulmonary bypass “CPB”, which is a technique by which the pumping action of the heart and the gas exchange action of the lung, are replaced temporarily by a mechanical device during the heart operation.
2. secondary to chronic heart failure before heart transplantation.
3. nephrotoxic agents, particularly Cyclosporin drug.

Why do some patients suffer from skin cancer after transplantation?

Malignancy may be developed due to chronic use of immunosuppression drugs and rarely from receiving transmitted malignant cells with the donor organ.

The malignancies are Lymphoproliferative of the Epstein-Barr virus type or B-Cell hyperplasias.

Cancers are an unfortunate consequence of chronic immunosuppression. In general, transplant recipients have a threefold increase in the incidence in various cancers when compared with age-matched controls. Some specific cancers are more than 100 times more frequent in immunosuppressed patients than in the general population.

For all tumours, the average time of appearance of the cancer after transplantation is 58 months. The most common tumours among transplant patients are those of the skin and lips, non-Hodgkin lymphomas, Kaposi sarcomas, and uterine, cervical, vulval, and perineal cancers.

What is rejection, and how many kinds are there?

Rejection of organ transplants is a complex immunologic phenomenon that involves cell-mediated and antibody-mediated responses, both of which are targeted on the human lymphocytes antigens in the graft.

The basis of morphology and the mechanisms involved in rejection have been classified as hyper acute, acute, and chronic.

1. Hyper acute rejection:
   • May occur within minutes or a few hours in pre-sensitised persons. It is characterised by widespread acute arteritis and arteriolitis, thrombosis of vessels, and ischemic necrosis, all of which result from reaction with pre formed humoral antibodies.
   • As a consequence of the vascular damage, the graft never becomes vascularized and it undergoes ischemic necrosis.
   • It should be noted that with the current practice of cross-matching (testing recipient for the presence of antibodies directed against donors lymphocytes), hyperacute rejection is no longer a significant clinical problem.
2. Acute rejection:
   • May occur within days of transplantation, or may appear suddenly months or even years later, after immunosuppression has been employed and terminated.
   • Acute graft rejection is a combined process in which both cellular and humoral tissue injuries play parts. In any one patient, one or the other mechanism may predominate. Histologically, humoral rejection is associated with vasculitis, whereas cellular rejection is marked by an interstitial monocular cell infiltrate.
3. Chronic rejection:
   • In this type of rejection, the endothelial cells are damaged or destroyed, but the time constants of this part of heart rejection are generally much longer. Some researchers believe that the immunologic basis for accelerated coronary artery disease may be similar to rejection.

Why do some patients suffer from infection following transplantation?

Infection is an unfavourable outcome event, which almost always is related to the immunosuppression therapy.

About 30% of patients experience an infection episode, which most commonly develops within three months of transplantation.

The most common organ infected is the lung, and in one study, when this organ was involved the mortality was 22%.

The organism most frequently causing infection after heart transplantation is the Cytomegalovirus (CMV). Overall, viruses cause about 45% of infection, and bacteria about 45%; fungi and protozoa account for the remainder.

Why do coronary arteries get damaged after heart transplantation?

Accelerated coronary artery disease is the third most common cause of death after heart transplantation, following behind infection and acute rejection. The disease has a multifactorial aetiology, with little agreement about the relative importance of the various risk factors. Some studies provided evidence of immune involvement in this disease, and showed anti-endothelial antibodies in patients with accelerated coronary artery disease.

Why do most patients not feel pain, despite the existence of coronary disease after heart transplant?

Most of the patients with this disease after heart transplantation fail to experience typical angina (chest pain); this may be related to the likelihood that the heart allograft (donor heart) denervated permanently.

What are the common side effects of Cyclosporin drug?

All of the commonly used immunosuppressive drugs increase the risk of infection complications and cancer.

Cyclosporin toxicity may result in renal failure, liver failure, high blood pressure, and neurotoxicity.

Neurotoxic reaction are manifested by a fine tremor, paresthesias and, occasionally, seizures.

Other unusual side effects include the development of Hirsutism (abnormal hairiness), observed in almost all patients who receive Cyclosporin. This effect regresses as the dosage of Cyclosporin is lowered.

What are the techniques for heart transplantation?

There are two main techniques for heart transplantation:

Heterotopic, in which the donor heart is placed parallel to the recipient’s heart; and

Orthotopic, in which the patient’s heart is replaced with a donor heart.

1. Heterotopic heart transplant

Exploration of the possibility of using the donor heart as an accessory pump had been carried out previously in laboratory experiments, most notably by Demikhov.

Two techniques were developed at the university of Cape Town, the first of which was a means of bypassing or supporting the left ventricle only, and the second a means of biventricular support.

Advantages and disadvantages of heterotopic as opposed to orthotopic heart transplantation:

Advantages

1. 1. The recipient heart acts as a build in heart assist during;
      1. recovery from ischemia of donor heart sustained during transplantation;

sever acute rejection episodes.

1. 1. Recipient heart may maintain circulation after irreversible rejection while awaiting a second donor.
   2. Heterotopic transplant allows for some possible recovery of the recipient heart.
   3. Can be performed even in the presence of a high pulmonary vascular resistance.

Disadvantages

1. 1. Risk of systemic emboli from clots in the poorly contracting recipient left ventricle.
   2. Continuing angina related to recipient ischemic heart muscle.
   3. Risk of infection and thrombus formation in relation to presence of the prosthetic valve in the recipient heart (this is a contraindication to heterotopic transplantation)
2. Orthotopic heart transplantation

The technique of orthotopic heart transplantation has been well established for more than 30 years, based on the first description by Lower, Stofen, and Shamway. Nevertheless anastomosis of donor to recipient atria according to this technique creates atria cavities with abnormal geometry.

This abnormal geometry has been demonstrated to be responsible for tricuspid and mitral regurgitation and for arrhythmia’s resulting from sinus node injury. The risk of atrial septal aneurysms or atrial thrombus formation is certain. Because of these problems, some surgeons proposed a more anatomic surgical technique with complete excision of the recipient atria and direct anastomosis on the left pulmonary veins, right pulmonary veins, inferior vena cava and superior vena cava. But the benefit of this procedure on clinical outcome has not been demonstrated.

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IMPORTANCE AND WAYS OF SAVING CORAL REEFS

Importance:

Coral reefs are important for many reasons. Most importantly, they provide protection and shelter for many different species of fish. Without coral reefs, these fish are left homeless with nowhere to live and no where to have their babies.

Not only do these fish increase the diversity of our world, but also reef fish and mollusks feed between 30 and 40 million people every year. They also make beautiful pets and the money made by catching and selling these animals provides many people with an income so that they can feed their families.

And coral are very important in controlling how much carbon dioxide is in the ocean water. You read earlier about how the coral polyp turns carbon dioxide in the water into a limestone shell. Without coral, the amount of carbon dioxide in the water would rise dramatically and that would affect all living things on Earth.

In addition, coral reefs are very important because they protect coasts from strong currents and waves by slowing down the water before it gets to the shore. That is why they are called barrier reefs. They provide a barrier between the ocean and the shore.

Ways of Saving Coral Reefs:

• Support reef-friendly businesses. Ask what your dive shop, boating store, tour operators, hotel and other coastal businesses are doing to save the coral reefs. This is especially important in coastal areas with reefs. Let them know you are an informed consumer and care about reefs.

• Don’t use chemically enhanced pesticides and fertilizers. Although you may live thousands of miles from a coral reef ecosystem, these products end up in the watershed and may ultimately impact the waters that support coral.

• Volunteer for a reef cleanup. You don’t live near a coral reef? Then do what many people do with their vacation: visit a coral reef. Spend an afternoon enjoying the beauty of one of the world’s treasures while helping to preserve it for future generations.

• Learn more about coral reefs. How many different species live in reefs? What new medicines have been discovered in reef organisms. Participate in training or educational programs that focus on reef ecology. When you further your own education, you can help others understand the fragility and value of the world’s coral reefs.

• Become a member of your local aquarium or zoo. Ask what they are doing and what your donation can do toward saving the world’s coral reefs. The answer may pleasantly surprise you.

• When you visit a coral reef, help keep it healthy by respecting all local guidelines, recommendations, regulations, and customs. Ask local authorities or your dive shop hot to protect the reef.

• Support conservation organizations. Many of them have coral reef programs, and your much-needed monetary support will make a big difference.

• Spread the word. Remember your own excitement at learning how important the planet’s coral reefs are to us and the intricate global ecosystem. Sharing this excitement gets everyone you speak with involved.

• Be an informed consumer. Consider carefully the coral objects that you buy for your coffee table. Ask the store owner or manager from what country the coral is taken and whether or not that country has a management plan to insure that the harvest was legal and sustainable over time.

• Don’t pollute. Never put garbage or human waste in the water. Don’t leave trash on the beach.

• Recycle. This is the first step each of us can take to make a change. Recycle anything and everything. If your community doesn’t have a program, do it anyway, and get one started.

• Conserve water. The less water you use, the less runoff and wastewater that eventually finds its way back into our oceans.

• Report dumping or other illegal activities. Environmental enforcement cannot be everywhere, and your involvement can make a big difference.

• Keep it clean. You may be in the habit of picking up your own trash. You may even participate in an organized cleanup. But have you considered carrying away the trash that others have left behind?

• Only buy marine aquarium fish if you know they have been collected in an ecologically sound manner. In some areas, marine fish harvested for the pet trade, are stunned with sodium cyanide so that capturing them is easier.

• Surf the net! Many different addresses exist to link you to information about coral reefs and what you can do to become involved. A good starting point is at http://www.noaa.gov/public-affairs/coral-reef.html

• Don’t start a liverock aquarium. Although this living rock is still harvested legally in some places, its collection is devastating to the reef organisms habitat.

• Hire local guides when visiting coral reef ecosystems. Not only do you learn about the local resources, but you will be protecting the future of the reef by supporting a non-consumptive economy around that reef.

• Don’t anchor on the reef. If you go boating near a coral reef, use mooring buoy systems when they are available.

• If you dive, don’t touch! Take only pictures and leave only bubbles! Keep your fins’ gear, and hands away from the coral, as this contact can hurt you and will damage the delicate coral animals. Stay off the bottom because stirred-up sediment can settle on coral and smother it.

• Participate in the Great American Fish Count. What better way to enjoy your vacation time than snorkeling or diving in America’s coral reefs and helping scientists better understand reef fish populations?

• Volunteer. Volunteer and community coral reef monitoring programs are very important. If you do not live near a coast, get involved in your local save the river (bay, lake, or other estuarine environment) program. Remember, all watersheds affect the oceans and eventually the coral reefs.

• Support the creation and maintenance of marine parks and reserves. Encourage your friends to get involved with projects to protect special areas.

• Be a wastewater crusader! Make sure that sewage from your boat, from others’ boats, and from land is correctly treated. The nutrients from sewage feed growing algae that can smother and kill corals.

• Inform yourself. Find out about existing and proposed laws, programs, and projects that could affect the world’s coral reefs.