Saturday, June 20, 2009

Steve Jobs' Reported Liver Transplantation

N.B. The post is based on publicly available sources. I have not ever personally treated Mr. Jobs and have no access to his private medical records.
Several hours ago the Wall Street Journal reported that Mr. Jobs underwent a liver transplantation approximately two months ago. This is somewhat consistent with my earlier posts about his condition, i.e. that the tumor had recurred and spread to his liver. At the time of my earlier posts I had come to understand that Mr. Jobs was not a candidate for transplantation for unspecified reasons. If the report is true, then this situation has obviously changed.
The reason for liver transplantation would be that the carcinoid tumor had spread SOLELY to his liver and that in the opinion of his physicians removal of the entire liver would be more likely to produce a cure, long term survival or improvement of overall medical condition than conventional medical treatment.
Liver transplantation becomes an option when the tumor is of a size or in a position where partial removal of the liver (the tumor containing portion) or treatment which is aimed at removing the tumor nodules only (freezing [cryoablation], heating [radio frequency ablation], hepatic artery embolization, hepatic artery chemotherapy) is failing or is not able to be performed. Contraindications (reasons against) to the transplantation would be that the tumor has spread outside the liver. The reason for this is that the treatment necessary to prevent liver rejection, immunosuppressive treatment, interferes with the body's natural ability to prevent tumor growth and therefore can cause other tumor metastases to grow. Transplantation is an accepted, but uncommon treatment for metastatic carcinod. The reason is that there is no, in the language of medical literature, prospective randomized trials (a study to compare the efficacy of transplantation vs. 'conventional' treatment where your treatment is determined by random choice) to demonstrate that this is an effective treatment. In reality due to the rarity of the condition it is unlikely that such a trial could ever be done.
That being said, if the reports are true and the transplantation is successful Mr. Jobs is highly likely to be able to return to a fully functional life style as long a he continues to comply with his physician's orders as to his treatment.

Tuesday, June 16, 2009

Recipe from the TWiT Army Mess Hall - Sauteed Polenta with Sweet Italian Sausage and Broccoli Rabe

For 1 recipe basic polenta, kept warm or cheat & use precooked polenta in a roll
  • 4 cups water
  • 1 teaspoon salt
  • 1 cup cornmeal or instant polenta

  • 2 tablespoons olive oil plus additional if necessary
  • 1 pound sweet Italian sausage links
  • 1/4 cup water
  • 1 bunch broccoli rabe (about 1 pound), chopped coarse and tough stems discarded
  • 1 garlic clove, chopped and mashed to a paste with 1/2 teaspoon salt
  • 1 cup chicken broth
  • a 28- to 32-ounce can whole tomatoes, drained, seeded, and chopped
  • 1/4 cup dried currants
  • 2 tablespoons tomato paste
  • Accompaniment: freshly grated Parmesan

On a lightly oiled baking sheet spread warm polenta about 3/4 thick and cool to room temperature. Polenta may be made 2 days ahead and chilled, covered.

In a large non-stick skillet heat 1 tablespoon oil over moderately high heat until hot but not smoking and brown sausage. Add water and cook sausage, covered, turning occasionally, until cooked through, about 10 minutes. Remove lid and cook mixture until any remaining water is evaporated. Transfer sausage with tongs to a bowl and reserve fat remaining in skillet. Cool sausage slightly and slice diagonally.

Cut polenta into 1 1/2-inch diamond shapes or squares. In skillet sauté polenta in 2 batches in reserved fat over moderately high heat, turning occasionally, adding additional oil to skillet if necessary, until golden on both sides. Transfer polenta as cooked with a slotted spoon to bowl with sausage and cover.

In skillet heat remaining tablespoon oil over moderately high heat until hot but not smoking and sauté broccoli rabe with salt to taste, stirring, until just wilted. Add garlic paste and sauté, stirring, 1 minute. Stir in remaining ingredients and simmer, stirring, until tomato paste is incorporated and sauce is slightly thickened. Add sausage and polenta and cook until heated through.

Serve polenta sprinkled with Parmesan.

To make basic polenta:
In a heavy saucepan bring water and salt to a boil and gradually whisk in cornmeal in a thin stream. Cook polenta over moderately low heat (it should be barely boiling), stirring constantly, until very thick and pulls away from side of pan, about 40 minutes for cornmeal and about 15 minutes for instant polenta. Remove pan from heat and cover to keep warm. Stir polenta just before using. Polenta will keep warm, covered, about 20 minutes. Makes about 3 cups.

Note: In the traditional method of cooking polenta, forty minutes of constant stirring is required to achieve a lumpless texture and fragrant flavor. However, Italian-food expert Marcella Hazan has developed a method that involves very little stirring during this time. We believe it produces a very good polenta, one nearly as flavorful and smooth as the traditional procedure. To make satisfactory polenta in a real hurry, an imported instant polenta (precooked cornmeal) is available. This cooks in a mere fifteen minutes.