The University Children’s Hospital in Zürich, Switzerland, is one of the world’s leading centers for child health. Highly qualified specialists from all disciplines of pediatrics, pediatric surgery, and pediatric psychology are offering state-of-the-art diagnostic work-outs and every type of prophylactic, interventional and surgical treatment available today.
In order to give an interview to Swiss Health Magazine, Martin Meuli had to sacrifice a break in between operations, as his agenda gets filled up months in advance. Our magazine originally interviewed Professor Meuli several years ago, when he shared many interesting and impressive plans for the future.
– Professor Meuli, thanks for taking the time to speak with us. During our conversation several years ago, you spoke about some novel research in the field of skin transplantation. Tell us about developments in this direction…
– The project under consideration began in 2001 and studies have been continuing since. When I saw little patients with heavy burns or with other serious skin injuries, I understood that we could not do a lot to improve their appearance, unfortunately, but I hoped that a solutions could be found and so I engaged Prof. Dr. Ernst Reichmann as the head of our tissue biology research unit (TBRU). The vision was to develop laboratory-grown skin from a patient’s own cells, i.e. to start tissue engineering of the skin («Skingineering»). Over the subsequent 15 years, hundreds of laboratory experiments and tests were conducted until we could start transplanting such laboratory skin substitutes on to pediatric patients. Today, we can say that this method is working. Nevertheless, some problems regarding clinical application must still be addressed.
In the near future, a second clinical trial is planned in order to use bigger transplants in children and adults in different European countries. If these studies prove successful and if we receive all of the necessary permission, then we will be able to offer this innovative therapy to patients on a routine basis.
– Are such studies being conducted anywhere else today?
– No. Today, our project is the only one of its kind. But we collaborate with medical centers in various countries, not only Swiss ones. Foreign medical experts and researchers are also involved in the project.
– We look forward to news on this subject. Tell us, please, about the methods you are applying today. What kind of issues do your little patients come to you with?
– As a result of the successful work of the «Skingineering» laboratory, a few months ago we opened a new unit of the University Children’s Hospital — the Children’s Skin Center, where many specialists in the areas of burn surgery, plastic (esthetic) surgery and children’s dermatology and pediatricians are working together. To the best of our knowledge, such a skin center for children, which cares for each and every skin problem children may suffer from, is unique.
– Which other areas of expertise are represented in your hospital?
– We offer a comprehensive program of prenatal diagnosis and surgery (www.swissfetus.ch). The process is organized as follows. First, expectant mothers undergo a complex survey, including genetic testing, in our Center for Fetal Diagnosis and Therapy. Thereafter, the parents-to-be receive non-directive prenatal counseling that details diagnosis and all therapeutic options.
– What do future parents need to do if a disappointing provisional diagnosis was made? How do people learn about your Center?
– For further tests and study, it is necessary first of all to contact a specialized center. But it often happens that the doctor says: There is nothing to be done, the disease is complicated, and it is better to abort the baby. But the parents disagree! They use the Internet, where they might find many more options for resolving the problem. And they themselves decide what to do. Patients from other countries, having completed ultrasonography and knowing about the disease of their future baby, often come to us. The number of such patients is increasing.
– Today, women are more likely to give birth at a mature age, but the older the future mother is, the more likely she is to meet with some problems. Can they come to you for diagnosis in that case?
– Yes, they can. This will include ultrasonography, magnetic resonance imaging, a blood test and an amniotic fluid analysis. It’s a very fast, precise method that can show if there are any problems with the fetus’ development during the early stages of pregnancy.
Mature pregnant women (those who are already 35 years old) are in the at-risk group. For example, the risk of problems with the placenta is more likely in mature pregnant women than in younger pregnant women. This is the same as regards the possibility of genetic abnormalities in the child. In particular, Down’s syndrome is much more often diagnosed in children born to women of 42, for example, than those of 26.
– You have mentioned spina bifida, a diagnosis that may be treated by a prenatal operation. Tell us more about that disease and its treatment process.
– Spina bifida is observed in one out of a thousand or two thousand pregnant women. This is a developmental defect arising in the early stages of pregnancy. The main problem is that a part of the spinal cord is openly exposed to the amniotic cavity and is therefore progressively damaged during pregnancy. By intervening early, meaning during gestation, this very fragile spinal cord tissue can be protected by an appropriate soft tissue coverage and thus neurologic function can be preserved at birth. Unfortunately, not all cases of that disease are operable, and we can help only one, or, at the most, two out of four patients suffering from that disease.
The treatment of spina bifida is also part of a new program, which was initiated in 2010. At that time, we had only a couple of patients with such a diagnosis. Last year, 14 patients came to the Center, and the day before yesterday we operated on our sixteenth patient. And today after lunch, I saw another one, from France. More and more women are coming to us from other countries: from European and Scandinavian countries, from Russia, Brazil, the USA… Our Center is one of few where such operations are performed.
Professor, Doctor of Medicine, graduated from the Faculty of Medicine at the University of Zurich in 1984 and practiced in Switzerland’s leading medical institutions in the departments of urology and general surgery for several years. He accepted a position in the University Children’s Hospital Zurich in 1986. Four years later, he became a specialist in the Swiss Medical Association (FMH) in the field of pediatric surgery. From 1993 to 1995 he worked as a researcher at the Center for Fetal Surgery, University of California (San Francisco, USA), after which he returned as head physician of the Burn Center at the University Children’s Hospital Zurich. Since 2003 he has been Director of the Pediatric Surgery Clinic, Co-Director of the Center for Fetal Diagnosis and Therapy, and a board member of the University Children’s Hospital Zurich.