The latest medical advances from Johns Hopkins Medicine.

APRIL 2005: K-Pro: Last Resort to Save Vision ... New Fibroid Center ... Benefits of Probiotics ... Pacemakers Work ... Dangers of Vitamin E ... The Other Da Vinci ... Ready, Set, Gobi!

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K-Pro: Last Resort to Save Vision

Corneal transplants are almost routine these days, but Esen Akpek, M.D., Director of the Ocular Surface and Dry Eye Clinic at Hopkins' Wilmer Eye Institute, is going one step further with a new type of artificial corneal transplant called keratoprosthesis (K-Pro for short). K-Pro has been performed less than 200 times worldwide and Dr. Akpek is the only eye specialist who has used it on children as a last resort to save eyesight.

As with all corneal transplants, K-Pro requires a donor cornea but it does not need to be of transplantation quality as the donor cornea will be sliced and reshaped. The front and back plates of the implantation device are screwed together, with the donor cornea in the middle, like a sandwich. When the patient's opaque cornea is removed, the entire transplant unit is placed in the eye. While patients must use daily eye drops and wear a contact lens to protect and moisten the artificial cornea, the procedure can give patients about to loose their sight a new lease on life.

A New Fibroid Center

Johns Hopkins has established a Fibroid Center to develop innovative, less invasive approaches to treat women whose only option to get rid of fibroid tumors was a hysterectomy. Directed by gynecologist John Griffith, the Center's specialists include interventional radiologist Kevin Hyun Kim, who specializes in minimally invasive embolization techniques to destroy or shrink fibroids.

Benefits of Probiotics

Living happily in your large intestine is a diverse group of bacteria known as gut flora, many of which you need. But sometimes they could use a little help, and that's the aim of probiotics, natural compounds popular among alternative medicine advocates. Based on studies in animals, Steve Solga, M.D., a liver transplantation specialist at Hopkins, is now using probiotics in patients with advanced liver disease with great success. Dr. Solga's strategy rests on switching the gut flora from producing ammonia, which must be handled by the liver, to a group that doesn't produce ammonia.


Pacemakers Work

According to a recent study in the New England Journal of Medicine, a special type of pacemaker called a biventricular pacemaker helps people with heart failure live longer and feel better. Commenting on the study, cardiologist Rick Lange, M.D., expects that this finding will change the standard of care for many people with heart failure.

"The study estimates that for every nine biventricular pacemakers put in, one death and three hospitalizations for major cardiac problems will be prevented, so it's a significant study." In addition, this type of pacemaker is relatively inexpensive when compared to implanted defibrillators.


Dangers of Vitamin E

High dose vitamin E, long known as a powerful antioxidant to eliminate dangerous free radicals, is now proving to do more harm than good. Hopkins researcher Peter Miller conducted a 7-year clinical trial in which patients with heart disease took vitamin E. He found an increased risk overall of death and a significantly increased risk of heart failure in those taking vitamin E compared to a placebo.

Miller recommends that patients taking 400 IU of vitamin E per day or more, stop. He says the small amount of E in a multivitamin is probably fine, but stresses that no vitamin regimen is a substitute for a good diet, regular exercise and adequate sleep.


The Other Da Vinci

Last December, cardiac surgeon David Yuh celebrated a Hopkins milestone when he conducted the first robot-assisted heart surgery on a human patient. During the surgery, he sat at the controls of the Da Vinci robotic device, consisting of two robotic arms and a single camera arm that are inserted through small incisions to access the patient's heart. Two months post-surgery, Dr. Yuh reports that the pioneer patient's recovery has been "swift and uneventful."

The benefits of this minimally invasive technology are clear: no open chest, less pain and trauma, and a shorter recovery and hospital stay. Today, the procedure is an alternative to traditional open-heart operations only in selected cases--mitral valve repair, atrial septal defects and lead placements for certain types of pacemakers. However, within the next 3 to 5 years Dr. Yuh expects that this technology will likely be used in 10 to 15 percent of heart surgery cases.


Read Dr. Krabak's daily blog during the race at www.jhintl.net
During the last week in April, many of the world's running elite will converge in China's Gobi Desert for one of the most spectacular races on the planet. Hopkins News for You readers will have a special window into the drama and excitement of the event through daily reports and photos from the field provided by Brian Krabak, M.D., and posted on our website at www.jhintl.net starting April 22.

Dr. Krabak, a sports medicine and rehabilitation specialist at Hopkins, a veteran of Olympic medical teams, and an avid racer himself will serve as a Medical Director of the 250 km event, working alongside Hopkins colleague Brandee Waite, M.D. and other physicians from throughout the United States. The race will cover a varied terrain of grassland, rocks, rivers, small mountains and sand dunes, with changes in altitude from 154 m below sea level to above 2000 m.

Dr. Krabak expects to handle everything from sprained ankles and torn ligaments to concussions and complex musculoskeletal injuries. One of his greatest challenges will be making the tough decision of whether an injured athlete should compete and risk further injury; not a simple decision in the face of patients passionately engaged in one of the most important races of their lives. All the while, he will likely remember the words of the missionary Mildred Cable, who will be honored at the race: "Only a fool crosses the great Gobi without misgivings."

Visit www.jhintl.net for updates as Dr. Krabak prepares for and joins the race.

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