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QUOTE OF THE MONTH |
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"What it boils down to is hope. The only way we can justify patients coming all this way and trusting us is to offer more than compassion. You give them hope by making your technical skills the best. You create a
scientific environment that promises progress in therapy. And just as critical: You give them hope that comes from really caring about them. I know this model works. I've seen it work."
Henry Brem, MD, Director, Neurosurgery
CLINICAL NEWS
New Fibroid Center
Johns Hopkins has opened a new center that will specialize in state-of-the-art therapies for uterine fibroids and in the rapid application of new research to the treatment of these mostly benign growths of the wall of the uterus.
However, fibroids may result in excessive bleeding, anemia, infertility, and excessive pressure on the bladder and bowel. A significant number of hysterectomies each year are performed due to fibroids.
"Linking clinical practice to medical research is the best way we have of determining why fibroids affect some women and not others, and in deciding when to intervene medically or surgically," says gynecologist John Griffith, MD,
MPH. On the treatment side, the Hopkins team will emphasize minimally invasive techniques that focus on removing or shrinking fibroids instead of surgically removing the entire uterus. Particular attention will be paid to preserving
the uterus for women who have not completed childbearing.
64-Slice CT Avoids Surgical Inspection
Johns Hopkins has installed a 64-slice CT scanner that produces precise diagnostic pictures within five to 10 seconds for patients experiencing symptoms associated with heart attack. In use at Hopkins since February 21, the scanner is one
of two identical systems operating in the United States. It is expected to replace many diagnostic angiograms, the current standard for diagnostic coronary imaging.
The new scanner is an Aquilon 64 CFX multislice CT manufactured by Toshiba. Similar devices also are manufactured by Siemens and General Electric. Features include production of images at twice the speed and in greater detail than the
32-slice scanners, and picture quality so good it decreases the need for invasive, riskier angiograms or cardiac catheterizations to check for arterial blocks.
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RESEARCH NEWS |
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 Stem Cells Replace Damaged Tissue in Pigs
Cardiologist Joshua Hare's lab has some amazing pigs. After suffering massive heart attacks, they have almost entirely regenerated hearts, with the help of stem cells. Injected directly into the heart three days afterward, the
cells help restore function as new tissue replaces what is dead or damaged. The animnals recover in about two months, and the scar tissue that often leads to congestive heart failure melting away.
Before Hare's study, regrowing the heart was an intriguing, but far-distant idea. Hare has quickened that timetable, so much so that an FDA-approved Phase I study of the therapy will begin soon. "We will be the first group in the world,"
he says, "to test allogeneic mesenchymal stem cells for cardiac regenerative therapy."
Among the challenges is to find out what exactly causes the benefits. Do the stem cells themselves differentiate and divide, or is it their presence that prods existing muscle to being repair? Another is the fact that until now, data
from a rat model indicates that stem cell therapy may be less effective in older animals--a concern for human treatment, as heart attacks most often afflict the elderly.
Even with such challenges, this is an exciting time, Hare says. "We have had one of those Aha, eureka moments where new facts dramatically change the way you view biology." And the upcoming clinical trial should shed light on how stem
cell repair proceeds in the milieu of an aging heart. If the trials go well, Hare says, stem cell therapy after heart attack could find its way to the clinic in five to 10 years.
"Smart" Immune Cells Kill More Cancer
In efforts to educate the body to fight off cancer, researchers have found that some immune cells are "smarter" than others. Hopkins scientists tested kill-rates of two kinds of T-cells instructed to attack myeloma, a cancer of the bone
marrow. Those that live in bone marrow outperformed their counterparts circulating in blood by more than 90 percent.
"It is very difficult to design cancer therapies that get the body's immune system to recognize and kill cancer cells that the system has ignored for a long time," says oncologist Ivan Borrello, M.D., whose research appears in the
March 1 issue of Cancer Research. "Now, we have evidence that ‘educating' T-cells in the bone marrow may be the most effective way to get an anti-tumor response."
To treat patients, the scientists will collect a small amount of bone marrow from patients and with relative ease, grow and activate large numbers of T-cells from that source. These would then be given intravenously back to patients. The
researchers believe that patients with other blood, bone marrow and solid tumors such as breast cancer may also benefit from this type of immunotherapy.
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QUALITY AND SAFETY |
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Increasing Safety in the ICU
Complex systems--such as intensive care units--are breeding grounds for errors because interdependent components interact in unexpected ways. To achieve favorable outcomes, ICUs require that many processes occur in sequence.
For example, patients are cared for by many providers with varying levels of expertise across several disciplines, and these providers use highly sensitive and potentially dangerous technologies and medications. Such complex systems
require careful planning, excellent teamwork and communication, and designed redundancies to recheck for proper care processes.
This article by Peter J. Pronovost, MD, PhD; Albert W. Wu, MD, MPH; and J. Bryan Sexton, PhD provides a practical framework for improving patient safety in the ICU.
Click here to read the complete paper in PDF format.
INTERNET RESOURCES: Neurology and Neurosurgery
Brain Tumor Center: Learn about one of the largest brain tumor treatment and research centers in the world and a perfect example of Hopkins' multi-disciplinary approach to treatment.
Neurology Residents' Case Rounds: The Johns Hopkins Neurology Residents are currently providing case presentations to MedScape and all of these cases are available for viewing to registered users. There is no cost to register.
HOPKINS AROUND THE WORLD
J.F. Geschwind, Director of Cardiovascular and Interventional Radiology, will co-direct and speak at the Innovations in Cancer Therapies Symposium in London May 1-4. Other speakers from Hopkins include Ihab Kamel,
Michael Choti, Richard Schulick, and Wells Messersmith.
Register here.
J.F. Geschwind will also speak at The 9th International Symposium on Interventional Radiology and New Vascular Imaging to be held May 11-14 in Hyogo, Japan.
Register here.
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