International Physician Update

Latest Advances from the Bench and the Bedside

Benefits of Lung Surgery for Emphysema Patients
Patients with severe emphysema who undergo lung volume reduction surgery along with medical management are more likely to function better and face no increased risk of death after two years compared to those treated with medical management alone, according to results of a five-year study at Johns Hopkins and 16 other clinical research centers across the country.

The investigators also found that patients whose disease was concentrated in the upper lobes of the lungs and whose exercise capacity was low before surgery were more likely to survive longer and function better after surgery than those who received medical management alone. In contrast, patients who had more diffuse disease and greater exercise capacity were more likely to develop complications from the surgery.

“The findings provide crucial new information for weighing the benefits and risks of lung volume reduction surgery for the treatment of severe emphysema,” says biostatistician Steven Piantadosi, a lead investigator in the study. The findings were presented May 20, 2003, at the American Thoracic Society 99th International Conference in Seattle, Wash., and appeared in the May 22 edition of the New England Journal of Medicine.


Anti-HIV Drugs Save Vision, Improve Outlook for AIDS Patients
A Hopkins team reported in the April issue of Archives of Ophthalmology that AIDS patients who received the multiple anti-HIV drug regimen HAART (highly active antiretroviral therapy) had a 75 percent lower risk of visual impairment than those who did not. In a second, multicenter study, published in the May issue of Ophthalmology, AIDS patients with vision loss who took HAART reported higher overall quality of life than those who did not.

AIDS patients are at high risk of vision loss from cytomegalovirus (CMV) retinitis, an infectious disease of the retina. Symptoms include “floaters” and permanent loss of central vision. With HAART, which became available in 1995, many patients’ immune systems seem to recover enough to control CMV retinitis. The condition at one time affected 30 percent of patients at some point during their lives, but has probably decreased to 7.5 percent with the advent of HAART, says lead author John Kempen.

By the time CMV is diagnosed, Kempen says, many AIDS patients are already legally blind or have significant vision loss. “AIDS patients should take HAART as soon as and as much as they can,” he says. “HAART often can save both their life and their vision.”