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Medical News from Johns Hopkins
This is a service for doctors worldwide from Johns Hopkins International. To receive reports directly, please send e-mail to jhis@jhmi.edu.
1. "Hedgehog" Signal Distinguishes Lethal from Localized Prostate Cancers
2. More Frequent Monitoring Advised for Diabetes Patients
3. Double Drug Combination Better Than One for Tumors
4. Meet the Colleague: Geriatrician John Burton, M.D.
5. New on www.jhintl.net; Surgery Demonstrations; CME; Antibiotic Guidelines online; Twins Separation
1. "Hedgehog" Signal Distinguishes Lethal from Localized Prostate Cancers
Most prostate cancers grow slowly, making "watchful waiting" a common alternative to immediate surgical removal of the prostate. However, there is no sure way to tell whose cancer will stay in the gland, and whose will be aggressive and spread and turn out to be fatal. Johns Hopkins researchers may have discovered a way to distinguish lethal metastatic prostate cancers from those restricted to the prostate with a test that measures the activity of a growth and development signaling pathway called Hedgehog. If the test can predict which prostate cancers will spread, it could revolutionize how doctors decide to treat patients with prostate cancer.
In the September 12 online edition of Nature, the researchers report that only three of 12 localized prostate tumors obtained at surgery had detectable activity of the Hedgehog signaling pathway. In contrast, all 15 samples of metastatic prostate cancers, donated at patients' deaths, had Hedgehog activity, which was 10 to 100 times higher than the highest levels seen in localized tumors. It remains to be seen whether Hedgehog activity in localized cancers will predict the ability to be metastatic.
"If we can use Hedgehog activity to predict whether a tumor will metastasize, we will have a great diagnostic tool, but manipulating the Hedgehog signaling pathway may also offer a completely new way to treat metastatic prostate cancer," says urologist and oncologist David Berman, M.D., Ph.D. "Right now nothing works very well -- you can help temporarily by cutting off testosterone, but the cancer always comes back."
2. More Frequent Monitoring Advised for Diabetes Patients
A Johns Hopkins study suggests that people with type I and type II diabetes should monitor their blood sugar levels more than the usual twice daily to make sure that levels are not elevated over 150 milligrams per deciliter for sustained periods. The research team has added new and detailed evidence of the link between elevated blood sugar levels in people with diabetes and increased risk of developing life-threatening forms of cardiovascular disease -- including coronary heart disease, stroke and peripheral artery disease.
Their findings, part of a broad retrospective meta-analysis published in the Annals of Internal Medicine online September 21, suggest monitoring long-term blood sugar control by level of glycated hemoglobin (also called glycosylated hemoglobin) and adding this measurement to regular monitoring of cholesterol levels and blood pressure. "The relationship between blood sugar levels -- or glycemic control -- in people with diabetes and whether this increases their risk of developing heart disease has remained unclear until now, despite many different studies about specific types of cardiovascular problems," said the study's senior author, endocrinologist Sherita Golden, M.D., M.H.S.
3. Double Drug Combination Better Than One for Tumors
Cancer researchers have long suggested that new targeted drugs may work best when paired with other therapies. In a new study published September 15 in Cancer Research, scientists have taken the first steps to demonstrate this synergy in mouse and cell line models. The findings show that two different drugs may work better in a "one-two punch," targeting a cancer development process in two types of cells. The early results are so promising that preliminary testing of the drug combination in humans is now being planned.
"Combining these two types of drugs may have a greater impact on cancer development than using them alone," says oncologist Roberto Pili, M.D. "Our idea is to attack the way cancers form new blood vessels by disrupting the angiogenesis process in two different cells." Anti-angiogenesis drugs which inhibit vast networks of blood vessels that feed tumors have thus far failed to make the anticipated dramatic impact on targeted tumors when used alone in human clinical studies, say the investigators. Earlier evidence by the Hopkins scientists and others suggests that a new class of drugs which helps normalize how DNA is wrapped around protein structures called histones also has secondary effects on limiting blood vessel development.
4. Meet the Colleague: Geriatrician John Burton, M.D.
One of the founding fatherrs of modern geriatrics and the former chief of Hopkins' #1-ranked Division of Geriatric Medicine talks about the challenges and joys of treating older people.
Question: Typically, geriatric patients have been cared for by adult medicine specialists, but you believe that physicians who treat older people need special training. Why?
Dr. Burton: Older patients have complicated, multiple illnesses and often minimal physiological reserves. Caring for them puts a premium on diagnostic and therapeutic judgment. You just can't look in a textbook to find the answers. In geriatrics, you need above all to be an effective communicator, to possess deep compassion and exercise outstanding judgment. All these skills take particular training and focus. Serving as a primary care physician for older patients was both the most challenging and the most rewarding experience I've ever had. Read more...
5. New on www.jhintl.net
****Multimedia Surgery Demonstrations -- View demonstrations of common urological surgeries, including anatomical retropubic prostatectomy, laparoscopic live donor nephrectomy, laparoscopic prostatectomy. Read more...
****Upcoming CME Courses -- Gynecological Pathology; Gastrointestinal Pathology; Lipid Disorders Training Program; Ophthalmology; Neurology for the Primary Care Practitioner; Cardiovascular Topics; Urogynecology. Read more...
****2004 Antibiotic Guidelines Now Online -- The Johns Hopkins electronic Antibiotic Treatment (ABX) Guide, currently used on personal digital assistants (PDA) and desktop computers, is now online. It has been called a “must have” by Pharmacy Practice News. Read more...
****Conjoined Twins Separated -- Read about the surgery, technological tools, the surgical team, and listen to audio of the press briefing given by Dr. Benjamin Carson and the medical team. Read more...
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