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Hopkins News For You
This is a service for our friends around the world from Johns Hopkins International. To receive reports, please send e-mail to patientnewsletter@jhmi.edu or visit our website at www.jhintl.net.
August 2004
New Malaria Drug Works Wonders
MRI Ok for Patients with Heart Devices
Traditional Vision Screening is Best, for Now
Avoid Painful Ears When Flying
The New Check-up Focuses on Risk Factors
Otolaryngologist Ralph Tufano, M.D., on Thyroid Problems
New Malaria Drug Works Wonders
A Chinese herbal drug called artemisinin (Art'-e-mis-e-nin) is proving quite effective against malaria, leading health organizations worldwide to compete for a limited supply. Johns Hopkins immunologist David Sullivan, M.D. says artemisinin works wonders against the malaria parasite.
"Artemisinin is being instituted largely because there is no resistance in the malaria parasite to the drug and also because it rapidly kills the malaria parasites. It's about twice as effective at killing the parasites very rapidly as any of our other available agents." Malaria is now almost entirely resistant to other medications, and it continues to be a killer worldwide. The mosquitoes that harbor the parasite are also continuing their spread around the globe. Dr. Sullivan says artemesinin is being given as part of a drug cocktail to try to prevent the parasite from becoming resistant to it.
MRI Ok for Patients with Heart Devices
In animal and laboratory studies, scientists at Johns Hopkins have shown that modern implanted heart assist devices -- such as pacemakers and defibrillators -- can be safe for use in MRI machines, a diagnostic and imaging tool long ruled potentially unsafe for millions of people who currently have a surgically implanted cardiac device. Their findings should eventually make MRI scans more available to people who might benefit from early detection of cancer and other diseases, when treatments are most likely to succeed, and for guiding devices during minimally invasive surgery.
"Many people, such as the elderly and patients with arrhythmogenic right ventricular dysplasia, who might benefit from an MRI scan are currently denied them because they have an implanted, electrical heart device," said the study's senior author, electro-physiologist Henry Halperin, M.D.
Traditional Vision Screening is Best, for Now
An exciting new method for eye screening called photoscreening is on the horizon. The test relies on a light beam being directed into the eye and a photograph taken of the pupil. Such a method would allow very young children to be tested. However, while such a screening tool is very attractive, Hopkins eye specialist Michael Repka, M.D., says that at this time photoscreening is not as good and it is better to stick with the tried and true traditional vision screening.
"My recommendation right now is to have visual acuity measured at age three or four. If photoscreening is available, there would be no harm and a potential advantage to doing it but you should not accept the photoscreening as the definitive or final say." Dr. Repka feels confident that as photoscreening is validated it will be more reliable, and would also allow eye conditions to be treated very early in life when they have the best chance of being cured.
Avoid Painful Ears When Flying
As more and more people take to the air for travel, about one-third to one-half experience pain in their ears when they do. Dr. Howard Francis, an ear, nose and throat specialist at Johns Hopkins, says a maneuver called the Valsalva will help most people. This maneuver increases the pressure in the throat to help equalize the pressure between the outer cabin and the middle ear space during the ascent and descent of flights.
To perform the Valsalva maneuver, simply pinch your nostrils hard so that no air escapes and blow forcefully but steadily against them. This should allow the pressure to equalize and can be repeated as many times as necessary. Dr. Francis says chewing gum does not help but decongestant medications, especially nasal sprays, can be quite helpful. He recommends that people use a spray once an hour or two before flying and not do so again until the return trip.
The New Check-up Focuses on Risk Factors
Many people believe that a hallmark of good medical care is an annual visit to the doctor that includes both screening tests and a physical examination during which the doctor listens to the heart and lungs, inspect the eyes and ears, and checks reflexes. However, while an annual physical exam may feel reassuring, most major medical organizations no longer view them as necessary for healthy patients who have no symptoms. Several reports have found that many components of the typical physical make no difference in overall longevity for people with no symptoms. Even many tests that are useful, such as blood tests for cholesterol, don’t need to be done every year in people whose results have been within desirable ranges.
How often you should see your doctor and what the doctor does during each visit will vary depending on your age, health status, and specific risk factors. With patients over 50 with no symptoms, a doctor’s primary task is to identify risk factors for specific illnesses and to counsel patients about how to reduce them. Experts estimate that modifiable lifestyle factors account for two thirds of chronic illnesses associated with aging. Since smoking and an unhealthy diet increase the risk of heart disease and cancer, the time you have with your doctor may be better spent discussing how to change those habits and obtaining tests tailored to your particular needs rather than on a thorough physical. (Johns Hopkins Health After 50 Newsletter, June 2004).
Ralph Tufano, M.D., on Thyroid Problems
Dr. Ralph Tufano is a member of the Department of Otolaryngology–Head & Neck Surgery, which was ranked the #1 otolaryngology department in the United States in this year's U.S. News & World Report survey of the best hospitals in America. In addition to his interest in disorders of the thyroid, Dr. Tufano specializes in swallowing disorders, disorders of the larynx, pharynx, oral cavity and salivary glands, and head and neck tumors.
Question: What are the main problems one can have with the thyroid gland?
Dr. Tufano: The thyroid is situated in the lower portion of the neck, has two lobes connected by a bridge, and sits over the trachea. This gland helps with metabolism and also regulates the body’s temperature. People can have an overactive thyroid, or hyperthyroidism and in that case excessive amounts of the hormone can affect other parts of the body, such as the heart, causing increased heart rate or irregular heartbeat. It also can make the person feel overly excited or irritated and experience sudden weight loss. People with low thyroid hormone production, or hypothyroidism, may realize they are more lethargic than normal, or that the energy they had is not there anymore, and they may notice they are gaining weight.
The thyroid can also develop nodules, and in this case we work with our endocrinology team to follow these patients and ask for a biopsy. A biopsy is important to determine the course of action and to be sure we are not dealing with any type of cancer. Unfortunately, due to the anatomy of the neck it is difficult to determine if a person has a thyroid nodule. Most people don’t pay attention to the thyroid until it becomes a real problem. It is important to tell your primary care physician if you feel some of these symptoms. He or she is the one that is going to perform the necessary tests so that when the patient comes to me or an endocrinologist, he does not have such a serious problem, or if there is a problem, we can treat it early.
Question: What treatments are available for each of these thyroid conditions?
Dr. Tufano: I am very fortunate to work with an excellent team of endocrinologists, and we always take a multidisciplinary approach. Most of the time, if the patient has hypothyroidism, we will give him hormone replacement to bring the hormone back to a normal level. With hyperthyroidism, depending on the factors that are causing excess production of the hormone, there are medications that can control the situation, and if the medication does not work, there is the option of surgery to remove the thyroid.
In the case of nodules, a fine-needle biopsy is typically performed to determine if we have a diagnosis of something malignant. If we do, then we remove the gland. If we have a benign process and the patient is symptomatic with a large mass, has difficulty swallowing or breathing, we consider removal, too. Otherwise, it is just a matter of observing those nodules to control their growth.
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