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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 with the name of this e-newsletter.
February 2004
1. New Wrinkle in "Off Pump" Heart Surgery
2. Hopkins-style Cancer Care in Singapore
1. New CT Identifies Disease Earlier, Noninvasively
2. Zapping Seizures
Dangers of Tanning Beds
Cardiologist Eduardo Marbán, new Chief of Cardiology, on what's new in treating the damaged heart
New Wrinkle in "Off Pump" Heart Surgery
When the blood vessels to your heart are blocked, surgery to replace them is a modern miracle. Improvements on this approach now let the heart remain beating during surgery, thus avoiding the heart-lung machine. But Hopkins heat surgeon David Yuh says new research is raising concerns about this so called 'off pump' surgery.
"Patients have to be very careful when off pump is being offered to ask the surgeon about their experience with this type of surgery and what the results have been. If a surgeon hesitates or doesn't seem to give you a satisfactory answer, then that should cause you to pause," he says, referring to reports published in The New England Journal of Medicine that say there may be a higher incidence of graft failure in the off pump population.
Hopkins-style Cancer Care in Singapore
The same level of Hopkins-style care available at Johns Hopkins in Baltimore can now be found in the small but scientifically burgeoning Asian nation of Singapore. Located in a wing of the National University Hospital, the Johns Hopkins-National University Hospital International Medical Centre (IMC) operates as a private hospital offering Singaporean and international patients the latest cancer care and protocols.
Under the management and standards of Johns Hopkins Medicine, the IMC, through its clinical trials program, also gives patients access to new treatment protocols in cancers specific to Asian populations. Oncologist Alex Chang oversees inpatient and outpatient care, and the 20 practicing physicians who are credentialed by Hopkins and NUH. Currently, the IMC serves a mix of local and foreign patients who find Singapore a more convenient destination than traveling to the United States for similar care.
New CT Identifies Disease Earlier, Noninvasively
Hopkins' newest CT scanner is not only dramatically improving early detection of disease, but the amazingly clear images it produces are also helping surgeons make better decisions about treatment later on. The 1.5 milllion dollar "multi-slice" CT can take images of organ systems never before seen, images so sharp and well-illuminated that Hopkins radiologists are using them to detect plaque obstruction and narrowing in the arteries around the heart, kidneys and other organs, and to stage malignant tumors and their spread more accurately.
"In every pancreas, every liver, the surgeon wants to know if there is vessel invasion," explains radiologist Elliot Fishman. "We can do CT angiographic maps of patients that are key in determining the need for surgery, what type of surgery, and whether they should have chemotherapy at the end." In addition to giving infinite views of organs--as opposed to the one or two projections in conventional angiography--the new scanner is also faster, non-invasive, safer and less expensive, says Fishman.
Zapping Seizures
In the past decade, no less than nine new drugs to control epilepsy seizures have become available. But if patients are not helped by two or three of them, says Hopkins neurologist Greg Bergey, the chance of a fourth ending their seizures is only about 5 percent. Dr. Bergey's hopes for real change are resting on a new device now moving into clinical trials that reflects recent thinking that mildly zapping the central nervous system with electrical currents can be therapeutic.
The new tool, an implantable device no larger than a cracker called External Responsive Neurostimulator System (ERNS), delivers currents in response to seizures. A computer chip is tuned to detect a seizure pattern specific to each patient, sensing the earliest onset of activity. Then, the researchers anticipate, the brief, mild stimulus that is released will disrupt or stop the seizure. The device rests in a cavity in the skull and the patient can't feel the stimuli. Hopkins is now collaborating with several other major centers to test the first implants of the device.
Dangers of Tanning Beds
Erroneously called a "healthy glow," a tan can now be had year-round, in any climate, with the use of tanning beds. But Dr. Daniel Sauder, chief of dermatology at Hopkins, says that while tanning outdoors is distinctly unhealthy, tanning beds may be even worse. "People have a false sense of security from the sun tan parlors because those generally use the longer wavelength ultraviolet A which don't show a visible burn unless you get into very high doses.
People think it is safer but, in fact, the longer wavelength penetrates much deeper so it hits the blood vessels. Even in a short exposure you can measure changes in the blood in terms of immune function." Dr. Sauder says that tanning booths are probably contributing to the meteoric rise in skin cancers seen worldwide. Especially troubling is the increasing incidence of melanoma, the most deadly form of skin cancer.
Dr. Eduardo Marbán, Chief of Cardiology
A native of Cuba, Dr. Marbán attended Yale Medical School and came to Hopkins in 1981 for his residency and subsequent career as a cardiologist. In this interview, the new head of cardiology discusses the changing art of treating the damaged heart and offers some throughts for the future.
Question: What is different in cardiology since you trained 20 years ago?
Dr. Marbán: It was still lead pipes and plumbing then. I would listen to a patient tell me he had trouble exercising, then hear fluid in his lungs and extra heart sounds, the sounds of congestive heart failure. At the time we didn't have a clue what was happening. A lot of interesting biology was beginning, how the vascular wall reacts to cholesterol, how heart failure weakens the contractions of the heart, why instabilities of rhythm arise during heart attacks. Today, we're poised for a revolution.
Question: How is that affecting treatment?
Dr. Marbán: We're beginning to use coated stents. Instead of focusing on the mechanics of opening up a clogged artery and putting in a spring, we're coating these springs with biological factors, reducing the risks of re-stenosis.
Question: How would you treat heart failure today?
Dr. Marbán: We know this disease occurs when the heart doesn't beat strongly enough. Its muscle has grown weak, perhaps from coronary artery disease or high blood pressure. We have a host of medications now that prolong life--beta blockers and ACE inhibitors. We also have amazing devices to help the problem. The biventricular pacemarker can resynchronize a damaged heart by sending an electrical current into the chambers on both sides. Automatic internal defibrillators can keep people alive. And Left Ventricular Assist Devices (LVAD), which once were just bridges to keep people alive until a transplant, today are taking the place of transplants.
Question: What is coming next?
Dr. Marbán: Gene and stem-cell therapy are what is most exciting. I actually believe that in two or three years, we are going to be able to put stem cells, grown from bone marrow or even from heart tissue, back into damaged hearts to regrow myocardial tissue. I would say the future for battling heart disease looks very bright.
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