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Hopkins News for You
This is a monthly service for our patients and friends around the world from Johns Hopkins International. To receive monthly reports via e-mail, please send e-mail to patientnewsletter@jhmi.edu.
January 2003
When A Second Opinion Should be Your First Choice
Coiling Better than Stenting to Treat Aneurysms
Extended Release Drugs Better for Seizure Patients
Lupus Patients Benefit from Cancer Therapy
The Signs of Stroke
When A Second Opinion Should be Your First Choice
When it comes to taking your doctor's advice on certain medical procedures, patients may want to consider that old military saying: "Trust, but verify." Though many patients are reluctant to seek second opinions, medical professionals themselves say that it is a good idea. This is especially true for people who are elderly or undergoing certain procedures. Hopkins doctor Barbara Cook, M.D., says that seeking a second opinion for one particular type of heart surgery, replacing heart valves, is a must.
"Those are very serious surgeries, and I think that getting a second opinion is a very good idea," says Dr. Cook, adding that second opinions allow patients to consider other options. Prostate cancer is another good example. "Men have several options if they have prostate cancer: Surgery versus radiation therapy, for example. Getting a second opinion and going to different experts who manage that condition is part of being well-informed," she says.
Coiling Better than Stenting to Treat Aneurysms
Treating brain aneurysms, abnormal ballooning of an artery wall, by inserting coils to stop the bleeding, decreases the risk of patient death and disability by nearly 25% for those whose aneurysms burst, according to a study led by Johns Hopkins interventional neuroradiologist Kieran Murphy. Preliminary results of the study, started in 1994, were so favorable that the trial was ended ahead of schedule so the procedure could immediately be used to benefit patients.
During the procedure, miniature platinum coils are folded gently, one by one, into the aneurysm like a ball of yarn to stop the bleeding," Dr. Murphy notes that the procedure also can be used to prevent aneurysms from bursting. "With coiling, we can either help fix the damage or prevent it from occurring." Surgical clipping, currently the most commonly used treatment for brain aneurysms, requires opening the skull and placing a metal clip across the neck of the aneurysm to stop the bleeding.
The minimally-invasive coiling procedure involves inserting a catheter through an artery in the leg up into the brain and filling the aneurysm there with the tiny coils. Compared with invasive surgery such as clipping, the coiling procedures are remarkably simple and require a shorter hospital stay, lower risk to the patient, less post-operative recovery time, with typically fewer complications.
Extended Release Drugs Better for Seizure Patients
Many patients with epilepsy taking a common drug to control seizures can reduce side effects by switching from three or four short-acting doses to two extended-release doses per day, say researchers at Hopkins. The drug, carbamazepine, is a drug used to control partial seizures, which originate in one part of the brain and then spread to other areas.
"While the treatment is effective at reducing seizures, some patients, particulary at high doses, experience adverse side effects such as drowsiness, dizziness, double-vision and unsteady walking," says neurologist Gregory Krauss, co-author of the study. "Switching to longer-acting doses is not only more convenient for the patient, but actually reduces side effects."
Lupus Patients Benefit from Cancer Therapy
Johns Hopkins doctors are using high doses of the anti-cancer drug cyclophosphamide to successfully treat patients with moderate and severe forms of lupus, a chronic and sometimes fatal autoimmune disease.
After a 2 ½ years follow-up period, five of 14 patients in the study had complete responses and three of those patients have remained disease-free after completely discontinuing treatment. Six patients achieved a partial response and take lower doses of previously ineffective immune-suppressing drugs. Two patients did not respond to the therapy, and one patient had some response but developed new renal disease.
"Living with long-term severe lupus is devastating as the body's immune system attacks itself," says rheumatologist Michelle Petri. "The idea with this treatment is to blast the lupus once and wipe out the abnormal immune system, and allow the body to relearn and function normally without further therapy."
The Signs of Stroke
Sometimes a headache isn't just a headache but a sign of something far worse, such as a stroke, the leading cause of death in the United States. While the vast majority of headaches are benign--even if very painful--certain headaches could signal a type of stroke caused by a sudden hemorrhage, or burst blood vessel, in the brain.
Hopkins neurosurgeon Rafael Tamargo describes what to look for: "The onset of the headache is acute, it's very sudden. Also, it's unlike any headache you have experienced before. The headache does not go away and it cannot be treated with medications such as Tylenol or Motrin."
Other forms of stroke are marked by very subtle symptoms. A TIA, or transient ischemic attack, occurs when a fragment of arterial plaque breaks loose and lodges in the brain. According to Dr. Tamargo, the tell-tale signs of a TIA are, at first, transient episodes of numbness or weakness in the arms or legs, usually on one side of the body. TIAs, says Dr. Tamargo, can also affect eyesight.
"Problems with one eye, particularly the sensation that there is loss of vision like a curtain coming down, is worrisome." If you experience anything like the above symptoms, Dr. Tamargo counsels patients to go to the emergency room immediately because many strokes can be treated and their long-term effects lessened if caught early.
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