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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.
June 2003
Reduced Use of Eye Patch Effectively Treats Lazy Eye
Anti-Depressant Reduces Hot Flashes in Menopausal Women
New Treatment for Brain Tumors Approved
What is Gastroesophageal Reflux Disease (GERD)?
Interventional Radiologist J.F. Geschwind on Treatment of Liver Cancer
Reduced Use of Eye Patch Effectively Treats "Lazy Eye"
Researchers at the Johns Hopkins and 34 other ophthalmology centers across North America report that in children with moderate amblyopia, or "lazy eye," patching the unaffected eye for two hours daily works just as well as patching the eye for six hours, the standard amblyopia treatment. The findings will likely change the way doctors treat moderate amblyopia and could lead to better compliance with treatment and improved quality of life for children with amblyopia. Amblyopia is the most common cause of visual impairment in children in the United States.
Anti-Depressant Reduces Hot Flashes in Menopausal Women
Menopausal women battling hot flashes may have a new weapon to add to their arsenal: paroxetine. Researchers at Johns Hopkins and 17 other institutions found that a slow-release form of the antidepression, antianxiety medication, which is sold under the brand name Paxil, reduced hot flashes in a group of menopausal women by up to 65 percent. Hot flashes traditionally have been treated with estrogen and progestin hormone supplements, which can reduce their frequency by 80 percent to 90 percent. But recent studies about the increased risk of heart attack, stroke, blood clots and breast cancer caused by these hormones have led women and their physicians to search for alternatives.
Paroxetine is "the best nonhormonal drug we know about right now," says Vered Stearns, M.D. "If a woman wants to try nonhormonal therapy, she will know within days whether it's going to work."
New Treatment for Brain Tumors Approved
The U.S. government has approved a much-awaited localized chemotherapy treatment for malignant brain tumors developed by Hopkins neurosurgeon Henry Brem. The method relies on a coin-sized polymer wafer coated with a chemotherapeutic agent that releases the drug onto malignant cells. Surgeons using the wafer first remove the tumor, then cover the newly exposed brain surface with several of the slender disks. This area is often a "gray zone" where cancer cells that are beyond the reach of surgery can hide. "When you apply therapy directly where it is needed, you minimize adverse effects in the rest of the body," says Dr. Brem.
A recent study of 240 patients showed the wafers plus follow-up radiation extends life for patients. Originally the treatment was only approved for recurring, highly invasive glioblastoma multiforme tumors after surgery. Now its use is expanded to all patients with primary malignant tumors.
What is Gastroesophageal Reflux Disease (GERD)?
Gastroesophageal Reflux Disease (GERD) occurs when stomach acid makes its way into the esophagus, usually because the valve at its upper end relaxes as we get older. GERD's symptoms can include an acid taste in the mouth, trouble swallowing, and regurgitation of food. Alcohol, chocolate, caffeine and heavy, spicy meals can aggravate the condition. For patients with mild GERD, doctors usually recommend lifestyle changes, such as stopping smoking, losing weight, eating smaller meals, avoiding acidic foods (tomatoes, citrus and spicy foods, coffee and peppermint), eating at least 3 hours before bedtime, and raising the head of your bed to keep stomach acid down.
Although antacids provide temporary relief, long-term use can result in diarrhea and a buildup of magnesium in the body. About 80% of patients who suffer from acid reflux respond well to prescription medications. For a few patients with severe, chronic heartburn that does not respond to medications, a laparoscopic surgical procedure that increases pressure in the lower esophagus to stop acid from rising, is one option. If untreated, chronic GERD can lead to bleeding, ulcers, scarring, and Barrett's esophagus (severe damage to the lining of the esophagus) which doctors believe may be a precursor to esophageal cancer. GERD also causes many respiratory symptoms. A persistent cough, hoarseness, and even asthma may be associated with acid reflux and will resolve when the GERD is treated.
J.F. Geschwind, M.D., on New Treatments for Liver Cancer
Dr. J.F. Geschwind, Director of Cardiovascular and Interventional Radiology at Johns Hopkins and pioneer in the chemoembolization technique for treating liver cancer, talks about his research and treatment of cancer through image-guided procedures.
Question: What research are you working on to improve treatment of liver cancer?
Dr. Geschwind: Two areas of research interest me. The first is how to best determine tumor response following therapy at the site of the tumor. When I started, what was puzzling to me was the lack of a reliable imaging method to assess tumor response. I realized that MRI probably offered the best approach to determine dead tumor tissue. Since then, we have successfully used the technique in the clinical setting. The second area is related to the use of intra-arterial therapy for liver cancer using a procedure called chemoembolization (using a catheter to deliver drugs to kill the tumor). For the past 3-4 years, we have focused our attention on delivering drugs that specifically target tumor metabolism. In the past, interventional radiologists focused on blocking off the artery to the tumor rather than using it to deliver toxic drugs to tumors.
Question: Right now, chemoembolization is a palliative treatment. Do you see it as way of treating operable liver cancer?
Dr. Geschwind: I believe chemoembolization will remain a palliative treatment. It is probably the best therapeutic option against advanced liver cancer. However, it is possible that chemoembolization may play a greater role either pre- or post-operatively, for example as a bridge to liver transplantation or resection. If a tumor is too big to be surgically removed then chemoembolization could be performed before surgery to shrink the tumor, allowing surgery to be performed safely. We have already treated a few patients this way at Hopkins, allowing the resection of tumors that could not be removed before pre-operative chemoembolization.
On the other hand, several non-surgical treatment options exist for patients who are candidates for surgery, generally with tumors measuring less than 4 cm. The most commonly used is called radiofrequency ablation and consists of applying heat within the tumor resulting in its destruction. In most cases surgery is not necessary and several studies have shown this method to be quite effective.
Question: Do you think the technique could be applied to other kinds of cancer other than liver cancer?
Dr. Geschwind: The reason why chemoembolization has been so successful in liver cancer is because the liver has a dual blood supply, providing a natural protection to healthy liver tissue. It would be difficult to use this technique in other solid organs. However, it can and has been used successfully in some soft tissue bone and kidney tumors.
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