|
|
|
International
INTERNATIONAL
The London Telegraph
Reuters
The Associated Press
The Philadelphia Inquirer
The Wall Street Journal
The Washington Post
Boston Globe
Pittsburgh Post-Gazette
The Los Angeles Times
San Francisco Chronicle
San Jose Mercury News
Science Magazine
All News Channel (Cable)
KCOP-TV13 (Los Angeles)
KCRA-TV3 (Sacramento)
WMAR-TV2 (Baltimore)
“Arts and sciences are not cast in a mold, but are
formed and perfected by degrees.”--Michael de Montaigne
(1533-1592)
Stroke Research at
Penn Leads to Milestone
About 700,000 Americans suffer strokes each year, and almost half of those who survive are permanently disabled. Treatment efforts traditionally have focused on limiting the damage caused by stroke. But no attempts have been made to actually restore the brain’s lost function.
On July 1, doctors at the University of Pittsburgh Medical Center announced that they had entered that fray, conducting a transplant of nerve cells into the brain of a 62-year-old woman. The cell line they used originated in the lab of Pathology and Laboratory Medicine’s Virginia M.-Y. Lee, PhD, and John Q. Trojanowski, MD, PhD.
Doctors hope to restore movement to the woman’s right arm and leg and help her regain her speech loss, all lost in a September 1997 stroke. They plan to do the same procedure on 11 more patients.
The clinical trial represents the first attempt to treat stroke with such a transplant, as well as the first time that laboratory-grown adult human cells have been implanted into the human brain. “This is really a historic turning point in transplantation therapy,” Trojanowski told The Philadelphia Inquirer. “But by no means do I say we are ready to treat every stroke patient,” he added. “There is some serious heavy lifting yet to do. It would be disingenuous to imply anything else.”
The story began more than a decade ago, when Lee developed the cell line from a rare and primitive tumor. The tumor contained cells that hadn’t yet differentiated, or matured, so they retained the capability to function in different parts of the body. Lee and her collaborators chemically coaxed the cells into neurons. (They also ensured that the nerve cells would not revert back to tumor cells.)
While fetal human and fetal animal cell transplants have been tried for neurodegenerative disorders, such as Parkinson’s disease, with promising results, this is the first study to address neurological deficits from stroke. Twelve patients between the ages of 40 and 75 who have suffered a stroke between six months and six years ago will undergo the procedure. After the surgery, they will have regular blood tests, physical examinations, and brain scans to monitor their bodies for rejection and to determine whether the implanted cells are having any effect on brain function.
If the technique passes safety tests, scientists will
expand the scope of the trials, including trying the
approach on other neurological disorders.
Reports began July 2.
[Editor’s note: Media Relations efforts extended this story to include a description of the background role played by Penn researchers. In one instance—a front page story in The Philadelphia Inquirer—Trojanowski and Lee’s research was mentioned before the actual procedure.]
NATIONAL
The Orlando
Sentinel
Scranton Times
Delaware State News
Centre Daily Times
CNN Late Edition
WHYY-FM (NPR)
Picture If You Will . . . No More Cancer
When an article in The New York Times told of a new drug that “eradicates any type of cancer” in mice, some reports went so far to suggest The Big C had finally been licked. Media hype was soon tempered by warnings from doctors that what works in mice may not necessarily work in humans. Still, the news raised hopes that a cure may come sooner rather than later and led to discussions about the previously unthinkable—a world without cancer.
Helping several news outlets imagine such a place was Arthur L. Caplan, PhD, director of Penn’s Center for Bioethics. “Curing cancer would do to the health care industry what the end of the Cold War did to the defense establishment,” Caplan told The Orlando Sentinel. “There might need to be some downsizing.”
Roughly a quarter of the entire U.S. health care budget goes to the diagnosis, treatment, and care of persons with cancer, he noted. “Think about the number of cancer hospitals out there. The number of specialists, and not just oncologists, but in fields like urology, dermatology,” he said on National Public Radio’s Weekend Edition. “Huge swaths of medicine are devoted to the treatment of cancer. If you suddenly cure it, if it suddenly went away, you’d have to revolutionize the structure, organization, and personnel of medicine.”
And what vexing medical problem would take cancer’s place as the most formidable foe? “You may see some jostling about diseases to see what will be the next priority,” Caplan said. “But people may not fear Alzheimer’s or heart disease as much as they do cancer, and that may result in less money being spent on medical research.”
Without cancer to worry about, people might start to act a little differently too, he noted. “I think we would actually see people living more recklessly. It would be harder to push certain health initiatives. I might predict a boost in certain kinds of behavior that people avoided in part because they thought it would give them cancer. I don’t know about smoking, but I think we’d see a whole lot more sunbathing.”
And, he added, “We certainly don’t want to see
bioethics go out of business along with the conquest of
cancer. That could not be a good thing.”
Reports began May 9.
Health Plan Magazine
Many teenagers don’t make the best patients. They’re surly. They don’t take their medications. They get into a lot of trouble. Things might improve if their doctors took more time to connect with them, according to Kenneth R. Ginsburg, MD, assistant professor of pediatrics.
“Their risk behaviors are really what affect their health,” Ginsburg told Health Plan Magazine. “For that reason, how we treat them in a medical setting has to be much more holistic.”
For his study “Factors Affecting the Decision to Seek Care: The Voice of Adolescents,” Ginsburg asked teens to identify and rate the reasons why they do or do not seek health care. Some top concerns: picking up germs and diseases at doctors’ offices and caregivers not respecting teens’ thoughts. Ginsburg noted that simple interventions—cleaning hands in front of them, for instance—can go a long way to assuaging fears.
The goal should be to improve communication between adolescents and health care professionals. What they don’t tell their doctor can harm them. The top cause of death of adolescents is accidents, largely related to drugs and alcohol. Violence and suicide rank as the second and third highest causes of death. And AIDS is one of the top killers of people in their 20s. The time is right for frank and honest talk about risk factors and good health practices. “We are talking about the onset of many behaviors that are going to affect health for the rest of their lives,” he said, “whether it’s substance abuse or how they deal with depression.”
Each time an adolescent comes into his office with an
earache or a sore throat, Ginsburg treats the problem and
then asks the teen about school or whether he or she is
happy. “Teenagers in crisis look for responsible
adults,” he said. “Doctors can close doors, so
teenagers can really open up if the doctor says the right
things. That can be absolutely lifesaving.”
The report appeared in the May/June issue.
Mademoiselle
Self
Premenstrual syndrome is a physical condition involving biological changes in the brain, hormone levels, and the immune system. That hasn’t always been understood—in 1987 PMS was labeled a mental disorder by the American Psychiatric Association—and only recently have researchers begun to zero in on a precise explanation.
A study published last January in The New England Journal of Medicine concluded that PMS symptoms occur when some women overreact to the normal ups and downs of the hormones estrogen and progesterone during the three to six days before their period. The study suggests that the brains of women with severe PMS may be genetically programmed to respond more sensitively to the fluctuation in hormone levels.
Most women experience low-level discomfort—bloating, fatigue, backaches—in the week before their periods. But 3 percent to 7 percent of women suffer through nearly unbearable bouts of tears, frustration, and rage that can have devastating effects. “I’ve had people tell me that every bad move they ever made in their lives—breaking up with perfectly good boyfriends, quitting perfectly good jobs—they made premenstrually,” Charlotte Furey, study coordinator of Penn’s premenstrual syndrome program, told Mademoiselle magazine.
Because of the diverse nature of PMS, some women may not realize they have it. Instead, they may focus on seeking treatment for a single problem, such as headaches or depression. Furey encourages her patients to keep a daily record of symptoms. Reviewing the journal with her patients, Furey separates true PMS symptoms from unrelated ones. She also explains how and why PMS symptoms can disappear for brief intervals. Good events can sometimes change brain chemistry enough to trump symptoms. “Your PMS can go away if you fall in love or get engaged,” Furey explained, “but it will come back when the excitement dies down.”
For many, happy thoughts are hardly enough to bring
relief. “Severe PMS is a disorder,” Ellen Freeman,
PhD, research professor of obstetrics and gynecology and
director of Penn’s premenstrual syndrome program, told
Self magazine. “To argue that it shouldn’t be
treated is analogous to saying we shouldn’t treat
depression.”
Reports appeared in the June issues.
LOCAL
Intelligencer-Record
(Upper Bucks edition)
Tribune (Scranton)
Herald-Standard (Uniontown, Pa.)
Public Opinion (Chambersburg, Pa.)
Express-Times (Easton, Pa.)
Patriot-News (Harrisburg)
New Lung Test a Breath of Fresh Air
Good news for anyone with a pulmonary disease like pneumonia, asthma, or emphysema: Penn researchers have developed a quicker and more accurate method of evaluating lung function. The advance promises to lead to quicker diagnoses and more effective treatment.
It’s called Micropore Membrane Inlet Mass Spectrometry. Co-inventors James E. Baumgardner, MD, PhD, assistant professor of anesthesia and bioengineering, and Bryan E. Marshall, MD, professor of anesthesia, presented the technique at the annual conference of the Shock Society of America in San Antonio in June.
Lungs function normally with a delicate balance of oxygen and carbon dioxide exchange. When this gas exchange is impaired, pulmonary distress results. For more than 20 years, the established research tool of studying impaired lung function was the Multiple Inert Gas Elimination Technique (MIGET). Complex and difficult, the method requires one to three tablespoons of blood and takes four hours to process. The new Penn method—building on the same basic mechanics of MIGET but adding a sensitive probe—requires just one teaspoon of blood and yields results in 10 minutes.
Baumgardner told the Intelligencer-Record that the new test enables doctors “to take this sophisticated technique out of the laboratory and into the clinical setting.” Said co-inventor Marshall: “The ability to measure lung function routinely, with the detail of a research lab, allows scientists to provide pulmonary disease patients with more accurate diagnosis, precise drug or other treatment, and specific assessment of progress or effectiveness of previous therapies.”
The doctors are collaborating with SpectrMedix Corp. of
State College to develop and market the technique.
Reports began June 17.
The Philadelphia Inquirer
Spina bifida is the most common debilitating birth defect, affecting about one in every 2,000 babies. It can cause leg paralysis, deformities, and brain damage. Sixteen weeks into her pregnancy, Mellissa Kipfmiller learned that her baby had a severe form of the disease, in which a nerve bundle protrudes from an unfused spinal cord.
Desperate for help, she was referred to N. Scott Adzick, MD, professor of surgery and director of the Philadelphia area’s only fetal-surgery program. On March 21, he performed corrective surgery on the then-23-week-old fetus, the first such surgery at Children’s Hospital. (Only one other hospital, Vanderbilt University Medical Center in Nashville, has reported performing the operation, a handful of times.) The happy ending: On May 2, a healthy, well-developed Noah Kipfmiller entered the scene.
“This is only one case, so clearly, before we can say anything definitive, we need to show this can work for a broad range of babies,” Adzick told The Philadelphia Inquirer. “But when you think of the incidence of this disease ... this is important.”
Adzick began developing his techniques for repairing the disorder six years ago when he was at the University of California, San Francisco. He theorized that nerve damage occurs not just because of the spinal defect, but because the nerves bump against the uterine wall and are attacked by the amniotic fluid. In sheep experiments, he showed that early intervention is crucial to prevent irreversible damage.
So, with the fetus weighing just one pound, Adzick and a team of specialists in maternal and fetal medicine went to work. Neurosurgery’s Leslie Sutton, MD, assisted in the historic surgery, stretching the skin surrounding the spinal defect to cover the protruding nerves, then sewed the skin shut.
Doctors can’t be sure Noah’s bladder and bowel functions are normal until he is toilet trained, but his legs work well. The only detectable deficit is below the knee on his right leg. On his spine, he has a slight bump and a scar. Another surgery to repair a layer of muscles will be done when he weighs about 10 pounds. Beyond that, doctors are optimistic, but they have no experience to draw on.
“This is pretty neat,” Adzick told the paper.
“We hope it will be the beginning of something
bigger.”
The report appeared on July 3.
The Philadelphia Inquirer
“Outpatient” surgery shouldn’t connote “minor” surgery, say Penn researchers. At a time when more than half of people who have surgery go home the same day, outpatients need to be more aware of what to expect post-surgery. So concludes a study conducted by K. Bobbi Traber, MD, assistant professor of anesthesia and medical director of HUP’s Admission Evaluation Center, and Beth Ann Swan, PhD, nurse practitioner at the School of Nursing.
“People come in with the perception, ‘Oh, ambulatory surgery, I’ll be fine,’” Swan told The Philadelphia Inquirer. “You’re not really fine. ... Because they don’t anticipate that, they don’t plan for that.”
Swan and Traber studied 100 patients who had hernia operations or laparoscopic procedures such as the removal of uterine fibroids or gallbladders at Abington Memorial and Jeanes hospitals and HUP in 1995. (Between 1992 and 1996, the percentage of U.S. surgeries performed on outpatients rose nearly 6 percent.) They found that two-thirds of the patients were in pain seven days after their surgery. Almost half experienced nausea and vomiting during the first 24 hours and 15 percent were queasy on the fourth day. Three of the patients fell ill at home. More than half were still unable to take care of themselves after a week. Only 22 percent had returned to work by then. “The recovery period is really being shifted into a person’s home,” explained Swan.
Traber said doctors are more aware of problems patients face at home than they were three years ago. Penn’s admission center tries to prepare patients for what recovery will be like before they’ve had surgery, but it doesn’t always sink in. During the surgery, anesthesiologists are using drugs that wear off more quickly and are less likely to cause nausea, Traber said. Doctors also are giving patients new, more effective anti-nausea medications and are getting better at managing pain at home.
Traber also pointed out that Penn will keep a patient in
the hospital without reimbursement if doctors believe the
patient is not ready to go home. Before they leave, patients
must be alert and able to walk, drink, and go to the
bathroom by themselves.
The report appeared on June 15.
Perspectives
“I can imagine college kids saying, ‘Hey, let’s have a Viagra party.’”--Arthur L. Caplan, PhD, director of Penn’s Center for Bioethics “Viagra Debate Vigorous” The Washington Post, 4/26
“Infants are perceived by many in our society as being vulnerable. Women are not perceived that way. Little babies aren’t supposed to die. Adults die.” --Joyce Thompson, nurse midwife “Maternal Mortality Too High” USA Today, 5/19
“What I love about sleep is it connects us so viscerally, so fundamentally, to the biology of the planet and other species. There is a kind of archaic innocence to that.” --David F. Dinges, PhD, associate professor of psychiatry [Subject: Drugs used to treat narcolepsy] Morning Edition, National Public Radio, 5/7
“We couldn’t be sure that the embryos were normal. And, you know, nobody asks to be born and wouldn’t it have been dreadful if something had gone wrong?” --Luigi Mastroianni, MD, professor of obstetrics/gynecology [Subject: Update on the first test-tube baby] News 10 First, 4/29
“Once a drug is on the market, the resources that the FDA has to monitor all of the drugs—to look at their real effects—is absolutely trivial.” --Brian L. Strom, MD, MPH, professor of medicine [Subject: FDA surveillance] CBS World News Roundup, 6/24
“After founding the University of Pennsylvania Health System in 1993, it took us a couple of years to evolve our thinking, because there wasn’t anyone else who had done quite this kind of thing—building a fully integrated academic health system. ... In effect, we transformed the way health care is delivered.”--William N. Kelley, MD, dean of the School of Medicine and CEO of Penn’s Health System “CEO Portrait: William N. Kelley” Philadelphia Business Journal, June 19-25
“There’s nothing wrong with looking to technology or wanting technology. It’s only wrong when the cost of it gets so large that we can’t meet basic needs. And technology gets to be a problem when we get so in love with it that we can’t stop it.” --Arthur L. Caplan, PhD, director of Penn’s Center for Bioethics “Caplan Grapples With Technology” Dallas Morning News, 6/14
Snips & Clips
CONSTANT CRAVING . . . With new insights into how the brain functions under drug dependency, researchers across the country are on the hunt for a drug therapy to treat cocaine addiction, though past attempts have failed. “We’ve tried 50 or 60 medications, and so far none is effective—zero,” Charles O’Brien, MD, PhD, professor and vice chair of psychiatry, told The Wall Street Journal. Armed with the knowledge that cocaine affects many kinds of brain cells—including those of the dopamine, serotonin, and norepinephrine systems— researchers are now investigating drugs designed to tweak neurochemical receptors in the brain and “vaccines” to mount immune responses against cocaine. O’Brien’s group is investigating propranolol, a beta-blocker known to reduce stage fright, to see if it can ease the symptoms of stress leading to relapse. Printed June 8.
STICK ‘EM UP . . . Last fall, a panel of NIH researchers concluded that acupuncture is effective in treating a number of conditions, including nausea and post-operative dental pain. According to People magazine, studies conducted by Abass Alavi, MD, professor of radiology and chief of the nuclear medicine division, went a long way toward convincing the panel that acupuncture isn’t quackery. Using an imaging technique called SPECT (single photon emission computed tomography) to view the brains of acupuncture patients, Alavi and colleagues found that after treatment, blood flow increased in the thalamus. Though the mechanism through which acupuncture relieves pain is still unknown, the studies confirmed that physiological—not just psychological—changes took place in the acupuncture patients. “This brings us a step closer to saying that acupuncture is not hocus-pocus,” said Alavi. Printed April 13.
DAIRY: QUITE CONTRARY . . . According to the National Dairy council, lactose intolerance affects about 20 percent of Americans. The inability to digest lactose, the milk sugar found in dairy products, is caused by a deficiency of the enzyme lactase, which breaks down the sugar. “Most cases of lactose intolerance run in families,” David C. Metz, MD, assistant professor of medicine, told Inside magazine. “As affected people get older, they manufacture less of the enzyme lactase and they can’t digest as much lactose as they did at a younger age. We don’t fully understand the mechanism.” Printed in the Summer 1998 issue.
HOG HEAVEN FOR HISTAMINES . . . Allergy sufferers, beware: The combination of a warm winter with a damp spring has allowed grasses and plants to flourish—and pollen and mold spore counts to soar. “Many people are having symptoms which are more severe than usual, and some people are having symptoms for the very first time in their entire lives because of El Niño,” Michael Phillips, MD, professor of medicine, told WPHL-TV’s 17 News at Ten. But new over-the-counter and prescription drugs for allergy sufferers can provide relief without drowsiness, says Phillips. Aired May 13.
HOW DO I LOOK? . . . Patients who plan to undergo cosmetic surgery at Penn can preview the results with the help of a medical aesthetician. Using graphic art techniques, medical aestheticians can alter the image of a patient’s face on a computer screen to simulate the effects of surgery. Patients can envision the results of surgery, “but once they see it in front of them, it just sets their minds at ease,” Jo-Ellen Cozen, a licensed clinical aesthetician affiliated with the Center for Human Appearance, told WTXF-TV’s Fox Ten O’Clock News. The technique also helps patients think realistically about the limitations of cosmetic surgery. Aired June 5.
MIND PAIN . . . Could your headaches actually be migraines? Most people get tension headaches, or mild pain and pressure surrounding the entire head, Steven Galletta, MD, professor of neurology, explained to WCAU-TV’s News 10. But migraines cause throbbing, excruciating pain on one side of the head or face and may be accompanied by nausea, vomiting, and a heightened sensitivity to noise and light. “We know we’re only seeing about one-third of the people in the United States who truly suffer from migraines,” said Galletta. People who have migraine symptoms should see their doctors; new prescription drugs are about 70 percent effective in relieving migraines, Galletta noted. Aired April 28.
BAD TO THE BONE . . . Fibrodysplasia ossificans progressiva, or FOP, is a rare genetic disorder characterized by excessive and uncontrolled bone growth. “The disease is commonly misdiagnosed,” Frederick S. Kaplan, MD, professor of orthopaedic surgery, told KYW-TV’s Eyewitness News 3, because patients in the early stages of the disease often have painful swellings that “look like tumors.” In fact, FOP sufferers are sometimes mistakenly given cancer treatments, including chemotherapy. Kaplan headed a team of Penn researchers that uncovered the inappropriate production of a protein that leads to FOP, the first insight into the molecular mechanism of the disease. Aired June 30.
MORAL COMBAT . . . Is it ethical to deny potentially life-saving treatments to some patients in the name of science? Chapman Medical Center in Orange, California recently backed out of an NIH-sponsored study of lung volume reduction surgery because only some participating emphysema patients would receive the surgery; others would be put on a regimen of physical therapy as a control. And, as a condition of receiving funding, centers participating in the clinical trial may only perform the surgery on patients enrolled in the study—even if a non-enrolled patient can afford to pay for the procedure out-of-pocket. “Morally and probably legally, it’s not possible to ask a doctor to not provide a treatment he believes is medically appropriate,” commented Arthur L. Caplan, PhD, director of Penn’s Center for Bioethics, in The Orange County Register. Printed June 16.
|
|
|
August 1998 George Beschen, Editor Marion Wyce, Assistant Editor Administration: Lori Doyle, Chief Public Affairs Officer Rebecca Harmon, Director of Media Relations Jacquelin Sufak, Director of Internal
Communications Media Review is published monthly by the University of Pennsylvania Medical Center’s Department of Public Affairs to keep the faculty and administration aware of recent Penn-specific media highlights. To make comments, e-mail beschen@mail.med.upenn.edu or write to Editor, Media Review, 218 Blockley Hall, 3400 Spruce Street, Philadelphia, PA 19104-4283. |
