PHILADELPHIA INTERNATIONAL MEDICINE NEWS BUREAU
Contact: Leonard N. Karp
lkarp@philadelphiamedicine.com
215-735-3989
For Immediate Release:
In this month’s issue:
1. Cryoablation Research at Temple Can Lead To New Treatment for Uterine Bleeding, Colon Cancer
2. New OR Suites at Jefferson Use Voice Activated Technology
3. University of Pennsylvania Researcher Finds Drugs Designed To Fight Depression May Also Prevent
Heart Attacks4. In Spirit of Season, Magee Helps Others Around the World
Cryoablation Research at Temple Can Lead To New Treatment for Uterine Bleeding, Colon Cancer
Philadelphia - Tests now underway at the Temple University Hospital and School of Medicine, members of Philadelphia International Medicine, may lead to new ways to treat uterine bleeding, and could prove beneficial in treating Barrett's esophagus and colon cancer. The research on a technique called cryoablation, is just one example of the Philadelphia region's dominance as a center for medical research and education.
"With more than $400 million a year in medical research funded by the National Institutes of Health alone, the Philadelphia region is one of the chief medical centers in the United States," said Andrew Wigglesworth, president and CEO of Philadelphia International Medicine.
"Various research projects now underway at Temple University Hospital, the University of Pennsylvania Health System, Thomas Jefferson University Hospital, Fox Chase Cancer Center, MossRehab, Magee Rehabilitation Hospital and Crozer-Keystone Health System create a foundation of medical expertise that can't be matched by any other single center in the United States."
As an example, researchers at Temple are testing cryoablation, a colorless perflurocarbon (PFC) liquid chilled to -30 degrees Celsius which is introduced into an organ cavity to freeze diseased tissue without harming surrounding healthy tissue. Initially, cryoablation is being tested in treating abnormal uterine bleeding, a condition for which 1 million women in the US seek treatment each year. While the research at present is focusing on uterine bleeding, it may also be beneficial in treating other disorders requiring ablation in a hollow organ, such as the colon, esophagus and eye.
Though freezing tissue with PFC liquid is new, the substance has been used for almost a decade to help infants and adults with difficult respiration breathe more easily.
The uterus, colon, esophagus and eye are all hollow and have irregular internal surfaces that are difficult to access with instruments. Liquids can reach the entire surface area.
Currently, women with abnormal uterine bleeding typically undergo repeated procedures because it is difficult to locate and excise diseased tissue. Often, hysterectomy is chosen when a less radical treatment would suffice.
Temple researchers envision a day when cryoablation will join accepted pre-hysterectomy treatments such as dilation and curettage, laser ablation or surgical removal of tissue with probes. It has the added advantage of being non-invasive, more thorough and safer.
New OR Suites at Jefferson Use Voice Activated Technology
Thomas Jefferson University Hospital, a member of PIM, has opened one of the most highly developed and technologically equipped set of operating rooms (ORs), allowing surgeons here to perform more innovative and minimally invasive procedures.
The suite of four minimally invasive surgery (MIS) operating rooms is equipped with technology that allow physicians to operate equipment, such as a robotic arm or overhead lights, just by speaking or by using a touch pad.
Jefferson University Hospital officials and medical staff anticipate that the time span needed to complete surgical procedures will be significantly reduced, said Sherry Josue, RN, nursing services vice president, perioperative services, Jefferson University Hospital.
"These are the ORs of the future," Josue said.
Surgery has traditionally required an "open" incision, where the surgeon makes a 25-centimeter cut to expose the patient's organ. The procedure can take several hours. In addition, the patient faced four to five days of hospitalization and a six- to eight-week recovery period.
Laparoscopic surgery, sometimes called "keyhole" surgery, however, is a less traumatic procedure, that involves making relatively small incisions. The specially skilled surgeon uses an endoscope and small "ports" through which are passed miniature instruments. The scope enables the surgeon to watch what he or she is doing on video monitors. This method reduces surgery time and, because it is less invasive, a patient's hospital stay and recovery period is minimized, Josue said.
Among the laproscopic procedures that can be performed in the MIS ORs are:
Studies have shown that having dedicated MIS suites at hospitals can reduce costs. As much of the equipment in these ORs are on ceiling mounts that swivel out of the way as the room is being cleaned, the time to set up and put away equipment between procedures is eliminated. Ceiling-hung equipment booms also hold equipment up off the floor, which might otherwise be cluttered with carts. The boom technology can also help reduce the risk of infection. The booms allow for uncluttered floor space, making it much easier to clean and disinfect the floors properly without having to relocate a lot of equipment.
The advanced hands-free or voice-activated system known as HERMES also helps to eliminate the need for surgical team members to touch equipment outside the sterile field, further reducing opportunities for contamination.
The MIS ORs were also designed to accommodate AESOP, a robotic arm that holds a camera and endoscope assembly for the surgeon during an endoscopic procedure. Not only does AESOP reduce the need for a person to do this task, but in many instances the robot arm does a better job by moving precisely where the surgeon commands, providing a rock-steady image and never fatiguing.
The MIS suites also have a video camera system in place to provide live video to other locations for teaching purposes. Jefferson University Hospital produced its first live Webcast of a surgical procedure, a laproscopic nephrectomy, in one of the new ORs on October 23.
Because of the high demand on surgical facilities at Jefferson University Hospital and the need to keep the time ORs are out of service to a minimum, the MIS suites were designed and constructed within a very short span of time. After initial planning, the task was completed in three months as compared to the average development and construction time of 12 to 18 months.
For more information on the OR suites, call Philadelphia International Medicine at 215-735-3989.
University of Pennsylvania Researcher Finds Drugs Designed To Fight Depression May Also Prevent Heart Attacks
In a large study of smokers, the researchers associated a class of antidepressants, called selective serotonin reuptake inhibitors (SSRIs), will lower heart attack risk. These findings are published in the latest issue of Circulation: a journal of the American Heart Association.
"We found a 65 percent reduction in risk of a heart attack among SSRI users compared to nonusers," said Stephen Kimmel, MD, who is an associate professor of medicine in the University of Pennsylvania Health System Cardiovascular Division and the department of Biostatistics and Epidemiology. "How it works is still unknown, but we have reason to believe that, like aspirin, SSRIs act to thin the blood and prevent clotting."
In the study, Kimmel and his colleagues compared people who were hospitalized for a first heart attack (653 people) with a randomly selected group of people who had no history of a prior heart attack (2,990 people). All patients in both groups were smokers.
Of the 143 SSRI users identified, 87 percent said they were taking the drugs for depression; 3.5 percent for anxiety and 9.1 percent for unknown or other indication. Patients were studied over a 28-month period and were between the ages of 30 and 65 years old. The SSRIs identified in this study included fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil) and sertraline (Zoloft).
"We actually collected this data for a study to test the value of nicotine patches in preventing heart attacks, since smoking is a high risk factor," said Kimmel. "In doing so we also collected detailed information about the prescription drug use of participants in the study."
The data Kimmel and his colleagues received allow them to also compare the risk of heart attacks in people who used antidepressants. In addition to smoking, studies have also suggested that depression may be a risk factor for heart disease and is linked to a higher probability of death after a heart attack. Earlier studies had suggested the association between antidepressants and lower heart attack risk. With the ready made pool of information, this study became the largest of its kind to examine whether SSRIs prescribed for depression lowered the risk of a first non-fatal heart attack.
The researchers were not, however, able to directly determine from the data how SSRIs may protect from heart attack. According to Kimmel, the study could not distinguish between whether the beneficial effects of treating depression reduced the risk of heart attack or if it was the SSRIs' pharmacological effects. As devised, the study did not involve the use of validated depression scales, which are used to assess the severity of depression - and therefore were unable to reach a definitive conclusion.
Tentatively, Kimmel and his colleagues theorize that the drugs might protect the heart the same way aspirin does, by preventing platelets, the parts of the blood that form clots, from clumping together. The majority of heart attacks are caused by blood clots.
"However provocative, these are just preliminary findings," said Kimmel. "We did not start out looking at this problem, exactly, but it does provide a springboard for further research - both statistically, such as ours, and in the laboratory."
In Spirit of Season, Magee Helps Others Around the World
Magee Rehabilitation Hospital is doing its share to improve access for persons in need worldwide to gain access to wheelchairs.
Occupational Therapists Julia Santini and Kelly Somma are spearheading a drive by Magee Rehabilitation Hospital's therapy team to collect wheelchairs that are no longer being used or needed. The Wheels for the World collection took place earlier this year.
The donated chairs have been placed in storage until they are delivered to area prisons where inmates will repair and refurbish the chairs prior to shipment to countries where they are in need, such as Ghana and Romania.
Wheels for the World has distributed over 8,000 wheelchairs to over 40 countries. The wheelchairs are taken overseas by teams of physical and occupational therapists, as well as others, who personally fit each chair for the client's needs. Wheels for the World is designed to meet the physical, emotional and spiritual needs of people with disabilities in practical ways.
Philadelphia International Medicine is an organization that provides medical and patient support services to international patients. It also provides continuing medical education and health care training and education to international physicians, administrators and other practitioners. As the international department of several Philadelphia-area hospitals, international patients gain access to physicians and hospitals rated among the best in the world through one telephone call to PIM. You can reach PIM by calling 1-215-735-3575; fax, 1-215-790-1267; or e-mail, physicians@philadelphiamedicine.com. You can find out more about PIM through its Website at www.philadelphiamedicine.com.
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