PHILADELPHIA INTERNATIONAL MEDICINE NEWS BUREAU
Contact: Leonard N. Karp
lkarp@philadelphiamedicine.com
215-735-3989
For Immediate Release:
In this month’s issue:
1. Philadelphia International Medicine To Host Middle East Medical Exchange
2. New Jefferson Research to More Accurately Picture Extent of Colorectal Cancer
3. Temple University Hospital GI Department Offers Innovative Treatments
4. Crozer-Keystone Health System Again Named One of the Top Integrated Health Systems
Philadelphia International Medicine To Host Middle East Medical Exchange
Philadelphia - Philadelphia International Medicine is sponsoring a five-day clinical and business Philadelphia - Middle East Medical Exchange from Oct. 6 to 11, 2002. During the Medical Exchange, participants will be able to take part in meetings with clinicians and administrators at many of the best hospitals in the United States. A goal of the Medical Exchange is to develop business relationships with the hospitals of Philadelphia and key health care organizations throughout the Middle East. For more information, please call Nawal Khafaji, MD, at 215-735-3575, or email at nkhafaji@philadelphiamedicine.com. An enrollment form is attached.
As part of the Medical Exchange, participants will be able to meet with researchers and clinicians at Philadelphia International Medicine hospitals who are developing the new technology and procedures that will become the standards of patient care in the 21st century. Some examples of research and services at Philadelphia International Medicine hospitals are listed below:
New Jefferson Research to More Accurately Picture Extent of Colorectal Cancer
Researchers at Thomas Jefferson University Hospital, Jefferson Medical College and the Kimmel Cancer Center at Thomas Jefferson University, buoyed by a new five-year, $5 million grant from the National Cancer Institute, are beginning a clinical trial to determine whether a simple test for the protein that causes traveler's diarrhea will help provide surgeons and oncologists with a more accurate picture of the extent of colorectal cancer in patients.
The scientists hope the test will enable them to determine whether or not cancer has spread from the colon to the lymph nodes, and at the same time, result in improved diagnoses and more appropriate treatment.
The work, led by Scott Waldman, MD, PhD, Samuel M.V. Hamilton Family Professor of Medicine and director of the Division of Clinical Pharmacology at Jefferson Medical College, may ultimately result in a blood test that could tell patients whether their colorectal cancer thought cured has returned.
The test looks for evidence of a protein, guanylyl cyclase C, or GCC, which is expressed only by intestinal cells and colorectal cancer cells. Most colorectal cancers originate in the cells that line the intestine - cells that normally make GCC. When the cells become cancerous, they continue to make GCC.
According to Waldman, knowing the extent of disease is crucial to managing patients with colorectal cancer. Patients typically undergo surgery to remove the cancer and the nearby lymph nodes, which are the first place cancer usually spreads. After surgery, a pathologist examines lymph node tissue for cancer cells. If none are found, the patient is "staged" as having cancer confined to the bowel. But if cancer is found in the lymph nodes, the patient's prognosis and management changes.
But such a system is flawed because most pathologists examine only a thin slice of lymph node tissue, Waldman says, potentially missing a cancer. In addition, such a test lacks sensitivity, relying on a pathologist's eye to see colon cancer cells in a field of cells on a slide.
"There's clearly a problem with that system because about 20 percent of patients thought to have disease confined to the bowel show up with recurrent disease and ultimately die of the returning disease," he says. "There's thought to be micrometastases that have escaped histopathological detection."
Waldman uses a two-pronged approach: a powerful amplification technique called RT-PCR analysis to magnify the presence of cancer cells compared to normal cells and couples it with GCC, which he hopes will be a very specific marker for cancer. "Then you can take a lymph node and use the amplification technique to amplify the signal for cancer," he explains.
GCC appears to be very specific to colon cancer cells outside the intestine, and is only expressed in metastatic colon cancer cells that have spread there. By combining the marker with the amplification technique, which can detect one cancer cell in 10 million cells, researchers may have a very specific and sensitive way to detect metastatic colon cancer cells in the lymph nodes of patients undergoing colorectal cancer staging, he says.
"We hope to use this new molecular technique to improve the accuracy of colorectal cancer staging so that more people can receive chemotherapy and can benefit from it," he says. The trial, for which recruitment has already begun, is looking at approximately 2000 patients at five centers including Jefferson and the Fox Chase Cancer Center, also part of Philadelphia International Medicine.
The trial will examine RT-PCR-GCC analysis as a method to determine if disease spread to the lymph nodes and then follow those patients to see how they do clinically during the next five years. "We expect to find the GCC-RT-PCR analysis will identify patients who have tiny amounts of cancer in the lymph nodes that were undetected by histopathology," he says. "The pathology will be done in parallel with testing for GCC. We believe that the patients who are histopathology negative but GCC positive will do worse in terms of clinical progression - they will develop recurrent disease that was missed the first time. "
In a previous trial, Waldman and his Jefferson co-workers examined 21 colorectal cancer patients. One group of 11 patients had been disease-free for at least six years and deemed "cured." The other group of 10 patients developed recurrent disease within three years after cancer surgery. The latter had been told initially that they had no signs of cancer in their lymph nodes after surgery, meaning their cancer had not spread. When pathologists examined lymph node samples of each patient for the presence of GCC, they found the disease-free patients' lymph nodes showed no signs of the marker. Conversely, GCC was present in every patient whose cancer had returned.
Temple University Hospital GI Department Offers Innovative Treatments
Temple University Hospital's Section of Gastroenterology has a long history of offering novel diagnostic modalities, new therapies and clinical trials. The Section established the first Functional Gastrointestinal Disease Center in the country 18 years ago, and for several years in a row has been recognized by U.S. News & World Report as one of the leading GI centers in the country.
"We have a long-term commitment to using state-of-the-art technology and have a staff that is uniquely experienced," says Robert S. Fisher, MD, section chief of Gastroenterology. That commitment to technology and unique experience can be seen in many treatment therapies being offered at Temple. Among them are electric gastric stimulation and laser therapy. Each of these treatments requires highly specialized training and is not widely available.
Electric Gastric Stimulation Relieves Symptoms
In November 2000, Temple became the first in the region to place a gastric electric stimulator in patients with intractable nausea and/or vomiting related to diabetic or idiopathic gastroparesis. Early trials indicated that 50 percent of patients experienced significant symptom relief from this innovative procedure. Since then, the procedure has been FDA approved. At Temple, the treatment has proven to be even more successful than anticipated, providing significant symptomatic relief in 60 to 70 percent of patients.
"For the right patient, this procedure provides a marked improvement in quality of life," says Henry P. Parkman, MD, director of the Temple GI Motility Laboratory. Dr. Parkman plans to formally present his research findings in the near future.
Parkman, working with general surgeon John Meilahn, MD, laparoscopically places two stimulating wires into the stomach muscle and a pacemaker into a subcutaneous pocket in the right lower quadrant of the abdomen. The procedure takes from one to three hours and typically requires a two-day hospitalization.
"Once the stimulator is activated, we see a consistent improvement in symptoms over the course of a month," says Parkman. "We are seeing patients who have suffered with debilitating symptoms for years go back to work, attend school and generally be more productive."
Laser Therapy Eliminates Bleeding
Laser therapy has been available for the treatment of several GI conditions since 1984. However, the equipment is expensive and the learning curve steep, which may explain why the treatment is still only available at select centers such as Temple.
"We have used the laser since its introduction and have unmatched experience in the region when it comes to the application of the technology," says Benjamin Krevsky, MD, director of GI Endoscopy.
The Nd:YAG laser (Neodymium: Yttrium Aluminum Garnet) generates an infrared beam of light that is introduced through a fiberoptic cable. Temple physicians use the laser most often for the treatment of radiation proctopathy, esophageal cancer palliation and Barrett's esophagus ablation.
Radiation proctopathy is a common complication of radiation therapy in the treatment of prostate and cervical cancer. Patients may develop arterial venous malformations (AVMs) that bleed.
"The laser allows us to cauterize the AVMs without touching them," says Krevsky. "Non-contact means no further bleeding, which is a big advantage in using the laser."
Esophageal cancer is often diagnosed in its late stages when patients are suffering from severe dysphagia. The traditional therapy in this case is radiation, chemotherapy and stent placement. But laser treatment allows physicians to burn away tumor tissue and obviates the need for a stent. "Patients experience improved swallowing almost immediately and, unlike radiation, the laser procedure can be repeated as often as needed," says Krevsky.
Patients suffering from Barrett's esophagus benefit from the removal of the premalignant tissues that line the esophagus. "We have found that after burning off the Barrett's mucosa, the squamous cell mucosa usually regenerates," says Krevsky. Krevsky and his team are studying the treatment's long-term effects in limiting the progression to cancer.
Gastric antral vascular ectasias, or "watermelon" stomach, is the result of the proliferation of AVMs in the antral portion of the stomach. The cause of the condition is unknown although it has been associated with cirrhosis. Patients experience both acute and chronic bleeding and often require transfusions.
"We use the laser to burn off the abnormal vessels, which is followed by healing without recurrence of the vessels and a reduction in bleeding," says Krevsky. This cauterization process is done without contacting the tissue, which allows doctors to remove more vessels at each treatment session and be more precise, since blood is not blocking the operating field.
"Laser technology has many positive applications," says Krevsky. "And Temple is committed to finding the right applications for this valuable tool."
Crozer-Keystone Health System Again Named One of the Top Integrated Health Systems
For the third consecutive year, Crozer-Keystone Health System (CKHS) has been named among the "Top 100 Integrated Healthcare Networks" in the United States. CKHS ranked 62nd in the 2001 survey, published in Modern Healthcare magazine.
The health care rating process, conducted by SMG Marketing Group Inc., uses data generated from the facility lists provided by the individual health care systems, as well as data from several SMG surveys. The rating system analyzes each health care system's performance level in eight weighted categories: integration (24 percent), integrated technology (15 percent), financial stability (12 percent), outpatient utilization (10 percent), hospital utilization (10 percent), services and access (10 percent), contract capabilities (10 percent) and physicians (9 percent). CKHS received a score of 71.09.
"This survey is a testament to the fine physicians and employees affiliated with Crozer-Keystone Health System," says Joan K. Richards, chief operating officer of the Crozer-Keystone Health System and president of CKHS hospitals. CKHS is among the largest health systems in the state of Pennsylvania, averaging about 38,000 patient admissions, 27,000 surgeries and 200,000 primary care office visits per year among its five hospitals, 35 primary care sites and numerous long-term and community health services.
"We continue to provide patients high-quality care that is individualized and cost-effective," says Gerald Miller, president and chief executive officer of Crozer-Keystone Health System. "Despite the size and spectrum of our services, we are still able to coordinate our patients' care effectively."
Among individual hospitals, Crozer-Chester Medical Center was ranked among the top 100 critical care hospitals in the nation. The study looked at three ICU patient populations based on procedure and diagnosis codes: Patients with medical diagnoses, such as pneumonia, heart attack or stroke; patients who enter an ICU after surgery, such as bypass surgery, vascular surgery or lung removal; and patients on a ventilator for four days or longer.
SMG Marketing Group Inc. has conducted the annual survey of top integrated health systems since 1994, analyzing the performance of 578 health systems. In that time, CKHS has been ranked among the top 100 three times, reaching its highest ranking of 33rd in the nation in 2000.
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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