PHILADELPHIA INTERNATIONAL MEDICINE NEWS BUREAU
Contact: Leonard N. Karp
lkarp@philadelphiamedicine.com
215-735-3989
October 06, 2002

For Immediate Release:

In this month’s issue:

1. PET/CT Scanning Available at Fox Chase Cancer Center Aiding Physicians in Detecting and Accurately Diagnosing Cancers

2. More Than 100 Physicians at The Children's Hospital of Philadelphia Make Best Doctor's List

3. Stealth Surgery Available at Jefferson; Use of Infrared Optics Allows for Less Invasive Procedures

4. Allogeneic Stem Cell Mini-transplants at Temple University Hospital Show Great Promise Health Systems


PET/CT Scanning Available at Fox Chase Cancer Center Aiding Physicians in Detecting and Accurately Diagnosing Cancers

Philadelphia - Fox Chase Cancer Center, a member of the Philadelphia International Medicine (PIM) network of hospitals, is among the few medical centers now offering patients the newest in imaging technology called PET/CT scanning. PET/CT is the fusion of two advanced technologies that combine detailed images of a patient's internal anatomy together with a unique view of cell metabolic function, aiding physicians in detecting and accurately diagnosing various cancers.

"This is another example of how Philadelphia International Medicine hospitals bring the latest in patient care and technology to their patients," said Andrew Wigglesworth, president and CEO of PIM. "International patients and their physicians can take advantage of this new technology by calling PIM at 215-735-3575."

"PET/CT is the most sophisticated imaging equipment available and we're very excited to now offer this new technology to our patients," says Lee P. Adler, MD, chief of nuclear medicine and senior member at Fox Chase Cancer Center. "This technology will allow us to optimize the treatments we offer patients and ultimately achieve greater success in their care."

PET stands for positron emission tomography and it detects changes in cellular function - how cells are utilizing nutrients like sugar and oxygen. Areas with a high degree of metabolic activity have a greater chance of being cancerous. A computerized tomography or CT scan allows physicians to see the internal or anatomical structures within the human body. Together these two technologies make up the revolutionary PET/CT scan that enables Fox Chase physicians to view metabolic activity and pinpoint the location of abnormal lesions to target the disease more precisely.

"When used alone the PET and CT scans are good diagnostic tools, but when combined, they're much superior," says Adler. "The advantage here is the cancer is highlighted on the computer screen. We're able to pinpoint the location of the cancer, determine the extent of the disease, and evaluate the effectiveness of the patient's treatment," says Adler.

The PET/CT unit will be used at Fox Chase to determine if tumors are benign or malignant, to examine if prior therapy has been effective, and to detect if cancer has spread to other parts of the body. This technology will be particularly useful to more accurately diagnose and stage cancers of the lung, colon, breast, esophagus, and head and neck.

Before undergoing PET/CT, patients receive an injection of a sugar substance called fluorodeoxyglucose (FDG). This substance travels to cells throughout the entire body and is completely harmless. Since most cancerous tumors are highly metabolic, more of the FDG sugar substance goes to the cancer than to the normal tissue. During the procedure, the patient lies flat on a table that moves through a wide opening in the machine while the PET/CT images are taken. The areas within the body that absorb the FDG sugar are highlighted on the PET/CT computer screen indicating that cancer is present.

"We traditionally use CT scans to diagnose patients with cancer, however, we don't always know how extensive the disease is until we operate," says Melvyn Goldberg, MD, chief of Fox Chase's thoracic surgery program. "With PET/CT, we'll be able to more accurately stage our patients and avoid diagnostic surgeries. The PET/CT has the capability of finding cancers including those that have spread to other organs that are 8 millimeters in size, which is a huge improvement over CT alone," explains Goldberg.


More Than 100 Physicians at The Children's Hospital of Philadelphia Make Best Doctor's List

More than 100 physicians from The Children's Hospital of Philadelphia have been named as Best Doctors in America for 2001-2002 by leading specialists throughout the United States. The Children's Hospital is part of the Philadelphia International Medicine network of hospitals.

Physicians named from Children's Hospital represent more than 20 pediatric subspecialties including adolescent medicine, allergy immunology and infectious diseases, anesthesiology, cardiology, child development, critical care, dermatology, emergency medicine, endocrinology, gastroenterology and nutrition, general pediatrics, genetics, hematology, neonatology, neurology, obstetrics and gynecology, oncology, ophthalmology, orthopedics, otolaryngology, pathology, plastic surgery, pulmonology, radiology, surgery and urology.

Children's Hospital physicians of all specialties are internationally recognized in the clinical and research arenas, and provide the highest quality of care while maintaining a family-centered approach and advancing pediatric healthcare worldwide.

"The recognition of more than 100 physicians from The Children's Hospital of Philadelphia underscores this institution's position as a leader in the field of pediatric medicine," said Steven M. Altschuler, MD, president and chief executive officer of The Children's Hospital of Philadelphia. "Our clinicians and researchers are world-renowned and it is an appropriate honor that leading specialists from throughout the nation recognize Children's Hospital physicians as leaders in their fields."

The Best Doctors are selected by a survey that invites leading specialists from across the nation to name those specialists they would recommend to their own family members if they needed medical care. Each year, more than 30,000 leading specialists from throughout the nation and across 400 subspecialties of medicine are surveyed. The evaluations are peer-reviewed annually. Approximately 30,000 specialists from across the U.S. are listed as Best Doctors in America this year.


Stealth Surgery Available at Jefferson; Use of Infrared Optics Allows for Less Invasive Procedures

A combination of futuristic computer technology and traditional surgery is allowing surgeons at Thomas Jefferson University Hospital (TJUH) to successfully treat chronic sinus problems less invasively. TJUH is a member of the PIM network.

"Stealth" or image-guided surgery incorporates technology such as infrared optics, electromagnetic beams, "interactive" CT scans and sophisticated computers to treat sinusitis or sinus infection. Jefferson Hospital, one of the first hospitals in the Philadelphia area to offer stealth surgery, provided an in-depth demonstration of this innovative procedure during a live Webcast on Tuesday, Sept. 17.

Sinusitis or sinus infection is an inflammation and infection of the sinus cavities that occur when mucus that normally drains into nasal passages begins collecting in the facial sinuses instead. It is estimated that 35 million people develop sinusitis annually, making it one of the most common health conditions in the United States. Symptoms of sinusitis include postnasal drip, nasal congestion, fatigue, dental pain, troubled breathing and loss of smell.

Image-guided endoscopic surgery is usually recommended for patients with chronic sinus infections not responding to medications for this condition.

This three-dimensional mapping allows otolaryngologists-- head and neck surgeons-- to see more clearly as they make their way through the sinus cavities, thus minimizing the chance of sinus surgery complications and allowing surgeons to perform more thorough and safer procedures. This technique has been used extensively at Jefferson for the past six to seven years.

"The sinuses are entered through the nasal passageway much like going through a corridor and gaining access to rooms off the corridor," explained William Keane, MD, professor and chairman, Otolaryngology-Head and Neck Surgery, Jefferson Medical College of Thomas Jefferson University.

"Sinus surgery, in earlier years, required making an open incision on the face, or through the mouth to gain access to the sinus cavities," Keane said. These approaches require prolonged recovery time with greater discomfort and less successful results than with functional endoscopic sinus surgery (FESS)."

In the hands of a surgeon experienced with this procedure, FESS involves the insertion of an endoscope, a very thin fiber-optic tube, into the nose for visual examination of the openings into the sinuses. "Stealth" surgery, however, enhances FESS, said Marc R. Rosen, MD, assistant professor of Otolaryngology-Head and Neck Surgery, Jefferson Medical College of Thomas Jefferson University.

"The 'stealth' system provides the surgeon with a more precise ability to maintain orientation as he operates through the relatively complex anatomy of the sinuses," said Rosen.

After taking a special computed tomography (CT) scan of the patient's sinuses to create a "road map" of the patient's skull, the surgeon can correlate the CT image with the position of a probe. The surgeon places a hand-held probe in the patient's nose, while correlating the probe's position with the scan on a computer screen. This image-guidance system shows the location of the probe's tip so the surgeon can safely navigate through trouble spots.

The technology is particularly useful if a patient's sinus anatomy is unusual or the patient has already had one or more sinus procedures. In these cases, there is greater risk due to altered anatomy and loss of landmarks due to scarring left from the previous surgery.


Allogeneic Stem Cell Mini-transplants Show Great Promise

Temple's Bone Marrow Transplant (BMT) physicians are performing a new kind of transplantation that is showing great promise in patients with most types of blood malignancies, as well as renal cell cancer. The approach uses blood stem cells from matched related and unrelated donors along with very low intensity chemotherapy and radiation regimens (mini-transplants).

"We are over three years into our protocol, and in our first 36 patients we are seeing continuous, complete remissions with most forms of blood cancers, including acute myelogenous leukemia, myelodysplastic syndrome, chronic myelogenous leukemia, chronic lymphocytic leukemia, preleukemia, and multiple myeloma," says Kenneth F. Mangan, MD, FACP, Director of the Fox Chase-Temple BMT Program. "Many patients with relapsed non-Hodgkin's and Hodgkin's lymphomas are also responding, including patients with mantle cell lymphoma, a previously incurable malignancy."

Most of the patients participating in the protocol were over age 50 and had failed several conventional therapies, including autologous stem cell transplants. The goal of the protocol is to harness a graft-versus-tumor effect. "We want the tissue matched donor cells to attack the malignancy, so we do not rely on high-intensity chemotherapy or radiotherapy with this regimen," says Mangan. "We have virtually eliminated mortality from regimen-related toxicities with this approach."

The mortality rate with the mini-transplant approach is about half that of conventional, high-dose chemotherapy approaches. This lowered risk makes it possible for physicians to treat patients up to age 70 with matched related donors, and to age 60 with matched unrelated donors.

The approach has recently been expanded to treat metastatic kidney cancer. The Fox Chase-Temple BMT Program is one of the first programs to employ matched unrelated donors with the mini-transplant approach for this form of cancer. Chemotherapy options for metastatic kidney cancer patients are extremely limited and results are uniformly disappointing. The use of unrelated donors should allow access to this exciting new treatment for the more than 80 percent of these patients who do not have a matched sibling donor.

"Our regimen employs low doses of fludarabine and melphalan or cyclophosphamide, or just one dose of total body irradiation equivalent to one-sixth the usual dose," says Mangan. "In conjunction with other immunosuppressive medications, we have been successful in getting the graft in with almost no serious side effects."

Best Indications for Mini-Allogeneic Stem Cell Transplants:

All require HLA identical sibling or volunteer donor.


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.