PHILADELPHIA INTERNATIONAL MEDICINE® NEWS BUREAU
Contact: Leonard N. Karp
lkarp@philadelphiamedicine.com
215-735-3989
In this month's edition of the PIM News Bureau:
1. PIM/Jefferson Internet Webcast to Highlight Diagnostic Technique for Lung Cancer
2. MossRehab Conducts Video Seminar with Italy Rehabilitation Hospital
3. Crozer-Keystone Presented Leadership Award for Work in Evidence-Based Medicine
PIM/Jefferson Internet Webcast to Highlight Diagnostic Technique for Lung
Cancer
Philadelphia -- Thoracic surgeons at Thomas Jefferson University Hospital are taking advantage of a technique that is a safer, more accurate way to diagnose a variety of diseases of the lung, most notably, lung cancer. The technique, video mediastinoscopy, is especially aimed at helping surgeons both diagnose and stage lung cancer. Philadelphia International Medicine® (PIM) and Thomas Jefferson University Hospital will hold a live internet webcast demonstration of the technique on June 4. Taine T.V. Pechet, MD, will conduct the mediastinoscopy procedure, as Joseph Friedberg, MD, narrates.
The webcast is available to international physicians, medical organizations and PIM affiliates. To participate in the live webcast, please contact Lucia Rosenberg of PIM at lrosenberg@philadelphiamedicine.com as soon as possible.
"Video mediastinoscopy allows greater visualization of the mediastinum, making it easier to see and safer than the basic mediastinoscopy procedure alone," says Joseph Friedberg, MD, director of the Division of Thoracic Surgery at Thomas Jefferson University Hospital. "It's the difference between looking through a tunnel and looking through a telescope," he says.
According to Dr. Friedberg, video mediastinoscopy is especially important in both determining the pathological stage of lung cancer - that is, whether or not a lung cancer has spread to the lymph nodes within the chest, and determining appropriate treatment based on stage. Patients with disease in the mediastinal lymph nodes may be better treated with chemotherapy and radiation prior to surgery, which has been shown to improve survival, explains Dr. Friedberg. At the same time, video mediastinoscopy may also help avoid unnecessary surgery.
Mediastinoscopy is a procedure in which a six-inch hollow scope is inserted into the airway, allowing the surgeon to see better. But its effectiveness is limited. In video mediastinoscopy, which has only been available in the last few years at various medical centers across the country, a tiny camera is attached to the end of the scope, magnifying and projecting an image onto a screen. Seeing such enlarged images enables surgeons to make more definitive diagnoses of both benign diseases of the chest such as sarcoidosis and more serious problems such as lymphoma, metastatic lung cancer and other types of cancer that may have spread to the mediastinal lymph nodes.
The procedure, along with two others, will be demonstrated and discussed on the Internet during a June 4 webcast from the operating rooms of Thomas Jefferson University Hospital.
Jefferson thoracic surgeons perform an estimated 200 video mediastinoscopies a year.
"Video mediastinoscopy is easier to teach, safer to do and probably will be more widely adopted in the near future for establishing the stage of lung cancer," Dr. Friedberg says.
Jefferson thoracic surgeons are also using a scope and a camera to determine if a lung nodule is cancerous. The procedure, called video-assisted thoracoscopy for wedge resection, is aimed at minimizing the extent of surgery and decreasing the amount of pain for the patient. During this procedure, a surgeon makes three tiny incisions in the rib cage, inserting an endoscope (a telescope connected to a small video camera) through one of the incisions. While viewing the lungs on screen, he removes a "wedge" - the suspected tumor and some surrounding tissue. The wedge is subsequently sent to a pathologist, who tests the tissue sample to see if it is benign or cancerous.
"It's a way of definitively identifying what a nodule is in a lung," says Dr. Pechet, assistant professor of surgery at Jefferson Medical College. "Complete excision is far more accurate than a needle biopsy in finding out if there is cancer."
If the pathologist determines that a tissue sample is cancerous, Dr. Pechet will continue the operation and may make a larger incision to remove an entire lobe of the lung. At the same time, he says, "If it is not a cancer, we have saved this patient a large incision and the benign disease is removed."
The procedure "is minimally invasive, probably has faster recovery time, less pain and tissue trauma, and gives an equivalent surgical result," he says, when compared to open surgery.
Surgeons at Thomas Jefferson University Hospital are finding success by combining light-based cancer therapy with surgery to treat patients with advanced lung cancer that has spread within the chest. While the number of patients treated to date is small, many patients are living three to four times longer than did those patients who did not receive the therapy.
Non-small cell lung cancer (NSCLC) is one of the most difficult cancers to treat, particularly when it spreads to the lining of the chest cavity. Even if the cancer is operated on, the disease returns in as many as 90 percent of patients. Survival frequently is measured in months. Results with chemotherapy - the current standard of care - are disappointing, with most patients living only between six and nine months.
Dr. Friedberg is trying another way. He is leading a clinical trial examining the effects of light, or more specifically, photodynamic therapy (PDT), on this type of advanced NSCLC. Such patients have cancer that has "broken out of one lung and seeded the lining of the chest cavity," he explains.
In PDT, a nontoxic photosensitizing agent, photofrin, is injected into the bloodstream and absorbed by cells all over the body. These compounds tend to concentrate more in cancer cells than in normal cells. When the compound is exposed to a certain wavelength of light, it absorbs the light energy and produces a form of oxygen that kills the cells. The damage occurs only where the light is shined.
In the study, each patient is given chemotherapy until the cancer stops responding, meaning the disease begins to grow again. If the cancer has not spread beyond the chest, the patient then receives photofrin 24 hours prior to surgery to remove the tumor. During surgery, he or she receives an appropriate dose of light therapy.
MossRehab Conducts Video Seminar with Italy Rehabilitation Hospital
MossRehab, a member of Philadelphia International Medicine, partnered with colleagues from Villa Beretta in Italy to host a CME education seminar entitled "Evaluation and Management of Muscle Overactivity and Joint Contracture in Persons with Upper Motor Neuron Syndrome."
The conference linked by videoconferencing an audience attracted many physicians and clinicians from the Mid-Atlantic area. The program in downtown Philadelphia provided physicians with an understanding of the functional consequences of Upper Motor Neuron Syndrome (UMN). Renowned researchers, diagnosticians and surgeons from the MossRehab and the Jefferson Health System presented the latest methods of evaluation and treatment of disabling impairments related to UMN (upper motorneuron) syndrome such as: muscle overactivity, spasticity and contractures. Presenters showcased through educational multi-media the impressive patient functional outcomes utilizing the latest diagnostic and treatment modalities.
A presentation by Franco Molteni, MD from Valduce Hospital Rehabilitation Center Villa Beretta Costamasnaga, Italy reaffirmed the advantage of developing educational partnerships with the treatment teams in Philadelphia. Video conferencing is now used consistently to keep the Italian and Philadelphia teams in frequent communication and allows patient evaluations.
Crozer-Keystone Presented Leadership Award for Work in Evidence-Based Medicine
Crozer-Keystone Health System is one of only six health care organizations in the nation to receive a 2003 Leadership Award from VHA Inc., a nationwide network of leading health care organizations and their affiliated physicians. The annual awards, which were presented during the VHA Leadership Conference in Boston, recognize health care organizations for their efforts to improve clinical effectiveness, operational performance and service, supply chain management and community health.
Crozer-Keystone received the 2003 Leadership Award for Clinical Effectiveness in a Health Delivery System category. The award recognizes clinical cost and quality initiatives. Crozer-Keystone won the award this year for achieving an Evidence-Based Medicine (EBM) culture.
"It is a great honor to have our hard work and dedication recognized by VHA," says Marc Edelman, CKHS vice president, who is overseeing the CKHS evidence-based medicine initiative. "It's a tribute to our clinicians, staff, managers and everyone involved in the Evidence-Based Medicine program."
The EBM program is based on the idea that patient care for many common conditions should follow certain guidelines that - based on solid medical evidence - have proven to bring about positive outcomes.
Launched in 2001, the EBM Task Force began by examining two of the most frequently treated conditions across the health system - acute myocardial infarction and community-acquired pneumonia. The goal in 2002 was to sustain improvement in clinicians' implementation of the evidence-based clinical guidelines.
After 18 months, the results are impressive. The acute myocardial infarction project has improved the use of aspirin at admission by 4 percent, while the average time to angioplasty is down by 33 minutes and the average time to thrombosis has decreased by 53 minutes. The community-acquired pneumonia project is also causing a major change in the process of care. In addition, Dale Schumacher, MD, MPH, CKHS clinical informatics officer, and Suzanne Jenkins, director of CKHS Evidence-Based Medicine, are working with the clinical staff on six more EBM projects that are either in progress or under development as a result of the initial success of the program.
These new and existing EBM projects will continue to incorporate the evidence-based medicine principles and capabilities into the treatment of inpatients and outpatients, as well as physician and staff education.
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.