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. Fox Chase Cancer Center Physicians Study Breast Cancer Vaccine
2. Thomas Jefferson University Hospital Researchers Conclude That Ultrasound Can Help Detect Ligament Wear and Tear in Athletes
3. Breakthrough Partial Surgical Approach Cured 91 Percent of infants of Hyperinsulinism
4. Penn Named One of Best in Nation at Incorporating Internet and Web Technology
Fox Chase Cancer Center Physicians Study Breast Cancer Vaccine
Philadelphia - Physicians at Fox Chase Cancer Center, a member of Philadelphia International Medicine, are testing a new vaccine for treating breast cancer.
Typically, vaccines (such as those for chicken pox or measles) are designed to prevent diseases by preparing the immune system for a possible attack. The strategy of therapeutic vaccines is to boost the body's immune system to fight cancer cells that may not be eliminated with traditional cancer treatment.
This vaccine study is for women whose breast cancer cells produce an excess amount of a protein called HER2. "HER2 is made at low levels by normal cells," explained Margaret von Mehren, MD, a medical oncologist at Fox Chase Cancer Center and principal investigator of the study. "In normal cells, the HER2 protein helps direct cells to grow and reproduce. Sometimes, cancer cells make too much HER2 protein, which causes these cells to grow uncontrollably."
The purpose of this study is to test the safety of the vaccine named delta-HER2 plus AS15 adjuvant. An adjuvant is a compound that enhances the human immune response. "The eventual goal in studying delta-HER2 is to see if it will help the body produce antibodies and other immune cells to attack the cancer cells that are making too much HER2 protein," added Dr. von Mehren.
The study is sponsored by GlaxoSmithKline Biologicals and Corixa. Fox Chase Cancer Center, one of the nation's first comprehensive cancer centers designated by the National Cancer Institute in 1974, conducts basic and clinical research; programs of prevention, detection and treatment of cancer; and community outreach.
Thomas Jefferson University Hospital Researchers Conclude That Ultrasound Can
Help Detect Ligament Wear and Tear in Athletes
For years, professional and weekend athletes alike have suffered from injuries occurring in the main ligament on the inner side of the elbow called the ulnar collateral ligament (UCL). From major league baseball pitchers to javelin throwers, repeated overhand throwing causes stress and tension in the elbow and can lead to significant damage.
A new study by radiologists and sports medicine specialists at Thomas Jefferson University Hospital, a member of Philadelphia International Medicine, published in the April issue of Radiology, indicates that diagnostic ultrasound can help detect wear and tear that occurs in the UCL.
The trial, led by co-investigators Levon N. Nazarian, MD, Thomas Jefferson University Hospital ultrasound specialist and professor of radiology, Jefferson Medical College of Thomas Jefferson University, and John McShane, MD, clinical assistant professor of family medicine and director, Primary Care Sports Medicine in the department of family medicine, Jefferson Medical College, used dynamic sonography to reveal the abnormalities of the anterior band of the UCL in 26 major league professional baseball pitchers. Dr. McShane is also a sports medicine specialist at the Rothman Institute at Jefferson.
"Our study shows the wear and tear that occurs on the UCL in baseball pitchers, even those who have no symptoms," said Dr. Nazarian. "This information can then be used as a baseline for comparison if the pitcher injures himself. We then re-image the elbow to see if any changes have taken place and decide if the pitcher needs surgery or other treatment."
Small tears in the ligament can eventually grow into one large tear. This could ultimately produce so much damage that the ligament is unable to hold the bones together strongly enough while the pitcher is throwing.
In the future, this approach may be able to predict who is at higher risk for injury. However Dr. Nazarian points out that long-term studies would be necessary before any conclusions could be drawn.
In a previous study, Dr. Nazarian had determined that diagnostic ultrasound could help treat tendon problems such as "tennis elbow." Using ultrasound as a guide, a needle is inserted into the areas that contain scar tissue. The needle is then used to break up and puncture the scar tissue and smooth any bony calcification. An injection of cortisone is then given to the area to enable the body to break up or dissolve the scar tissue, and lay down new tissue that is more elastic and lengthened, causing less stress and tension.
Breakthrough Partial Surgical Approach Cured 91 Percent of infants of
Hyperinsulinism
Researchers from The Children's Hospital of Philadelphia, a member of Philadelphia International Medicine, successfully cured 91 percent of infants of a rare but serious condition called focal congenital hyperinsulinism (HI). In this condition, excess levels of insulin cause low blood sugar, which may lead to irreversible brain damage in children.
Using a team approach combining medical tests, operative biopsies and precise, technically demanding surgery, the physicians were able to cure newborns of focal congenital HI without causing diabetes, a common complication of conventional HI surgery.
N. Scott Adzick, MD, surgeon-in-chief at The Children's Hospital of Philadelphia, described this research at the annual meeting of the American Pediatric Surgical Association.
Dr. Adzick reported results from a study of 34 children with a median age of 7 weeks who underwent surgery from 1999 to 2002 at The Children's Hospital of Philadelphia. As determined by both preoperative testing and an operative biopsy, all the children had the focal form of congenital HI, in which the abnormal tissue is confined to a limited area of the pancreas, the organ that produces insulin.
Of the 34 patients, 31 did not subsequently require medication to control their insulin levels. The remaining three children continued to require medical treatment for low blood sugar, but like all 34 patients, did not develop diabetes.
Both HI and diabetes involve an imbalance of insulin. Hyperinsulinism results from excess insulin; diabetes from insufficient insulin. While some forms of HI in infants are transient and relatively common, congenital HI is a rare genetic disease, with several subtypes, based on specific mutations.
The most severe forms of congenital HI affect an estimated 100 to 200 infants annually in the U.S. Of that number, approximately two-thirds may have the focal type, as found by the Children's Hospital team.
The Children's Hospital team uses medical tests performed by interventional radiologists to guide the diagnosis and the delicate surgery on the infant's pancreas, an organ the size of an adult's little finger.
The surgical team performed a partial pancreatectomy, removing the diseased portion of the pancreas while leaving the rest of the organ intact. In contrast, in the other form of congenital HI, diffuse HI, abnormal tissue permeates the pancreas, and 98 percent of that organ must usually be removed. This near-total pancreatectomy leaves the child at risk for diabetes.
At most centers where surgery is performed for HI, near-total pancreatectomies are the norm, because physicians are unable to accurately differentiate between diffuse and focal HI. Children's Hospital is the only center in the United States, and one of only two in the world, to perform partial pancreatectomies for focal HI.
The physicians use interventional radiology techniques to help distinguish focal HI from diffuse HI before the surgery. These are selective stimulation and sampling of blood vessels in different parts of the pancreas to help pinpoint the location of the abnormal cells. During the surgery, they use pancreatic biopsies, analyzed rapidly by a pathologist, to confirm that diseased tissue is removed.
"We draw on the talents of a full team -- pediatric endocrinologists, radiologists, pathologists and surgeons -- to achieve these results," said Charles A. Stanley, MD, chief of endocrinology at Children's Hospital.
"This team approach enables us to distinguish focal disease from diffuse disease, identify the specific site of the focal lesion and perform a surgical cure for the vast majority of children with focal hyperinsulinism."
Penn Named One of Best in Nation at Incorporating Internet and Web Technology
The University of Pennsylvania Health System (UPHS), a member of Philadelphia International Medicine, has been named one of the nation's "Most Wired," according to the 2003 Most Wired Survey and Benchmarking Study, released by Hospitals & Health Networks magazine.
"Information has become an essential medical tool for our healthcare workers - every bit as important to patient care as any other diagnostic device," said George Brenckle, PhD, Chief Information Officer of UPHS. "It is our goal to facilitate the seamless processing and retrieval of patient information and allow our patients to feel confident in our abilities to care for them while respecting their privacy."
Hospitals & Health Networks conducted the survey, in cooperation with McKesson Corp. and the Healthcare Information and Management Systems Society (HIMSS). It measures the nation's hospitals on their use of Internet technologies for safety and quality, customer service, disaster readiness, business processes and workforce issues.
"Hospitals are empowering patients with information and providing tools to doctors and nurses to improve quality," says Alden Solovy, executive editor of Hospitals & Health Networks, the journal of the American Hospital Association.
The 100 Most Wired are providing Web-based patient education at the bedside, disease-specific self-assessments online and are linking clinical equipment to feed patient readings directly into the medical record. "Patient care is at the heart of these initiatives," Solovy says. "The nation's 100 Most Wired hospitals are emphasizing clinical quality and patient services in their efforts to remain technology leaders."
Most Wired hospitals are using Web-based technologies to feed readings from
clinical equipment directly into the medical record:
· 70% of Most Wired organizations push readings from cardiac function monitors
to medical records
· 71% of Most Wired organizations push blood glucose monitor readings to
medical records
Most Wired hospitals continue their drive to make customer services available
via the Internet:
· 42% provide preregistration
· 87% provide physician referrals
· 53% provide appointment scheduling
Most Wired hospitals are deploying electronic disease surveillance systems:
· 55% have partially electronic methods of disease surveillance
· 26% have fully electronic methods of disease surveillance
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