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. Temple Gastroenterology Investigates New Treatment for Gastroparesis
2. Men At Greater Risk of Developing Prostate Cancer When A Brother Has the Disease; Fox Chase Cancer Center Study Finds Risk is Increased Nearly Three-Fold
3. Burn Treatment Center at Crozer Marks 30th Year
Temple Gastroenterology Investigates New Treatment for Gastroparesis
Philadelphia - Researchers in the gastroenterology department of Temple University Hospital, part of the Philadelphia International Medicine® network, are studying the effect of Botulinium toxin, commonly known as Botox ®, as an alternative therapy for patients with gastroparesis whose condition has not improved with standard treatment.
"This research, funded by the American College of Gastroenterology, is the only randomized, placebo-controlled, blinded study of the effects of Botulinium toxin on gastroparesis that we know of," says Frank Friedenberg, MD, associate professor of medicine at Temple, who is leading the study. "We believe this non-invasive approach may be an effective therapy with fewer side effects than current treatments."
Gastroparesis often occurs in people with Type 1 or Type 2 diabetes but, states Friedenberg, "it can also be caused by post-viral syndromes, anorexia nervosa, stomach surgery and certain medications such as narcotic analgesics and drugs with anticholinergic properties."The symptoms of gastroparesis, which include heartburn, nausea, early satiety, vomiting of undigested food, weight loss and bloating, are similar to those found in certain other disorders such as peptic ulcer disease and upper GI tract malignancy. Diagnosis is made using a gastric emptying scan that measures stomach emptying after a radiolabelled meal.
The primary treatment for gastroparesis in diabetic patients is the control of blood glucose levels to prevent damage to the nerves that control movement of food in the stomach. Diabetic patients with astroparesis also frequently improve with tight glucose control. A change in eating habits is recommended as well. Smaller portions and a low-fat, low-fiber diet that is easy to digest frequently ease symptoms.
Current medical treatments include drugs such as metoclopramide, erythromycin, domeperidone and tegasarod; however, efficacy is inadequate for nearly half of patients. These medications also have side effects such as sedation and diarrhea that may discourage continuation of therapy.
When medical therapy fails, other treatments include parenteral nutrition, venting jejunostomy, pyloroplasty, gastric pacemaker insertion and, in particularly severe situations, total gastrectomy.
Friedenberg's study on Botulinium toxin follows preliminary research conducted at Temple with ten gastroparesis patients. In that study, 70 percent of patients experienced a reduction in their symptom after being treated with Botox ®.
The Botox ® treatment is simple and non-invasive. Botulinium toxin is injected directly into the pyloric sphincter muscle to block the release of acetylcholine, relax the smooth muscle tissue and improve the passage of gastric contents into the small bowel. Botox ® works locally and no systemic side effects have been noted in other clinical trials. Patients can leave the hospital within two hours of the procedure.
"This research study is not only about relieving the symptoms of this condition, but also about improving our understanding of the pathophysiology of gastroparesis," says Friedenberg. "Our study examines the changes in regional gastric emptying and looks at changes in the electrical activity of the stomach pre- and post-injection."
Temple University Hospital's Gastroenterology Section has the nation's first Functional Gastrointestinal Disease Center where patients can be treated by a team of gastroenterologists, psychiatrists and nutritionists. Temple's experts have published in the fields of motility, endoscopy, laser cancer therapy, acid/peptic disorders and hepatology.
Men At Greater Risk of Developing Prostate Cancer When A Brother Has the
Disease;
Fox Chase Cancer Center Study Finds Risk is Increased Nearly Three-Fold
It has been well-established that the risk of prostate cancer is increased among men who have a first-degree relative (father, son, brother) with the disease, but new research shows the risk is greatly increased for men who have a brother with prostate cancer. The meta-analysis research led by Deborah Watkins Bruner, PhD, at Fox Chase Cancer Center, a member of Philadelphia International Medicine, was published online Sept. 12, 2003, in the International Journal of Cancer.
"This study is the first to report a statistically higher risk associated with having a brother with prostate cancer than having an affected father," said Bruner.
Bruner, director of the Prostate Cancer Risk Assessment Program at Fox Chase, and her colleagues conducted a systematic review and meta-analysis of the current literature, using 23 of 332 published studies that met meticulous criteria.
The results confirmed an increased risk of prostate cancer for men with a family history of the disease, but the meta-analysis revealed a 2.9 fold increased risk when the affected relative was a brother. The risk increased 1.8 fold when the affected relative was a second-degree family member (a grandfather or uncle), and 2.1 fold when the relative with prostate cancer was a father.
"Unlike the maternal-child pattern that we see with inherited breast cancers, a brother with prostate cancer was associated with a significantly increased risk of the disease compared to a father or any other relative with the disease," explained Bruner. "This may suggest that the risk may be related to shared environmental factors such as dietary exposures or age of onset of disease, which might reveal a stronger genetic risk."
Bruner said this is another crucial step to better identify who is at risk of developing prostate cancer. "The ultimate goal is to reduce unnecessary screenings and biopsies by identifying at-risk populations and better tailor prostate cancer screening for those men."
Bruner concluded by saying more research into patterns of inherited prostate cancer risk is needed. "We need to assess the risk of disease associated with younger age (less than 65 or 70 years) of onset, dietary habits and lifestyle behaviors that may interact with inherited genes to increase prostate cancer risk."
Burn Treatment Center at Crozer Marks 30th Year
Burn care has seen many changes since the Nathan Speare Regional Burn Treatment Center at Crozer-Chester Medical Center, a member of Philadelphia International Medicine, opened its doors in 1973. Improved technologies and treatment techniques have enhanced survival rates for burn patients. Also, increased awareness and product improvements have reduced the incidence and severity of many types of burn injuries.
But as physicians, nurses and staff members mark the Burn Treatment Center's 30th year in operation, one thing has remained constant through the years: the Burn Treatment Center's dedication to providing the highest level of burn treatment to adults and children.
Just ask Joe Adamson. In 1994, Adamson was burned over 80 percent of his body in an industrial accident. An explosion threw Adamson through a wall and set him on fire. He was immediately flown to the Burn Treatment Center, where he was given a 1 percent chance of survival. Through the efforts of the center's physicians and staff, he made it through those first frightful days. And after more than a year of treatment, rehabilitation and counseling, he was able to return home to his wife and two children.
Though he still suffers from the effects of his burns, Adamson is thankful for the life-saving efforts of the Burn Treatment Center staff. "The staff at the Burn Center did a beautiful job. Everyone there is the greatest - so friendly and hard-working," says Adamson. "The staff became like family to me. I still look forward to seeing everyone when I return for my treatments."
Adamson - like many patients - was aided by the comprehensive, multidisciplinary approach of the Burn Treatment Center. The center, which treats about 300 patients each year, is the only burn facility in suburban Philadelphia that provides all of the services needed to meet the needs of burn patients and their families within a single unit. It is one of only 65 burn centers in the nation that meet the criteria of the American Burn Association's Burn Center Verification/Consultation Program. This means that the center has met the highest standard of care for burn patients as approved by the American College of Surgeons.
Since its inception, this team has been committed to using the latest technologies and techniques. The Burn Treatment Center was one of the first facilities to use cultured cell transplantation, or cloning of a patient's skin, and the team also helped design the shower trolley used in the cleansing of burn wounds.
During his 22 years with the center, Linwood Haith, MD, co-director of the Burn Treatment Center, has seen advancements in the treatment of burns. "The rate of survival from severe burns has definitely improved as the result of improvements in burn care," he says. "We have seen a more aggressive approach to the treatment of burn wounds, including earlier surgery and increased use of skin substitutes."
In addition, educational efforts - led in part by the Burn Treatment Center's extensive community outreach activities - and governmental regulations have changed the nature of burn injuries, according to Haith. The center treats fewer burns from workers in industrial accidents, adolescents in train yards, and smokers who fall asleep, for example.
Over the years, the Burn Treatment Center has broadened its expertise to include treatment of such skin disorders as Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis Syndrome (TENS); and necrotizing fasciitis, or flesh-eating disease.
No matter the nature or severity of his or her injuries, each patient who comes to the Burn Treatment Center benefits from 30 years of experience.
Mary Lou Patton, MD, co-director of the Burn Treatment Center, has been with the center for 19 years. She says, "Our patients certainly benefit from our experience. Over the years, we have had the opportunity to treat a vast array of burn injuries, which means that we most likely have experience in treating any patient who comes to us. And Crozer administration has always given us the support we needed to implement new techniques and enhance our services."
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