PHILADELPHIA INTERNATIONAL MEDICINE® NEWS BUREAU
Contact: Leonard N. Karp
lkarp@philadelphiamedicine.com
215-735-3989
In this month's edition:
1. Innovative Procedure for Treating Uterine Fibroid Tumors
Will be Demonstrated on the Web at Thomas Jefferson University Hospital
2. Temple Gastroenterology Investigates New Treatment for Gastroparesis
3. Pennsylvania Hospital Awarded Joint Commission Accreditation and Top-tier
Reviews
Innovative Procedure for Treating Uterine Fibroid Tumors Will be Demonstrated
on the Web at Thomas Jefferson University Hospital
The webcast for uterine fibroid embolization will air on Thursday, November 13, at 4:30 p.m.
For years, women with uterine fibroids, benign tumors of smooth muscle, have had to undergo hysterectomies or other surgical procedures to remove the fibroids, procedures that could be painful, leave scars and affect their future fertility.
"While benign, fibroids can cause abnormal bleeding and pelvic pain, and may be a cause of infertility and repeated miscarriage," said cardiovascular and interventional radiologist Joseph Bonn, MD of Thomas Jefferson University Hospital, a member of Philadelphia International Medicine. "Some women cannot work a normal work day because of the pain and bleeding. Their symptoms can be incapacitating."
But Dr. Bonn has found that uterine fibroid embolization can be a better
alternative to hysterectomies for women.
Dr. Bonn and Carin Gonsalves, MD, assistant professor of Radiology, Division of
Cardiovascular and Interventional Radiology, Jefferson Medical College of Thomas
Jefferson University will demonstrate this procedure during a webcast on Thursday,
November 13, at 4:30 p.m. from Jefferson University Hospital.
"It's a minimally invasive procedure that blocks the arteries that supply blood to the fibroids," Dr. Bonn explained.
Traditionally, fibroids have been removed surgically through two conventional surgical choices-hysterectomy and myomectomy, said Dr. Bonn, associate professor of Radiology and director, Division of Cardiovascular and Interventional Radiology, Jefferson. The presence of fibroids is the most common reason women have hysterectomies in the United States -- a total of approximately 175,000 each year.
A hysterectomy-- the surgical removal of the uterus-- may be performed
several different ways, including making an incision in the abdomen or vagina,
said Dr. Bonn. But there is a 15 percent to 38 percent risk of postoperative
fever, in addition to a less than two percent risk of post-operative bleeding
and injury to a nearby pelvic organ. General anesthesia is also required and has
its own risks.
In a myomectomy, fibroids are removed while leaving the rest of the uterus in
place. Bleeding and other complications are somewhat higher than with
hysterectomy, but a myomectomy appears to be successful in controlling symptoms
in about 80 percent of women.
However, fibroids may regrow after a myomectomy, with recurrence rates of
between 10 and 30 percent, Dr. Bonn said. The procedure may also cause extensive
pelvic scarring which may make future surgery very difficult, he said.
Uterine fibroid embolization, however, simply employs the use of a catheter placed into the uterine arteries, Dr. Bonn said. Small particles are injected into the arteries through the catheter, which result in the blockage of the arteries feeding the fibroids. The uterine arteries are most easily accessed from the femoral artery, located at the crease at the top of the leg. The patient is left with an inch-long band-aid incision.
"This technique is essentially the same as that used to control bleeding
that occurs after birth or pelvic fracture, or bleeding caused by malignant
tumors, " said Dr. Bonn. "We, in essence, starve the fibroids of
blood, causing them to shrink and no longer bleed heavily."
The procedure, which takes approximately 1 to 1-1/2 hours, is usually done in
the hospital with most patients able to go home the same day, the Jefferson
radiologist said. The patient is sedated and very sleepy during the procedure.
Fibroids are the most common tumors of the female genital tract. They occur in 20 to 25 percent of women of childbearing age. While fibroids may appear when patients are in their twenties, most patients do not have any symptoms until their late thirties or forties.
It's unknown how fibroids develop, Dr. Bonn said. They arise after menstruation first starts during adolescence and decline after menopause, which supports research data that suggests the development of fibroids is dependent on the presence of hormones (primarily estrogen). Once fibroids appear, their growth rate is also dependent on estrogen and progesterone and possibly other hormones.
Growth rates vary greatly among women and the exact cause for this variability is not known, making the prediction of the behavior of fibroids very difficult.
The Webcast is approved for AMA PRA Category 1 credit. Jefferson Medical College of Thomas Jefferson University, as a member of the Consortium for Academic Continuing Medical Education, is accredited by the ACCME to provide continuing medical education for physicians. For more information to view the Webcast, please email Lucia Rosenberg of PIM at lrosenberg@philadelphiamedicine.com .
Temple Gastroenterology Investigates New Treatment for Gastroparesis
Researchers in the Gastroenterology Section of Temple University Hospital, a member of Philadelphia International Medicine® (PIM), 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 Dr. 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 gastroparesis 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.
Dr. 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 Dr. 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.
Pennsylvania Hospital Awarded Joint Commission Accreditation and Top-tier
Reviews
Pennsylvania Hospital, located in the historic Society Hill district of Philadelphia, has achieved the Gold Seal of Approval(tm) for health care quality for both hospital and behavioral health care accreditation from the Joint Commission on Accreditation of Healthcare Organizations. The award of accreditation is for a three-year period and means Pennsylvania Hospital has demonstrated compliance with national standards for patient safety and quality of care. Pennsylvania Hospital is a member of the PIM network.
Over the course of four days, both the hospital and Hall Mercer, its Behavioral Health Services Center, were evaluated by a team of Joint Commission surveyors against a set of national standards intended to stimulate continuous, systematic, and organization-wide improvement in a hospital's performance and its outcomes of care. The survey resulted in a score of 96 (out of 100) for Pennsylvania Hospital and 97 for Hall Mercer.
"During their visit, members of the survey team commented time and time again on the extraordinary level of cooperation, dedication and teamwork exemplified by our staff and physicians," said Timothy Morgan, Executive Director. "It is this collegiality and our staff's unending desire to provide excellent patient care that makes Pennsylvania Hospital such a exceptional place for patients, physicians, and employees."
In addition to the Joint Commission Survey, the Pennsylvania Department of Health conducts a residual survey to assess compliance with Department of Health regulations usually not included in the Joint Commission Survey.
Unlike the Joint Commission, the Department of Health does not score facilities. Instead, after examination, the State provides the institution with a formal, written review, which includes findings of areas in need of improvement. The State survey resulted in top-tier reviews for Pennsylvania Hospital with no adverse findings.
Pennsylvania Hospital -- the nation's first -- was founded in 1751 by Benjamin Franklin and Dr. Thomas Bond. Today, the 515-bed acute care facility offers a full-range of diagnostic and therapeutic medical services and is a major teaching and clinical research institution. Awarded the Gold Seal of Approval(tm) for health care quality by the Joint Commission on Accreditation of Healthcare Organizations, Pennsylvania Hospital has a national reputation in orthopaedics, cardiac care, vascular surgery, neurosurgery, otorhinolaryngology (ENT) and urology, as well as obstetrics, high-risk maternal and fetal services, neonatology, and behavioral health.
The hospital campus also includes specialty treatment centers such as the Joan Karnell Cancer Center, the Center for Bloodless Medicine and Surgery, and the PENN Neurological Institute. The hospital has over 21,000 inpatient and 197,000 outpatient admissions each year, including over 4,200 births.
The Joint Commission of Accreditation of Healthcare Organizations, founded in 1951, seeks to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations.
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
.