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PHILADELPHIA INTERNATIONAL MEDICINE® NEWS BUREAU
Contact: Leonard N. Karp
lkarp@philadelphiamedicine.com
215-735-3989
For immediate release:
In this month's issue:
1. Newborns with Heart Defects Have Low Blood Flow in Brain Before
Surgery, Say Researchers at The Children's Hospital of Philadelphia
2. Jefferson Using Shaped Beam Surgery to Sculpt Therapy for Hard-to-Treat Brain
Tumors
3. Fox Chase Cancer Center Nurses Receive Magnet Re-Designation
4. New Penn Surgical Suites Outfitted with Robotic, Fluroscopic Technology
Editors note: Research by Philadelphia International Medicine physicians may lead to new ways to treat some of our most challenging diseases. Below are some examples from our hospitals.
Newborns with Heart Defects Have Low Blood Flow in Brain Before Surgery, Say
Researchers at The Children's Hospital of Philadelphia
Philadelphia -- As survival rates have steadily improved for children with heart defects, physicians have focused more attention on improving quality-of-life factors such as neurological and cognitive abilities. A new study shows that newborns with congenital heart disease often have abnormally low blood flow in their brains before they undergo surgery.
Researchers from The Children's Hospital of Philadelphia led the study, published in the December issue of The Journal of Thoracic and Cardiovascular Surgery.
One of every 100 children is born with a heart defect -- one-third of which are severe enough to require surgery during the newborn period. Many of those high-risk children are identified as having neurological and cognitive problems during the months and years that follow. While some of these problems may be related to the complexity of the surgery, evidence is mounting that abnormal neurological conditions play a role even before surgery.
The current study, which used a novel magnetic resonance imaging (MRI) technique developed by members of the investigative team, was the first to measure the infants' cerebral blood flow before surgery. The reduced blood flow was associated with abnormal features in the newborn brain, according to pediatric neurologist Daniel J. Licht, MD, who led the multidisciplinary research team at Children's Hospital.
"Some of the neurodevelopmental problems that these children experience may be attributable to necessary surgical practices such as heart-lung bypass," said Dr. Licht. "However, many infants with heart defects have neurological abnormalities before surgery."
The research team at The Children's Hospital of Philadelphia studied 25 newborns born at term with congenital heart defects. They found cerebral blood flow to be significantly lower than in healthy newborns, sometimes drastically reduced. The low blood flow was also associated with a condition called periventricular leukomalacia (PVL), a scarring of white matter in the brain. PVL has often been linked to neurological problems such as attention deficit-hyperactivity disorder in infants without heart disease. More severe forms of PVL have been associated with cerebral palsy in infants who are born prematurely.
A previous study by the same multidisciplinary team at Children's Hospital found PVL to be common before surgery in newborns with congenital heart disease. The current study could not determine whether the low blood flow levels caused the PVL, but those levels may be useful in guiding future treatments. "If we can define early markers for injury severity or injury risk, we may be able to better identify newborn babies who could benefit from protective therapies, thereby improving their quality of life," said Dr. Licht.
Dr. Licht is a Pfizer Scholar and is also supported by the W.W. Smith Charitable Trust. Dr. Licht's co-authors were Jiongjiong Wang, Phd, David W. Silvestre, B.S., Susan C. Nicolson, MD, Lisa M. Montenegro, MD, Gil Wernovsky, MD, Sarah Tabbutt, MD, Phd, Suzanne M. Durning, R.R.T., David M. Shera, Phd, J. William Gaynor, MD, Thomas L. Spray, MD, Robert R. Clancy, MD, and Robert A. Zimmerman, MD, all from the Neuro-Cardiac Research Program of The Children's Hospital of Philadelphia, and John A. Detre, MD, of the Hospital of the University of Pennsylvania.
Jefferson Using Shaped Beam Surgery to Sculpt Therapy for Hard-to-Treat Brain
Tumors
In contrast to traditional surgical techniques, neurosurgeons and radiation
oncologists at Thomas Jefferson University Hospital in Philadelphia are using a
new type of advanced radiation technology to "surgically" treat a wide
range of tumors in the brain and spine, curing tumors that they couldn't treat
before.
The new technology, called shaped beam surgery, can mold radiation beams to fit
the exact size and shape of a tumor. It is available now only at Jefferson in
the Delaware Valley and in a small number of medical centers in the nation.
"Shaped beam surgery is a major advance in treating both benign and malignant tumors in the brain and the spinal cord regions," says neurosurgeon David Andrews, MD, professor of neurosurgery at Jefferson Medical College of Thomas Jefferson University and director, division of Neuro-oncologic Neurosurgery and Stereotactic Radiosurgery, Thomas Jefferson University Hospital.
The majority of the new technology's use to date has been for benign tumors in the brain, Dr. Andrews says. "We are curing benign tumors we couldn't treat before," he says, and as a result, "often restoring vision and hearing where tumors involve these functions."
"Shaped beam surgery gives us infinite flexibility to deal with lesions from the top of the head to the bottom of the spine," says Dr. Andrews, who is director, Radiosurgery Units, Jefferson Hospital for Neuroscience. "We can wrap doses around structures such as the spinal cord, and can create a very high dose of radiation and leave the cord untouched. There's no other technology out there that can do this."
The new technology enables specialists to focus radiation more precisely on specific targets while leaving healthy tissue virtually untouched, holding great therapeutic promise for hard-to-reach and difficult-to-treat tumors, including meningiomas, pituitary tumors, recurrent brain tumors, spine tumors and acoustic tumors, among others, notes Walter J. Curran Jr., MD, professor and chair of Radiation Oncology at Jefferson Medical College and clinical director of the Kimmel Cancer Center at Jefferson.
Shaped beam surgery relies on sophisticated computers to develop and carry out a treatment plan that includes tailoring the shape and intensity of the radiation beams to fit the exact size of the tumor - all while sparing healthy tissue.
Part of the challenge in radiosurgery is to position the patient properly for radiation treatment. The new technology overcomes this in part by rotating around the patient, constantly editing the beams of radiation and adapting the shape of the beam to the shape of the tumor to meet the specific therapy needs at any angle.
X-rays are taken to locate the tumor. Then, along with results from a computed tomography (CT) scan, a computer program calculates to the millimeter the best position for the therapy for the patient's tumor. A computer-guided treatment couch then positions the patient - re-positioning when necessary - moving the individual's tumor into exactly the position needed to receive radiation. With the computer's help, treatment planning that might take hours - if not days - can be reduced to minutes.
"This is important because tumors are frequently very irregularly shaped, and we want to spare healthy tissue," notes Maria Werner-Wasik, MD, associate professor of radiation oncology at Jefferson Medical College and director of radiation oncology in the Radiosurgery Program at the Jefferson Hospital for Neuroscience.
While it's early in its use at Jefferson, Dr. Andrews notes that there is evidence that the technology is already helping improve survival for individuals with the usually deadly brain tumor, glioblastoma multiforme. Preliminary data show that patients' median survival time has improved from 12 to 19 months. Unfortunately, the treatment is palliative at best and not a cure. He says the therapy is comparable to if not better than standard treatment.
The new technology will not replace the Gamma Knife, which is used in many similar ways for treating difficult-to-reach areas in the brain. According to Dr. Andrews, the Gamma Knife is more likely to be used when the individual patient's tumor requires targeting a very high dose of radiation at a very specific point in the brain. The Gamma Knife is static, he notes, whereas shaped beam surgery is dynamic.
"Shaped beam surgery does everything the Gamma Knife can do and more," he says, including treatments for various types of tumors, epilepsy, trigeminal neuralgia, and even, in some cases, obsessive compulsive disorder and movement disorders.
While the new technology doesn't always promise a cure, it can often improve a patient's quality of life. "It will be both therapeutic and palliative," Dr. Andrews says.
Fox Chase Cancer Center Nurses Receive Magnet Re-Designation
Fox Chase Cancer Center, the first specialty hospital in the United States to receive the prestigious Magnet designation for excellence in nursing, has done it again!
"Studies shows that Magnet facilities have positive outcomes for patients, nurses and the workplace," said Joanne Hambleton, RN, MSN, CNA, vice president of nursing and patient services, quoting published research on magnet hospitals versus non-magnet hospitals. "Furthermore, patients experience lower mortality rates, greater satisfaction during their stay and are able to go home sooner."
According to Anne Jadwin, RN, MSN, CNA, AOCN, director of nursing, earning magnet status once is a tremendous accomplishment and source of pride for the Fox Chase nurses. "Receiving Magnet recognition for another four years highlights the commitment of our staff to continually meet the needs of our patients, physically and emotionally, in the best way possible."
"While the Magnet Award represents nursing excellence, our department could not have achieved such goals without the support of dedicated and talented staff members throughout our organization," concluded Hambleton.
New Penn Surgical Suites Outfitted with Robotic, Fluroscopic Technology
The University of Pennsylvania Medical Center has expanded its surgical capacity to 31 operating rooms by adding a new surgical suite that features four advanced, state-of-the-art Operating Rooms (OR) that contain the latest in minimally-invasive and surgical technology and have the capability to easily adopt new technologies in the years to come.
Each OR is a spacious 750 to 800 square feet and can broadcast surgeries live - via cameras located throughout the room, in overhead lights, and on instruments - to locations around the globe. There is an OR dedicated to robotic surgery, which is finding applications in numerous surgical procedures and is quickly becoming the future of surgery.
Another OR - dedicated to vascular surgery - is outfitted with dedicated fluroscopic equipment and a control room to accommodate the growing field of endovascular surgery done through small skin incisions. An on-site pharmacy is conveniently located near the ORs to expedite the delivery of medications. An expanded recovery area completes the surgical suite, providing surgical patients with a soothing, private space to recuperate.
"We're extremely proud to show the fruits of a four-year collaboration across numerous disciplines," remarks James L. Mullen, MD, Associate Executive Director of HUP. "We not only wanted to provide the benefits of the latest, revolutionary surgical technology to our patients, but also ensure that we can keep providing cutting-edge care for many years to come."
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
.
The
following programs are offered through Philadelphia International
Medicine’s Institute of Education and the PIM member hospitals listed.
Included in the cost for continuing medical education seminars,
workshops, and conferences is tuition and introduction to Philadelphia
International Medicine as well as (for programs held in Philadelphia) a
walking tour of Philadelphia, tours of Philadelphia International
Medicine hospital facilities and lunch with a PIM faculty member in the
participant’s field. All
programs are conducted in the English language. Air and ground
transportation, meals (except those included in the program), hotel
accommodations and personal expenses are not included.
The Institute of Education will coordinate your program
registration, itinerary for your visit and assist you with hotel
reservations and information on local restaurants and events.
Please call (215) 735-3269 for program registration, or email us
at lrosenberg@philadelphiamedicine.com.
For more information, visit our website at www.philadelphiamedicine.com
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