PHILADELPHIA INTERNATIONAL MEDICINE® NEWS BUREAU
Contact: Leonard N. Karp
215-575-3720
lkarp@philadelphiamedicine.com
March 29, 2006
For immediate release:
In this month's issue:
- Strokes in Children Need to Be Recognized Quickly
- Jefferson Offers Minimally Invasive Surgery for Removing Brain and Skull Base Tumors; Breakthrough allows doctors to remove brain tumors through nose and nasal sinuses
- Crozer-Chester Medical Center Opens ‘Acute Care of Elders’ Unit
- Penn Researcher Christopher M. Clark, MD, Selected for National Task Force on Early Stage Alzheimer’s Disease
Editors note: Philadelphia International Medicine will be moving as of May 1 to new offices at 1835 Market Street, 10th Floor, Philadelphia, PA, 19103. Our new telephone number will be 215-563-4733; fax, 215-563-2777. Our email and website remain the same, www.philadelphiamedicine.com.
Research, new techniques and improved facilities by Philadelphia International Medicine hospitals and physicians may lead to new ways to treat some of our most challenging diseases. Below are just some examples from our hospitals.
Strokes in Children Need to Be Recognized Quickly
Philadelphia – Who would think a seemingly healthy teenager would suffer a stroke? Certainly not 13-year-old Colin Quinn, of Exton, Pa., who suddenly found he couldn’t get into the family car as he was leaving a guitar lesson. Colin was unable to move the left side of his body.
Fortunately, Colin’s parents acted quickly, calling an ambulance and having him taken to a pediatric hospital that was prepared to assess and treat this sudden event. The medical staff diagnosed it as a stroke - an interruption in blood flow within the brain. Today, two years later, Colin still has lingering weakness in his left arm and other aftereffects, but has largely recovered.
"Although usually thought of as afflicting only elderly patients, strokes may occur as early as infancy," said pediatric neurologist Rebecca Ichord, MD, who treated Colin at The Children’s Hospital of Philadelphia. "Stroke needs to be considered by first-line pediatric caregivers who encounter a patient with suspicious neurological symptoms, such as difficulty walking or using an arm.
"Emergency medicine staff members are far more aware of the possibility of stroke among adult patients than they are among children who are brought to the hospital," added Dr. Ichord, who directs the Pediatric Stroke Program at Children’s Hospital.
Dr. Ichord led a study featured at the "Children and Stroke" news conference today at the International Stroke Conference sponsored by the American Stroke Association. Her study team found that delays were common in diagnosing stroke in children, and proposed that improved knowledge and management of stroke symptoms could lead to improved outcomes.
Dr. Ichord and colleagues from Children’s Hospital and the University of Pennsylvania School of Medicine explained results of a study of 12 children aged 2 to 18 years old, who presented to various local emergency centers in 2003 and 2004. All the children had acute arterial ischemic stroke, with the main symptoms either one-sided paralysis or difficulty walking normally.
Although the majority of children in the study were brought to medical attention promptly after the onset of their symptoms, they experienced delays approaching 24 hours before receiving a definitive diagnosis and emergency stroke-specific treatment.
"The faster we can recognize and diagnose stroke, the more quickly we can apply effective treatment," said Dr. Ichord. "The first treatment involves neuroprotective measures, which include maintaining adequate blood pressure, and supplying fluids and appropriate medication. Later, the patient may need aggressive physical rehabilitation."
Strokes in children may occur as complications of other illnesses, such as sickle cell disease, in which misshapen blood cells obstruct circulation. Another cause of stroke may be a whiplash injury to the neck, which damages an artery, and leaves it a vulnerable site for blood clots.
Colin Quinn’s stroke may have been related to a previously undetected heart condition, but whatever the cause, the prompt recognition and treatment of his symptoms apparently contributed greatly to his recovery. Dr. Ichord will be working with other pediatric medical centers to broaden awareness of pediatric stroke. "We will be researching a clinical assessment tool used to assess strokes in adults, and adapting and evaluating it for use in children," she added.
Jefferson Offers Minimally Invasive Surgery for Removing Brain and Skull Base Tumors; Breakthrough allows doctors to remove brain tumors through nose and nasal sinuses
A state of the art program has opened at Thomas Jefferson University Hospital offering a new alternative for people with brain and skull base tumors. The Jefferson Center for Minimally Invasive Cranial Base Surgery and Endoscopic Neurosurgery is a comprehensive center in the Philadelphia area where surgeons are able to remove skull-based tumors through nose and nasal sinuses instead of the traditional, more invasive surgery which required opening up the brain and skull.
Marc Rosen, M.D., assistant professor of Otolaryngology-Head and Neck Surgery, and James Evans, M.D., assistant professor of Neurosurgery, both of Jefferson Medical College of Thomas Jefferson University serve as the center’s co-directors. Drs. Evans and Rosen have been working together for several years and have performed at least 150 of these endoscopic procedures to date.
"This leading edge surgical technique gives us a new way to treat patients with benign and malignant brain, cranial base and sino-nasal tumors," noted Dr. Rosen.
"Through this Center, our multidisciplinary team of medical experts has been able to dramatically improve patient outcomes and reduce the length of hospital stays," added Dr. Evans. "Patients can also begin radiation and chemotherapy sooner than they would be able to with conventional surgical procedures."
"Jefferson’s innovative program combines neuro-navigation, endoscopic technology and minimally invasive approaches to effectively treat many cranial base and intracranial tumors previously requiring lengthy and often destructive procedures," said Dr. Evans.
"Better visualization and access to these difficult lesions has enabled improved resection, preservation of function, decreased post-operative morbidity, decreased hospital stay and fewer complications," added Dr. Rosen.
The new center at Jefferson has minimally-invasive operating suites in which to perform these procedures, equipped with state of the art computer navigation systems, and new endoscopic instrumentation. These procedures are also complimented by the Department of Neurosurgery’s Division of Neuro-Oncologic Neurosurgery and Stereotactic Radiosurgery. The Jefferson Hospital for Neuroscience is equipped with both a Novalis® Shaped Beam radiosurgery unit and gamma knife radiosurgery unit, representing the first configuration of its kind in the Delaware Valley. Our team is involved in advancing the field in skull base reconstruction surgical techniques and the development of state of the art robotic surgery technology.
Traditionally, cranial base tumors have been removed by opening large holes in a patient’s skull and by removing facial bones.
Jefferson’s multi-disciplinary team instead applies a more high-tech, minimally-invasive approach which is less destructive. The surgeons first use a thin endoscope with a camera attached to enter a patient’s nose and sinuses, allowing them to approach the tumors without external incisions.
Guided by the scope and enhanced computer navigation, the surgeons open small holes in the base of the skull and membrane covering the brain. The tumors are removed either in one piece, or broken up into smaller pieces if the tumors are too large.
"This is a radical departure from conventional surgery and is the newest extension of minimally-invasive surgery," Dr. Rosen noted.
"This is sure to be the standard of care in the near future," added Dr. Evans.
Some examples of the many conditions that can be effectively managed by minimally invasive endocsopic techniques include: pituitary tumors, craniopharyngiomas, chordomas, chondrosarcomas, meningiomas, sino-nasal malignancies, juvenile nasal angiofibroma, cerebrospinal fluid leaks, meningoceles, encephaloceles, colloid cysts, as well as other intracranial and intraventricular tumors.
Crozer-Chester Medical Center Opens ‘Acute Care of Elders’ Unit
Crozer-Chester Medical Center recently opened an ACE (Acute Care of Elders) Unit, located on the One North wing of the medical center. Designed to be safe, comfortable and easy for seniors to use, the specialized unit strives to decrease the risk of functional decline that sometimes occurs during hospitalization of patients who are over the age of 65.
Led by a board-certified geriatric physician and nurse manager with experience in the ACE approach to personalized care, the ACE team also includes a case manager, specially trained nurses, a clinical nurse educator, a social worker, rehabilitation therapists, a pharmacist and a dietician.
The team works with each patient’s attending physician to design and provide personalized treatment. The attending physician continues to oversee the patient’s care plan with the input and benefit of rounds conducted on the unit by the ACE team.
"Our team works in conjunction with admitting physicians to provide comprehensive care for patients," says William Zirker, MD, MPH, chief of the Division of Geriatric Medicine at Crozer-Chester Medical Center and medical director of the ACE Unit. "We want to ensure that the patient maintains function, while avoiding unnecessary invasive tests and reducing falls and the use of restraints. We also work to avoid common acute illnesses in the elderly such as pneumonia, urinary tract infection, congestive heart failure and dehydration."
In addition, the goals of the ACE Unit are to help older patients recover as quickly as possible from the illness or injury that required hospitalization; prevent the complications often associated with a hospital stay; maintain their ability to perform the activities of daily living; and enable them to return to their former living arrangement.
Special features on the specially-designed unit include:
- New signage written in a larger font and placed at a lower level on the wall
- A large day room for patients to visit with family and friends
- A child-friendly play area for visiting grandchildren
- A sitting area in the middle of the unit so those walking will have a place to take a break
- New lighting
- Adaptive devices on toilets
- Contrasting colors on the walls and door frames
- Chair and bed alarms
- Access to low beds that drop to 6 inches from the ground.
Penn Researcher Christopher M. Clark, MD, Selected for
National Task Force on Early Stage Alzheimer’s Disease
Christopher M. Clark, MD, associate director of the University of Pennsylvania Alzheimer's Disease Center and Director of the Memory Disorders Clinic, has been selected to become a member of the national Alzheimer’s Association Early-Stage Professional Task Force. The task force will focus on the unique challenges facing people with early stage Alzheimer’s disease and help develop recommendations to increase their participation in the leadership and services offered by the Association.
The Professional Task Force will be made up of a multi-disciplinary group of health care professionals involved in the diagnosis, treatment, and program services for people with Alzheimer’s, and staff from the national and local chapters of the Alzheimer’s Association. The task force will work closely with its counterpart – the Advisory Group of People with Dementia – that is made up of individuals diagnosed with early-stage Alzheimer’s disease. The two leadership groups met in Chicago for the first time, January 30th and 31st, 2006.
"I am excited to be joining this important initiative of the Alzheimer’s Association," said Clark. "There are millions of people living with Alzheimer’s now and, as baby boomers continue to age, the prevalence of Alzheimer’s will increase. It’s important to focus on early-stage individuals and to work with those affected by the disease. We need to address their unique needs and find ways to reduce the stigma associated with diagnosis so we can empower and support individuals and their families – now and in the future."
There are 4.5 million people currently living with Alzheimer’s disease in the United States. By 2025, that number could increase to as much as 6.5 million; and by 2050, that number could range between 11.3 million and 16 million. "It’s important that Alzheimer’s is diagnosed early in its progression to allow individuals and family members to plan for the future," added Clark.
Early-stage Alzheimer’s is the disease phase at which a careful medical interview can detect clear-cut deficiencies including the decreased knowledge of recent occasions or personal history, and the diminished ability to perform complex tasks – such as planning a dinner party, or paying bills and managing finances.
Clark, a board certified neurologist, is an Associate Professor of Neurology at the University of Pennsylvania School of Medicine. He is also the Associate Director of Penn’s Alzheimer's Disease Center (ADC) and Memory Disorders Clinic, and Director of the recently initiated Center of Excellence for Research on Neurodegenerative Diseases at Penn. He is a Fellow of the University of Pennsylvania's Institute on Aging and has been a Penn faculty member since 1989.
Clark has spent most of his career studying Alzheimer's disease. He is the current Principal Investigator of a National Institute of Aging grant, and an investigator for numerous other studies including the landmark Alzheimer's Disease Neuroimaging Initiative (ADNI). His research interests focus on Alzheimer's disease and the development of diagnostically specific markers, the identification and evaluation of new treatments, the development of new instruments to measure rates of change, and studies of the relationship between Parkinson's disease and Alzheimer's disease.
Currently, the Alzheimer’s Association is collaborating with four Alzheimer’s disease Research Centers to prepare a grant proposal to measure the effectiveness of early stage programs offered through the Association’s chapter network.