Advances in Medicine | Penn Medicine

Neuro Diagnostics at the Patient’s Bedside

noreply@blogger.com (Unknown) — Wed, 07 Mar 2012 18:00:00 +0000

Patients with severe neurological injuries have access to comprehensive neurological care at Penn’s award-winning Neuro-Intensive Care Unit (Neuro ICU) at the Hospital of the University of Pennsylvania.

Penn’s Neuro ICU uses a multidisciplinary approach to providing care for patients with traumatic brain injury and spinal cord trauma, stroke, aneurysms, neurovascular disease, brain tumors, brain infection, epilepsy and neuromuscular emergencies. Awarded the prestigious Beacon Award for excellence in critical care by the American Association of Critical Care Nurses (AACN), Penn’s Neuro ICU also has some of the most technically sophisticated bedside diagnostics equipment in the country.

“The condition of many of our patients is so critical that we are unable to move them,” said Soojin Park, MD, Penn neurointensivist. “The rooms in the neuro ICU are organized for effective workflow and provide us with enough room to perform many diagnostic tests, such as CT scans, right at our patients’ bedsides.”

Many advanced neurological tests involved in clinical studies can be performed at the bedside, allowing doctors to closely monitor patients and quickly provide or modify treatment.

Intracranial pressure monitoring: The rooms in the neuro ICU can be converted to sterile, mini-operating rooms. The design includes ample space around the heads of the beds so that sterility is preserved and several types of monitors can be placed to check pressure in the brain and drains to remove excess fluid. These tests are being used in connection with clinical research studies.
Near-infrared spectroscopy (NIRS): This non-invasive test measures the amount of oxygen in the blood and shows fluctuating delivery of blood to brain tissue. Doctors are able to better understand how the blood vessels in the brain are responding and can modulate pressure. Dr. Park is also studying the use of infrared with Doppler to measure changes in the blood vessels in correlation with oxygen levels and cerebral blood flow.
Xenon CT scanning: The patient inhales xenon gas during a CT scan to assess changes in cerebral blood flow after a traumatic brain injury. Xenon gas is safe and stable and acts as contrast agent to show blood flow and oxygen levels in the brain. This is test in being used in clinical trials at Penn.
Microdialysis: An invasive catheter with intracranial pressure monitoring can measure tissue biochemistry. Microdialysis is accomplished via an invasive dialysing membrane to measure tissue biochemistry.
Brain tissue oxygenation: An intracranial catheter with two probes can be placed in the brain to measure brain tissue oxygenation and temperature. Monitoring brain tissue oxygenation can be used to collect more accurate and timely information following brain injury and help prevent secondary injury from reduced oxygen and blood flow to the brain.
Continuous electroencephalogram (EEG): EEGs measure brain waves and a continuous EEG is used to rule out seizures in patients who are not conscious. The digital output allows neurologists to interpret the brain waves in windows of time, measuring and categorizing the activity.

“All of these tools provide a great deal of information about our patients,” said Dr. Park. “We analyze the information for patterns so we can understand what is happening and modify our treatment for each patient based on the analysis.”

For more information about the Neuro ICU, visit PennMedicine.org/neurosurgery/neuro-intensive-care or call 800-789-PENN (7366).

Finding a Better Way to Diagnose Lung Cancer

noreply@blogger.com (Unknown) — Wed, 22 Feb 2012 18:00:00 +0000

For years, the aggressive and deadly nature of lung cancer has hampered cancer researchers from finding an effective way of screening for lung cancer. The introduction of multidetector helical computed tomography (CT) technology has changed the landscape of lung cancer screening, and physicians and researchers at Penn Medicine have been on the forefront of applying this technology in new ways to detect and characterize a wide variety of disease conditions in patients.

Penn Medicine was a participating site in the National Cancer Institute’s National Lung Screening Trial (NLST) to determine whether screening with low-dose helical CT could lower mortality rates from lung cancer. Early results of the study indicate that helical CT detects many tumors at early stages. As is the case with most types of cancer, early detection leads to more effective and more successful treatment.

“Chest CT is good for showing lung detail, allowing us to see lung nodules as small as 1 millimeter,” said Drew Torigian, MD, thoracoabdominal radiologist and principal investigator for the NLST at Penn Medicine. “The X-ray source of CT rotates around patients as they pass through the scanner. The multiple images acquired show us the internal structure of the lung, including a 3-D view of nodules or tumors. For the first time, we have a screening test that has been shown to reduce the mortality rate of lung cancer.”

Primary results of the NLST published in June 2011 showed a 20 percent reduction in deaths from lung cancer among current or former heavy smokers who were screened with low-dose helical CT versus those screened by chest X-ray.
The findings are significant, according to Dr. Torigian, because a lung cancer diagnosis is often made when the cancer is more advanced and surgery and other treatments are not as effective.

The randomized national trial involved 53,454 current and former heavy smokers between the ages of 55 and 74 who were without signs, symptoms, or history of lung cancer. Participants in the NLST were randomly assigned to receive three annual screens with either low-dose helical CT or standard chest X-ray.

Better Tools and Better Teams

Along with the latest diagnostic tools, Penn Medicine has dedicated thoracic radiologists who interpret the results of all lung imaging. Because they see many imaging studies of the chest including the lungs, they are experts at identifying and screening abnormalities in this anatomical location of the body.

“Helical CT also finds small nodules that may not be cancerous,” said John Kucharczuk, MD, chief of thoracic surgery at Penn Medicine. “Penn’s lung nodule team is dedicated to reviewing all lung nodules found by imaging and determining the best course of treatment.”

The biggest downside to using helical CT as a screening tool is the high rate of false positive screens, or the frequent detection of lung nodules that are not due to lung cancer. Dr. Torigian said that the medical community is reviewing the results of the NLST and finding the best way to implement the technology in a cost-effective manner.

Lung Cancer by the Numbers

When it comes to lung cancer, the numbers are not good. More people in the United States die from lung cancer than any other type of cancer.

In 2011, more than 220,000 Americans will be diagnosed with lung cancer and more than 156,000 people will die of lung or bronchus cancer.
Smokers are 10 to 20 times more likely to get lung cancer. About 90 percent of lung cancer deaths in men and almost 80 percent of lung cancer deaths in women are due to smoking.
There are more than 94 million current or former smokers in the U.S.
Among both men and women in the United States, lung cancer is the second most common type of cancer, accounting for more deaths than breast cancer, prostate cancer, and colon cancer combined.

For more information about Penn Medicine’s lung cancer or smoking cessation programs or to make an appointment with a Penn lung specialist, visit PennMedicine.org/lung-cancer or call 800-789-PENN (7366).

The Fight Against Heart and Vascular Disease Gets Personal

noreply@blogger.com (Unknown) — Wed, 15 Feb 2012 18:00:00 +0000

Year after year, heart and vascular disease maintains its rank as the number one killer of Americans. Doctors at Penn Medicine are battling the epidemic through comprehensive and personalized management of cardiovascular risk factors.

There are many things people can do on their own to reduce their risk of developing heart and vascular disease, such as getting plenty of exercise and eating right. Penn Medicine’s Preventive Cardiovascular Program helps reduce that risk further using a multidisciplinary, personalized approach to treat cardiovascular risk factors. The program specializes in the treatment of complex lipid (cholesterol) and high blood pressure conditions, as well as the care of individuals with a family history of early heart attack, stroke or peripheral artery disease. The program’s expert team consists of cardiologists, vascular medicine specialists, lipid specialists, hypertension specialists, nurses and dietitians.

“We offer a wide array of preventive testing to refine cardiovascular risk assessment above and beyond traditional risk factors,” said Emil deGoma, MD, medical director of the Preventive Cardiovascular Program. “For selected individuals, advanced testing enhances our ability to personalize care for each patient; be it lifestyle changes and weight management for someone at low risk, or medication and intervention for someone at high risk.”

Advanced Risk Refinement Services

According to Dr. deGoma, the Preventive Cardiovascular Program uses innovative technologies and imaging capabilities to assess the risk of heart and vascular disease, including:

Genetic testing for heart attack risk: This blood test identifies someone’s risk for heart attack by examining variations in the sequence of their inherited genetic material, also known as DNA. Certain variations are associated with an increased risk of having a heart attack, while others can mean a decreased risk.
Vascular ultrasound screening (carotid intima-media thickness assessment): A non-invasive ultrasound evaluation examines the health of the carotid arteries, looking for warning signs such as the accumulation of plaque or thickening of the blood vessel wall.
Coronary artery calcium scanning: Another non-invasive test, this “heart scan” evaluates the coronary arteries for the buildup of calcium. Higher coronary artery calcium scores are associated with a higher risk for heart attack.
Advanced lipid laboratory testing: Testing beyond the standard fasting cholesterol panel can help diagnose lipid diseases, assess cardiovascular risk assessment, and identify the most appropriate treatment options.
Ambulatory 24-hour blood pressure monitoring. Continuous blood pressure monitoring provides a comprehensive assessment of blood pressure changes throughout the day and night. It is a valuable tool for diagnosing hypertension and ensuring the effectiveness and safety of treatment.

The wide range of risk refinement services offered by Penn Medicine’s Preventive Cardiovascular Program is located at the Ruth and Raymond Perelman Center for Advanced Medicine. For more information or to schedule an appointment, please visit PennMedicine.org/heart/prevention or call 800-789-PENN (7366).

Identifying Alzheimer’s Disease

noreply@blogger.com (Unknown) — Wed, 08 Feb 2012 18:00:00 +0000

There has never been a definitive test for diagnosing Alzheimer’s disease. Doctors usually know if someone has dementia, and based on symptoms and testing they can predict whether the dementia is caused by Alzheimer’s. But a diagnosis can only be confirmed by examining the brain for the specific plaques and tangles that indicate Alzheimer’s. Doctors are close to being able to predict which patients will develop cognitive disease.

Alzheimer’s disease is the most common cause of dementia. It is different from other causes of cognitive impairment and dementia because it is defined by the abundance of the two hallmark deposits found in the brains of patients with Alzheimer’s disease: neurofibrillary tangles formed by tau amyloid fibrils and senile plaques formed by beta amyloid (Aβ) fibrils. It causes progressive loss of intellectual and social skills severe enough to interfere with day-to-day life. The brain cells degenerate and die due to the damaging effects of the tangles and plaques thereby causing a steady decline in memory and mental function. Current medications and management strategies can temporarily improve Alzheimer’s symptoms, maximize function and maintain independence.

Researchers at Penn are involved in several studies designed to develop an easy test that can find the disease early on. With an easy and accurate diagnosis in the early stages of development, doctors can gain a better understanding of Alzheimer’s disease and look at more effective treatments for this disease.

Searching for Biomarkers

For more than 20 years, Penn researchers have investigated methods for diagnosing Alzheimer’s disease. Early success came from the development of a radioactive tracer that could detect the beta amyloid plaques associated with Alzheimer’s in the brain. The tell-tale chemical and physical indicators of the changes in the brain are known as “biomarkers.” Studies under way in Penn’s Alzheimer’s Disease Core Center use and compare different diagnostic technologies to detect these biomarkers of changes in the brain.

Penn researchers identify, measure and store the specific biomarkers found in proteins and fluids to better understand the physiological changes that occur over time in Alzheimer’s disease. “We look for consistency in these tests so that we can accurately interpret these biomarkers,” said John Q. Trojanowski, MD, PhD, co-director of Penn’s Center for Neurodegenerative Disease Research and director of the Alzheimer’s Disease Core Center. “We are close to being able to predict which patients will develop cognitive disease.”

Cerebrospinal Fluid Sampling

Cerebrospinal fluid (CSF) is the fluid that circulates through the brain and the spinal cord. It acts as a “shock absorber” for protection of these areas and contains proteins and other important biomarkers that may indicate existence of diseases such as Alzheimer’s. By analyzing CSF, Penn researchers can pinpoint the biomarkers that may signal an increased risk of developing disease. The CSF is obtained through a simple and safe process known as a lumbar puncture or spinal tap. The procedure is quick and involves no, or only slight discomfort.

Neuroimaging

Neuroimaging studies compare different diagnostic technologies to detect changes in the brains of patients with Alzheimer’s. PET scanners look at how the various brain regions use glucose. Doctors can tell by the pattern of glucose use whether a brain is developing Alzheimer’s because nerve cells use less glucose when they are beginning to fail. But PET can be expensive and the radioactive tracers used to create the images carry some risks for patient needing repeated testing.

New Penn Medicine studies examining MRI imaging of blood flow in each brain region mirrors the glucose use seen in the PET scans. The studies, published in November 2011 in Alzheimer’s and Dementia and Neurology, show MRI may be a useful way of diagnosing the disease and managing therapy. “This can become a useful way of diagnosing the disease and managing therapy,” said study co-author John Detre, MD, Penn neurologist.

Dr. Trojanowski and Leslie Shaw, PhD, also co-lead the Biomarker Core of the Alzheimer’s Disease Neuroimaging Initiative (ADNI), a public-private partnership launched in 2004 at 58 sites in the U.S. and Canada. Several hundred investigators are following more than 1,000 subjects over time to assess how the biomarkers change to reflect the onset and progression of cognitive impairment and dementia. The partnership extends through 2016 and is funded by grant support from the National Institute on Aging, pharmaceutical companies and foundations to identify, standardize and validate informative biomarkers for Alzheimer’s disease.

Biomarker for Tau-Related Brain Disorders

Penn researchers led by Virginia M.-Y. Lee, PhD, MBA, recently determined that a well-known chemical process called acetylation is associated with one of the biological processes related to Alzheimer’s disease and related disorders, and they seek to exploit this finding in their biomarker and drug discovery research in the near future.

Tau is one of the primary disease proteins associated with neurodegenerative diseases including Alzheimer’s. Tau proteins are expressed primarily in the central nervous system where they help with the assembly and stability of microtubules, the protein structures that are the backbone of the nerve-cell communication system.

“Cerebrospinal fluid sampling can measure these tau proteins that are the building block proteins of Alzheimer’s disease tangles, which correlate with the severity of the disease at autopsy. The hope is that by measuring tau in CSF, one can diagnose Alzheimer’s disease with more certainty during life. Indeed, our bold, long-term goal is to convert the current ‘gold standard’ for the definite diagnosis of Alzheimer’s disease. We hope to move from an autopsy evaluation to one that is done with living patients early in the disease process by developing a new biomarker standard for the definite diagnosis of Alzheimer’s disease and using a panel of biomarkers that includes measuring the levels of CSF tau,” said Dr. Trojanowksi. “Patients with Alzheimer’s and other dementias have an increased level of neurofibrillary tangles made up of tau proteins. By understanding the role of plaques and tangles we move closer to understanding and treating Alzheimer’s disease.”

For more information, or to schedule an appointment visit PennMedicine.org or call 800-789-PENN (7366).

Correct Diagnosis is Key to Successful Treatment

noreply@blogger.com (Unknown) — Wed, 01 Feb 2012 18:00:00 +0000

Penn Medicine’s excellent diagnostics and expert physicians provide patients with the best chance of a successful outcome. Effective medical treatment is based on an accurate diagnosis of each patient’s disease. As one of the nation’s top medical centers, Penn Medicine offers patients the latest, state-of-the-art diagnostic tools and tests. But technology is only as good as the people using it, and Penn physicians are experts at reviewing and interpreting test results. In fact, Penn physicians and researchers invented much of the current diagnostic technology and continue to look for ways to expand its uses.

Advances in Imaging

Medical care and treatment depends on the ability to see inside the body quickly and accurately. At Penn, the radiologists interpreting these images often specialize in just one field—such as heart images, brain images, or gastrointestinal images. Because Penn radiologists specialize in a specific area, readings are more accurate. In addition, because of this specialization, Penn radiologists are looking for physiological and molecular changes in the body, such as blood flow and glucose metabolism, as well as anatomical changes. Penn has a long history of excellence in imaging. The Hospital of the University of Pennsylvania is home to the first department of radiology in the United States. Many imaging technologies now in use were developed and perfected at Penn.

Radiologists continue to look for new ways to see what is happening inside the body—and why. Right now, Penn radiologists are working to advance several technologies.

Arterial spin labeling (ASL). This technology developed at Penn is now being licensed around the world as a non-invasive method for viewing cerebral blood flow in the brain.
Spiral CT (see related article about diagnosing lung cancer on page 4). Helical CT images provide high-resolution views with less radiation exposure to patients. Along with lung cancer, this technology is being used to diagnose vascular abnormalities and diseases.
Positron emission tomography (PET) for detecting Alzheimer’s disease (see related story on page X). A compound developed at Penn helps detect brain plaques associated with Alzheimer’s disease.

“Penn has traditionally emphasized research in addition to clinical care,” said R. Nick Bryan, MD, PhD, chair of Penn Radiology. “As one of the leading research institutes in the country, we are leaders in developing new imaging technology as well as bringing in the latest technological advances to help make difficult diagnosis in our patients.”

Developing Personalized Diagnostics

The Human Genome Project, an international scientific research project, identified and mapped the approximately 20,000 to 25,000 genes in human DNA, and determined the sequences of the 3 billion chemical base pairs that make up the human genome. The project ushered in a revolution in personalized medicine, and nowhere is that more apparent that at Penn Pathology and Laboratory Medicine.
“By finding and studying gene mutations, we will eventually have information that helps us identify cancer causing mutations and how they react to treatment for every cancer patient. It will be a terrific resource,” said David B. Roth, MD, PhD, chair of pathology and laboratory medicine at Penn. Additionally, predictive testing for mutations in genes that may predispose individuals to disease will provide more accurate risk assessment and has the potential for great impact on prevention, early detection and early intervention.
The Penn laboratory where the Philadelphia Chromosome was discovered is expanding to include a new Center for Personalized Diagnostics. Both a research and patient care center, its plans are to provide diagnostic gene sequencing and other genome-wide diagnostic tools for patients. The goal is to provide clinicians with information regarding their patient’s disease, so that a customized treatment regimen can be directed to the driving mutations specific for their patient.

“Personalized diagnostics are an important part of personalized medicine,” said Dr. Roth, “and Penn has the vision to see that this is next step in providing the best outcomes for patients. Large-scale gene sequencing is a laborious process, but the enormous results are worth it.”

For more information or to schedule an appointment with a Penn Medicine physician, visit PennMedicine.org or call 800-789-PENN (7366).

Gene Researchers: Curing Blindness

noreply@blogger.com (Unknown) — Thu, 26 May 2011 15:10:00 +0000

As one of the premier patient care, teaching and research ophthalmology departments in the country, Scheie is a world leader in research and consistently ranks among the top five programs in the nation in funding by the National Eye Institute.

“Scheie one the of the top-funded eye research programs in the country,” said Joan O’Brien, MD, chair of ophthalmology, “but almost all of our scientists are physician/scientists who bring this research back to their patients. Marrying the science to patient care allows us to treat vision loss in a personalized manner.”

Gene therapy is just one of the areas of focus for researchers at Scheie. With the rapidly expanding knowledge about genetic diseases, researchers can target the biology of eye diseases and develop personalized treatment for patients.

Using Gene Therapy to Cure Blindness

The work of Penn researchers received a great deal of publicity after they brought sight to children who suffer from inherited retinal diseases. Leber congenital amaurosis (LCA) is a group of inherited blinding diseases that damages light receptors in the retina. It usually begins stealing sight in early childhood and causes total blindness by the time patients reach their 20s or 30s.

Clinical trials conducted at The Children’s Hospital of Philadelphia (CHOP) have shown that gene therapy safely restored vision in young people with this rare form of congenital blindness. The treatment consists of injecting one eye with a virus genetically engineered to carry a normal version of the gene that causes LCA.

Although the patients have not achieved normal eyesight, their vision improved from detecting movements to reading lines on an eye chart. Three children, who previously sat at the back of the class relying on electronic screens and assistance from teacher aides, now, sit in the front of the class. One joins classmates on the playground for a game of softball and another joins them for soccer.

“For children and young adults with congenital blindness gene therapy is the best chance for restoring and improving their sight,” said Jean Bennett, MD, PhD, and lead author of the study. “With the success we have had in treating one eye, we are cautiously preparing to begin treatment of the other eye. Penn and CHOP are leaders in developing ocular gene therapy and are poised to move forward quickly with this promising research.”

Providing World-Class Care

Along, with their research, Penn Eye Care specialists provide the most up-to-date methods of treatment for the full range of eye disorders, from routine eye examinations to the most advanced ocular surgery.

For more information about eye care and ophthalmology research at Penn Medicine or to schedule an appointment with a Penn ophthalmologist, please visit PennMedicine.org or call 800-789-PENN (7366).

Watch a video of study participants before and after treatment.

Focusing on Vision

noreply@blogger.com (Unknown) — Thu, 26 May 2011 15:09:00 +0000

At Scheie Eye Institute and the F.M. Kirby Center for Molecular Ophthalmology, scientists investigate the causes of important eye conditions including macular degeneration, diabetic retinopathy, hereditary retinal degenerations, cataract and severe myopia that may be treatable with molecular therapies.

In addition to the gene therapy work being done by Jean Bennett, PhD, and Albert Maguire, MD, nearly 50 physician/scientists are involved in translational ophthalmology research at Penn, many of them bringing their research directly to the patients they treat.

Alexander Brucker, MD

Dr. Brucker is one of the most prolific investigators at Scheie Eye Institute. As a retina specialist, Dr. Brucker’s research focuses on medications and treatments for diabetic retinopathy, diabetic macular edema and age-related macular degeneration. He is also a member of the executive committee of the Diabetic Retinopathy Clinical Research Network (DRCRnet), the NEI-sponsored collaborative network dedicated to facilitating multicenter research of diabetic eye conditions.

Vatinee Y. Bunya, MD

Dr. Bunya is currently the principal investigator for several dry eye studies focused on studying different components of the tear film. In addition, she serves as a co-investigator for an international Sjogren’s syndrome study and is part of a multidisciplinary team working on the development of a new blepharitis reading center. She will soon begin her K12 research training grant, which focuses on the development of new topical therapies for dry eye disease.

Joshua Dunaief, MD, PhD

Dr. Dunaief is the recipient of the prestigious Cogan Award from the Association for Research in Vision and Ophthalmology. His research and clinical practice focus on age-related macular degeneration (AMD), a common cause of irreversible blindness in the U.S. Evidence suggests that cumulative oxidative damage contributes to AMD and aging in general and his research has found that AMD retinas have iron overload, which can increase oxidative stress. Dr. Dunaief’s lab is working to understand retinal iron homeostasis and how it may lead to treatments for AMD. His lab has found that treating genetically engineered mice with an oral iron-binding drug prevents both retinal degeneration and a Parkinson’s disease-like movement disorder.

Juan Grunwald, MD

Dr. Grunwald is world renowned for his research on blood flow in the retina. Currently, he is photographing the retinas of patients with kidney disease to identify retinopathy. The tiny blood vessels in the retina reflect vascular issues throughout the body and the photos provide a non-invasive way to obtain information about vascular disease. Dr. Grunwald is also an investigator on the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) and the Retinopathy in Chronic Renal Insufficiency Cohort study (RCRIC).

John Kempen, MD, MPH, MHS, PhD

Known nationally and internationally as an expert in ocular inflammatory diseases—such as uveitis, scleritis, and others—as well as ocular complications of AIDS, Dr. Kempen is the principal investigator for the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study, the first NIH-sponsored multicenter clinical research study in the field of uveitis. Following up on the results of the study, Dr. Kempen is now expanding his research to examine cancer-related mortality among patients with ocular inflammation who are being treated with immunosuppressive drugs.

Alan M. Laties, MD

Dr. Laties’ lab focuses on understanding the mechanisms of hereditary retinal degenerations and age-related macular degeneration (AMD), to perform pre-clinical evaluation of drug therapies, and to fast track laboratory results to patient care.

Maureen G. Maguire, PhD

As director of the Center for Preventive Ophthalmology and Biostatistics, Dr. Maguire’s current research projects include directing the coordinating center for the NIH-funded Comparison of Age-related Macular Degeneration Treatments Trials, a multicenter, randomized clinical trial involving 1,200 patients with choroidal neovascularization.

Eydie G. Miller-Ellis, MD

As a glaucoma specialist and director of the glaucoma service, Dr. Miller-Ellis’ research interests include medical and surgical interventions for glaucoma, and diagnostic techniques for the evaluation of glaucoma. She was the principal investigator for the Advanced Glaucoma Intervention Study and the Ocular Hypertension Treatment Study, two pivotal multicenter clinical trials sponsored by the National Institutes of Health that helped define glaucoma management. She is also the principal investigator for an upcoming multicenter clinical trial that will evaluate the relative efficacy of medical and surgical management of glaucoma.

Kenneth S. Shindler, MD, PhD

Dr. Shindler’s research area is optic neuritis, an inflammatory disease of the optic nerve that often occurs as part of the neurodegenerative disease multiple sclerosis. (MS). Dr. Shindler’s studies are helping to identify new drug therapies and drug combinations to prevent nerve damage in MS, and such therapies will also likely have benefits for other neurodegenerative diseases.

Dwight Stambolian, MD, PhD

Dr. Stambolian’s lab focuses on gene discovery of complex and single-gene disorders. His research projects include searching for the genes for myopia (near-sightedness), age-related macular degeneration (AMD), Nance Horan Syndrome (a disorder linked to the X-chromosome causing eye and dental abnormalities) and Tcm gene causing microphthalmia or small eyes.

Kalliopi Stasi, MD, PhD

As a cornea specialist and a clinician scientist, Dr. Stasi’s current research project, in collaboration with Penn’s Institute for Regenerative Medicine, focuses on establishing a method for culturing cornea/limbal stem cells and studying their properties in a way that they can be used in the future for transplantation in order to treat limbal stem cell deficiency from a variety of ocular conditions, from ocular burns to post-cancer to congenital diseases.

Richard Stone, MD

Dr. Stone is director of the Applied Ophthalmic Neurobiology Laboratory, studying control mechanisms regulating ocular physiology and development. His studies have addressed the mechanisms responsible for myopia (near-sightedness). His studies have identified several signaling pathways that appear to be involved in controlling eye development, a number of which have now been extended to children. These include the identification of a drug-inhibiting myopia progression in children, the first such clinical innovation in several centuries, and the idea that the daily light-dark cycle might influence eye development.

Gui-shuang Ying, PhD

Dr. Ying is the principal investigator of the Data Coordinating Center for a multicenter study “Telemedicine Approaches to Evaluating Acute-phase Retinopathy of Prematurity (e-ROP)”, a four-year study funded by the National Eye Institute. Retinopathy of prematurity (ROP) is the leading cause of treatable childhood blindness, but is becoming an increasing problem in underserved areas of the U.S. and Canada, and epidemic rates are being found in rapidly developing countries The e-ROP study evaluates the validity, reliability, feasibility and cost-effectiveness using telemedicine to examine the eyes of at-risk babies. The study will enroll 2,000 babies with birth weight of 1250 grams (2.76 pounds) or less from 10 neonatal intensive care units in the United States. The study hopes to greatly reduce the number of examinations needed to be performed by specially trained ophthalmologists, and significantly increase the number of babies who receive appropriate timely evaluations.

Penn Provides Specialized Care for Pituitary Disease

noreply@blogger.com (Unknown) — Thu, 26 May 2011 15:08:00 +0000

The symptoms can be vague. Headaches, weight loss or gain, fatigue, and cold intolerance: Symptoms that might be dismissed as menopause or stress. But these symptoms can sometimes mask pituitary disease.

The Penn Pituitary Center was created to diagnose and treat people with pituitary disease. The center's multidisciplinary team of endocrinologists, neurosurgeons, radiation oncologists, neuroradiologists, interventional radiologists and neuro-opthalmologists are recognized internationally for their expertise in the diagnosis and treatment of neuroendocrine diseases.

The pituitary gland is about the size of a pea and sits in a small cavity at the base of the brain. It produces major hormones that control bodily functions.

“If the pituitary gland’s functions are compromised by disease or a tumor, hormone production is impaired and an individual will experience symptoms,” says endocrinologist Julia Kharlip, MD.

"The symptoms may go unexplained for months or sometimes years until the problem is uncovered by an astute clinician or when the patient’s peripheral vision begins to be affected by a growing pituitary tumor," Dr. Kharlip continues. "The good news is that although these diseases are insidious, once diagnosed, they can be treated successfully, restoring quality of life and preserving vision.”

The Penn Pituitary Center provides the latest specialized care for patients with pituitary disease including:

Acromegaly
Cushing's disease
Hyperprolactinemia
Gonadotroph and other clinically nonfunctioning pituitary adenomas
Pituitary and hypothalalmic lesions
Hypopituitarism
Diabetes insipidus

Because these are complex disorders, care of one patient involves multiple specialists.

“Seeing so many doctors may sound daunting, but our center coordinator makes navigating the multiple visits easier for families, often scheduling all appointments on the same day. All physicians at Penn have access to electronic medical records and images. Once a patient starts their journey, there is no more logging of the bulky stacks of handwritten notes or image envelopes from visit to visit," Dr. Kharlip said.

“Once all of us had a chance to evaluate the patient individually, the specific case is discussed among the team at a conference, where we can form a consensus of opinion about treatment plans from all disciplines,” says Dr. Kharlip. "When several treatment options are reasonable, we involve the patient in choosing the approach that is best for him or her."

Every person’s experience with pituitary disease is unique and deserves a treatment plan tailored to their needs. Consequently, patients with pituitary disease benefit from the observations and expertise of many medical fields including endocrinology, ophthalmology and neurosurgery.

“We can offer patients advanced care that community hospitals may not be able to offer because we have the expertise and technology only an advanced academic institution like Penn Medicine has,” says Dr. Kharlip.

Surgical expertise

Pituitary disease affects nearly 22 percent of the U.S. population. It is often caused by a tumor and surgery is almost always part of the treatment plan. The good news is most pituitary tumors are benign, or non-cancerous.

“Having surgery when the pituitary is damaged can be dangerous. Before surgery, the endocrinology team works with patients to make sure their hormones are at safe levels,” said Dr. Kharlip.

Sean Grady, MD, is the chairman of the department of neurosurgery at Penn Medicine. He says the procedure to remove pituitary tumors is straightforward, but its complications can be substantial.

“Pituitary tumors are usually removed with minimally invasive techniques through a patient’s nasal cavity,” says Dr. Grady. “It requires no incisions, and patients usually go home within three days.”

But because of the tumor’s location within the brain, it’s important for patients to have their surgery performed by a team whose experience and expertise ensures the best possible outcomes.

“We perform two to three surgeries like this per week,” says Dr. Grady. “Not only does our surgical team have vast experience with this type of procedure, the entire team within Penn’s Pituitary Center is aware of the alternatives to surgery when surgery may not be the best option.”

After surgery, patients may receive radiation treatment to prevent recurrence or shrink any part of the tumor that could not be surgically removed.

“Penn offers patients the latest approaches in radiation treatment,” says Dr. Kharlip. “From Gamma Knife® radiation therapy, which delivers a single high dose of gamma radiation to the tumor, to proton therapy which is only offered in a handful of locations within the country, to traditional radiation therapy, patients have the benefit of Penn’s expertise throughout their entire treatment.”

For more information about the Penn Pituitary Center, or to make an appointment, please call 800-789-PENN (7366) or visit PennMedicine.org.

Advanced Neuro Critical Care

noreply@blogger.com (Unknown) — Thu, 26 May 2011 15:07:00 +0000

It might look like every other intensive care unit (ICU) in a hospital, but Penn Medicine’s Neuro ICU is a highly specialized unit with experts trained to monitor, treat and rehabilitate patients with neurological issues.

W. Andrew Kofke, MD, specializes in anesthesiology and critical care and is co-director, with Joshua Levine, MD, of the 22-bed unit.

“While we act very similar to a regular ICU, our staff is trained and specialized to look for specific issues and complications neurosurgery and neurology patients may encounter as they recover,” says Dr. Kofke.

The Neuro ICU is part of the Penn Medicine Neuroscience Center. It is a level I trauma center and acute brain injury center, treating and monitoring patients who have experienced head trauma, spinal cord injuries, epilepsy, brain infections, strokes and patients who have had neurosurgery, including removal of tumors on the pituitary gland.

Bringing Penn Medicine Expertise to the Community

noreply@blogger.com (Unknown) — Thu, 26 May 2011 15:06:00 +0000

Patients throughout the region are realizing they don’t have to travel to Philadelphia to see a Penn Medicine physician. In many suburban communities, Penn Medicine is right around the corner.

Beginning with the opening of its first multispecialty site in Radnor in the 1990s, Penn has focused on bringing its expert services and nationally recognized physicians to the communities it serves. Following the model established in Radnor, multispecialty Penn Medicine medical buildings were opened in Bucks County and Cherry Hill, NJ.

In 2010, Penn Medicine extended its reach into the suburbs with two new state-of-the-art medical centers, Valley Forge and Woodbury Heights.

Valley Forge

Valley Forge, a 90,000-square-foot outpatient medical building at the intersection of Chesterbrook Boulevard and Swedesford Road in Chester County, opened in July 2010. It is home to a large family medicine practice, on-site laboratory and radiology services and specialists.

This location also serves as a primary care training site for University of Pennsylvania School of Medicine students.

Designed as a “green building” and Leadership in Energy and Environmental Design- (LEED) certified, the building’s design reduces water runoff and uses less energy. Construction is also under way for a same-day surgery center that is expected to open in 2012.

Woodbury Heights

Located at 1006 Mantua Pike in Woodbury Heights, New Jersey, this facility is a 30,000-square-foot outpatient medical building with Penn primary care, obstetrics and gynecology, specialty care physicians, on-site laboratory services, and physical therapy.

Bucks County

Like the other community-based medical centers, the Bucks County facility provides expert primary care and specialty health care, plus a full range of services to residents of Bucks County. Now families can see their primary care physician, consult with a specialist, get lab work and radiology services all in one place.

Cherry Hill

Cherry Hill was the first multispecialty facility to bring Penn Medicine physicians to South Jersey. Along with a large family medicine practice, lab and radiology, physicians from several specialties see patients at Cherry Hill.

Radnor*

The model for Penn’s community-based practices, Radnor offers services in over 40 medical specialties. In addition to physician appointments, Penn Medicine patients also have access to on-site lab and radiology services, a pharmacy and optical shop.

A variety of on-site health education programs are offered in the spring and fall. Open to the public at no charge, the Mainly Your Health programs feature Penn Medicine physicians and clinicians who discuss the latest treatment advances and ways to stay healthy. The Mainly Your Health lecture series is being expanded to several other Penn Medicine community locations.

*A facility of the Hospital of the University of Pennsylvania

Information about all Penn Medicine hospitals and locations including services available, driving directions and visitor information is available at PennMedicine.org.

Finding Relief from Knee Pain

noreply@blogger.com (Unknown) — Thu, 26 May 2011 15:05:00 +0000

Knee pain is a common complaint and it has many causes. At Penn Medicine, teams from orthopaedics, sports medicine, radiology, and physical therapy and rehabilitation work together to help patients find relief from knee pain.

An accurate diagnosis of the cause of the knee pain is the first step in developing the appropriate treatment plan.

Getting the Whole Picture

X-rays are usually the first step in diagnosing knee pain or injury. When a patient shows up with knee pain, he or she is evaluated by a Penn orthopaedic specialist who performs a focused exam that matches the symptoms to what is seen on film.

“X-rays are good screening tools for assessing the bones and structures,” said Nancy Major, MD, from Penn Radiology. “We get multiple views of the knee joint and almost always move forward with an MRI that lets us see inside the knee joint.”

Magnetic resonance imaging, or MRI, allows the radiologist and orthopaedic specialists to look inside the joint at cartilage, ligaments and tendons. It may even show small fractures that don’t show up on the X-ray.

“The X-ray and MRI can help the physician and the patient determine the best way to manage the knee pain,” Dr. Major said.

Non-surgical Options

If reducing pain is the primary goal of treatment, joint preservation is the next priority, according to John Kelly IV, MD, Penn sports medicine specialist.

“We look for ways to treat the patient and the knee,” Dr. Kelly said. “A stronger knee often means a reduction in the stress that causes pain. Weight reduction and physical therapy may help alleviate the pain and improve the patient’s health.”

If strengthening is not enough, Dr. Kelly said the least invasive treatment methods are often the best, especially for younger patients.

“People are living longer so a knee replacement for someone in his or her 40s may have to last 50 years,” Dr. Kelly said. “If we can treat the pain with injections or arthroscopic (minimally invasive) surgery and postpone major surgery for a few years, the patient stands a better chance of long-term success.”

Joint Replacement Improves Quality of Life

Often, joint replacement surgery is the best solution for managing debilitating knee pain or injuries. Undoubtedly one of the greatest medical advances for improving patients’ quality of life over the past 40 years, knee replacements have been performed in millions of Americans, easing pain, improving range of motion, and keeping them active.

“Younger people aren’t ready to slow down and they are not going to let their pain dictate their activities,” said Craig Israelite, MD, orthopaedic surgeon at Penn Presbyterian Medical Center. “It used to be we wouldn’t even consider joint replacement for a patient under the age of 60. But now, with new materials that are more durable and longer lasting, we can help younger patients and get them back to their life.”

In addition to performing a large number of surgeries, Penn orthopaedic surgeons also perform more complex and complicated knee replacement procedures, as well as many minimally invasive procedures. They are also continually working to improve the fit and function of joint replacements. The ultimate goal is to make the replacement feel and act as normal as possible, especially for knees.

Back in Action

Every patient experiencing knee pain finds themselves in physical therapy at some point during their treatment. The ultimate goal is to return to normal activities without pain and physical therapy builds strength in the knee and improves the range of motion.

“The first thing we do with knee patients is an evaluation of the problem, what are the pain levels, whether or not they have had surgery and what type of surgery and what is the normal activity level to which the patient needs to return,” said Brian Leggin, PT, DPT, OCS with Good Shepherd Penn Partners Penn Therapy and Fitness.

Extension, range of motion of the knee and strengthening the thigh and hip muscles are key components to rehabilitation, according to Leggin. Without full extension—being able to straighten the leg without a bend at the knee—patients will walk with a limp.

As the range of motion improves, the therapy focuses on activities that make the leg stronger. Studies have demonstrated that improving strength leads to better function. Leggin also said studies show that following surgery, patients make the biggest gains in the first three months of therapy and after six months, most return to a normal level of activity.

People experiencing knee pain from arthritis or injury can find more information or schedule an appointment with a Penn orthopaedic specialist at PennMedicine.org or by calling 800-789-PENN (7366).

Advanced Reproductive Care

noreply@blogger.com (Unknown) — Thu, 26 May 2011 15:04:00 +0000

Penn Fertility Care has helped thousands of couples become families. Last year alone, fertility specialists at Penn performed more than 400 in vitro fertilization procedures. Fertility treatments have advanced considerably throughout the last 40 years as evidenced by development of reproductive options including in vitro fertilization, cryopreservation of sperm, eggs and embryos, micromanipulation of gametes and embryos, preimplantation genetic diagnosis and third-party reproduction.

IVF

In vitro fertilization (IVF) is the most successful infertility treatment, according to Anuja Dokras, MD, PhD, medical director of Penn Fertility Care’s in vitro fertilization program.

It is commonly used when the fallopian tubes are severely damaged or absent, and for other indications such as unexplained and male factor infertility. For IVF, the ovaries are stimulated with hormones to produce multiple egg-containing follicles. The eggs are retrieved surgically and immediately transferred to the laboratory where they are fertilized and cultured for a few days. On a predetermined date, the developing embryos are inserted into the uterus for further growth and implantation.

Due to its high success rate, IVF has been used more frequently in recent years as a therapy for all causes of infertility.

Micromanipulation

Micromanipulation of eggs and sperm can help make IVF more effective, especially in cases of male infertility. According to Dr. Dokras, intracytoplasmic sperm injection (ICSI) is a technique whereby a sperm is inserted directly into the harvested egg. Specialized tools are used to pick up an individual sperm and inject it into the inner part (cytoplasm) of the egg allowing sperm that cannot swim (decreased motility) or bind to an egg to fertilize it.

“We have success with this procedure in cases of severe male infertility,” said Dr. Dokras. “If the man produces no sperm, we can also use sperm taken through a testicular biopsy to fertilize the egg.”

Other micromanipulation methods used in infertility treatments include the use of a laser to make a small opening in the shell surrounding the egg (zona) to help the embryo attach to the uterus.

If one or both parents are carriers or affected by a genetic or chromosomal disorder, embryo biopsy for preimplantation genetic diagnosis (PGD) may be performed before the embryos are transferred to the uterus, Dr. Dokras said. This allows couples to make informed decisions about their next steps in the IVF process by ensuring that embryos unaffected by the genetic or chromosomal disorder are selected for transfer to the uterus.

Third-Party Reproduction

Donated eggs, sperm and embryos have helped many couples realize their dream of starting a family. In other cases, a gestational carrier, or surrogate, helps couples create their family.

“Third-party reproduction is a process where one person (known or anonymous) provides eggs, sperm or embryos to another person or couple so that they may become pregnant,” said Dr. Dokras. "For women who are unable to carry a pregnancy, and for those who have experienced multiple pregnancy losses, surrogacy can be the answer."

Penn has a successful egg donation program that promotes responsible, healthy outcomes.

The donor embryo program is a relatively new service for patients who have not had success with IVF and other fertility treatments. Penn Fertility Care receives donated cryopreserved embryos from patients who have gone through successful in vitro fertilization treatment. Using donated embryos is an excellent form of treatment for couples that have been unsuccessful in achieving pregnancy through assisted reproductive technologies with their own eggs and sperm (or gametes).

Couples who choose to have their child carried by surrogate make most of the arrangements on their own and Penn fertility specialists work with the parties to facilitate the process. IVF is the most common method for achieving pregnancy with a surrogate.

“The third party’s assistance is limited to the reproductive process and does not involve raising the child,” Dr. Dokras said. “This may not be a traditional method to have a baby, but these services have helped to build families around the world.”

Assisted reproduction involving a third-party requires additional considerations including medical, financial and legal issues.

For more information or to schedule an appointment with Penn Fertility Care, please visit PennMedicine.org or call 800-789-PENN (7366).

Every Option for Treating Prostate Cancer

noreply@blogger.com (Unknown) — Thu, 26 May 2011 15:03:00 +0000

According to the American Cancer Society, more than 2 million men in the U.S. count themselves as prostate cancer survivors. Men worried about developing prostate cancer, making decisions about their treatment, or trying to stay well after treatment, will find a full spectrum of care at Penn Medicine.

Prostate cancer is the most common cancer in American men, and in most men it grows very slowly. It occurs when cells in the prostate gland grow out of control. There are often no early prostate cancer symptoms, but some men have urinary symptoms and discomfort. In 2010, an estimated 218,000 men in the U.S. were newly diagnosed with prostate cancer and an estimated 32,000 deaths were attributed to the disease.

Experts at Penn Medicine's Abramson Cancer Center say age is the strongest risk factor for prostate cancer. Prostate cancer rarely occurs before the age of 40, but the chance of having prostate cancer rises rapidly after age 50. African-American men appear to be at higher risk for developing prostate cancer than men of other races.

Many men who come to Penn Urology have already had a positive prostate biopsy. Before a treatment plan is developed, Penn urologists get a complete diagnosis. This may include an endorectal coil MRI of the prostate gland and pelvis. This technique, developed at Penn Medicine, currently represents the optimal method for visualizing the local anatomy and assessing the extent of the disease.

After the evaluation, patients are encouraged to seek an opinion with a Penn radiation oncologist with special expertise in prostate cancer and have an extensive discussion with the urologist as well. They are provided with a comprehensive list of management options, which may include “active surveillance,” surgery or radiation therapy.

Active Surveillance

Sometimes called “watchful waiting,” active surveillance involves diligent monitoring of the prostate. According to Alan J. Wein, MD, PhD (Hon), chief of Penn Urology, active surveillance may be an excellent option for men with low-volume disease that does not appear aggressive.

“Just like any treatment, this is not for everyone. But especially for older patients with a low PSA, limited disease and a biopsy that has shown the disease is not aggressive, active surveillance may be a good option,” Dr. Wein said. “When this option is selected, patients agree to diligent monitoring of their condition and all (doctor and patient) must agree to the changes that move them from surveillance to active management.”

Prostatectomy

Radical prostatectomy is surgical removal of the whole prostate gland plus some of the tissue around it, including the seminal vesicles. It is used most often if it looks like the cancer has not spread outside of the gland.

Radical prostatectomy is done as both as a nerve-sparing open surgical procedure and a robotic-assisted minimally invasive procedure. Penn’s urologic surgeons at the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center and Pennsylvania Hospital are experts in both approaches.

“Not everyone is a candidate for surgery,” said Dr. Wein. “We consider factors such as patient life expectancy, general health and stage of the cancer before considering surgery. The patient must consider, as well, his willingness and that of his family, to accept the risks, both general and specific, of the procedure.”

In the last few years, robotic-assisted prostatectomy has become the surgical option of choice for many men. When David I. Lee, MD, founded Penn’s robotic urology program in 2005, he was one of the first urologists in the region performing robotic-assisted prostatectomy.

“Prostate cancer strikes both young and older men,” Dr. Lee said. “For younger, healthier patients surgery may be the best treatment.”

According to Dr. Lee, robotic prostatectomy allows the surgeon a three-dimensional view of the prostate. The robot also provides magnification of the prostate and surrounding area, allowing the surgeon to see small vessels.

Patient outcomes are similar for both open radical prostatectomy and robotic prostatectomy.

Radiation Therapy

Penn Radiation Oncology provides access to the most advanced technologies and treatments available for prostate cancer including intensity-modulated radiation therapy and proton therapy.

Like surgery, radiation therapy is a primary treatment for prostate cancer, but it is non-invasive. External beam radiation is used to kill cancer cells and prevent them from dividing. Penn’s state-of-the-art external beam radiation tools for treating prostate cancer include photon (X-ray) beams and proton particle beams.

Photon beams are delivered by a linear accelerator, according to Neha Vapiwala, MD, chief of genitourinary cancer service for Penn Radiation Oncology. Intensity-modulated radiation therapy (IMRT) allows for bending and shaping of the photon beams to better conform to the size and contour of the tumor or target. Image-guided radiation therapy (IGRT) uses modern imaging techniques to identify the target throughout the treatment.

“Proton beam therapy is an incredible new tool we’ve just added to our armamentarium in the fight against prostate cancer,” Dr. Vapiwala said. “For many prostate cancer patients who are considering non-invasive treatment, proton therapy is a potential option.”

Penn Medicine's Roberts Proton Therapy Center is the largest and most advanced facility in the world for this targeted form of cancer radiation. Proton therapy is external beam radiotherapy in which proton beams are directed at the tumor. The radiation dose that is given through proton particles is very targeted, and exposure to surrounding normal tissues can be reduced or eliminated. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation. The possible result is a better chance for curing cancer with fewer harmful side effects.

Ongoing studies at Penn are currently investigating whether the favorable dose delivery of proton therapy results in less exposure and reduced side effects for patients with prostate cancer.

Cryotherapy

Despite the best efforts of both radiation oncologists and urologic surgeons, sometimes prostate cancer recurs. For those rare cases, cryoablation of the prostate gland may be used.

“Cryotherapy is a viable treatment option for local recurrence of prostate cancer,” said Joseph F. Harryhill, MD, Penn urologist at Pennsylvania Hospital. “When cancer recurs after radiation therapy, surgery can be difficult. We now have sophisticated equipment that allows us to precisely target the area to be treated.”

During cryotherapy treatment, Dr. Harryhill uses ultrasound to guide the placement of thin needles into the area being treated. Argon gas is used to form ice at the end of the needles. Cancer cells are more sensitive to cold than regular cells, so the freezing destroys the cancer cells.

Pennsylvania Hospital is one of the few facilities in the region offering this secondary therapy for prostate cancer.

For more information or to schedule an appointment, please visit PennMedicine.org, PennCancer.org, or call 800-789-PENN.

Teenagers Face Unique Challenges

noreply@blogger.com (Unknown) — Thu, 26 May 2011 15:02:00 +0000

Adolescence can be a challenging time. Many teenage girls experience irregular or absent menstrual bleeding, pelvic pain, excessive hair growth and ovary cysts. These symptoms may be the sign of an endocrine disorder.

The glands of the endocrine system release hormones that regulate many bodily processes, including menstrual and reproductive function. Fortunately, endocrine disorders can be managed by a reproductive endocrinologist.

Suleena Kansal Kalra, MD, is a reproductive endocrinologist who specializes in adolescent reproductive health at Penn Medicine. A reproductive endocrinologist is an obstetrician/gynecologist with specialized training and expertise who diagnoses, manages and treats endocrine disorders that affect menstrual and reproductive function.

For adolescent females, the normal changes related to puberty may occur too early, too often or not at all, according to Dr. Kalra. In some young women, these irregularities can be attributed to an endocrine disorder that could affect their future fertility and overall reproductive health.

Dr. Kalra provides specialized, one-on-one care for adolescents experiencing endocrine disorders that can affect reproductive health. She is available to see adolescent women at Penn Fertility Care at Pennsylvania Hospital and at the Radnor facility.

Penn Fertility Care offers a full range of adolescent reproductive health services, including evaluation and treatment for:

Abdominal pain
Amenorrhea
Congenital uterine anomalies
Dysmenorrhea
Endometriosis
Fertility-preserving surgery
Hirsutism
Irregular menstrual bleeding
Ovarian cysts
Polycystic ovary syndrome (PCOS)
Reproductive options for cancer patients
Reproductive surgery

For more information or to make an appointment with a Penn reproductive endocrinologist, call 800-789-PENN (7366) or log on to PennMedicine.org.

Penn Leads in Transfusion Free Heart Surgery

noreply@blogger.com (Unknown) — Fri, 11 Feb 2011 14:01:00 +0000

Penn Medicine has a long history of pioneering advanced surgical techniques. Bloodless cardiac surgery is just one of those surgical advances. The Bloodless Cardiac Surgery Program at Pennsylvania Hospital is one of the few bloodless programs in the nation to offer a full array of cardiac procedures, including complex heart surgery. Surgeons from around the world, including four cardiac surgeons recently visiting from Beijing China, have worked with Penn surgeons to observe and learn about bloodless cardiac surgery.

The complexities of performing bloodless cardiac surgery require meticulous surgical technique. From preparation through recovery, successful bloodless surgery requires the talents of a very experienced, multispecialty team. Penn cardiovascular surgeons have mastered the exact level of skill and precision necessary to perform bloodless procedures. They successfully perform the most complex and intricate surgeries using bloodless strategies, and in fact, have helped design some of these processes and techniques.

“We have to be fast and precise,” said Charles R. Bridges, MD, ScD, chief of cardiovascular surgery at Pennsylvania Hospital. “In bloodless surgery, any post-surgical bleeding is unacceptable so our radar is finely tuned to recognize and address any potential bleeding issues.”

Bloodless surgery, also known as “transfusion-free” surgery, is performed without the use of stored or donated blood products. It also involves special pre-operative and post-operative blood management techniques to minimize blood loss.

Why Bloodless?
Interest in blood conservation techniques is growing around the world. Some patients do not want blood products used during surgery because of their religious beliefs. In third-world countries, blood supplies are limited and the blood that is available has not been subjected to the same safety measures employed in the U.S. In addition, emerging research shows that blood transfusions can put patients at higher risk for complications including infection, kidney failure and death, according to Dr. Bridges. These results point to the conservation of blood during cardiac surgery when it can be done safely.

“The consensus is, blood use does impact surgical success,” Dr. Bridges said. “A blood transfusion is a type of transplant. It promotes inflammation and an immune reaction. Heart patients are already vulnerable because of the stress from surgery so a transfusion is a double hit. We now have unequivocal evidence that unnecessary blood transfusions are harmful to patients.”

Dr. Bridges said more than 90 percent of the cardiac surgeries performed at Pennsylvania Hospital can be performed without the use of blood products.

“At Pennsylvania Hospital we are doing increasingly complex procedures following blood conserving techniques including the largest series of reoperative cardiac surgery (second-time heart surgery) and complex aortic surgeries in the country. Our goal is to perform all procedures using bloodless techniques when it can be done safely,” he said.

Benefits of bloodless cardiac surgery include:
§ Fewer complications related to transfusions.
§ Faster recovery time
§ Shorter hospital stay
§ Less chance of infection
§ Faster healing time for wounds

Blood Conserving Techniques
Every member of the cardiovascular team involved with patient care follows meticulous blood conservation protocols beginning before admission and continuing throughout the patients stay in the hospital.

Before surgery, patients see a member of the bloodless medicine staff. Hemoglobin levels are checked and any anemia is managed before surgery. If catheterization is needed in addition to surgery, it is performed several days before the surgery to allow patients’ hemoglobin levels to return to normal.

During surgery, up to three units of patient blood is held, separately but still connected, and protected from the heart-lung machine. This protects the blood and its components and provides fresh blood for use following the surgery. In addition, a mini heart-lung circuit is used, reducing the amount of saline that is used. Saline dilutes the blood.

“Meticulous surgical technique also helps reduce blood loss,” Dr. Bridges said. “The less time a patient is on the heart-lung machine, the less blood that is lost.”

Post surgery, Dr. Bridges said blood is not routinely drawn from patients, but only when it is necessary for patient care. When blood is taken for testing, pediatric tubes that hold less blood are used.

For more information about bloodless cardiac surgery or to schedule an appointment, please call 800-789-PENN (7366) or visit PennMedicine.org.

It Pays to Get a Second Opinion

noreply@blogger.com (Unknown) — Fri, 11 Feb 2011 14:00:00 +0000

Most people don’t like going to the doctor and patients diagnosed with a heart condition are no exception. But getting a second opinion from an experienced physician at a high-volume center like Penn Medicine can benefit most patients.

“One of the biggest mistakes patients make is not getting a second opinion,” said William J. Untereker, MD, associate director of cardiology at Penn Presbyterian Medical Center. “People’s life goals are different and treatments are different. If there is any serious risk to a recommended treatment, the patient should seek a second opinion.”

As a leading center for heart care in the region, physicians at Penn Medicine are often asked to provide second opinions on patient care. Medicine is not an exact science. Physicians often have different opinions about how to diagnose or treat heart disorders and those differences can sometimes be based on how familiar a doctor is with a test or treatment or how willing he or she is to use them, and whether they have had time to think through other options.

Dr. Untereker describes the case of an 80-year-old patient with two leaking heart valves who was referred to Penn Medicine for valve surgery.

“The patient also had high blood pressure,” Dr. Untereker said. “By managing the patient’s blood pressure we were able to reduce the amount of leak through the diseased valves. This improved the patient’s condition so that surgery with high risk and a long recovery was not needed.”

Dr. Untereker recommends patients make sure their risky procedure is done by a high volume, experienced provider. A physician with this expertise has the best chance of getting a good outcome. He also recommends that patients get a full, written explanation of any procedure that is recommended, including the risks and benefits. If there are serious risks, that is the time to get a second opinion.

“Patients should remember that there are only two reasons to have a procedure that is associated with risk,” Dr. Untereker said. “The first is you want it because of your symptoms; the second is because your doctor thinks you will live longer or statistically benefit from it. Make sure you know to which category you belong.”

Penn Physicians Place Region’s First Subcutaneous ICD

noreply@blogger.com (Unknown) — Fri, 28 Jan 2011 14:01:00 +0000

In August, electrophysiologists from Penn Medicine implanted the region’s first subcutaneous implantable cardioverter defibrillator (ICD) for sudden cardiac arrest, a potentially fatal electrical malfunction of the heart. The patient, a young athletic male in his 20s, had the new system implanted during an outpatient procedure at the Hospital of the University of Pennsylvania (HUP).

“I am very glad we are able to provide this technologic breakthrough. He is an athletic young man who is now protected from life-threatening arrhythmias. It is reassuring to not have to worry about problems related to intravascular leads,” said Frank Marchlinski, MD, director of the Penn Medicine electrophysiology program.

Conventional ICDs require placement of at least one lead in or directly on the heart. Most frequently they are threaded through a vein and then placed inside the heart. The device then monitors the heart’s rhythm and delivers a life saving electric shock when a harmful arrhythmia is detected.

The new device, known as a subcutaneous implantable defibrillator or S-ICD, works much like an external defibrillator, but the entire system is implanted just under the skin on the chest. A small power unit is placed under the skin on the side of the chest and is attached to a thin sensor and shocking cable implanted under the skin near the breast bone. The new device implantation is part of an ongoing clinical trial that involves 35 sites globally. Penn’s patient is one of only 330 total patients enrolled in the trial around the world.

The trial is a prospective, multicenter, single-arm design approved in the U.S. by the FDA under an investigational device exemption (IDE). Results from four studies conducted at eight sites in Europe found that the S-ICD detected 100 percent of induced and spontaneous irregular heart rhythms with 98 percent conversion success. They confirmed that the subcutaneous defibrillator helped reduce problems associated with traditional models, including difficulty implanting the leads, risk of damage to the heart or the device, chance of infection and the need to remove a defective or damaged electrode in or on the heart. The device received European approval in 2009 and is commercially available there.

Interdisciplinary Care and Innovation the Foundation of Penn Valve Center

noreply@blogger.com (Unknown) — Fri, 28 Jan 2011 14:00:00 +0000

For more than a decade, the clinical specialists of Penn Medicine's heart valve disease program have led the way in the development of new techniques and devices for valve disease. Today, this clinical expertise comes together in the Penn Valve Center.

Based in the Heart and Vascular Center, the Penn Valve Center provides patients with valve disease access to superior interdisciplinary treatment in one convenient location. Penn is the largest provider of heart valve care in the region and performs more than 1,000 valve procedures annually.

"We have built an impressive record of performing valve repair and replacement procedures and lead Pennsylvania with better than expected outcomes," says Joseph Woo, MD, director, minimally invasive and robotic surgery program. "We strive to improve longevity and quality of life for valve patients by offering a full range of interventional and surgical options, including minimal access and transcatheter valve procedures."

Surgeries are performed in one of Penn Medicine's three hybrid cath lab/OR suites, which are located at the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center. These state-of-the-art surgical suites, which feature the technologies needed to perform both minimally invasive and open procedures, are specially designed to allow for collaboration between interventional cardiologists and cardiovascular surgeons.

"The hybrid OR possesses superior imaging technology, which means fewer and smaller incisions are required to complete a case," explains Wilson Szeto, MD, surgical director, transcatheter cardio-aortic therapies. "This results in shorter hospital stays and better patient outcomes."

Following valve surgery, patients are evaluated postoperatively and at one year. This longitudinal clinical support is provided by advanced nurse practitioners working in collaboration with the cardiovascular surgical team.

"One of the key benefits of the Penn Valve Center will be the creation of a sophisticated and secure health information platform that allows us to accurately follow our patients' life-long progress," says Nimesh Desai, MD, PhD, cardiovascular surgeon and architect of the Penn Valve Center database.

"Long-term follow up allows us to offer an enhanced level of care while gaining a better understanding of the health needs of valve surgery patients over time," says Michael Acker, MD, chief of cardiovascular surgery. "It also means that we can provide referring physicians with robust feedback."

The Penn Valve Center is supported by active research programs, which have placed it at the forefront of new developments in the diagnosis and management of heart valve disorders. In addition to the host of Penn-initiated research projects, there are also a number of national, multicenter studies in which the Penn Valve Center participates.

Procedures Offered at the Penn Valve Center:

Advanced port-access surgery for mitral valve repair and replacement
Balloon valvuloplasty to treat mitral stenosis and aortic stenosis
Percutaneous (catheter-based) mitral valve clip repair to treat mitral regurgitation
Transcatheter aortic valve replacement or surgery to treat aortic stenosis
Valve-sparing aortic root replacement
Complex aortic root construction of all types
Robotic surgery with three-dimensional endoscopic imaging

For more information about the Penn Valve Center or to schedule an appointment, please 800-789-PENN (7366), or visit PennMedicine.org/heart.

Penn Provides World-Class Treatment for Abnormal Heart Rhythms

noreply@blogger.com (Unknown) — Fri, 14 Jan 2011 00:00:00 +0000

Penn’s cardiac arrhythmia program is a regional and national referral center for heart rhythm disorders. For patients at risk for recurrent, sustained ventricular tachycardia or fibrillation, an implantable cardioverter defibrillator (ICD) is often the treatment of choice and Penn is a pioneer in the development and use of ICDs.

In 1981, Penn Medicine physicians implanted one of the first ICD devices used to treat ventricular arrhythmias, abnormal life-threatening rhythm from the ventricles. Since that time, they have remained at the forefront of every new development and contribution in the field of implantable devices.

“Penn Medicine has been at every stage of this cutting-edge technology for the past 30 years,” said Francis E. Marchlinksi, MD, director of Penn’s electrophysiology program. “Members of our team helped determine the guidelines for implantation and we continue to investigate new advances in ICD technology.”

How ICDs Work

Implantable cardioverter defibrillators detect ventricular tachycardia or fibrillation and shock the heart to restore the normal rhythm. The device is connected to leads positioned inside the heart or on its surface that deliver electrical shocks. The leads are connected to a pulse generator about the size of a deck of cards that is implanted beneath the skin of the chest or abdomen. Electronics in the devices sense cardiac rhythms and sometimes pace the heart, as needed.

ICDs have been very useful in preventing sudden death in patients with known, sustained ventricular tachycardia or fibrillation. Newer ICDs are smaller and have simpler lead systems. The device leads placed in the heart can be installed through blood vessels, and do not need open chest surgery.

Penn is a full-service arrhythmia center, with programs located at the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center and Pennsylvania Hospital. The electrophysiologists, many of whom are recognized as “Top Doctors” and “Best Doctors,” cover all aspects of ICD management from implantation through extraction, with an emphasis on optimization. The optimization clinic evaluates patients to make sure their biventricular ICD or pacemaker is working appropriately for treating heart failure.

“ICDs shock the heart back into a normal rhythm and that can be very uncomfortable for patients” Dr. Marchlinski said. “An ICD is insurance for the heart: it can save the patient’s life during a life-threatening episode, but it should rarely be triggered.”

The Penn Difference

Penn Medicine’s arrhythmia team is led by board-certified electrophysiologists who collaborate with heart failure specialists, cardiovascular surgeons and other specialists in treating the full spectrum of heart rhythm disturbances. These extended teams of caregivers review all cases on a daily basis to further optimize treatment strategies.

Each year, physicians at the Hospital of the University of Pennsylvania place more than 400 ICDs, a number that has increased by 40 percent in just the past three years. In addition, more than 4,000 electrophysiology procedures and 1,100 catheter ablation procedures are performed annually.

The cardiac arrhythmia program at the Hospital of the University of Pennsylvania is one of the largest hospital-based electrophysiology programs in the country with the largest team in the region. Its five EP laboratories are equipped with state-of-the-art imaging and mapping systems and technologies designed to enhance and improve the accuracy, safety and effectiveness of cardiac device implantation.

The Next Generation of ICDs

The leads of ICDs are a common reason for device replacement, which increases the risk of complications. While Penn has one of the few programs in the country experienced in lead extraction, this research can lead to expanded indications for the use of ICDs as well as improved safety, according to Dr. Marchlinski.

Other technologies on the horizon include biological pacemakers and transmitters that can be placed in the heart to improve its ability to squeeze.

Symptoms of Tachycardia & Ventricular Fibrillation

Tachycardia, a rapid heart beat, can produce detectable symptoms including:

Palpitations
Heart pounding or racing
Dizziness
Lightheadedness
Fainting or near fainting
Rhythm may be fast and regular or fast and irregular.

Ventricular fibrillation (VF) is a severely abnormal heart rhythm that can be life threatening. A person experiencing a VF episode suddenly collapses or becomes unconscious because the brain and muscles have stopped receiving blood from the heart.

The following symptoms may occur within one hour before the collapse:

Chest pain
Dizziness
Nausea
Rapid heartbeat
Shortness of breath

For more information about the arrhythmia program at Penn Medicine or to schedule an appointment please visit PennMedicine.org/heart or call 800-789-PENN (7366).

Penn Team Advances Complex Aortic Care

noreply@blogger.com (Unknown) — Thu, 13 Jan 2011 12:01:00 +0000

Patients with aortic disease often find themselves facing complex surgery. At Penn Medicine, the cardiovascular and vascular surgical teams have more experience with these technically demanding procedures and the complex circulatory issues that surround them than any other center in the area. In fact, Penn is known nationally and internationally for successfully performing complex interventions on high-risk patients.

In addition to performing hundreds of procedures every year, Penn’s complex aortic program is also unique because of its integrated surgical team.

“We have a core group of cardiovascular and vascular surgeons who started the aortic program together,” said Ronald M. Fairman, MD, chief of vascular surgery and endovascular therapy. “This partnership is more clinically and academically productive, and it is a model few hospitals

or academic medical centers can replicate.”

The largest artery in the body, the aorta arises from the left ventricle of the heart. Anatomically, it goes up (ascending aorta) from the heart, bends (aortic arch), and then goes down (descending aorta) through the chest and abdomen. The descending aorta is subdivided into the thoracic aorta that descends within the chest and the abdominal aorta that descends within the belly.

Cardiovascular surgeons perform most surgery involving the thoracic aorta, while surgery involving the abdominal aorta is performed by vascular surgeons. Many complex aortic cases involve both the thoracic and abdominal aorta and the aortic surgeons at Penn work together, producing better outcomes for patients.

Conditions Requiring Surgery

The primary cause for aortic surgery is aortic aneurysm, when the artery wall weakens and expands or bulges as blood is pumped through it. An aneurysm can develop anywhere along the course of the thoracic and abdominal aorta.

Aortic dissection occurs when the inner lining of the aorta tears. At the tear site, the blood begins to flow into the wall of the aorta creating two channels, a true and false lumen. As this potentially life-threatening condition advances, the false lumen expands and may compress the true lumen of the aorta as well as important branches of the aorta. Rupture of the aorta is catastrophic. Type A dissections begin in the ascending aorta and Type B dissections in the descending aorta.

Aortic Remodeling

Traditionally, aortic surgery has focused on treating those life-threatening conditions, according to Joseph E. Bavaria, MD, vice chief of cardiovascular surgery and director of Penn’s thoracic aortic surgery program. At Penn, classic open repair of aortic dissections is now being augmented by the use of endovascular stent grafts that reinforce the weak spot in the aorta.

“We have gotten very good at fixing these life-threatening conditions,” Dr. Bavaria said. “Now we are focusing on what happens after the surgery and how we can give patients the best chance of long-term survival. We recently introduced the concept of aortic remodeling. By identifying potential dissections early and placing stents to reinforce the arterial wall, we can stop blood flow to the false channel. By removing the pressure on the wall of the artery we can stop the tear.”

Penn is a world leader in the concept of aortic remodeling and researchers recently published one of the first papers describing the use of stents as an adjunct to open repair.

Penn cardiovascular surgeons are also developing advanced methods for performing aortic arch surgery and valve-sparing aortic root procedures.

“Our methods have advanced to a point where we can repair almost any leaking (insufficient) aortic valve problem without replacing the valve,” Dr. Bavaria said.

Penn surgeons routinely perform the most complex aortic procedures including:

Aortic root reconstruction
Valve-sparing aortic root replacement
Aortic valve repair
Thoracic aortic aneurysms
Abdominal aortic aneurysms
Thoraco-abdominal aortic aneurysms
Aortic dissection; Types A and B
Mechanical and biological valve conduits
Minimally invasive methods of aortic aneurysm repair (endovascular stent grafts)

Personalized Heart Care

The complex aortic program at Penn Medicine is currently enrolling patients genetically predisposed to developing aneurysms in a new genetic trial. By looking for genetic markers physicians hope to be able to identify those people with the highest risk for a life-threatening rupture.

“We know that 25 percent of catastrophic Type A dissections start at a size of less than five centimeters,” Dr. Bavaria said. “We need to identify those 25 percent. We may be able to recommend elective aneurysm repair based on genetic information. That’s a new concept.”

Penn is one of only five centers in the country participating in the NIH-funded GenTAC Program and is one of the top enrollers in the trial. In fact, Penn surgeons have been leaders in every endovascular therapy and aortic clinical trial in the U.S. for nearly 20 years, according to Dr. Fairman.

“We treat aortic disease as a team. Our surgeons, anesthesiologists, nurses, surgical facilities and units are focused on treating these patients, and we have incomparable experience and outcomes,” Dr. Fairman said. “By collaborating on advancing aortic therapies we can make greater strides. It’s a model of care that only exists at Penn.”

For more information about the complex aortic program at Penn, please visit PennMedicine.org/heart. Appointments can be scheduled by calling 800-789-PENN (7366).

Joint Replacement Improves Quality of Life

noreply@blogger.com (Unknown) — Tue, 30 Nov 2010 21:24:00 +0000

Joint replacement surgery is undoubtedly one of the greatest medical advances for improving patients’ quality of life. Over the past 40 years, hip and knee replacements have been performed for millions of Americans, easing pain, improving range of motion, and keeping them active.

Currently, over 400,000 hip and knee replacements are performed in the United States annually. At Penn, orthopaedic surgeons perform more than 2,000 joint replacement procedures a year, treating painful and debilitating joint conditions caused or aggravated by arthritis, trauma, injury and infection.

The number of people seeking relief from joint pain is increasing. Americans are living longer and staying active, and aging baby boomers don’t want to stop participating in sports and other activities because of pain.

“Younger people aren’t ready to slow down and they are not going to let their pain dictate their activities,” said Craig Israelite, MD, orthopaedic surgeon at Penn Presbyterian Medical Center. “It used to be we wouldn’t even consider joint replacement for a patient under the age of 60. But now, with new materials that are more durable and longer lasting, we can help younger patients and get them get back to their life.”

Studies show that the more procedures surgeons perform, the more successful their results, or outcomes. In addition to performing a large number of surgeries, Penn orthopaedic surgeons also perform more complex and complicated joint replacement procedures, as well as many minimally invasive procedures.

“At Penn, we offer advanced, individualized care and we see many patients with complex and complicated problems,” said Gwo-Chin Lee, MD, orthopaedic surgeon.

Along with providing the highest quality patient care, Penn Orthopaedics is involved in educating future orthopaedic surgeons and developing new procedures and joint replacement components.

Building a Better Knee

As leaders and innovators in orthopaedics, Penn physicians are continually working to improve the fit and function of joint replacements. The ultimate goal is to make the replacement feel and act as normal as possible, especially for knees.

Penn ortho surgeons aim to mimic the normal kinematics of the knee. One of the new prosthetics that has been developed replaces both of the patient’s own cruciate ligaments, which makes a significant difference in how the knee feels. It also mimics the normal, asymmetrical anatomy of the knee. The result is a knee that is more stable and feels more natural to the patient.

Patients with arthritis in the knee may also be candidates for partial, or unicompartmental, knee replacement. If an injury results in pain or arthritis on just one side of the knee joint, Penn surgeons are able to use a mini-incision to replace the affected part of the knee joint, with minimal damage to the surrounding muscles and tendons. Patients recover much more quickly from a partial knee replacement and the new prosthetics that are used result in less pain than a traditional knee replacement. Patients can often walk unassisted (without a cane or crutches) within a week after the surgery.

Dr. Lee uses a knee system that includes a rotating platform placed on the tibia (shin bone) that decreases wear on the knee system and allows for some rotation of the knee. He said this helps provide more natural movement of the joint.

One of the latest innovations is the development of customized cutting blocks, designed to improve the accuracy of fitting the knee system. Software analyzes X-ray, MRI and CT images and creates a model of the patient’s knee. Cutting blocks are fabricated from the models and attached to the femur and tibia, allowing the surgeon to precisely fit the knee prosthesis. Called Patient-Matched Custom Knee Replacement, or PMI, the method provides a custom fit and correctly aligns the new joint.

New Hip Materials Offer Durability

For hip replacements, the newest advances are in the types of surfaces being used. The ball and cup implants may be ceramic-on-ceramic, metal-on-metal or metal-on-plastic. Penn surgeons have also seen some success with a new multi-bearing cup for hip replacements. The U.S. Food and Drug Administration (FDA) recently approved use of the cup that can be fitted with a liner of any of the materials. All have unique benefits and all have risks.

“Hip replacements are not one-size-fits-all,” said Dr. Israelite. “All patients are evaluated to determine the best material for their lifestyle and activity level.”

Penn orthopaedic surgeons often perform a minimally invasive hip replacement. The smaller incisions allow the surgeon access to the hip joint while preserving muscle function, enabling patients to return more quickly to their favorite activities.

Penn Sports Medicine Helps Get Patients Back in Action

noreply@blogger.com (Unknown) — Fri, 23 Apr 2010 18:56:00 +0000

It happens to everyone at some time in their lives: They overdo it on the golf course, join the kids for some touch football, or forget they are no longer 17-year-old student athletes. From the weekend warrior to the professional athlete, the specialists at the Penn Sports Medicine Center provide comprehensive care for athletes of all abilities.

Specially trained in the field of sports medicine, all of the physicians at the Penn Sports Medicine Center have one goal — to help their patients get back in the game as quickly as possible. The center’s multidisciplinary approach to care results in individualized treatment plans focusing on the most appropriate treatment and rehabilitation for every injury.

A sports medicine patient can be anyone who is active and needs treatment in order to get back to work, weekend activities or organized sports.

“Our sports medicine team is really multifaceted,” said Brian Sennett, MD, chief of sports medicine at Penn. “We see nearly 4,000 patients a year and provide treatment for a full range of sports injuries related to recreational, high school, collegiate and professional athletic performance.”

The physicians at the Penn Sports Medicine Center are experts in treating serious injuries. They combine treatment, therapy and surgery for the least invasive approach to achieving the best possible outcomes. Arthroscopy, a key sports medicine procedure, involves the insertion of a fiberoptic camera into a joint, enabling the surgeons to watch their movements on a TV monitor while operating through small incisions. This type of minimally invasive surgery benefits patients because it results in minimal scarring, a shorter hospital stay, and a faster recovery.

Along with providing the highest level of patient care, Penn sports medicine physicians are at the forefront of the research of athletic injury and recovery. The research done at the Penn Sports Medicine Center is widely published.

Therapy services for the Penn Sports Medicine Center are provided by Good Shepherd Penn Partners.

Repairing the ACL

A tear of the anterior cruciate ligament (ACL) is a painful injury that can stop any athlete in his or her tracks. The ACL holds the knee joint together and when it is injured, it can make something as simple as walking painful and difficult.

John Kelly, IV, MD, is focusing on ways to reconstruct the ACL that are minimally invasive and less painful. By using surgical instruments designed for the shoulder — they are smaller and less invasive — he can incorporate what he calls a “kinder and gentler” procedure. He refers to it as “augmentation” because it enhances the patient’s own ACL instead of replacing or reconstructing the ligament.

“We leave the existing ACL in place and either repair it or reinforce it,” Dr. Kelly said. “By restoring the patient’s normal anatomy, we can stabilize the knee joint and preserve the normal movement and feeling of the knee.”

While the procedure is not for every patient, young and active patients who have had the procedure have had good results with minimal pain.

Focusing on the Shoulder

In many cases, sports medicine focuses on preventing injury. Shoulder injuries, especially rotator cuff tears, can be career ending for athletes — making normal movement painful. The rotator cuff is the series of muscles and tendons that stabilize the shoulder.

Penn orthopaedic surgeon and sports medicine specialist Russell Huffman, MD, focuses on shoulder issues and helping patients regain motion.

“A rotator cuff tear results in shoulder disability and in the case of large, untreated tears, can lead to arthritis,” Dr. Huffman said. “Fortunately, the majority of rotator cuff surgery can be done arthroscopically with less pain and quicker recovery for the patient.”

Dr. Huffman says many of his patients are young athletes experiencing shoulder instability. For those patients, he is able to restore stability and function through arthroscopic surgery. In more complex cases, he needs to rebuild the bone for added stability, and in extreme cases, shoulder replacement may need to be performed.

In all cases, the role of surgical care is to restore function and eliminate pain. Dr. Huffman performs shoulder surgery at Penn Presbyterian Medical Center.

Creating New Cartilage

Cartilage is the smooth surface that lines joints and allows for fluid motion. Cartilage does not contain blood vessels so any damage or injury is slow to repair.

New cartilage can be generated from the patient’s own cells. That material can then be transplanted back into the joint. In the lab, Penn is looking at new ways to generate biologically compatible cartilage.

The lab is the McKay Orthopaedic Research Lab at Penn. Robert Mauck, PhD, and the research team in the soft tissue biology and engineering lab are looking for new methods to grow cartilage.

“More than 25 million people in the U.S. have some form of osteoarthritis,” said Dr. Mauck. “Arthritis disrupts the rebuilding of the cartilage, and once that begins it is irreversible.”

According to Dr. Mauck, the team is working with the next generation of biocompatible materials that can be combined with cartilage stem cells to create materials for joints, knees and the spine. The research is in its early stages, but Dr. Mauck said the results so far are promising.

Through research and advances in surgical and rehabilitation techniques, orthopaedic sports medicine specialists have been able to treat and rehabilitate athletes whose injuries were once career-ending and put them back in the game.

Advancing the Treatment of Orthpaedic Cancer

noreply@blogger.com (Unknown) — Fri, 23 Apr 2010 18:55:00 +0000

It wasn’t that long ago that cancer in the bone or soft tissue was a serious diagnosis that usually meant amputation of the affected limb. The orthopaedic oncology program at Penn Medicine has a long history of successfully treating these tumors and is one of the largest musculoskeletal tumor referral practices in the country.

Penn's orthopaedic oncology service sees approximately 1,100 new orthopaedic tumor patients each year and performs about 700 surgical procedures. Specialty areas include the treatment of malignant (cancerous) and benign (non-cancerous) tumors of bone and soft tissue with a special interest in limb preservation.

Over the years, the program has advanced treatment so patients have other options besides amputation.

Bone and soft-tissue sarcomas mainly occur in the spine, pelvis and extremities. The most common bone sarcomas—osteosarcoma and Ewing’s sarcoma—normally occur in adolescents and young adults, and chondrosarcoma usually occurs in older adults.

Treating Sarcoma

A three-pronged treatment approach can be used to treat sarcoma—chemotherapy, radiation and surgery. Most tumors start in the bone and then quickly spread beyond, making them too difficult to treat surgically without other treatment. Many of the new chemotherapy agents shrink the size of sarcomas and radiation stops their growth. The smaller tumor can then be safely removed.

If part of the bone is removed with the tumor, modular prosthetics are now available to preserve the limb. The replacement can be exactly sized, allowing patients to maintain their mobility.

A Team Approach

Patients at Penn are treated by a multidisciplinary orthopaedic oncology team. The team meets weekly to discuss all patients and the next steps in their treatment plan. Team members specialize in:

Orthopaedic oncology
Pathology
Musculoskeletal radiology
Hematology-oncology
Radiation oncology
Interventional radiology
Surgical oncology
Plastic surgery

The orthopaedic oncology team is based at Pennsylvania Hospital so that they may meet and collaborate in a common setting. The team uses the strength of their combined experience in treating these tumors and together they develop the appropriate treatment plan for every patient.

Future Treatments

The Roberts Proton Therapy Center at Penn could provide another treatment option for bone and soft-tissue sarcomas.

Proton therapy allows the most precise targeting of dosage to the tumor and lowest unintended radiation dose to normal tissues. The protons can be energized to specific energies or velocities that precisely target the tumor, with little dose beyond the target area.

This puts Penn in the unique position of researching this technology and the role it may play in treating bone and soft-tissue tumors in the future.

Urology Patients Benefit from Robotic Technology

noreply@blogger.com (Unknown) — Thu, 15 Apr 2010 20:03:00 +0000

When David I. Lee, MD, joined Penn Medicine in 2005, he was one of the first urologists in the region performing robotic-assisted prostatectomy. Now, the procedure has become the standard of care — and the treatment of choice for most men.

Dr. Lee, chief of urology at Penn Presbyterian Medical Center, founded Penn’s robotic urology program. Five years later, he is one of the world’s most experienced urologists in the area of robotic-assisted prostatectomy, having performed more than 2,000 procedures.

The program at Penn has expanded with robotic-assisted procedures now performed at Penn Presbyterian, the Hospital of the University of Pennsylvania and Pennsylvania Hospital. And it’s not just for prostate surgery anymore. Penn urologists, members of the Urologic Cancer Program at the Abramson Cancer Center, are using robotic-assisted procedures to treat renal cancer, bladder cancer and using their minimally invasive skills in multidisciplinary programs with neurosurgery and women’s health.

Penn Presbyterian Medical Center
Robotic prostatectomy increases precision by allowing the surgeon a three-dimensional view of the prostate. The robot improves magnification of the prostate and surrounding area, allowing the surgeon to see small vessels and close them with sutures. As a result, the advantages over traditional prostate cancer surgery include:

Less blood loss/fewer transfusions
Less pain
Less risk of infection
Less scarring

Penn Presbyterian is a high-volume practice — Dr. Lee performs about 12 robotic-assisted prostate procedures a week — and the surgery takes about two hours. By comparison, surgeons less experienced in robotic procedures may take more than four hours to perform a robotic-assisted prostatectomy.

"We have found that having this extensive experience leads to improved continence and potency outcomes for our patients," Dr. Lee said.

In 2008, C. William Schwab, II, MD, began performing robotic partial nephrectomy at Penn Presbyterian as a treatment for kidney cancer. He is now also performing radical nephrectomy (complete removal of the kidney) and adrenalectomy (removal of the adrenal gland that sits above the kidney).

During the procedure, the kidney’s major blood vessels are clamped closed. Because so much blood passes through the kidney, the vessels cannot be closed for longer than 30 minutes without damaging the kidney tissues. During that 30 minutes, the surgeon must remove the tumor with a margin of healthy tissue and reconstruct the remaining healthy tissue.

"The robotic-assisted partial nephrectomy can be complicated, but is a good option for patients when their kidney tumors are amenable to a kidney sparing approach," Dr. Schwab said. "The procedure is now routinely performed and we continue to see positive outcomes with no tumor remaining after the surgery."

Penn urologists use robotic-assisted procedures to treat:

Prostate cancer
Renal cancer
Bladder cancer and new multi-disciplinary programs with neurosurgery and women’s health.

Hospital of the University of Pennsylvania
Along with robotic-assisted prostatectomy and partial nephrectomy, urologists at the Hospital of the University of Pennsylvania are performing robotic-assisted cystectomy (removal of all or a portion of the bladder) and urinary diversion.

"Robotic-assisted cystectomy is typically a better approach for small bladder tumors," said Thomas J. Guzzo, MD, MPH. "Only a few hospitals are performing cystectomies robotically, but at Penn we continue to use the robotic surgical system more and use it for more complicated procedures."

Future Advances
Currently, Dr. Lee is collaborating with Katherine Kuchenbecker, PhD, from Penn’s innovation in mechanical engineering and applied mechanics program, to test an "add-on" for the surgical robot that enhances the surgeon’s sense of touch.

"One of the criticisms of the robot is the lack of tactile feedback provided to the surgeon," explains Dr. Lee. "With this add-on instrument, the surgeon receives a ‘vibration’ sense that may be very useful and make it easier to teach robotic surgical techniques."

TransOral Robotic Surgery (TORS): New Procedure Developed at Penn Changes the Treatment of Cancer

noreply@blogger.com (Unknown) — Thu, 08 Apr 2010 20:20:00 +0000

In December 2009, the U.S. Food and Drug Administration (FDA) approved the use of transoral robotic surgery (TORS) for the treatment of tumors of the mouth and throat in adults. TORS, a minimally invasive robotic-assisted surgical procedure, was developed at Penn in 2004. Beginning in 2005, more than 375 Penn patients participated in the world’s first clinical trials of TORS — the most comprehensive study of the trial on record.

Advancing Medicine

For more than 200 years, Penn Medicine has pushed the boundaries of medicine. Robotic-assisted surgery is the new frontier in modern medicine and Penn surgeons like Bert W. O’Malley, Jr., MD, and Gregory S. Weinstein, MD, co-directors of the Penn Center for Head and Neck Cancer at the Abramson Cancer Center at the University of Pennsylvania, are leading the way.

The introduction of the surgical robot led Drs. O’Malley and Weinstein to look for ways to apply the technology for treating tumors of the mouth and throat. Previous surgical treatments for cancer of the tongue, tonsil, voice box and throat involved making a large incision and usually caused patients a great deal of discomfort and scarring. Many patients had difficulty swallowing after the procedure and they often required extensive reconstructive cosmetic surgery.

The result was TORS. The arms of the surgical robot provide better access to small — and often difficult to reach — areas in the throat and mouth. The small size and dexterity of the instruments at the end of the surgical robot’s arms allow the surgeon to see and operate as if he were standing right next to the tumor — no matter where it is located.

Transoral robotic surgery, TORS, is used to treat malignant and benign tumors of the:

Mouth
Voice box
Tonsil
Tongue
Throat

Gaining Approval

In order to receive FDA approval, Penn had to demonstrate success of the procedure as well as its teachability — could other surgeons learn how to perform TORS and have similar successful outcomes.

"TORS is very teachable," Dr. O’Malley said. "In the first month after the FDA clearance, we had calls from more than 80 physicians about the training."

Penn Medicine currently has the only TORS training program in the country. In April, Drs. O’Malley and Weinstein will hold a major national TORS training course during the World Robotics Symposium in Orlando.

Patients in the clinical trials experienced excellent results from TORS. The treatment was as effective as more traditional therapies, such as open surgery or chemotherapy and radiation, at removing tumors.

Clear Benefits for Patients

While the invention and development of TORS is a tremendous advancement in surgery, the greatest benefit of the procedure is the successful treatment of patients with tumors of the mouth, voice box, tonsil, tongue and areas of the throat.

When compared with traditional procedures, the benefits of TORS include:

Quicker return to normal activity
Shorter surgical time and hospitalization
Reduced risk of long-term swallowing problems (more commonly seen with chemoradiation or traditional open surgery)
Fewer complications compared to open surgery
Less scarring than open surgery
Less risk of infection
Less risk of blood transfusion when compared to open surgery
No routine use of tracheostomy during surgery (routinely used for open surgery)

Support from All Levels

The support and resources of Penn Medicine were crucial for successful development of TORS, according to Drs. O’Malley and Weinstein. Developing and introducing a new surgical technique to the world requires a comprehensive effort from system leadership, the school and the physicians.

TORS is an example of blending new technology with innovation. It represents the type of clinical translational research for which Penn Medicine is known.

"We look at each new medical advance as a platform for new things," Dr. O’Malley said.

"At Penn, we do more than buy the latest technology and use it. We buy it, then create, innovate and educate."