|
Hopkins News For You
This is a service for our friends around the world from Johns Hopkins International. To receive reports, please send e-mail to patientnewsletter@jhmi.edu or visit our website at www.jhintl.net.
April 2004
Getting Rid of Fibroids While Preserving the Uterus
The Mind-Skin Connection
Tips to Reduce Infections
Gynecologist Nikos Vlahos on Infertility
Getting Rid of Fibroids While Preserving the Uterus
Fibroids are benign tumors that affect 40 percent of women over 40. As they grow, they can become troublesome and even prevent pregnancy. Traditional treatment involves surgical removal of only the fibroids (myomectomy) or complete hysterectomy. But a myomectomy leaves a woman with the risk the fibroids will return; a hysterectomy crushes her hopes of becoming pregnant.
Kevin Kim, M.D., director of gynecologic intervention, offers women a simpler new therapy called uterine fibroid embolization, a procedure that eliminates fibroids without destroying the uterus. Through a .5cm incision in the groin, the surgeon threads a catheter into the uterine artery that supplies blood to the fibroids. He then injects tiny, spongy beads into the artery, plugging the vessels that feed the fibroids. When deprived of blood and oxygen, the growths die and shrink. The uterus lives on. The procedure takes less than 45 minutes and is effective in over 90 percent of patients.
The Mind-Skin Connection
Psychodermatologist Francisco Tausk, M.D., has dedicated his career to understanding the relationship between the mind and the skin. It all began, he says, after he took a training course in hypnosis during medical school. "I tried it on a patient with dermatologic disease and the result was so impressive that I stayed interested," Tausk says. Years later, Tausk led a study that found that psoriasis patients who were susceptible to hypnosis responded quite well to the mind-body therapy. "They essentially cleared their psoriasis," Tausk says.
Recently he has been targeting skin cancer. In published studies with animals, he has shown that mice stressed by exposure to fox scent developed tumors far earlier than mice not stressed in this way. "We showed for the first time that a natural stressor increases development of tumors after exposure to ultraviolet light," Tausk says.
Such findings, he explains, are moving dermatologists closer to drug and stress-reduction therapies to reduce the risk of skin cancers for certain patients. "We're only beginning to explore this phenomenon," Tausk says, "but it holds much promise for patients vulnerable to stress."
Tips to Reduce Infections
While bird flu remains in the news and experts worry that SARS might re-emerge as well, what can you do to protect yourself and your loved ones from respiratory infections? Start with the simple things, says Trish Perl, M.D., director of infection control at Johns Hopkins Hospital. Sneezing into a tissue and frequent handwashing are a good place to start. Isolation is also important, she says.
Dr. Perl recommends buying a small bottle of alcohol-based waterless gel to keep with you at all times so you can wash your hands anywhere. She also advocates the use of masks by people who have respiratory infections. Measures such as these are known to reduce transmission of respiratory infections by up to 70 percent.
Gynecologist Nikos Vlahos on infertility
A native of Greece, Nikos Vlahos, M.D., is Assistant Professor of Gynecology and a specialist in reproductive endocrinology and infertility.
Question: What are the main causes of infertility nowadays?
Dr. Vlahos: The main causes have not changed dramatically in the last 30 years. Apart from male factor infertility, the main reasons for infertility are tubal disease, ovulatory dysfunction and endometriosis. Initially, in vitro fertilization (IVF) was designed to treat women with blocked fallopian tubes, nevertheless IVF is also extremely successful in all other types of infertility. What we see more and more is women who are not able to conceive due to their age. Women used to have children between the ages of 21 and 25. Now, due to social and professional reasons, women are delaying childbearing and this decreases their chances of conceiving even if they are completely normal otherwise.
Question: What new treatments exist at Hopkins?
Dr. Vlahos: As a large referral center, we treat women from all over the world who have experienced multiple failures with conventional treatments. We have developed specialized protocols for older women who did not respond well to regular medication using new medications such as GnRH antagonists and aromatase inhibitors. We also have a very successful egg donor program that works very well for older women, especially age 43 and older or for women with premature ovarian failure.
Question: Is it true that birth control pills impair fertility if taken for a long time?
Dr. Vlahos: No, that is a myth. In fact, there are studies that show that birth control pills offer some degree of ovarian protection in women undergoing chemotherapy for breast cancer. The only effect of birth control pills on fertility is not due to the medication itself but because women on birth control pills have the option of planning their pregnancies later in life. Studies have shown that fertility rates for women who have been on birth control pills are exactly the same as those of the same age who have not used any contraception.
Question: Is it possible to treat infertility surgically?
Dr. Vlahos: Yes, it is possible for women with endometriosis and for a specific type of tubal disease. The most important development is that we are now able to perform extensive reconstructive surgeries through the laparoscope that previously required large abdominal incisions. In the past, these surgeries would take from 4 to 5 hours and patients had to stay in the hospital for 3 or 4 days. Now, we can do the exact same procedure using laparoscopy and the patient goes home the same day.
Question: What new research being conducted?
Dr. Vlahos: Right now we have a grant to work on embryo implantation. Implantation is the process that allows the embryo to attach to the wall of the uterus. Unfortunately, human implantation is a very inefficient process and only 20% of human embryos are able to attach to the uterine wall and produce a pregnancy. In the IVF process, we often transfer 3 or even more embryos back in our patients to maximize their chance of conceiving. Occasionally, all these embryos may implant resulting in a twin or triplet pregnancy with significant risks for the babies and the mother. The objective of the research is to identify the embryo that has the biggest chance of attaching to the uterus and also to find the best possible way to prepare the uterus to accept this embryo.
|
