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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 with the name of this e-newsletter.
July/August 2003
1. Pre-Diabetic Adults at Increased Risk of Colon Cancer
2. Depression Treatment Effective for Alzheimer's Patients
1. New Implant to Treat Parkinson's Disease
2. Botox for Stroke Patients?
Early Detection Still Best Prevention of Common Cancers
Dr. Julie Freischlag, Surgeon-in-Chief
1. Pre-Diabetic Adults at Increased Risk of Colon Cancer
People with impaired glucose tolerance (IGT), a precursor of diabetes, are at higher risk of dying from colon and other cancers, says a Hopkins study published in the American Journal of Epidemiology. Patients with IGT are nearly twice as likely to die from any cancer and more than four times as likely to die from colon cancer as those with normal glucose tolerance. "By contrast, adults with outright diabetes had little or no association with risk of cancer death," says author Frederick Brancati, M.D. The exact reason for the apparent increased risk is not clear, although earlier studies suggest that high levels of insulin may promote growth of cancer cells.
2. Depression Treatment Effective for Alzheimer's Patients
Hopkins researchers have shown that Zoloft, a drug used to treat depression, also improves quality of life and alleviates disruption in daily activities for Alzheimer's patients who also suffer from major depression. However, the drug did not improve thinking, remembering and learning; cognitive skills that often are impaired in Alzheimer's patients.
"Depression in Alzheimer's patients, and even Alzheimer's disease itself, often goes undiagnosed, in part because doctors feel they have little to offer in the form of treatment. This study shows that a simple treatment for depression improves the quality of life and seems to slow the functional decline of Alzheimer's disease," says Hopkins neuroscientist Constantine Lyketsos, M.D., lead author of the study.
1. New Implant Approved for Parkinson's Disease
The U.S. government has approved a brain stimulator to treat Parkinson's symptoms that may bring relief to people afflicted with the progressive disease. While many tremors can initially be treated with medication, over time these drugs become less effective. The result is that patients may suddenly find themselves frozen in place or with limb movements they can't control.
Hopkins neurosurgeon Fred Lenz says the implantable stimulators can reduce both symptoms by feeding signals through tiny wires placed in the brain. "It's not like a heart pacemaker which senses the presence of the heartbeat and, if there's a significant pause, will stimulate the heart. This stimulator is controlled independent of activity in the area where it's located. So you have a lot of ability to adjust the stimulation to optimize the treatment." (Dr. Lenz is known for developing a procedure called Deep Brain Stimulation to diminish tremor, slowness and gait problems in patients with Parkinson's.)
2. Botox for Stroke Patients?
Botox injections, popular as a way to reduce wrinkles, may also help some stroke victims regain partial use of their hands, according to a study at Indiana University. Many stroke victims have muscles that are in permanent spasm, sometimes rendering limbs useless. Hopkins rehabilitation specialist Sam Mayer says Botox, which paralyzes muscles, may partially restore function. "It has a dramatic effect on tightening of muscles. If the hand, for example, is clenched in a fist we can relax the hand. There is usually a good effect on pain control and also on the ability to move the limb more easily." Mayer notes that shots usually need to be repeated because patients frequently develop antibodies to the drug, making it ineffective. Injections have also been used with some success in locked-up ankles and shoulders.
Early Detection is Still Best Prevention for Common Cancers
The war against cancer is fought on many fronts, from research to surgery to chemotherapy. But the most important weapon is preventive screening tests. For many forms of cancer, early detection makes the difference between quick and relatively uncomplicated treatment, and a prolonged battle. Men and women 50 and older should be especially diligent about having regular screenings. Below are common tests and screenings for the most common cancers:
• Breast Cancer: Two tests are used to screen for breast cancer. The first is physical examination of the breasts to detect changes in tissue and appearance, performed by a doctor during check-ups and by the patient herself on a monthly basis. The second is a mammogram, currently the best method available to detect this type of cancer early. Women 40 and older should speak with their physician to ensure regular mammograms.
• Cervical Cancer: Since the widespread use of the Pap smear, cervical cancer deaths have declined between 20 and 60% depending on the stage in which the cancer was detected. Beginning at age 18, women should have a Pap test at least every three years.
• Colon Cancer: This is the second most common and the deadliest cancer in the U.S. But when detected early, treatment of colon cancer can be very effective. Fecal blood testing is the most common test. If results show an abnormality, then a colonoscopy is done to look for potentially cancerous polyps. Men and women over age 50 should have a fecal blood test every 1 to 3 years. Individuals with a family history should have colonoscopies every five years, starting at age 40.
• Prostate Cancer: Prostate cancer is most common in men over 50 and, like breast cancer, tends to run in families. The risk increases if a father, brother, or son had the disease. The most common test remains the digital rectal exam. Sonograms and X-rays may also be performed on the urinary tract if cancer is suspected. Research continues on the value of the PSA blood test. Digital rectal exams should be performed on men over 40 during regular exams, with additional testing as necessary.
Dr. Julie Freischlag, Surgeon-in-Chief
Dr. Julie Freischlag, the new Surgeon-in-Chief at Johns Hopkins Hospital, is the first woman to hold the position at the birthplace of surgical training in the United States. She is a specialist in treating Thoracic Outlet Syndrome, a hard-to-diagnose and painful condition that occurs when the artery, vein and nerves that run down the arm from behind the collarbone, are compressed. Dr. Freischlag developed an improved, safer surgery and has a 90% success rate in treating these patients.
Question: You are a surgeon and a researcher, too?
Dr. Freischlag: Yes, and the fact that there are quite a few surgeons here who are excellent researchers is partly what attracted me to this institution. What they bring to research is the ability to study the tissue or tumor in the laboratory and bring their findings to clinical practice. I want to enhance that research even more.
Question: In what way?
Dr. Freischlag: By continuing to look at the origin of diseases to develop preventive measures and ways to prolong survival after we get these diseases, but also by placing greater emphasis on developing innovative surgical approaches using new technologies. Certainly there have been advances in imaging and surgical tools that allow us to operate more effectively and safely. We are increasingly using robotics in both open cavities like the abdomen and in harder-to-access areas like the chest and heart to make surgery less invasive and easier for the patient and surgeon.
Question: How else do you see surgery changing at Hopkins?
Dr. Freischlag: One new push is to make the services that we offer multidisciplinary and one-stop. For example, patients who come here with a cardiac problem should also be able to see a cardiologist, a cardiac surgeon, a vascular surgeon and anyone else who can help them.
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