Minimally Invasive Aortic Aneurysm Repair Receives FDA Approval
The Ochsner medical institutions have been on the forefront in evaluating a new minimally invasive endovascular treatment for abdominal aortic aneurysms (AAAs), bulges in the wall of the aorta that can rupture and cause death (see The Ochsner Journal, October 1999). Traditional aneurysm treatments involve a major painful operation opening the entire abdomen to gain access to the weakened area of the blood vessel, 6–10 days in the hospital, and 4–6 weeks of convalescence. These new therapies allow physicians to utilize x-rays and catheters to thread a stented graft through the blood vessel to the weakened area through two small incisions with greatly reduced pain and decreased hospital stay (1–2 days).
The FDA gave final approval for the AneuRx endograft in October 1999. Dating back to 1995, Ochsner has been the only institution in the Gulf South involved in clinical trials of these devices. Over 90 endografts for treatment of AAAs have been placed at Ochsner, with approximately half of these in 1999 alone. Because of experience with this device, Ochsner is one of six training sites in the country for physicians learning to use the AneuRx endograft.
An important aspect of this new endovascular treatment has been the team approach employed. Ochsner's team includes vascular surgeons Drs. Money and Sternbergh and interventional radiologist Dr. Yoselevitz. “Each person has different expertise which combine to greatly benefit our patients,” says Dr. Sternbergh.
For more information regarding endovascular AAA repair, contact Glen Carter, RT(R)(CV), endovascular AAA coordinator, at 504 842-2119 or 504 842-4053.
Ochsner Team Receives DNA Patent
In August, US Patent No. 5,936,079 was assigned to the Alton Ochsner Medical Foundation for the invention of a possible new way to cure cancer by researchers Julia L. Cook, PhD, and Richard N. Re, MD. The application of this new gene therapy that uses pieces of DNA called oligonucleotides could eventually hold promise in the treatment of cancer of the breast, prostate, and colon, among others.
In certain kinds of cells, the p53 gene acts as a policeman. When a healthy cell is damaged by x-rays, viruses, or other carcinogens, the p53 gene ‘turns on’ to produce p53 protein, which causes the damaged cell to self-destruct, thereby preventing it from becoming cancerous. Many human cancers are found to be lacking in p53 function. “What we are trying to do is replace p53 function using small pieces of DNA that can be put into a cell so as to act like p53,” says Dr. Re.
Dr. Julia Cook: “We know that p53 can bind to specific stretches of DNA to regulate genes. We hypothesized that if we could use small pieces of DNA to create triple-stranded DNA at the p53 binding site, we might achieve a beneficial result. Everyone remembers the Watson-Crick model of DNA as a double helix. What we have done is to insert a third short string of DNA to create a triple helix at the p53 binding sites. When the triple-stranded DNA forms at those sites, it appears to act as if normal p53 protein were bound at those sites. We made a dozen different varieties of oligonucleotides with DNA-binding potential, hoping that they would interfere with cancer growth. We have been able to retard, and in some cases stop, cancer growth while not affecting healthy cells.”
Radiology Replaces Major Surgery with Uterine Fibroid Embolization
At least one quarter of all women develop fibroids–benign tumors of smooth muscle that grow in different parts of the uterus and can cause annoying, painful problems such as pelvic, back, or leg pain; heavy menstrual bleeding; and painful intercourse. Fibroids are the leading cause of hysterectomies in the United States, but Ochsner is offering a new minimally invasive alternative involving a small incision, a catheter, and tiny polyvinyl particles that essentially starve and kill fibroids without major surgery.
Embolization teams an interventional radiologist with the patient's gynecologist who discusses treatment options with the patient, and, if embolization is the best route, the patient is then referred to the radiologist. During the procedure, a catheter is inserted into the groin at the femoral artery, and then manipulated to the uterine artery, which feeds the fibroid. Polyvinyl alcohol particles the size of sand grains are then released that cut blood flow to the fibroid. The procedure typically lasts 1 1/2 hours and does not require general anesthesia; patients typically spend only 1 night in the hospital. Hysterectomy requires a 2-hour surgery and 3–5 hospital days for recovery. For embolization, which is not considered major surgery, a week at home is usually sufficient for complete recovery.
Embolization's shorter recovery time, continued possibility for pregnancy, and minimal surgical invasion can treat all a patient's fibroids at one time, reducing the need for further procedures and trauma. Patients will experience some temporary, intense pain following the procedure, which is treated with medication. Ideal candidates for embolization are women 35 to 55 years of age (especially premenopausal women since fibroids shrink after menopause when estrogen production ceases, which is necessary for fibroids to grow) and women who have been treated with medical and surgical alternatives short of a hysterectomy.
Uterine embolization was first used in fibroid patients in France in 1995 as a means of decreasing the blood loss that occurs during the surgical removal of fibroids. It was discovered that after the embolization, while awaiting surgery, many patients' symptoms went away and surgery was no longer needed. The first embolization procedure performed in the United States was by the UCLA Medical Group in 1997. Approximately 2000 to 3000 patients have had this procedure worldwide. Ochsner initiated its Uterine Fibroid Embolization program in July 1999.
Not all fibroids have to be removed; many can simply exist in the uterus until they begin to cause problems. Initial fibroid treatments include anti-inflammatory agents or birth control pills. Further options include hormone therapy to shrink the fibroid, but once therapy stops the fibroid usually returns. Surgical alternatives include:
Myomectomy: Surgical removal of fibroids (requires follow up surgery to remove new fibroids)
Hysteroscopy-Ablation: Destroying the uterine lining and inhibiting future pregnancies
Hysterectomy: Removal of the uterus
Uterine Embolization: Starving the fibroid of its blood supply, thereby shrinking the mass and eliminating the problem
For more information regarding Uterine Fibroid Embolization contact the Ochsner Radiology Department at 842–3495.
Ochsner is the Consumer's Choice
In October 1999, for the fourth year in a row, Ochsner Foundation Hospital was named a National Research Corporation (NRC) annual Consumer Choice Award winner. Previously called the “Quality Leader Award,” the name was changed to reflect the growing importance of consumer choice in the healthcare field. The NRC chose 126 hospitals nationwide as 1999 award winners by polling 170,000 households. Consumers selected winners based upon quality of care and hospital image. Ochsner was the only hospital in the greater New Orleans area to receive the award.
Ochsner Physician to Head Multinational Cancer Association in 2000
Richard J. Gralla, MD, Director of the Ochsner Cancer Institute and Head of Hematology/Oncology, has been elected President-elect of the Multinational Association of Supportive Care in Cancer (MASCC). Dr. Gralla will begin serving as President in March 2000. MASCC is the largest international organization to address supportive care in cancer. Supportive care refers to those aspects of medical care concerned with the physical, psychological, and spiritual issues faced by persons with cancer, their families, their communities, and their health care providers.
Dr. Gralla also headed the committee that recently compiled and published the American Society of Clinical Oncology's clinical practice guidelines for the use of antiemetics (J Clin Oncol 1999; 17:2971–2994.).
Ochsner Implants Louisiana's First Pediatric Bi-Ventricular Assist Device
In August, Ochsner Pediatric Cardiac Surgeon Dr. James Davis and Transplant Surgeon Dr. Clifford Van Meter implanted Louisiana's first Pediatric Bi-Ventricular Assist Device (Bi-VAD). The device, which pumps blood in and out of the heart, is worn outside the body, resting on the chest.
“Bi-VAD is essentially an artificial heart sitting outside the body, acting as both ventricles of the heart, pumping the blood throughout the body,” explains Dr. Davis. Bi-VAD also allows patients to lead a somewhat active lifestyle and regain their strength for transplant. The maximum length of time a patient has remained on the device is 515 days. “By placing a patient on Bi-VAD, we buy the body time to strengthen, and it also affords us the time to wait for a transplant to become available,” said Dr. Davis.
Bi-VAD consists of two sets of tubing channeled through the heart and attached to two cannulae resting on the chest. Although this is not a new device, this was the first time it was put to pediatric use in Louisiana.
Bi-VAD and VAD, the only FDA-approved bi-ventricular and univentricular postcardiotomy support and bridge to transplant systems available in the United States, are multi-functional devices produced by Thoratec Laboratories (925 847-8600, www.thoratec.com). These devices have built in flexibility to support one or both ventricles of a failing or a recovering heart and can be used on all sizes of patients and in a variety of conditions. The VAD system can delay or defer an inevitable transplant by allowing the patient's heart to recover sufficient function, saving lives, time, and money.
Race for the Cure
In May, the 4th Annual Susan G. Komen Race for the Cure took place in New Orleans (one of 99 cities nationwide) to raise money for breast cancer research, education, screening, and treatment. Ochsner was New Orleans biggest corporate sponsor with a team of 175 registered runners and walkers. Several Ochsner physicians personally sponsored race participants. Thank you Drs. John Bolton, John Bowen, Gunner Cederbom, John Cole, George Fuhrman, Sandra Kemmerly, Robert Perrillo, and William Richardson for your support of this cause.
New Programs at the Ochsner Diabetes Institute
The Ochsner Diabetes Institute, one of the few diabetes programs in the New Orleans area recognized by the American Diabetes Association, has expanded its educational program. In addition to its 3-day education and training program, the Institute is adding four new 2- to 3-hour monthly classes on topics including nutrition, hypoglycemia, monitoring, medications, stress and social adjustment, behavior changing strategies, treatment of chronic complications, and much more. Classes are initially being offered on Mondays from 2pm to 5pm and Fridays from 8am to 11am on the 9th floor of the Ochsner Clinic. It is recommended that patients take the classes in order, but the program permits flexible scheduling to match individual lifestyles. Each class accommodates two to eight patients. Participants require a physician referral and should contact their insurance company for benefits details. [Louisiana law mandates that insurers pay for outpatient diabetes education.] For additional information from the Ochsner Diabetes Institute, call 504 842-3406.
Laparoscopic Surgery for GERD
Ochsner is now performing approximately 90 laparoscopic anti-reflux surgical procedures per year over a wide range of ages with excellent outcomes: 97.5 % of patients have had no or rare heartburn, 95% demonstrate no regurgitation, and the surgical complication rate is very low. Only one patient required a chest tube and no patients have required blood transfusions. Five percent of patients have had mild long-term dysphasia and 2.5% have had severe dysphasia following the procedure; two patients required dilation but none required surgery for dysphasia. There have been no long-term complaints of bloating, nausea, or diarrhea and no patients have died perioperatively. The average length of stay in the hospital is 2.5 days and the average length of time to return to normal activities is approximately 2 weeks.
Laparoscopic fundoplication should be reserved for patients with documented disease who, despite lifestyle modifications and appropriate medical therapy, still find their lives disrupted. These may include younger patients (less than 50 years of age) facing a lifetime of medication, patients who have symptoms despite their medications, patients who have difficulty complying with their drug regimen, and patients who prefer a single intervention to long term therapy. In every case, it is essential to obtain comprehensive diagnostic test results to ensure the proper course of action. Procedures require preoperative endoscopy, esophageal motility, and 24-hour ambulatory pH probe (when the diagnosis is in doubt).
If you would like to discuss a particular case, please contact William S. Richardson, MD, Director of Laparoscopy, Department of General Surgery, or John C. Bowen, MD, Chairman, Department of Surgery, at (504) 842-4070.
AASLD 50th Anniversary Campaign
Dr. Robert Perrillo was selected to be the General Chairperson for the American Association for the Study of Liver Diseases' (AASLD) 50th Anniversary fund raising campaign, A New Era of Discovery and Hope. In November, the campaign obtained 3.5 million dollars in grants and endowments for research and education in liver diseases($1,000,000 more than their goal). Alton Ochsner Medical Foundation became the first major donor this September, contributing $25,000 over 5 years in the form of an unrestricted grant.
Need Cardiology Info?
The Ochsner Heart and Vascular Institute's newsletter Murmurs is now available online at www.ochsner.org/cardiology. This resource, along with a 24-hour physician hotline (888 317-3717), provides a valuable resource for urgent questions, consultations, and referrals, as well as a forum for comments and suggestions.
- Ochsner Clinic and Alton Ochsner Medical Foundation
