By Jana Soeldner Danger
Today’s medical advances often seem truly wondrous. New treatments and technologies continue to save lives and improve their quality. Here are a few in our community.
When 14-month-old Amelia Durbin’s parents frantically rushed her to Joe DiMaggio Children’s Hospital, the little girl’s heart was racing at a life-threatening 326 beats per minute, almost three times the normal rate. Alarmed doctors diagnosed a form of arrhythmia known as ventricular tachycardia. They needed to get a catheter into her heart immediately to map the arrhythmia and eliminate it.
In older patients, a catheter is inserted through a vein or artery. But Amelia’s vessels were much too tiny for that.
So the Joe DiMaggio team tried a completely different approach to a problem that has challenged their profession for decades. After making an incision between Amelia’s ribs, they used a small needle to create a hole in the tip of her heart so the catheter could be inserted directly. The new technique was successful.
“Saving her life was very emotional for all of us,” says Dr. Daniel Benhayon, cardiac electrophysiologist at JDCH. “It was an amazing experience.”
Pacemaker for Pain
A clinical trial underway at Holy Cross Hospital is testing a device designed to control or eliminate debilitating pain suffered by amputees. ‘“It’s like a pacemaker for pain,” says Dr. Porter McRoberts, medical director of spine and pain medicine at Holy Cross.
When a person’s leg is amputated, the nerve in the stump tries to continue to grow down a limb that is no longer there. This can result in a painful bulb of nerve tissue, and traditional pain remedies often don’t relieve it. These patients can’t wear prosthetic limbs because the prostheses press against the nerve bulbs.
The device consists of an electrode cuff coiled around the nerve and connected by an internally placed wire to a pulse generator implanted into a small pocket in the abdomen. The generator stimulates the nerve at a frequency of about 50,000 cycles per second, much faster than the brain can process. “It acts like an electronic version of Lidocaine, blocking the action of the nerve,” Dr. McRoberts say.
No More Blood Thinners
Atrial fibrillation is a condition in which the upper left chamber of the heart fails to contract and pump blood properly. When this happens, a small appendage on the atrial can become a reservoir for stagnant blood where clots form, then migrate and cause strokes. The standard of care has been to put patients on anticoagulants, or blood thinners, for life.
But like the appendix, the atrial appendage is an unnecessary part of the body, and when doctors do open heart surgery, they often clip it off so clots can no longer form there. It was not, however, done as a stand-alone procedure because of its invasiveness.
Now, Dr. Richard Cartledge, chief of cardiovascular surgery at Boca Raton Regional Hospital, eliminates the appendage with an ultra-minimally invasive procedure that requires only three minuscule incisions, each just one-fifth of an inch long.
Using a high definition fiber optic camera and microscopic instruments, he seals off the appendage from circulation, and it is absorbed into the body. No more clots. No more blood thinners. “The patient goes home the next day with three dot-sized Band-Aids,” Dr. Cartledge says.
Breast Cancer Vaccine
Two clinical trials at Sylvester at Plantation are underway to determine whether a new vaccine may help prevent breast cancer recurrences in high-risk individuals.
Some breast tumors have more receptors than normal for a protein called Her-2, which causes cancer cells to grow and divide rapidly. While patients with tumors that over-express Her-2 traditionally receive a drug called Herceptin that targets the protein, the trials also offer Herceptin to those who express low levels of the protein. Randomly selected patients will also receive the new vaccine, while others will be given a placebo.
Says Sylvester’s Dr. Carmen Calfa: “The vaccine allows the immune system to recognize the cancer cells and go after them.”
New Scan for Tiny Hearts
Joe DiMaggio Children’s Hospital recently introduced a new, noninvasive diagnostic imaging procedure for pediatric patients suffering from heart disease in which doctors suspect inadequate cardiac blood flow.
Previously, the only test available to measure blood flow in the heart was a nuclear scan that exposed the patient to radiation and required catheterization and anesthesia. The new technology, called stress-perfusion cardiac magnetic resonance imaging, does not.
“The procedure increases the overall diagnostic accuracy of myocardial perfusion abnormalities in our young patients,” says Dr. Lazaro Hernandez, medical director of pediatric and congenital cardiac MRI at JDCH.
HIFU: A Noninvasive Prostate Cancer Treatment
A treatment for prostate cancer recently approved by the FDA uses ultrasound energy to heat and destroy targeted tissue while leaving the surrounding tissue undamaged, thereby reducing the risks of serious side effects. “There’s a marked decrease in impotence and incontinence compared to surgery or radiation,” says Dr. George Suarez, a urologist in Miami who was involved in work that resulted in the FDA approval.
High intensity focused ultrasound (HIFU) has been used in Europe and Japan for more than a decade. The noninvasive treatment concentrates intersecting beams of ultrasound energy through an acoustic lens in the same way a magnifying glass focuses sunlight.
The physician inserts an ultrasound probe into the anesthetized patient’s rectum to direct the beams. The temperature then rises rapidly to about 195 degrees, destroying the targeted tissue.
The standard version HIFU treats the entire gland; the focal procedure treats only the area where the tumor is located. The procedure takes between two and four hours, and patients are typically up and walking within a couple of hours. “It’s revolutionary,” Dr. Suarez says. “It’s a game-changer.”