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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.
March 2004
1. Prostate Cancer Worse in Obese Men
2. "Triple Swap" Kidney Transplant A Success
Diagnosing IBD in Children
Lutein May Help Eye Disease
Urologist Louis Kavoussi
Prostate Cancer Worse in Obese Men
Men who are obese are much more likely to have very aggressive prostate cancer than their leaner counterparts, concludes a study of more than 1100 men treated with surgery for prostate cancer. "What we found is that the most severely obese men in our study had higher failure rates than other men. We looked at body mass index, which is a measurement of weight and height and obesity is generally considered to be a bmi greater than 30 and we found that the really severely overweight men, those with a bmi greater than 35, had a much higher up to two times the risk of failure relative to normal weight men," says Stephen Freedland, MD, the urologist who conducted the study. By comparison, a man 1.8 m tall who weighed over 118 kg would have a bmi greater than 35. Freedland says this is yet one more health problem that can be attributed to excess weight.
"Triple Swap" Kidney Transplant A Success
On February 29, Johns Hopkins transplant surgeons performed the world's first "triple swap" kidney transplant involving plasmapheresis, a new technique for removing harmful antibodies that lead to rejection of the donated organ. "By combining kidney exchanges with plasmapheresis, virtually any incompatible donor and recipient now can give and receive a kidney," says Robert Montgomery, MD, PhD, director of the incompatible kidney transplant program. "All three kidneys are working well, and the six donors and recipients are quickly recovering." The three organ recipients had come to Hopkins separately to receive the new therapy but their hopes were dashed when doctors found that the level of harmful antibodies in their blood was too high for plasma pheresis. They each went home with what seemed like their last option taken away. Then the Hopkins transplant team discovered that by swapping kidneys among the pairs, they could "trade up" to either compatible matches or low levels of antibodies that could be removed by plasmapheresis.
Diagnosing IBD in Children
Magnetic resonance imaging (MRI), used with the contrast dye gadolinium, may help pediatricians better diagnose children with ulcerative colitis and Crohn's disease, according to a study by researchers at Johns Hopkins. Because ulcerative colitis and Crohn's disease--painful ailments with similar origins and symptoms--have very different treatment regimens, especially if surgical treatment is contemplated, early diagnosis is critical, the researchers say. The study showed that the gadolinium-enhanced MRI (G-MRI) confirmed these diagnoses in more than 90 percent of the children in the study who had inflammatory bowel disease (IBD). "For the most severe cases of ulcerative colitis, surgical removal of the colon is the only cure, while there is no cure for Crohn's disease," says Anil Darbari, M.D., pediatric gastroenterologist and lead author of the study. "Unfortunately, many children who are originally diagnosed with ulcerative colitis and have their diseased colon surgically removed are later found to actually have had Crohn's, which is discovered when the disease resurfaces in another area within the intestinal tract."
Lutein May Help Eye Disease
An inherited eye disease called retinitis pigmentosa may be slowed down by lutein, a pigment found in dark green leafy vegetables and some yellow ones, concludes a study by Hopkins ophthalmologist Gislin Dagnelie. "Lutein is one of a group of vitamins that are related to vitamin A. In the human body lutein and similar substances may play a similar role as an antioxidant preventing damage being done by either light or oxygen." Over the course of one year, lutein and a multivitamin taken together were able to slow the progression of this eye disease. Dagnelie says that taking a supplement is not necessary for people who don't have a retinal disease. Instead, he recommends getting lutein from foods such as spinach, kale, and orange peppers.
Urologist Louis Kavoussi
Dr. Lois R. Kavoussi, Professor and Vice Chair of Urology, is a world-renowned authority in minimally invasive approaches to urologic diseases. He pioneered the laparoscopic nephrectomy for kidney cancer and live donor kidney transplantation, a technique that eliminates the large incision for kidney removal. Dr. Kavoussi is also an expert in robotics and telesurgery.
Question: What is the main focus of the Urology department?
Dr. Kavoussi: We have several areas of expertise. The first one is the internationally known Center for Prostate Cancer. The treatments range from traditional surgery to non-surgical approaches, including laparoscopic and robotic approaches, research in gene therapy, radiation therapy, and also genetic studies to determine who may develop prostate cancer and who may be treated earlier, perhaps without surgery.
Question: Your department developed the radical retropubic prostatectomy for prostate cancer, which preserves the patient's nerves. What can you tell us about this procedure?
Dr. Kavoussi: For prostate cancer, the technique is to remove the prostate and spare the nerves that control erections. That technique was developed here by Dr. Patrick Walsh, and perfected here, so we have perhaps the best rate in the world in being able to preserve potency of the nerves. We are now looking at other ways to preserve the nerves with less invasive types of surgery.
Question: What are other areas of focus?
Dr. Kavoussi: We have a very active program in minimally invasive kidney surgery for kidney tumors and blockages of the kidney. There are ways of taking care of these without having to make a big incision. Sometimes we do this laparoscopically. For some of the smaller tumors, we are now able to just put a needle into the tumor using local anesthesia, and destroy it with a variety of different energies. We also have a group that is very interested in urinary incontinence, and we are working with doctors in the gynecology department to look at new ways to help people with urinary leakage. Also, for men with enlarged prostate and difficulty in urinating, we offer a variety of post-medical and surgical treatments to help them.
Question: You pioneered the laparoscopic nephrectomy for kidney cancer and living donor transplants. How is it helping patients?
Dr. Kavoussi: The advantage of the laparoscopic surgery is that there's shorter hospitalization, less pain and a quicker recuperation, as well as better cosmetic results compared to open surgery. However, we usually say that this kind of surgery is easy for the patient and hard for the doctors. This kind of procedure demands a lot from the surgeon, and there is a lot of extra training involved for a surgeon to become expert at doing laparoscopic surgery. The results overcome the disadvantages for the doctors, though, and we should not develop a kind of procedure just because it might be easy for the surgeon. The main goal here is to make it easier and less painful for the patient to recover.u discovered when the disease resurface
Question: Regarding kidney stones and testicular cancer, which are your areas of focus, what are your hopes for the future?
Dr. Kavoussi: With kidney stones we're working with some of our colleagues on developing a vaccine to try to prevent kidney stones using gene therapy. There are genes that run in the families of certain people who have kidney stone disease and we may be able to modify the gene and prevent them from having stones. Likewise, with testicular cancer we're doing work with laparoscopy to avoid a large incision in those patients who need more extensive surgery.
Question: What is your latest research?
Dr. Kavoussi: Our laboratory is working on developing robotic devices that will allow us to do surgery through much smaller incisions, and hopefully eventually no incisions. There is technology now with which we can destroy tissue inside the body without making any incision in some cases. It is experimental, but we hope to move that along.
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