University Times

Radiosurgery extends survival for brain cancer patients

Stereotactic radiosurgery, in which tumors are treated with intensely focused gamma radiation, significantly extended the lives of patients with malignant brain tumors, according to a study by UPMC Health System neurosurgeons.

The study, published in the October issue of the journal Neurosurgery, looked at 107 patients who had either glioblastoma or anaplastic astrocytomas, both malignant and often fatal brain tumors. Most patients with these tumors die within one or two years of diagnosis.

Patients in the study were treated with gamma knife radiosurgery as part of their planned treatment or after other treatments failed. The gamma knife delivers a focused amount of radiation in a single treatment session. Tumors treated were generally one and one-half inches in diameter or smaller.

"Survival was prolonged significantly when compared with expected survival after standard radiation therapy," said Douglas Kondziolka, Pitt associate professor of neurological surgery and radiation oncology, and principal author of the study.

For glioblastoma patients, median survival from diagnosis was 26 months, and 16 months after gamma knife radiosurgery, almost doubling survival in this group of selected patients. For anaplastic astrocytoma, median survival was 32 months compared to expected survival of 16-18 months.

******************

New system offers little hope to black patients needing kidney transplants, study says

A Pitt study contradicts the notion that African Americans' prospects for receiving better-matched kidneys — thus reducing their waiting times and improving survival rates — can be improved with a new method that matches donated kidneys to patients on the national transplant waiting list.

The study's findings indicate the method, called cross reactive antigen group (CREG) will not appreciably change the plight of African Americans, who comprise one-third of the national kidney waiting list but wait twice as long and are transplanted less frequently than white patients.

In the Oct. 15 issue of the journal Transplantation, the authors say the national kidney allocation system inherently favors non-black patients because too much emphasis is given to donor-recipient compatibility measures through human leukocyte antigens (HLA) matching, the results of which can be influenced by racial differences. HLA matching identifies proteins on the surface of immune system cells; CREG matching identifies shared molecules on these proteins.

Researchers performed a statistical analysis of 31,291 kidney patients transplanted at U.S. centers from 1991-1995 and of 1,780 kidney patients transplanted at Pitt's Thomas E. Starzl Transplantation Institute from 1981-1995. To determine if patient survival or graft longevity were influenced by matching, Pitt researchers and colleagues from UCLA and the University of Western Ontario examined both the HLA and CREG matching methods.

"HLA compatibility scoring arguably has had little effect on overall survival while prejudicing the transplant candidacy of African Americans and other hard-to-match populations," wrote Thomas E. Starzl, Pitt professor of surgery and one of the study's authors.

******************

Gene therapy can prevent complication from transplant failure in animal model

A study by researchers at the UPMC Health System may lead to the use of gene therapy for preventing chronic organ rejection, a major cause of patient death following transplantation.

The study results, published in the October issue of The Journal of Clinical Investigation, found that transplant arteriosclerosis, a potentially fatal complication of transplantation, can be prevented by the gene iNOS (inducible nitric oxide synthase) in animals receiving aortic grafts.

iNOS triggers production of nitric oxide, a potent chemical that suppresses transplant arteriosclerosis, which occurs over several months after transplantation.

"Our study suggests that iNOS expression partially protects aortic transplants from the development of arteriosclerosis and that iNOS gene transfer strategies may prove useful in preventing the development of this otherwise untreatable disease process," said Si Pham, Pitt assistant professor of surgery and principal investigator in the study.

******************

Project to study flu immunizations by EMS agencies

Emergency medicine physicians at UPMC Health System have begun a study to determine the feasibility of using local emergency medical service (EMS) agencies to immunize greater numbers of the general public with the flu vaccine.

Called the "MedicVax Project," it will continue through December and will involve numerous EMS agencies in western Pennsylvania. The Allegheny County Health Department is supplying the vaccine and co-sponsoring the project.

"This project will enhance community care by combining the resources of the health department with those of local EMS agencies to vaccinate large segments of the population at a low cost while maintaining control of the quality of care and its delivery," said Vince Monesso, Pitt assistant professor of emergency medicine and principal investigator in the study.

Paramedics will administer flu shots at booths at public locations and EMS bases throughout Allegheny and Fayette Counties. Some 50,000-70,000 American adults die each year from influenza, exceeding the number of vehicle-related fatalities. A 1996 survey by the Allegheny County Health Department indicated that 27.9 percent of those 65-79 years old had not received immunizations that year.

******************

UPMC cardiologists are first in U.S. to study new treatment for atrial fibrillation

Cardiologists at UPMC Health System are the first in the country to study a new treatment for atrial fibrillation, a condition in which the heart beats irregularly and very rapidly.

Called radiofrequency catheter ablation, the procedure combines sophisticated imaging techniques with virtual reality, allowing doctors to map the inside of the heart and short circuit abnormal electrical impulses that cause the irregular beats.

An estimated two million Americans have atrial fibrillation; about 15 percent of strokes are attributable to the disorder.

"Until now, there has not been an effective non-drug treatment for atrial fibrillation," said David Schwartzman, Pitt assistant professor of medicine and director of the Atrial Fibrillation Consultation and Advanced Therapies Center at UPMC Health System. Physicians insert a catheter into the upper chamber of the heart (the atrium) and, using intracardiac echocardiography and a magnetic imaging technique called CARTO, they can determine the exact location of the catheter's tip at all times. They then use this information to map the inside of the heart and reconstruct a real-time, three-dimensional view of the heart on a high-resolution computer monitor with no X-ray exposure.

Guided accurately to within 0.09 mm by the three-dimensional images, the physicians use radiofrequency energy to create a series of lesions in the atrium.

"There are a large number of circuits in the atria and these lesions create barriers to conduction between the different areas and stop irregular heart beats," Schwartzman said. "This procedure is minimally invasive." The procedure usually takes 3 to 5 hours, during which time patients are lightly sedated. Patients are discharged from the hospital the following day.

"The technique has been used in approximately 30 patients at three centers in Europe over the past six months," said Schwartzman, leader of a multicenter, FDA-approved trial of the procedure. "Thus far, atrial fibrillation suppression has been achieved in more than 75 percent of the patients."

******************

Living-at-Home program gets research funds

The UPMC Health System's Living-at-Home program has received a $4,000 grant from the Ladies Hospital Aid Society to fund a Pitt graduate researcher who will be assigned to identify ways to measure the program's benefits to its clients and the community, and to investigate possible revenue sources.

The Living-at-Home Program enables adults aged 70 and older to live independently at home as long as possible by making referrals for a range of services, from home-delivered meals to help with grocery shopping, housekeeping and yard work. As part of the UPMC System, the program can draw upon the system's clinical services, including in-hospital care.

The $4,000 grant will pay a research-oriented student from either the Graduate School of Social Work or the Graduate School of Public Health to work 15 hours per week for eight months.

******************

UPCI offers toll-free number and Web site for cancer information

The public can find out about the latest in cancer prevention, detection, diagnosis and treatment studies by accessing the University of Pittsburgh Cancer Institute (UPCI) through the Internet and by calling UPCI's toll-free Cancer Information and Referral Service.

The toll-free phone number is 1-800-237-4724 . The local number is (412) 624-1115.

The UPCI World Wide Web page address is: http://www.upci.edu The toll-free number is answered by nurses specializing in cancer care, who provide information on prevention and early detection of cancer, new and conventional cancer treatments at UPCI, and other topics. They also can perform computer searches of the National Cancer Institute's database for information about standard cancer therapies, experimental treatments and medical centers offering specific treatment approaches.

The Web site links readers to various UPCI resources and other organizations such as the American Cancer Society, the National Cancer Institute and the Leukemia Society of America.

To speak with a cancer nurse, call the Cancer Information and Referral Service between 8 a.m. and 5:30 p.m., Monday through Thursday, or between 8 a.m. and 5 p.m. on Friday. The UPCI Web page is accessible 24 hours a day, seven days a week.