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May 9, 1996


Trigeminal neuralgia study results published The first long-term study of patients treated with microvascular decompression surgery for medically intractable trigeminal neuralgia shows the procedure to be safe and effective.

Study results were published in the April 25 issue of the New England Journal of Medicine.

The study tracked 1,185 patients treated at Presbyterian University Hospital between 1972 and 1981. Peter Jannetta, professor and chairperson of neurological surgery, pioneered this procedure and was the surgeon for the majority of cases.

The trigeminal nerve, the fifth of 12 paired cranial nerves, has three large branches: the ophthalmic, the maxillary and the mandibular. They control sensation in the face, eyes and the front of the mouth and tongue. Trigeminal neuralgia is a syndrome of chronic facial pain. Although it usually begins as a relapsing disease, with pain-free intervals lasting months or years, these intervals grow shorter and ultimately disappear. As the disease progresses, patients can have difficulty talking, eating and maintaining facial hygiene.

Although some patients are successfully treated with medication, some require operations because drugs are ineffective or because their side effects are intolerable. About half of trigeminal neuralgia may eventually require surgery.

Microvascular decompression preserves the trigeminal nerve — unlike other surgical approaches that cause controlled injury to the nerve, ganglion or root, often resulting in facial numbness. Microvascular decompression involves a small opening in the skull behind the ear, microsurgical examination of the trigeminal nerve and repositioning of any compressive arteries, with a small protective pad placed between the nerve and the artery. If the blood vessel pressing on the nerve is a vein, it may be removed or moved and separated from the nerve as arteries are.

The study shows the procedure to be extremely safe and effective, although it demands special training and experience.

Pitt cancer research findings presented at AACR meeting Researchers from the University of Pittsburgh Cancer Institute and the University of Pittsburgh Medical Center (UPMC) Transplantation Institute reported findings from various studies at the 87th annual meeting of the American Association for Cancer Research in Washington, D.C., April 20-24.

Following are summaries of two Pitt presentations: Vitamin K may fight liver cancer Vitamin K may be useful in treating liver cancer, according to laboratory and clinical findings presented by surgery professor Brian Carr of the UPMC Transplantation Institute.

Currently, treatment options are limited for liver cancer patients. Eighty percent die within three years of being diagnosed.

Most patients with advanced hepatocellular cancer have increased levels of prothrombin, or DCP, in their blood. DCP is produced only when vitamin K is absent.

In the UPMC clinical study, 30 patients were given 40 mg of oral vitamin K for at least three months. The treatment halted progression of the cancer in six patients (for more than one year in four of the patients, and for two years in the other two patients). Liver function improved in seven other patients. Seven patients did not respond to the treatment.

In almost all of the patients, DCP levels dropped to normal levels. In half of them, another serum marker, alpha fetoprotein, also decreased.

Biomarkers found to correlate with head and neck tumor aggression University of Pittsburgh Cancer Institute research indicates that patients whose head and neck cancer tumors have high levels of two substances — transforming growth factor alpha (TGF-alpha) and epidermal growth factor receptor (EGFR), the cell receptor for TGF-alpha — die sooner than patients with low or undetectable levels of those substances.

"This striking correlation between TGF-alpha and EGFR expression suggests that together they may serve as a biological marker in head and neck cancer patients to identify high risk subgroups and guide therapy," said Jennifer Grandis of Pitt's otolaryngology department.

This research complements recent findings by cancer institute investigators that retinoic acid, derived from vitamin A, normalizes the increased output of TGF-alpha and EGFR in cultured cancer cells that were removed from patients' head and neck tumors.

Those findings, published in the February issue of Nature Medicine, strengthened preliminary data that retinoic acid could prevent head and neck cancers in people at increased risk for disease, as well as prevent development of new oral cancers in patients who already have been treated for head and neck cancer.

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