University Times

Double lung reduction best for emphysema

Lung reduction surgery for emphysema patients provides greater improvements in lung function when performed on both lungs rather than on one lung, according to a study presented by a Pitt researcher at the American Lung Association/American Thoracic Society 1996 international conference.

In lung reduction surgery, diseased portions of lungs are removed. The surgery is not a cure and does not stop the disease, but it offers patients with advanced emphysema an alternative to lung transplantation.

"Short of transplantation, lung reduction surgery provides the most significant benefit yet devised to improve patients with severe emphysema," said Robert Keenan, assistant professor of surgery and principal investigator in the study.

An estimated 2 million Americans suffer from emphysema. Since June 1994, more than 200 patients have undergone lung reduction surgery here.

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Study searching for genes that cause anorexia

The unyielding obsession that drives people with anorexia nervosa to starve themselves may originate in their genes, researchers say. UPMC scientists have joined researchers at 10 sites in North America and Europe in an attempt to find genes that may predispose people to eating disorders.

According to Walter H. Kaye, a Pitt psychiatry professor who is lead investigator at the Pittsburgh site, results from the international, two-year study may help researchers and clinicians identify people who are at the greatest risk of developing eating disorders and may some day allow health care professionals to provide preventive treatment.

Researchers are seeking to enroll approximately 200 families in which at least two members have anorexia nervosa or related eating disorders. Studies of twins and other family members hint at a genetic root to the disorders. Research has shown that individuals with anorexia nervosa have more relatives with eating disorders than people without the condition. Moreover, identical twins are more likely to have anorexia than fraternal twins.

The Price Foundation of Switzerland is sponsoring the study. For more information, call 1-800-895-3886.

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Transplantation Institute receives four NIH grants

The National Institutes of Health have awarded the Pitt-affiliated Thomas E. Starzl Transplantation Institute four grants totaling more than $6.2 million.

The grants were awarded to institute director Thomas Starzl; John Fung, chief of the Division of Transplantation Surgery, and his co-investigator Abdul Rao, director of cell transplantation and associate director of research at the institute; Angus Thomson, research professor of surgery and of molecular genetics and biochemistry; and Anthony Demetris, director of the Division of Transplant Pathology.

Starzl is studying why and how organs are accepted after transplantation. Fung and Rao's research will determine if bone marrow augmentation will improve organ function and patient survival, allowing for reduction or elimination of transplant patients' needs for immunosuppressive drugs.

Thomson is investigating the role of the dendritic cell in the acceptance of transplanted organs, particularly the liver. Demetris is studying how interleukin-6 affects the proliferation of biliary epithelial cells, which is seen in certain types of liver diseases.

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Bypass surgery better than angioplasty for diabetics, equally effective in non-diabetics, study shows

Severe coronary heart disease can be treated with either heart bypass surgery or angioplasty with similar survival rates, according to findings of a five-year, international study published this summer in the New England Journal of Medicine.

However, in patients who were also treated for diabetes (20 percent of the study's 1,829 participants), bypass surgery provided significantly better survival than angioplasty, the study showed.

The multi-center Bypass Angioplasty Revascularization Investigation was coordinated at Pitt and was the largest clinical trial comparing the two surgical procedures.

Among non-diabetics, patients who underwent bypass surgery had a survival rate of 89.3 percent. For those who underwent angioplasty, the rate was 86.3 percent. However, in a subgroup of 353 drug-treated diabetics, those who had bypass surgery had an 80.6 percent survival rate; those who underwent angioplasty had a 65.5 percent survival rate.

Some 362,000 angioplasties and 309,000 bypass surgeries are performed annually in the United States. The typical cost of angioplasty is about $15,000, and bypass, $30,000.

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Interaction with children benefits patients with Alzheimer's

A Pitt research project indicates a link between young children's interaction with Alzheimer's disease patients and patients' responsiveness.

Researchers at Generations Together, an intergenerational studies program within the University Center for Social and Urban Research, conducted the study.

Two groups of children from a local daycare center were invited to interact with two groups of Alzheimer's patients 30 minutes a week for six months. Therapists led the adult groups in music and movement activities, first without the children, then with them.

Observations and analysis of videotape showed the adults' smiles, touching, verbal expression and hand extensions increased significantly in the children's presence.

Nursing assistants who cared for the dementia patients were interviewed twice weekly about their patients' overall behavior, on a day when they had been with the children and on a day when they had not. Analysis of 536 observations revealed the patients' overall agitation levels were lessened on days they were visited by the children.

"What's significant about this is you're talking about people who are typically nonresponders," said Sally Newman, Generations Together executive director.

"Apart from the fact they don't remember, they're at a stage in their illness where they frequently have very little affect and communication is every limited. If we can provide a small amount of pleasure for them, I think we're onto something." A paper on the Generations Together study has been accepted for publication in the gerontological journal Activities, Adaption and Aging.

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National vaccine for melanoma study is under UPCI researcher's leadership

A unique vaccine against melanoma that could save many lives is being tested in a nationwide study directed by John Kirkwood, director of the University of Pittsburgh Cancer Institute's (UPCI) Melanoma Center.

The study involves the first-ever large-scale use of a cancer vaccine targeted against a specific substance found on melanoma cells. This anti-melanoma vaccine already has shown a potential to prevent recurrence of melanoma in a smaller study of patients with high-risk melanoma — melanoma that is likely to relapse after surgery.

In the current study, researchers are offering this therapy to patients with similar high-risk melanoma. "If this vaccine works in patients with high-risk disease, it may be added to Interferon alpha 2b, the only FDA-approved effective treatment and the one that we have developed over the last 10 years," Kirkwood said.

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Sleep problems affect health, study concludes

Intrusive thoughts caused by stress can make it difficult to fall asleep. They also may affect the quality and consistency of sleep, resulting in poorer overall health, according to research at the University of Pittsburgh Medical Center.

Results of two UPMC studies that looked at stress-related intrusive thoughts, one involving rescue workers of a fatal plane crash, were presented this month at the 104th annual conference of the American Psychological Association in Toronto.

Intrusive thoughts — ideas that pop into one's mind — are common after experiencing a stressful event. The more these thoughts occur, the more likely they will disrupt sleep, which in turn may lead to anxiety, depression and even the common cold, reported UPMC research fellow Martica Hall.

In one of the studies, 64 healthy men and women spent the night in a sleep lab where their sleep patterns were monitored. Before going to bed, half were told they would be reading a magazine after they woke up the next morning. The other half were told they would have to deliver a 15-minute speech that would be judged for content by one of the researchers. Participants experiencing more intrusive thoughts about making a speech took 10 minutes longer to fall asleep than participants with fewer speech-related intrusive thoughts.

A second study assessed the impact of stress-related thoughts in 155 volunteer workers involved in the rescue and clean-up operations following the crash of USAir Flight 427 on Sept. 8, 1994. "Results of this study showed a chain reaction effect. The more intrusive thoughts that occurred, the poorer the sleep. This led to worsening overall health and greater feelings of distress over the course of the two-, six-, nine- and 12-month assessment taken following the accident," Hall said.

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WPIC study shows spirituality has strong impact on well-being of heart transplant patients, families

Religious faith and spirituality have a strong impact on the physical and emotional well-being of heart transplant patients and their loved ones, according to results of a Western Psychiatric Institute and Clinic (WPIC) study presented at the 10th annual conference of the American Psychological Association last month in Toronto.

WPIC researchers Ronna Casar Harris and Mary Amanda Dew interviewed 275 pairs of adult heart transplant recipients and their family caregivers in a long-term study of mental health and health care compliance. As part of the National Institutes of Health-funded study, which began in 1989, respondents were asked many questions, including ones concerning the role of religion in their lives.

"Results of the study show that religion has a positive impact on the lives of patients who have faith that a higher power is watching over them not only during their recovery but in the long-term as well," said Dew, director of the study and associate professor of psychiatry, psychology and epidemiology.

According to the study, patients who felt that their beliefs exerted greater influence over their lives, and who consulted God to make important decisions, were more likely to feel positive about their health status one year after transplantation, even if they were experiencing medical complications.

Harris said: "Health care professionals who work with seriously ill patients and their families often refuse to identify religious supports and to build on patients' belief systems. There has been little consideration of the role that religion may play in patients' health, well-being and continued survival."

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New treatment shrinks tumors in transplant patients with cancer

Transplant patients who develop cancers that don't respond to standard treatment may benefit from an infusion of cells from their own immune system that have been activated to kill tumors, UPMC researchers reported last month (AUGUST) at the XVI International Congress of the Transplantation Society in Barcelona, Spain.

The complication of developing tumors following organ transplantation is called post-transplant lymphoproliferative disease (PTLD). Certain cells of the patient's own immune system, some of which may be associated with the Epstein-Barr virus, proliferate and tumors result. About 2 percent of transplant patients will eventually develop PTLD.

Standard treatment involves temporarily reducing or eliminating the doses of drugs taken to suppress the immune system and prevent organ rejection. However, in only 30 to 50 percent of patients do tumors respond to this therapy. PTLD can be fatal in as many as 80 percent of its victims, according to some reports.

Of the seven patients in the UPMC study — individuals whose tumors did not respond to reduced immunosuppression or in whom it was not a clinical option — four had complete remission of their tumors after single infusions of their own, manipulated immune cells.

The remaining three patients did not have complete regression of their tumors. The patients also had aggressive cancers that also tested negative for the Epstein-Barr virus. UPMC researchers say that further study in at least 20 more patients will help them determine if the presence of Epstein-Barr or the type and stage of cancer more strongly contributes to a patients' success or failure with the promising treatment.

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Nursing prof gets NIH grant

The National Institutes of Health's National Institute of Nursing Research has awarded Mary Christina Hines, assistant professor in the School of Nursing, a $319,000, four-year grant to study "Cardiac Receptor Activity in the Pregnant Rat." The study is designed to contribute to the identification of specific mechanisms that initiate and maintain an expanded blood volume during pregnancy.