22 février, 2005 05:42
Thanks to Sandra for sending the following article...Myrl
First-class treatment - Three new medical advancements come to Southwest Florida
By BETH FRANCIS, emfrancis@naplesnews.com
February 22, 2005
This is the first in an occasional series of stories about technological
advancements in health care.
You don't have to leave Southwest Florida to access the latest medical
technology.
Three of the newest innovations: A new way of doing breast biopsies. The
removal and freezing of a woman's ovary for reimplantation when she's ready
for children. And the use of a contraption called the Cyberknife, which
isn't really a knife at all but a precise way of using radiation to do
things like destroy inoperable brain tumors.
All are remarkable pieces of technology.
Naples Community Hospital was the second facility in the state to purchase
the Cyberknife five months ago. There are 17 in use around the country.
Dr. Paul Dernbach, a Naples neurosurgeon and co-director of Cyberknife
Radiosurgery at NCH, said
the Cyberknife is making treatment possible for patients who otherwise would
have no options.
"Who'd have thought we'd have such high-tech procedures available here in
little old Naples?"
Dernbach said.
Dr. Jan Forszpaniak of Naples was the first doctor to get en-bloc on
Florida's Gulf Coast, said Kevin Knight, spokesman for Neothermia, the
manufacturer of the innovative way of doing breast biopsies.
Forszpaniak, who's been using en-bloc for about five months, is so
enthusiastic about the procedure he believes it will soon replace
core-needle biopsies and open surgical biopsies as the standard of care.
And in Fort Myers, Dr. Craig Sweet, a reproductive endocrinologist, recently
became the first doctor in Southwest Florida to provide a patient with hope
for future children by cryopreserving, or freezing, ovarian tissue.
The patient, Julie Love, of Bonita Springs, had severe endometriosis that
required removal of her left tube and ovary for relief from the pain.
Endometriosis is a growth of endometrial tissue outside the uterus. When
efforts to remove the growth fail, sometimes organs have to be sacrificed.
Love had six surgeries to remove the growth, but they all failed to get rid
of her pain. Giving up an ovary meant getting rid of the pain, she didn't
want to give up on the idea of having children.
Not really a knife
The Cyberknife is nothing like a knife, and involves no incision into the
body. That's the beauty of it. Patients lie on a table and a huge robotic
arm guides a device that beams high energy X-rays to a precise point where
radiation therapy is needed, sparing nearby tissue that doesn't need
radiation.
Two X-ray tubes in the ceiling guide the robotic arm. The whole setup is
lodged in a room in the Lutgert Building at Naples Community Hospital with
walls and a ceiling made of lead 8 inches thick - to protect those on the
outside from all the radiation.
The Cyberknife is especially useful in obliterating brain tumors that
surgeons can't get to.
"The location of the tumor can be so risky it can't be cut out, and in the
past the surgeon had to say, 'Sorry, there's nothing I can do,'" said Mary
Ellen Masterson-McGary, chief physicist for radiation oncology at NCH.
"Here, the patients come in, they lay on the table for an hour or so. They
listen to music and often fall asleep. Then they get up and go have lunch or
play golf or go back to work. There's no pain on the table. There's no
anesthesia. It's nothing like major brain surgery."
The Cyberknife works on more than cancerous brain tumors. It also works on
non-cancerous tumors that may be pressing on nerves in the brain, or on the
spinal cord causing tremendous pain. It also obliterates tumors of the
prostate, lung, liver and pancreas.
Donald Nederhoed, 76, a Naples winter resident battled trigeminal neuralgia
for almost 10 years. His neurosurgeon, Dernbach, said it's difficult to say
exactly what causes the inscrutable facial pain. One theory is that a blood
vessel is pressing on the nerve that leads to the face.
Nederhoed said he tried various treatments before Dernbach suggested the
Cyberknife. Injections to his face helped a bit, but there was no long-term
relief. Then he was placed on a medication that, he says, put him in
Neverland. He didn't like that out-of-control feeling and it made it
difficult to live normal life.
So he agreed to try the Cyberknife. He's gone for more than two months
without the slightest pain after having the procedure.
"I went in and I brought some of my favorite hymns to listen to. I laid on
this table for one hour in a leaded room with this laser attached to a
robotic arm aimed at my face," he said. "Before I knew it, they said,
'You're done,' and I said, 'You've got to be kidding. I didn't feel a
thing.'"
Dernbach said the Cyberknife works on trigeminal neuralgia by delivering
radiation to the nerve causing the pain, thus rendering it non-functional.
Nederhoed said he can't believe the pain is gone.
"The relief is so great I could scream," he said.
Innovative breast biopsy
Breast biopsies are no fun, no matter how you look at them.
Women want them to be quick, as painless as possible. And accurate.
A new way of doing breast biopsies called en-bloc requires only a small
puncture, through which a probe is inserted. Using radiofrequency, it cuts
through breast tissue "like butter," said Naples breast surgeon Dr. Jan
Forszpaniak.
A basket-like clamp on the end of the probe surrounds the tumor, and the
radiofrequency cuts the tissue, sucking it out in seconds, giving
pathologists a sample the size of an almond. The sample is easier to
evaluate than smaller specimens from Mammotome core needle biopsies, where a
long, hollow needle is used to sample parts of a suspicious tumor.
With en-bloc, the tumor is often completely removed.
And en-bloc is less invasive. An open surgical biopsy requires a fairly
large incision and removes the entire tumor and surrounding breast tissue,
sometimes resulting in a permanent dent in the patient's breast. This is
undesirable because 80 percent of all biopsies don't find cancer.
Virginia Gentile, 75, of Bonita Springs has had both the Mammotome biopsy
and the new en-bloc biopsy. She had the Mammotome procedure about a year ago
and the en-bloc in the past month.
"The new one was faster and less painful," Gentile said. "I was anxious the
second time around, but this new way of doing the biopsy was much easier on
me. I was also much happier with my result. It was negative this time."
Forszpaniak is excited about the procedure, which was approved by the FDA in
May of last year.
"En-bloc takes six seconds from the time of anesthesia to perform as
compared to 10 minutes for Mammotome," he said. "It also gives us a better
sample, which makes the pathologist's job much easier in diagnosing the
tumor. It's a true advance for women."
Back to the future
Freezing ovarian and testicular tissue in liquid nitrogen for future
conception is a major breakthrough in reproductive medicine, said Sweet, the
reproductive endocrinologist.
And while the freezing of ovarian tissue is fairly standardized, Sweet said,
thawing and use of the tissue afterward is still considered experimental and
should only take place under the guidance of an Institutional Review Board,
which oversees human experimental research.
Sweet only knows of one baby born using this technique - in October 2004 to
a mother in Belgium.
"While, to my knowledge, only one child has been born through the use of
frozen, thawed and transplanted ovarian tissue, it is our hope that the
technology will advance in time for Julie and other potential patients to
benefit from it," Sweet said.
The way it works: Tissue is thawed and placed on the patient's sidewall,
close to where the ovary would have been. The implanted ovarian tissue has
to take up a blood supply, then the tissue responds to hormones in the body
and the woman ovulates, producing an egg from the implanted tissue.
Love, a student at Florida Gulf Coast University, said she's not ready for
children yet but wants to have the option in the future.
"I'm not married and still in college, so I'm not ready to have children.
However, I would like to believe that I will have the opportunity to have a
family when the time is right," she said.
It was difficult to decide to have her ovary removed, or continue with the
treatments that just didn't seem to be working. Love knew her other ovary
would be compromised because of her condition.
"I definitely want to have children some day. Having this procedure gives me
hope for my childbearing future in case I have a problem with the remaining
ovary," she said. "It also gave me courage to have the left ovary removed,
alleviate the pain and have a chance at a normal life."
Sweet said she believes this technique would be ideal for cancer patients
before chemotherapy and radiation treatment, and for patients like Love, who
must have one or both ovaries removed due to benign disease.
It's important, though, that people not use the technique in an attempt to
delay childbearing years, Sweet said.
"That wouldn't be an appropriate use of the technology," he said.
Pam Fowler, secretary of Lee Memorial Health System's Institutional Review
Board, said Sweet presented his plan for removing Love's ovary and freezing
it and the board signed off on it. He'll have to come back for further
evaluation when, and if, it comes to the point that he wants to implant the
ovarian tissue back into Love's body.
That's when things are considered experimental.
"Our goal is to protect the health, welfare and safety of patients involved
in any sort of experimental protocols," Fowler said.
Sweet, for his part, said he hopes technology advances more before that time
comes to implant the ovarian tissue back into Love's body. Until then, it is
housed in a cryopreservation unit in Sweet's office.
"For Southwest Florida, this is another milestone as we continue to
advance," Sweet said. "And it's very exciting for Julie. She's had a tough
time."
