Archive for June, 2004

New Technology Brings Hope To Patients with Inoperable Tumors

MEDIACONTACT:   Kelly Grinnell     


OMAHA, Neb. – The diagnosis of an inoperable brain tumor doesn’t have to mean certain death.  A spinal tumor does not have to mean paralysis and a tumor that pushes on the auditory nerve doesn’t have to mean a life of silence.  Instead, patients like 41-year-old Doug Reedy are finding options in technology, and hope at The Nebraska Medical Center.


When he first heard he had a large brain tumor, Reedy said he “just shut down.” He was told his only chance was an invasive and dangerous brain surgery that could lead to a stroke, blindness and possibly a coma.


A second opinion led Reedy to The Nebraska Medical Center and where he found a second option in the Novalis radiation therapy system, which became available to patients in May.


“There’s always got to be an option,” Reedy said.  The Novalis system is a good one for Reedy who says he has not suffered any side effects from the therapy.


“Novalis uses multi-directional radiation beams that shape a three-dimensional volume of radiation dose around the tumor while avoiding critical structures that may surround it such as the optic nerve in Mr. Reedy’s case,” said Robert Thompson, M.D. medical director of radiation oncology at The Nebraska Medical Center, which is one of only 21 Novalis treatment sites in the country and the only place in the region to offer this state-of-the-art technology.


Dr. Thompson says Reedy has probably had the tumor for as long as 20 years and while it is not cancerous, it is dangerous.

“The tumor is about the size of a large egg. It is compressing the hypothalamus and threatening his vision as well as the brain’s blood supply,” said Arun-Angelo Patil, M.D., neurosurgeon at The Nebraska Medical Center.


Reedy has lost sight in his left eye and the vision in his right eye is impaired. But since starting treatment about a month ago, he says he is seeing some signs of improvement.


Another patient, Chrisie Butler, was being tested for multiple sclerosis when doctors found the unexpected.


“There is a walnut-sized tumor at the base of Chrisie’s skull,” said Britt Thedinger, M.D., an otologist-neurotologist at The Nebraska Medical Center.  “Surgery to remove the benign tumor carries serious risks like injury to the nerves controlling hearing, balance, voice, swallowing and shoulder movement.”


In Chrisie’s mind those risks were too high.  Reluctantly, she scheduled the surgery still hoping for another option.  Then she got a call from neurosurgeon George Green, M.D., telling her to cancel the surgery, he found a better option while training on the Novalis at UCLA.


“Novalis offers several different options for shaping the radiation dose.  The ability to deliver the treatment in several fractions (treatments) instead of a single one can very significantly reduce the risk of side effects in many cases,” said Charles Enke, M.D., Chairman of radiation oncology for the University of Nebraska Medical Center. With Novalis Chrisie has experienced sporadic headaches and an occasional metallic taste in her mouth.


“This is a piece of cake compared to surgery,” Chrisie said.  She has a better than 70% chance that the tumor will stop growing and even shrink without damaging her cranial nerves.  Those are odds she’ll gladly take, “if it works, I don’t have to have that surgery,” she says.


The Novalis system by Brain Lab is the most innovative and advanced option available to treat tumors of the brain, head, neck, spine, liver, lung and prostate without harming surrounding healthy tissue.  This sophisticated approach to stereotactic radiosurgery and radiotherapy is quickly becoming the standard of care for advanced cancer treatment.


“Gamma knife has been available for decades as a way of delivering focused radiation in a single treatment,” Dr. Enke explained. “Novalis can treat any clinical problem that the gamma knife can treat, but the converse is not true.  For example, Novalis can treat areas in the skull base that gamma knife cannot reach. It can deliver a single fraction dose when appropriate but also has the ability to deliver fractionated treatment which may be desirable in certain clinical applications. In addition, Novalis is FDA approved to treat locations anywhere in the body while gamma knife is strictly limited to the brain and skull,” he said.


What makes it so appealing to patients is the non-invasive delivery of a precise dose of high-energy radiation, which can shrink or control the growth of a tumor by killing tumor cells or interfering with their ability to grow.  It is virtually painless; the patient remains awake throughout the procedure, which is usually performed on an outpatient basis.


Reedy said he was thrilled when he heard about this option.  “I was walking on air when I left the hospital that day,” Reedy recalled.  His wife Stacy said, “It was like music – it was too good to be true.  I thought it can’t be this easy!”


Both Chrisie Butler and Doug Reedy have been able to continue working full-time and enjoying their homes and families.  Both are thrilled to have an option that wasn’t available to them a couple of months ago. They say the fact that they are among the first patients in the region to undergo Novalis radiation therapy can only be described as “a God thing.”


With a history dating back to 1869, The Nebraska Medical Center is known for excellence, innovation and quality patient care.  As the teaching hospital for the University of Nebraska Medical Center, this 735 licensed bed facility has an international reputation for providing solid organ and bone marrow transplantation services and is well known nationally and regionally for its oncology, neurology and cardiology programs.

UNMC signs agreements with Chinese institutions

UNMC Today -Gov. Mike Johanns announced Thursday from Beijing, China, that three agreements have been signed during his trade mission to establish education, research and patient care partnerships with the UNMC and The Nebraska Medical Center.


“Medical research should not be limited by geographical boundaries,” Gov. Johanns said. “The three agreements signed this week help to ensure that the University of Nebraska Medical Center continues to be a leading research institution. The resulting partnerships will also likely increase diplomacy in other arenas as interest in the global market increases among Nebraska business and industry leaders.”


“This is a collaboration of students and faculty that will enliven both institutions and provide opportunities for the exchange of new knowledge,” said Don Leuenberger, vice chancellor for business and finance, during a conference call from China. “It’s a significant step forward for our institution.”


Nizar Mamdani, executive director of UNMC’s International Healthcare Services, signs an agreement on behalf of UNMC and The Nebraska Medical Center in cooperation with officials from the Central Hospital of China National Petroleum Corporation in HeBei, Beijing, China. Watching the proceedings is Gov. Mike Johanns, who served as witness.


An agreement signed Thursday between UNMC and the Graduate School of the Chinese Academy of Sciences (GSCAS) in Beijing opens the door to discussions about establishing a joint graduate program between the two universities in biomedical-related studies, including the fields of cancer biology, genetics and neuroscience. The partnership will involve faculty exchanges and student internships as a way to develop collaborative research projects and to further the graduate training programs of both campuses.


Another agreement, also signed Thursday, establishes a partnership between UNMC, The Nebraska Medical Center and the Central Hospital of China National Petroleum Corporation in Beijing to exchange medical information and education among their staff and institutions. Specific areas of interest include cancer treatment, bone marrow transplantation and radiology. UNMC and The Nebraska Medical Center hope to become a referral resource for Central Hospital of China patients who seek medical care in the United States.


“UNMC has tried to extend its experience in cancer and transplantation worldwide,” Leuenberger said. “We offer to train transplant teams from other countries. In return, it provides us with patients (from these countries) and brings in additional revenue.”


A third agreement signed Monday (June 14) in Shanghai will create an exchange program between UNMC and Shanghai Second Medical University. The program will allow the two institutions to collaborate on biomedical research, education and patient care. The program also will facilitate other cultural and business partnerships between the greater communities of Shanghai and Nebraska.


“Shanghai Second Medical Center is a big, vibrant and growing center that is ranked among the finest in China,” said Thomas Rosenquist, Ph.D., vice chancellor for research at UNMC. “We are fortunate indeed that the leaders in Shanghai are very interested in this interaction with UNMC, and have pledged their support. Medical education, research and patient care will benefit on both sides. This is an exciting and unique opportunity for us to grow internationally.”


Agreements with U.S. and Chinese academic institutions are “very rare,” Leuenberger said.


Date Published: Friday, June 18, 2004

UNO instrumental in restarting Afghan Fulbright program




Hassina Neekzad’s English is a little rusty.


Since learning English at Kabul University in the 1980s, Hassina fled Afghanistan and lived in Iran for 13 years, unable to teach or continue her studies. Now she’s studying English full-time at the University of Nebraska at Omaha, one of the first Fulbright Scholars from Afghanistan in a quarter century.


“I hope to be a good teacher,” said Hassina, a language teacher at Herat University in western Afghanistan. “I will get some experiences here that are useful for my country.”


Three or four more Fulbright Scholars will follow Hassina to UNO, among about 20 Afghans studying in the United States under the renewed Fulbright program. The Fulbright Visiting Scholars Program brings some 800 faculty and professionals from 130 countries to the United States each year for research and lecturing at American universities.


Afghanistan’s participation in the program ended in 1978, shortly before the start of decades of war that have devastated the country.


Thomas Gouttierre, director of UNO’s Center for Afghanistan Studies, directed the Fulbright program in Afghanistan from 1970 to 1974, before coming to UNO. Now UNO manages the Fulbright program in Afghanistan under a $25,000 grant from the State Department’s Bureau of Educational and Cultural Affairs.


Helping restore the Fulbright program in Afghanistan “is one of the things I’m most proud of in my professional life,” Gouttierre said.


UNO developed a test in Dari and Pashto, the primary languages of Afghanistan, as well as an English test and tested 240 Afghan scholars seeking to come to the United States. From the tests, UNO selected 50 for interviews, then passed 20 nominations along to the State Department.


Gouttierre estimated that 17 or 18 Afghan Fulbright Scholars will come to the United States this year.


Hassina was the first to come to UNO. She arrived in the United States in time to attend a White House dinner for Afghan President Hamid Karzai last month.


Some of the other Fulbright Scholars eventually joining her at UNO will stay at the school for their full year in the United States. Others will go to other universities after taking UNO’s intensive English course.


After Hassina takes intensive English, she will study language teaching methods at UNO.


The contrast between UNO and Herat University is dramatic, Hassina said, speaking mostly in English but sometimes with help from an interpreter. “The past 25 years everything was destroyed.”


Her university rents buildings because it has no campus. Students sit on the ground. The school has no computers.


The Fulbright program is one of several programs UNO and other branches of the University of Nebraska are operating in Afghanistan or seeking funds for.


UNO has concluded its biggest project, publishing books and training teachers for $7.7 million. The program initially called for training 1,500 teachers; UNO trained 4,000. The initial plan was for 9 million textbooks; UNO printed 15 million.


The former UNO printing operation has spun off as an Afghan-owned and operated business, the UNO Education Press. It publishes books and calendars, providing jobs for Afghans, Gouttierre said.

In the fall, UNO will bring its fourth group of Afghan teachers to Nebraska for an educational and cultural exchange.

The visit will conclude the second grant UNO has received for the teacher exchanges. The first grant was $200,000, followed by a $600,000 grant. UNO is seeking a third.


Dr. Ward Chambers is leading efforts to establish a regular exchange between the University of Nebraska Medical Center and Kabul Medical University. He has made five trips to Kabul, teaching short courses for Afghan doctors.


That program has been financed by private donations totaling $52,000, including some of Chambers’ own money.


 Chambers hopes to find funding for a formal relationship between the two medical schools, with Nebraska doctors rotating to Kabul for clinical practice.


Starting next summer, UNMC faculty will teach a course at Kabul University. Chambers said the medical school needs “everything.”


UNO also hopes to obtain federal grants for other projects. It has published a dictionary that gives the English translations of Dari words. Now UNO wants to publish a dictionary translating English into Dari and Pashto.


UNO is working with Western Nebraska Community College and the University of Nebraska Panhandle Research Center in Scottsbluff on plans to help the Afghan city of Bamiyan with agricultural and nursing education.


Before the Afghan wars began, UNO had a sister relationship with Kabul University. Gouttierre hopes to re-establish that tie.

Surgeon performs unique surgery

LINCOLN JOURNAL STAR (also appeared on the AP newswire and Nebraska newswire)

OMAHA – At age 30, Anna Lundmark is as fearless as they come. Some people also might call her lucky.


The former competitive skier once hit a tree while traveling 45 mph. A few years later, she landed on her head after flipping off a jump.


After 14 years of suffering from chronic debilitating back and neck pain, the Stockholm woman took a new risk – a procedure offered by Dr. Ake Nystrom, a fellow Swede and a surgeon at the University of Nebraska Medical Center.


The procedure is aimed at easing pain for people suffering from whiplash and similar neck and upper back trauma.


But experts in pain management and related fields say they are skeptical about the procedure, which is believed to be done on a regular basis only by Nystrom.


“On the surface it sounds a bit outrageous, but one can’t categorically say there isn’t anything to it,” said Dr. James Campbell, a neurosurgeon and pain specialist at Johns Hopkins Hospital in Baltimore.


During the three-hour procedure, the patient is awakened after a vertical incision is made on the back of his or her neck. Patients don a sterile glove to reach into the wound and point out pain points in their upper back and neck.


Nystrom then cuts away the connective tissue from the nerve at that site. He said he must work slowly, and carefully, since the wound is not anesthetized. Nystrom said he needs patients to be able to differentiate between their old pain and pain they would be feeling from the surgery.


Two months after the unique form of trigger-point surgery, Lundmark says she had the same results she did the week following surgery – a normal range of motion and minimal pain in her neck. That’s a change for a woman who once took six prescription pain pills a day, was forced out of competitive skiing and could turn her head at most a few degrees to each side.

“It’s like a miracle – it’s amazing,” she said.


Campbell said it is difficult to gather reliable data in the pain field because of a possible placebo effect.


Dr. David Apple – an orthopedic surgeon and medical director of Atlanta’s Shepherd Center, which specializes in pain management – shared Campbell’s sentiments.


“If a patient thinks you’re doing something that is going to help them, the mind over matter sort of takes over,” Apple said.


“It’s sort of an old adage – you can’t cut out pain,” he added.


Both Campbell and Apple say more structured research is needed to better understand the procedure’s level of effectiveness.


Nystrom’s patients undergo tests to their range of motion once before and once after the procedure, said Dr. Glen Ginsburg, medical director of the Munroe-Meyer Institute at UNMC, who helps conduct the tests.


“Every patient is statistically significantly better,” Ginsburg said.


Nystrom has been at the medical center since 2001. He came to the United States in 1994 and performed several hundred of the surgeries at the University of Pittsburgh, he said.


Most of Nystrom’s patients are Swedish, something Nystrom attributes to heavy media attention in Sweden.


He doesn’t actively pursue those patients, he said.


In 15 years, Nystrom has seen more than 600 patients for the surgery, though it didn’t become his focus until the mid- to late ’90s, he said.


Nystrom plans follow-up testing for some of the patients. Such testing has been hampered because of the large number of international patients, he said.


Nystrom has no plan to use an independent researcher to study the surgery – something that Campbell said is important in validating Nystrom’s findings.


But Nystrom said he is open to the idea if someone expressed interest.


Some medical insurance plans have covered the procedure, although a majority of Nystrom’s overseas patients pay for the procedure – generally between $15,000 and $17,000 – themselves, he said.


Celann LaGreca, a spokeswoman with Blue Cross and Blue Shield of Nebraska, said the company is reviewing the procedure before deciding whether to begin granting patient coverage requests.

Why the surgery appears to be working is unknown, Nystrom said.


“I don’t know that any better than anyone knows why operating on a tennis elbow relieves pain, and no one knows that,” he said.


Campbell said sometimes surgeons discover the rationale after getting an idea and finding that it works.


“But for every one of those ideas there are 99 where it just ends up being snake oil,” he said.

A car accident several years ago left Nina Andersson, 36, also of Stockholm, to deal with whiplash and pain that radiated into her arm, leaving her fingers numb. She was referred to Nystrom after seeing a hand surgeon in Sweden.


After the surgery, Andersson said she immediately noticed her pain was gone and tried to refuse the standard wheelchair ride out of recovery.


Martina Johansson, 28, who lives just outside Stockholm, said her mother read about the procedure in a Swedish women’s magazine. Johansson, who had been suffering since a 1998 car accident, said she had a few friends who tried to change her mind about having the surgery.


“I think it is difficult for anyone without chronic pain to understand that you have to take the chance,” she said in an e-mail.


Thirty hours after her August 2002 surgery, Johansson drove across the country on vacation. Today, she is back in Sweden, where she works as an engineer and has not relapsed, she said.


Nystrom recommends patients rest following the surgery. He says therapy usually is not needed.

He emphasizes that the procedure is not a cure-all. Like any surgery, there are risks, he said.


Lundmark had two hematomas, or collections of blood, in her back that were drained within days of the surgery. She was the only of his patients to have such a condition, and Nystrom said he suspects she has a blood-clotting disorder unrelated to the surgery.


He said it’s good that there are skeptics out there, but he stands behind the procedure and its ability to give people their lives back.


“What we do is not experimental surgery. We provide routine health care and we do that rather successfully,” he said.