العربية

Archive for July, 2015

Hyperbaric Oxygen Therapy Can Reverse Radiation Induced Vascular Injury

Hyperbaric oxygen therapy (HBO) has become an important treatment to reduce the uncommon but serious, late affects of radiation therapy.

“About one in 20 people will experience the late affects of radiation therapy and experience microvascular loss in that area,” says Jeffrey Cooper, MD, emergency specialist and medical director of the Hyperbaric Medicine Center at Nebraska Medicine. “We typically see an 80 to 85 percent success rate depending on the condition and how soon we see the patient. The longer the problem goes on before we treat the patient, the more difficult it is to treat the tissue.”

Jeff-Cooper-Emergency-Medicine

Jeffrey Cooper, MD
HBO, which has been available at Nebraska Medicine since the mid-1980s, involves breathing 100 percent oxygen in a sealed chamber under pressure to treat a variety of disorders, including carbon monoxide intoxication, decompression sickness, diabetic wounds, air emboli and life-threatening processes including gas gangrene and other necrotizing infections.

By delivering oxygen at two to three times normal atmospheric pressure, the therapy works by forcing more oxygen into areas that aren’t getting adequate amounts due to tissue damage or swelling. This increases the oxygen concentration in the blood and body tissues, which promotes healing. It also helps revive the immune system and helps the antibiotics work more effectively.

HBO treats the delayed side effects of radiation therapy by reversing the radiation-induced vascular injury to affected bone and soft tissues. During radiation, many of the smallest of blood vessels may be damaged or destroyed, which then limits the access of ingredients necessary for healing such as oxygen, antibiotics, nutrition, vitamins and growth factors.

One study showed that when hemorrhagic cystitis was treated within the first six months, the success rate was nearly 100 percent, says Dr. Cooper. The success rate for patients who were treated after six months dropped to 66 percent.

“Necrosis tends to be progressive and many tissues won’t heal even with surgical intervention,” he says. “The key is to reverse the necrotic process so the body can start to heal itself again. If we see the patient early enough, we can sometimes reverse the process without surgery. While some patients may still need surgical intervention, the patient will likely require less aggressive surgery and it will be more successful.”

Treatment for osteoradionecrosis typically requires 30 to 40 two-hour daily treatments, notes Dr. Cooper. An additional 10 treatments may be required after surgical interventions.

Head and neck cancers are some of the most common cancers that lead to osteoradionecrosis. Other common cancers in which treatment can lead to radiation injury include bladder, bowel, jaw and skin cancers.

HBO has also become an important therapy in treating hard-to-heal diabetic wounds, anemia, and problem flaps or grafts from plastic surgery. Head and neck surgeons at Nebraska Medicine have also seen success in promoting healing for various soft tissue and bone restorative and reconstructive procedures.

Nebraska Medicine is the only hospital with a 24/7 Hyperbaric Oxygen Unit that can treat acute and critically ill patients in the area. Acute cases include patients with gas gangrene, necrotizing fasciitis, carbon monoxide poisoning, crush injuries to the limbs and those suffering from diving accidents. The unit now houses four monoplace (one person) chambers in total.

“HBO is an adjunctive treatment that can change a person’s odds,” says Dr. Cooper. “It is most often used in combination with antibiotics and surgery, and if we see the patient early enough, it can stack the deck in a person’s favor. We’re seeing a marked reduction in morbidity and mortality in patients whom we treat. We’re seeing fewer complications and in some cases, it can mean the difference between an amputation and saving a limb. The key to its success is getting the patient to us before things get out of control. HBO can salvage at risk tissue, but it can’t recover lost tissue.”

New Lung Transplant Program Expected to Begin Early Summer

Providers anticipate 10 lung transplants in the first year, increasing to 35 to 40 by the third year.

One of the biggest supporters of the new lung transplant program is Heather Strah, MD. As director of Lung Transplantation, she plays an integral role in the planning process.

Heather-Strah
Heather Strah, MD
“There is definitely a need for a lung transplant program in this area,” says Heather Strah, MD, director of Lung Transplantation at Nebraska Medicine. “The nearest programs are almost 400 miles away. This creates quite a burden on the patient and family who must relocate for three months or more during the transplant process. Some patients are turned down because they are not able to relocate.”

Dr. Strah completed medical school at the University of Iowa Carver College of Medicine in Iowa City, an internal medicine residency at the University of Pittsburgh Medical Center and a pulmonary and critical care medicine fellowship at Washington University School of Medicine-Barnes Jewish Hospital. She also completed a post-doctoral research fellowship at Washington University School of Medicine in immunology. Washington University has one of the oldest lung transplant programs in the country and performs nearly 60 lung transplants annually.

Other members of the lung transplant team thoracic and cardiac surgeons Michael Moulton, MD, and Aleem Siddique, MD.

 

POC-pie-graph

Approximately 1,800 transplants are done in the United States each year. Thirty-five percent of these patients have end-stage chronic obstructive pulmonary disease (COPD), 15 percent have cystic fibrosis and 30 percent have interstitial lung disease or idiopathic pulmonary fibrosis. The remaining 20 percent have other conditions such as pulmonary hypertension or sarcoidosis.

Each patient must go through a thorough evaluation and screening process to make sure he or she is a good candidate. Lung transplants are generally reserved for individuals whose lung disease is in the most advanced stages and they are likely to die of their lung disease within one to two years despite maximal medical therapies, notes Dr. Strah. Good transplant candidates are in generally good health, other than their lung disease, and have a good support system.

Lung transplants are usually performed on patients between the ages of 16 to 65. Younger patients typically fare the best, says Dr. Strah. Survival for the first year is 80 percent. Five years out, half of patients will have died due to complications related to the transplant.

“For those who have good outcomes, a lung transplant can be a life-changing experience,” she says. “I have seen patients who have been living 20 years or more with their transplant.”

Dr. Strah stresses the need to refer potential candidates early on. About half the people on the waiting list receive a transplant within a year.

“There is no such thing as a referral that is too early,” notes Dr. Strah, “but there are definitely referrals that come too late. The lung is a fragile organ and it can take a long time to find a suitable donor so early referral is best.”

To contact Dr. Strah or request a referral, please call the clinic at (402) 559-4015.

Letter from the Director | Fred & Pamela Buffett Cancer Center

Ken_Cowan_1

Today we stand at the forefront of a revolutionary period for cancer research and patient care. For the very first time in history, we have the opportunity to uncover the mystery of cancer. These new findings promise to unlock our understanding of this deadly disease and forever change the way we administer treatment. Very soon, we will no longer treat cancer types but instead, personalize treatment by targeting specific gene mutations.

The Fred & Pamela Buffett Cancer Center is poised to take the lead in this effort – on a regional, national and international front. But to get there, we need to work together.

The culture of the new cancer center is defined by the idea that unplanned collaboration sparks discovery. The kind of magic where the stars align and everything falls into place.

Breakthroughs.

We are establishing a commitment to collaboration where the world’s best doctors and researchers ask questions, share ideas and find answers that profoundly improve patient outcomes. Here, science and medicine will align in new and uncharted ways.

Every square inch of the Fred & Pamela Buffett Cancer Center has been designed with this philosophy in mind. The physical layout will foster a new way of “doing” cancer research and care by breaking down the divisions and silos that have separated scientists and clinicians in the past.

The new Fred & Pamela Buffett Cancer Center wants to be something different, something out of the ordinary. Extraordinary patient care and scientific advancements will take place together, creating a synergistic precision that represents the future of medical care. Science and medicine will share not just a common space, but also a common goal.

For too long, the approach to treating cancer has been indiscriminate and lacking in precision. To kill the bad required physicians to also kill the good. It’s part of the reason cancer is so scary. Not just the disease itself, but because the treatments available cause significant damage and debilitation. Today we have the opportunity to discard the “one size fits all” treatments and develop and employ targeted, less toxic, more humane therapies.

The Fred & Pamela Buffett Cancer Center will bring together elements that aren’t commonly associated with cancer care, including music and fine art, meditation and yoga. Our team will aggressively work to cure disease of the body while recognizing the human mind and spirit play an integral role in the healing process. This integrated approach to medicine will help patients and their families deal with the challenges associated with cancer in an atmosphere that breeds hope, optimism and resilience.

The heroism found in each patient is the foundation from which we will build this great new center.

This is how I know we will succeed.

Because it’s personal.

 

Cowan-signature

 

Kenneth H. Cowan, MD, PhD

Director, Fred & Pamela Buffett Cancer Center

Russian researchers/physicians learn about UNMC

by Tom O’Connor, UNMC public relations

Russ0605
Members of the Russian delegation included (left-right) Ludmila Annable (translator), Aleksandr Khilkov (facilitator), Danielle Dohrmann, director of program development, international health and medical education and one of the UNMC hosts of the group, Kira Ageyeva, Dmitriy Kolpakov, Ward Chambers, M.D., executive director, international health and medical education and one of the UNMC hosts of the group, Dmitriy Kireyev, Anastasiya Pokrovskaya, Georgiy Yefimov, Maria Cochran (translator), and Konstantin Mironov.

A group of six Russian researchers/physicians spent three days at UNMC this week as part of the Open World Program, one of the most effective U.S. exchange programs for countries of the post-Soviet era.

“I think it was a very worthwhile visit,” said Ward Chambers, M.D., executive director, international health and medical education for the UNMC College of Public Health and one of the UNMC hosts for the group. “Russian scientists are just like scientists all over the world. When you’re dealing with other scientists, the politics between the two countries doesn’t matter. They are far more interested in knowledge than politics.”

The Russian delegation met with more than 20 UNMC administrators and faculty between Monday and Wednesday, including UNMC Chancellor Jeffrey P. Gold, M.D. They gained exposure to a variety of different areas, including organ transplantation, nanomedicine, HIV research, DNA sequencing, and human genetics.

“They were particularly interested in our HIV research, as infectious diseases and HIV are the focus of much of their work,” Dr. Chambers said. “It also was nice that some of our researchers were able to speak Russian with them.”

The Open World Leadership Center administers the Open World program. Begun as a pilot program in 1999 and established as a permanent agency in late 2000, the center conducts the first and only international exchange agency in the U.S. legislative branch.

It has enabled more than 17,000 current and future leaders from Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Ukraine, Tajikistan, and Turkmenistan to meaningfully engage and interact with members of Congress, Congressional staff, and thousands of other Americans, many of whom are the delegates’ direct professional counterparts.

The Open World program focuses both on assisting Congress in its oversight responsibilities and on conducting exchanges that establish lasting professional relationships between the up-and-coming leaders of Open World countries and Americans dedicated to showcasing U.S. values and democratic institutions.

Open World delegations consist of committed leaders (average age 38) who experience in-depth programming in themes of interest to Congress and of transnational impact.

Former U.S. Sen. Ben Nelson was instrumental in bringing the exchange program to Nebraska, Dr. Chambers said. Because of this, the Russian visitors are known as Ben Nelson Fellows.

Two prominent Nebraska business leaders and longtime supporters of UNMC, Mike Yanney and Walter Scott, are members of the Open World Leadership Center Board of Trustees. Scott is chairman of the board, while Yanney is chairman emeritus. Rep. Jeff Fortenberry of Nebraska also is a member of the board.

Dr. Green’s research led to lymphoma breakthrough

by Kalani Simpson, UNMC public relations

Green0610
Michael Green, Ph.D., assistant professor in the Eppley Institute,
A new recruit to the Fred & Pamela Buffett Cancer Center begins his UNMC career on the heels of a major contribution to a breakthrough in Hodgkin’s lymphoma treatment.

Clinical trial results for the new therapy inspired by his research were detailed in a December 2014 edition of The New England Journal of Medicine.

Michael Green, Ph.D., assistant professor in the Eppley Institute, while a postdoc at Dana-Farber Cancer Institute in Boston in 2010, was first author on the discovery of a therapy target — a gene whose increased expression allowed cancer cells to evade being seen and eradicated by the immune system.

Expression of this gene may be why Hodgkin’s relapse rates can be as high as 25 percent.

“It’s a ligand on the tumor cell surface that binds to a receptor on the T-cell and tells them not to perform their normal function,” Dr. Green said. “Its natural role in biology is after an infection to try and bring down the immune response after the infection has been cleared. But it has been hijacked by these cancer cells so they can shut down an anti-tumor immune response.”

Thankfully, there was a potential neutralizing antibody already in clinical trials. So a study involving patients with relapsed or refractory lymphoma got to skip straight to Phase II, to “a pretty remarkable result,” Dr. Green said. The treatment was awarded breakthrough therapy (BT) designation by the FDA. Dr. Green had already left for Stanford University by the time the clinical trial started, but feels very satisfied with the end result.

“That’s why we do what we do,” he said. “Publications and grants are nice but this is the real reason behind our research.”

At Stanford, Dr. Green turned his attention to the as-yet incurable follicular lymphoma. And there is no better place to continue this research, he decided, than at UNMC, where Jim Armitage, M.D., and Julie Vose, M.D., head up a world-renowned lymphoma study group.

“That was imperative in coming here,” he said. “I’m doing a lot of next-generation sequencing and there’s a genomics core here. I do a lot of immunology and there’s a very good flow cytometry core here. And the biggest thing really is a massive bank of tumors here.”

And the relationship history with the patients who gave them.

Now, Dr. Green is studying a novel gene mutation which helps follicular lymphoma cells evade the immune system. “We have defined the mutation we want to target, so now we are trying to identify a specific therapy — it is a great example of ‘precision medicine.'”

Loading