Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Compliments of Johns Hopkins USA spring 2011 Insight and news from Johns Hopkins Medicine What Do These Have in Common? See how Johns Hopkins researchers lead groundbreaking studies that may transform lives Contents S P R I N G 2 011 ore than Skin 4| MDeep Qu ic k Con s u lt Discover why people of all ethnicities should check for skin cancer. Good Night, Sleep 5|Tight Sleep apnea could be affecting your child’s health and development. 10|An Unbeatable Team First Pe rson Surgeons guided Steve Lucido back to normal after prostate cancer. Just old age – or brain fluid buildup? 11|Investigating S econ d Opi n ion Minimally Invasive Uncover whether this surgical technique may be right for you. ON THE COVER 6| Promising Pursuits Meet Johns Hopkins researchers who are exploring ways to make our lives better. Join Our Online Communities @HopkinsMedNews YouTube.com/johnshopkinsmedicine Search Johns Hopkins Medicine Learn more News and publications Hopkinsmedicine.org/news Clinical trials Trials.johnshopkins.edu ealth seminars H Hopkinsmedicine.org/healthseminars | 2 | johns hopkins health spring 2011 S ure, poor balance, forgetfulness and trouble with vision and hearing can all come with advancing age. But sometimes symptoms like these can mask a condition called hydrocephalus—aka fluid on the brain. Although the disorder can occasionally be secondary to head trauma, brain infections or bleeding in the brain, often there is no identifiable cause. So it’s not surprising that older adults suffering with the condition can easily be misdiagnosed, says Johns Hopkins neurologist Abhay Moghekar, M.D. Key signs of hydrocephalus—trouble with balance, motor control, memory and urinary continence—can mimic symptoms of other conditions that typically show up in older adults, like weakened joints, osteoarthritis, nerve disorders and Parkinson’s disease. “The symptoms of hydrocephalus are so common,” Moghekar says, “that diagnosis really needs a good clinician.” Diagnosis begins with an MRI, but other tests must be done to confirm the need for surgery in which shunts are inserted into the brain to drain fluid. For more information, appointments or consultations, call 877-546-1872 or visit hopkinsmedicine.org/neuro. 877-546-1872 | hopkinsmedicine.org/usa healthinsights get engaged Get Answers to Your Health Questions When You Need Them Eight in 10 Internet users have looked online for health information, whether it’s to research symptoms or get support in caring for a loved one. Johns Hopkins Medicine has teamed with a new consumer health Web site designed to gather the collective wisdom of many different health organizations in one place, making it easier for you to get the answers you need. The site, sharecare.com, comes from, among others, physician and popular television personality Dr. Oz. Visitors can explore health topics presented in an intuitive Q&A format, covering subjects that run the gamut from diabetes to infections to brain tumors. Sharecare.com gives you convenient access to vetted health knowledge from Johns Hopkins experts as well as videos and books by Johns Hopkins clinicians, and reminders about Johns Hopkins online seminars and other events. For more information, visit sharecare.com/group/johns-hopkins-medicine. With Inflammatory Bowel Disease, Sticking to Treatment Is Key Adjusting to life with a chronic medical condition is never easy. For the approximately 1 million Americans who have inflammatory bowel disease (IBD), an often-debilitating disorder of the gastrointestinal tract, there is pain, the need for medication and unpredictability. Both forms of IBD, Crohn’s disease and ulcerative colitis, are characterized by inflammation of the digestive tract and can cause abdominal pain, diarrhea and weight loss. Treatment for either form of IBD requires taking medications for the long haul, says Mark Lazarev, M.D., a Johns Hopkins gastroenterologist who specializes in treating patients who have these conditions. All medications aim to bring symptoms under control and reduce flare-ups by decreasing and suppressing inflammation. Still, finding which treatment is going to work best for each patient can take time. Patients sometimes think they only need to take their medications when they’re having symptoms. But the best chance for treatment success, Lazarev says, involves patients taking their medication every day as prescribed, and consulting with their doctors if they feel the medication isn’t working, or if they are experiencing any kind of side effect. “We see many patients who are feeling well and decide to stop the medication,” Lazarev says. “If people stop the medications, they’re going to relapse. IBD does not go away on its own.” Learning about your health just got easier than ever. From the comfort of your own home or wherever you have an Internet connection, you can access Johns Hopkins’ new online health education programs and engage real-time with a Johns Hopkins physician. These online educational programs allow you to learn more about health topics ranging from common sinus issues to complex neurological conditions. Each program features a 20- to 30-minute presentation by a Johns Hopkins physician followed up by an interactive Q&A session where viewers are encouraged to submit their questions via e-mail. All questions are kept anonymous and confidential. Check out upcoming programs that include diagnosing and treating pediatric sleep apnea and living with and managing the symptoms of inflammatory bowel disease. You can also view previous online presentations at hopkinsmedicine.org/ healthseminars. FREE Online Seminar Weighing the Options: The Benefits and Risks of IBD Medications Wednesday, May 25, 7–8 p.m. Join Johns Hopkins inflammatory bowel disease specialist Mark Lazarev, M.D., as he discusses IBD, available medical treatment options and the risks and benefits of various therapies. To register, visit hopkinsmedicine.org/ healthseminars. For more information, appointments or consultations, call 877-546-1872 or visit hopkins-gi.org. hopkinsmedicine.org/usa | 877-546-1872 spring 2011 johns hopkins health | 3 | quickconsult More than Skin Deep Cancer doesn’t care about the color of your skin, so make sure to get an easy and painless annual screening Should I worry about skin cancer if I have darker skin? Doesn’t the pigment in brown skin protect me? Risks and types of skin cancer can vary widely among different ethnic groups. If you have brown skin, the increased pigment does protect you from skin cancers caused primarily by sun exposure. But the sun isn’t the only cause. For example, the most common type of skin cancer in AfricanAmericans—called squamous cell carcinoma— can develop from chronic trauma or a chronic wound. For people with brown skin, melanomas tend to occur in areas that aren’t exposed to the sun, such as the soles of the feet, palms of the hands, nail beds and inside the mouth. How do I check for skin cancer? Check your skin about once a month, in addition to a yearly routine follow-up with your doctor. Be on the lookout for moles with asymmetry (dissimilar halves), irregular borders and a diameter larger than 6 millimeters, or the size of a pencil eraser. Change is really the name of the game, so alert your physician if you notice a mole that has changed in size, color or shape. | 4 | johns hopkins health spring 2011 Why should I go to Johns Hopkins? Johns Hopkins offers a full spectrum of skin cancer clinical care from diagnosis to medical and surgical treatment. We have specialized programs for people who are at higher risk for skin cancers because of family history. Other programs such as our unique Ethnic Skin Program focus on the special skin cancer risks that affect ethnic groups like AfricanAmericans, Hispanics, Asians and Native Americans. And our multidisciplinary melanoma service combines the expertise of dermatologists, surgical oncologists, and plastic and reconstructive surgeons. What happens if skin cancer is discovered during a screening? When caught early, most skin cancers can be easily treated as an outpatient procedure with a very high cure rate. The specific treatment varies depending on the type of skin cancer. For the most common types, Mohs micrographic surgery is often used. Mohs is a technique used to remove the cancer-containing tissue while leaving behind the most normal tissue. It has up to a 99 percent cure rate and is especially useful for treating skin cancers on the head and neck. It’s one of the many treatment options for skin cancer available at Johns Hopkins. Your doctor will discuss your options and help you choose the best treatment. n For more information, appointments or consultations, call 877-546-1872 or visit hopkinsmedicine.org/dermatology. 877-546-1872 | hopkinsmedicine.org/usa FREE Online Seminar Good Night, Sleep Tight Pediatric Sleep Apnea Wednesday, May 18, 7–8 p.m. Learn more about pediatric sleep apnea and treatment options from Stacey Ishman, M.D., Johns Hopkins pediatric otolaryngologist (ear, nose and throat doctor). To register, visit hopkinsmedicine.org/ healthseminars. Put concerns to rest for children who have a surprising disease: sleep apnea I t’s no secret that children need plenty of rest. But what you may not know is a sneaky sleep thief could be absconding with their health and social development. Although parents usually think of sleep apnea as an adult disorder, it can strike at a young age. For a condition known as pediatric obstructive sleep apnea, “the prime time is between ages 2 and 6, but I’ve seen it in newborns and teenagers,” says Stacey Ishman, M.D., an otolaryngologist (ear, nose and throat doctor) at Johns Hopkins. When sleep apnea robs kids of a healthy amount of shut-eye, they’re not only tired, but they also can become irritable, hyperactive or aggressive. Wornout kids have a tougher time remembering facts and focusing in school. “Studies actually show that up to 50 percent of kids with ADHD [attention deficit hyperactivity disorder] have sleep-disordered breathing or sleep apnea,” Ishman says. If left untreated, sleep apnea can undermine your child’s health in surprising ways, from putting the kibosh on growth hormone, hopkinsmedicine.org/usa | 877-546-1872 which is secreted mostly at night, to putting your child at greater risk for heart disease later in life. Do you notice loud snores coming from your baby monitor or child’s bedroom? There is reason to suspect sleep apnea. “The most common symptom is snoring that usually happens regularly and is often loud enough to hear through a closed door,” Ishman says. She advises parents to listen for pauses in their child’s breathing, which may sound like gasps or snorts, during REM sleep, typically between 1 and 6 a.m. For the only definitive diagnosis, children need overnight sleep studies. Pediatric sleep apnea is commonly treated by a tonsillectomy and adenoidectomy, Ishman says. Other treatment options include medication, weight management for overweight children and continuous positive airway pressure (CPAP) therapy. n For more information, appointments or consultations, call 877-546-1872 or visit hopkinsmedicine.org/otolaryngology. spring 2011 Days in a Daze Remember the exhaustion of caring for a wakeful newborn? That’s the same tiredness suffered by the estimated 2 to 4 percent of American kids with sleep apnea, says Stacey Ishman, M.D., an otolaryngologist at Johns Hopkins. Symptoms include: w D aytime sleepiness or daydreaming H yperactive behavior L earning difficulties A ggressive, defiant behavior M orning headaches D ifficulty waking in the morning M ood changes and irritability w Inattention w w w w w w johns hopkins health | 5 | Promisin Pursu How Johns Hopkins researchers lead groundbreaking studies that may transform lives | 6 | johns hopkins health spring 2011 877-546-1872 | hopkinsmedicine.org/usa ng uits S c i e n t i f i c r e s e a r c h can seem an endeavor far removed from most of our everyday lives. But much of it, whether it involves studying strands of DNA or electrical signals in the brain, is driven by the conviction that someday the insights will be applied to restoring people’s health—or even better, that it can help ensure they don’t get sick in the first place. As caught up as they may be in the process of basic scientific insight, researchers are always looking for those connections, and are thrilled to find them. Sure, they know all too well that in the end their discoveries may not turn out to be the hoped-for break. But just having a shot at relieving human suffering is the great underlying motivator in biology research. Johns Hopkins is home to researchers who have thrown themselves into dramatic hunts for treatments and cures spun off from basic research, with all the frustrating setbacks and exhilarating leaps that are part and parcel of these quests. Here are five of these searchers, each at the center of a project whose trail has led to a promising, if tentative, avenue of treatment. Every research story is personal, but all share the medical researcher’s dual commitment to both scientific discovery and helping people. > To learn more about The Johns Hopkins Institute for Basic Biomedical Sciences, visit hopkinsmedicine.org/ institute_basic_biomedical_sciences. hopkinsmedicine.org/usa | 877-546-1872 spring 2011 johns hopkins health | 7 | The Squirrel’s Secret R onald Cohn, M.D., was mulling over the way that muscles can shrink in debilitating ways in children and adults with a number of disorders, as well as in the elderly. So Cohn, a researcher in Johns Hopkins’ McKusick-Nathans Institute of Genetic Medicine, did what most of us do when confronted with a puzzle. “We wanted to learn from someone who has already solved the problem,” he says. In the case of muscle atrophy, the go-to experts turned out to be ground squirrels. “Squirrels can hibernate for six months without losing muscle,” explains Cohn, who specializes in both pediatrics and genetics. “We wanted to understand how they do it, and see if there’s a way to apply to it human conditions.” Backed by a prestigious “New Innovator” grant of $1.5 million from the National Institutes of Health, Cohn had squirrels shipped in from Wisconsin. Soon the critters were hibernating in comfortable nests in basement refrigerators underneath Cohn’s lab, breathing a mere four times a minute. When the squirrels were eventually warmed, woken and chipper, their muscles showed no sign of atrophy, or any of the scar tissue that normally forms around injuries. “They had been sitting in the refrigerator for months,” he says, “not eating or drinking, and their muscles were acting like the muscles in an athlete who is both running marathons and lifting weights.” Something was clearly protecting the squirrels’ muscles during the long disuse. Cohn and his team took to their microscopes, along with a range of state-of-theart genetic tests. They soon came up with a crucial clue: During hibernation the squirrels’ muscle cells were pumping out high levels of a protein that isn’t normally much seen in muscles. Now Cohn and his team are studying that protein, called SGK, and looking at the effects of raising levels of the protein in the muscles of nonhibernating mice. “We’re hoping we can find that this protein is of some broad benefit to muscle,” he says. “If it is, the results could eventually be helpful to patients with many different types of inherited and acquired forms of muscle diseases, and to those suffering from age-related muscle loss.” For more information about research at Johns Hopkins Medicine, visit hopkins medicine.org/ research. | When a Gene Does This, and Not That ‘‘H ow is your brain different than your colon?” asks Andrew Feinberg, M.D., M.P.H. That’s not a silly riddle, explains the Johns Hopkins cancer researcher; it’s an intriguing question that eventually could point the way to breakthrough treatments. That’s because every cell in your colon has exactly the same genes as every cell in your brain—and every other cell in your body. (Except for sperm or egg cells, which have half as many genes.) We think of genes as blueprints for how to build a You, cell by cell— except why do the exact same blueprints produce very different body parts? Even so-called identical twins can have significantly different characteristics, in spite of identical genes. “One twin can have autism while the other doesn’t,” Feinberg explains. 8 | johns hopkins health spring 2011 Several years ago Feinberg started to suspect those surprising differences might provide a critical clue to understanding and perhaps preventing cancer. After all, he notes, there are many instances in the human body where cells invade and spread into other organs as a normal and healthy biological process—including pregnancy. What could make a cell with the same set of genes invade organs when it isn’t supposed to, thus becoming a cancer? The answer, Feinberg reckoned, may have to do with the way that segments of some genes may undergo subtle chemical changes called “methylation.” “There’s a real interplay between genes, the environment, and what happens in the body as it grows and ages,” he says. To better understand the effect of methylation, Feinberg and colleagues have led the way in mapping out which genes seem to be affected by methylation in different people, with an eye to spotting possible links to cancer, as well as to other diseases and characteristics, including obesity, psychiatric disorders and aging-related ills. For starters, knowing where to look for methylation could help identify people at risk for certain disorders. Over the long term, these methylation maps could suggest strategies for drugs and other treatments that might undo or compensate for the effects of methylation. 877-546-1872 | hopkinsmedicine.org/usa When Genes Weaken Lungs T o a medical researcher, the term “idiopathic” is like a red flag before a bull. “When we call a disease ‘idiopathic,’ it basically means we have no idea what causes it,” says Mary Armanios, M.D. “And when we don’t know what causes it, we usually can’t even begin to treat it.” That’s why Armanios, a Johns Hopkins medical oncologist and researcher, felt a bolt of excitement when she stumbled on a surprising clue to a common and often devastating disease called idiopathic pulmonary fibrosis (IPF) that leaves lungs mysteriously swelled with scarring. It meant she might have a chance to strip away that frustrating first word from the disorder for some patients, and open avenues to possible treatments. Armanios had been studying a young man who had some of the symptoms of IPF, which can in some ways resemble premature aging, including hair that grays before high school and a thinning of some kinds of blood cells. (In fact, the disease was first identified by Sir William Osler, one of the founders of the Johns Hopkins University School of Medicine, who in 1892 noted that certain patients had apparently succumbed to an unrecognized disorder that left their lungs gray and shrunken.) The connection between IPF and premature aging had always been hazy, but Armanios took a closer look at the young man’s genes and found a distinctive pattern in the ends of the DNA known as telomeres—a pattern that proved to turn up in many others with IPF, which often runs through families. Clearly, this telltale disturbance in the telomere genes was the source of the disorder, which meant that in these cases, the “I” could be dropped from IPF. Armanios and others could begin the search for ways to repair the damage caused by this gene problem. Armanios’ efforts are already paying off by providing a possible way of identifying people who are at higher risk of the disorder, and who may be able to delay the onset of symptoms by avoiding secondhand smoke and other insults to their vulnerable lungs. (Most IPF patients aren’t themselves smokers.) Right now the most effective treatment for the full-blown illness is a lung transplant, but Armanios hopes to use her genetic insight to bring other tools to bear. “This form of the disease affects about 15 percent of the families that IPF turns up in,” Armanios says. “Over time we may be able to learn how to intervene with the progress of the disease for these people, or offer better treatments, or improve the outcomes for those who get lung transplants.” hopkinsmedicine.org/usa | 877-546-1872 Hairy Science W e hear with cells that have tiny hair bundles on top and line our inner ears. Incoming sounds vibrate some of these hair bundles, releasing a substance called glutamate from their cells, which in turn triggers an electrical signal in nerve fibers connected to the hair cells. That signal travels along the nerve to the brain, which interprets the signal as a sound. But if only it were as simple as it, well, sounds. The process of converting each and every incoming sound wave to a useful electrical signal, notes Johns Hopkins neuroscientist Elisabeth Glowatzki, Ph.D., is in fact a complex mechanical, chemical and electrical symphony of exquisite precision. “We’re trying to zoom in to every one of these steps to understand how the inner ear shapes the electrical signal in response to sound,” she says. “We need to understand how it all works if we’re going to understand how hearing can deteriorate, and maybe how it can be repaired.” To that end, Glowatzki’s team has pioneered a technique for recording electrical signals right at the end of the nerve fibers where they’re generated, providing a never-before-seen peek at the details of the signal. And that window into the inner ear’s signals is already providing new insights. For example, one long-standing mystery is how an inner-ear hair cell manages to generate a signal quickly and cleanly enough to allow catching the millionths-of-a-second delay between when a sound reaches the two ears—a delay that enables the brain to tell what direction the sound is coming from. Now Glowatzki’s group is looking closely at the way the hair cells coordinate the release of glutamate at their interfaces with as many as 20 nerve fibers to get that precise timing. These sorts of insights could pay off in much better inner-ear implants for people who have hearing loss. “Today’s implants use quite crude electrical stimulation of the nerve fibers in the inner ear,” Glowatzki says. “If we can piece together the different steps that are involved in converting sound signals into electrical signals in nerve fibers, we should be able to design an implant that can reproduce these signals better and produce a much more realistic sound.” name that FIELD W hat’s in a name? Even in science, a lot more than you might think. That’s what Johns Hopkins researcher Katherine Wilson, Ph.D., realized while writing a review on the structural proteins that make up the cell’s nucleus—that part of a cell that envelops and organizes our genes and affects much of what happens in the rest of the cell and thus in our bodies. “There were 81,000 papers on the biology of the cytoskeleton that turned up in computer searches, but only 110 papers with the keyword ‘nucleoskeleton,’ ” she says. “People were doing great work. They just weren’t making their papers ‘visible’ to bioinformatic searches.” She hopes this situation will improve soon. No wonder: Defective nucleoskeletal proteins are at the heart of several important disorders. Wilson herself is focusing on X-linked Emery-Dreifuss muscular dystrophy—the third most common type, and one that affects only boys. Its cause turns out to be the lack of a nuclear membrane protein that is needed for the nucleus to respond appropriately to mechanical force. The potentially good news is that it’s a small protein that seems a good candidate for gene therapy, a treatment technique in which a harmless virus could potentially deliver emerin into the muscles of boys who have the disorder. “It’s still very experimental,” Wilson concedes. “First we need to show that it can help emerin-deficient mice.” That’s what Wilson hopes to do soon. Backed by a private grant, she recently teamed up with a gene-therapy researcher who just happens to have been her biochemistry teacher in college, and applied for a Muscular Dystrophy Association grant to cover mouse and therapeutic virus costs. With three young children, Wilson says it’s exhilarating to be back in the saddle after a few years of sleep-deprivation. “After having done so much basic science work with this protein emerin, it’s very exciting to be working on something that could turn out to be a human therapy.” n spring 2011 johns hopkins health | 9 | firstperson An Unbeatable Team Faced with a diagnosis that every man dreads, Steve Lucido discovered life can return to normal after prostate cancer treatment My doctor Men, Cancer and Hope w w w ore than M 2 million men in the U.S. are prostate cancer survivors. rostate cancer is P the second most common form of cancer in men (after skin cancer). adical R prostatectomy surgery at Johns Hopkins’ Brady Urological Institute is considered to be the gold standard for cancer treatment. dropped the bombshell when I was age 56—just when my wife and I were beginning to enjoy our newfound freedom after the youngest of our three children had graduated from college and I was semi-retired as a real estate developer. I lived a healthy and active lifestyle—I ran every day and enjoyed paragliding, snowboarding, kayaking and mountain rescue near our home in Beaver Creek, outside Vail, Colo. So I was stunned when a routine blood test revealed my prostate-specific antigen (PSA) level had suddenly shot up, a red flag for prostate cancer. Even before a biopsy confirmed my worst fears, I dove into research about prostate cancer and treatments. I discovered that Johns Hopkins specializes in a way of performing prostate cancer surgery that minimizes the dreaded long-lasting side effects—incontinence and impotence— that once made the cure seem even worse than the disease. The surgical technique spares the nerve bundles near the prostate. I read all the bios of the different surgeons at Johns Hopkins online and gravitated toward Dr. Edward Schaeffer. Not only is he a surgeon, but a researcher, and that’s exactly the type of person I wanted to deal with a situation like mine. I fired off an e-mail to him with my bio, diagnosis and how I found out I had cancer. I was surprised when he called me about five minutes after I hit “send.” We talked for at least 45 minutes, and when I hung up the phone I knew he was my surgeon. Dr. Schaeffer performed my open radical prostatectomy on Oct. 6, 2008, and afterward he told me he felt really good about the surgery. He felt that he had gotten everything and was confident that I was going to heal well and be cancer-free. Today, I’m extremely grateful for Dr. Schaeffer’s expertise and the cutting-edge surgical techniques available at Johns Hopkins that have made it possible for me to remain cancer-free for more than two years—without the dreaded side effects. In fact, I learned to surf shortly after my surgery, and soon I’m hoping to learn to sail. n In His Own Words To watch a video of Steve Lucido telling his story, visit hopkinsmedicine.org/mystory. For more information, appointments or consultations, call 877-546-1872. | 10 | johns hopkins health spring 2011 Investigating Minimally Invasive secondopinion The facts versus the hype of this surgical technique A lthough minimally invasive surgery is nothing new, the number of conditions that can be treated with it continues to grow. Despite its surging popularity, however, it isn’t always the right answer. How do you know, then, when it’s right for you? In its broadest terms, minimally invasive surgery can be used anywhere there is a cavity, or a potential cavity, in the body, says Anne Lidor, M.D., assistant professor of surgery at The Johns Hopkins Hospital and a leader in physician training and education in minimally invasive surgery. It typically replaces open surgery with those involving small incisions, robotics or lasers. “The impetus for it is to decrease pain and improve convalescence,” adds Mohamad Allaf, M.D., director of minimally invasive and robotic surgery in the Department of Urology. There are all types of minimally invasive surgeries for all types of conditions, he says. Most people tend to think of laparoscopic surgery, during which a telescopic lens magnifies the area of surgery and enables a doctor to operate within the confines of a small incision. Technology has improved so much that surgeries can be conducted using a robotic arm that works in ways a surgeon’s hands or fingers cannot, says Allaf, whose department performs more than 1,000 minimally invasive surgeries a year. The most common in the U.S., Lidor says, is laparoscopic gallbladder surgery. But the technique can be used almost anywhere in the body for a multitude of conditions, ranging from pancreatic cancer to weight-loss surgery. But before you jump on the minimally invasive bandwagon, consult with your physician first; the technique is not for everyone. Allaf points out, for example, that a patient with a large tumor will likely require the traditional open surgery, as there is rarely enough space to operate laparoscopically. Also, “patients with lots of previous abdominal surgeries, with lots of scar tissue, can’t always have laparoscopic surgery,” Lidor says. “The same is true if you have a bad heart or lungs. You have to look at the individual patient.” n Excluding Factors The ideal candidate for minimally invasive surgery is a healthy patient who has never had previous surgery. Despite how the term is bandied about, however, it’s not always the best option. If any of the following conditions apply, minimally invasive procedures may not be for you. w You suffer from severe heart or lung disease. w You have had multiple surgeries. w You have a lot of scar tissue in the abdomen. w You have advanced cancer. For more information, appointments or consultations, call 877-546-1872 or visit hopkinsmedicine.org/minimally_invasive_robotic_surgery. hopkinsmedicine.org/usa | 877-546-1872 spring 2011 johns hopkins health | 11 | Non Profit Org. U.S. Postage PAID Johns Hopkins Health Marketing and Communications 901 S. Bond St., Suite 550 Baltimore, MD 21231 The Johns Hopkins Hospital has been consecutively ranked the No. 1 hospital in America by U.S.News & World Report for 20 years. hopkinsmedicine.org/usnews We’re here for you To find this issue online or e-mail it to a friend, visit hopkinsmedicine.org/health/usa For comments, requests or changes of address: NEW YORK PHILADELPHIA BALTIMORE E-mail [email protected] Write Johns Hopkins Health c/o Marketing and Communications 901 S. Bond St., Suite 550 Baltimore, MD 21231 WASHINGTON, D.C. Call 877-546-1872 W e are pleased to offer you Johns Hopkins USA, a convenient link to Johns Hopkins’ expertise—no matter where you live. With one call, a caring, knowledgeable coordinator will guide you through the best medical care in a way that is tailored to your needs. And to ensure your trip to Baltimore is smooth and comfortable, we’ll help you: n S chedule medical appointments with the right specialists Make travel, lodging and transportation arrangements n Know what to bring and what to expect n UNITED STATES CANADA To learn more or to request assistance, call 877-546-1872 or visit hopkinsmedicine.org/usa. Kathy Smith Director, Market Development Steven J. Kravet, M.D. Physician Adviser Johns Hopkins Health is published quarterly by the Marketing and Communications office of Johns Hopkins Medicine. Information is intended to educate our readers and is not a substitute for consulting with a physician. Designed by McMurry.