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Compliments
of Johns Hopkins
Medicine
International
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/intlseminars
|
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—also known
as 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 +1-443-287-6080 or visit
hopkinsmedicine.org/neuro.
+1-443-287-6080 | hopkinsmedicine.org/international
healthinsights
Get Answers
to Your Health
Questions When
You Need Them
get
engaged
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 as varied as diabetes, infections and brain tumors. Sharecare.com gives you
convenient access to 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.
F or 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 millions who
suffer with 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 long-term medication use, 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.”
For more information,
appointments or consultations,
call +1-443-287-6080 or
visit hopkins-gi.org.
hopkinsmedicine.org/international | +1-443-287-6080
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/
intlseminars.
FREE
Online Seminar
Weighing the
Options:
The Benefits and Risks
of IBD Medications
Wednesday, May 25, 7–8 p.m. (EDT)
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/
intlseminars.
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 people of African
descent—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 a critical sign, 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 non-Caucasian ethnic groups. 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
+1-443-287-6080 or visit hopkinsmedicine.org/dermatology.
+1-443-287-6080 | hopkinsmedicine.org/international
FREE
Online Seminar
Good Night,
Sleep Tight
Pediatric
Sleep Apnea
Wednesday, May 18, 7–8 p.m. (EDT)
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/
intlseminars.
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
lack of sleep could be affecting 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. Worn-out 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 stopping growth hormone, which is
hopkinsmedicine.org/international | +1-443-287-6080
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 +1-443-287-6080 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 children 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
+1-443-287-6080 | hopkinsmedicine.org/international
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 belief 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
an opportunity to relieve 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 characteristic to 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/international | +1-443-287-6080
spring 2011
johns hopkins health | 7
|
The Squirrel’s Secret
R
onald Cohn, M.D., was thinking about 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 thought, 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.
+1-443-287-6080 | hopkinsmedicine.org/international
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 secondary 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 telling 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 fullblown illness is a lung
transplant, but Armanios
hopes to use her genetic
insight to create new tools.
“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/international | +1-443-287-6080
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-ofa-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 EmeryDreifuss 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
orldwide, nearly
W
900,000 men were
diagnosed with
prostate cancer
in 2008.
rostate cancer is
P
the second most
common form
of cancer in men
(after lung cancer).
adical
R
prostatectomy
surgery at Johns
Hopkins’ Brady
Urological Institute
is considered to
be the gold standard for cancer
treatment.
gave me the news 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 outside Vail, Colorado. 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 +1-443-287-6080.
|
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 goal for it is to decrease pain and
improve recovery,” 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 technique can be used for conditions
ranging from pancreatic cancer to gallbladder
surgery, and is on the rise globally. Since 2007,
the number of robot-assisted procedures jumped
from 80,000 to 205,000, according to The New
England Journal of Medicine.
But before you assume minimally invasive is
right for you, 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
For more information, appointments or consultations, call +1-443-287-6080
or visit hopkinsmedicine.org/minimally_invasive_robotic_surgery.
hopkinsmedicine.org/international | +1-443-287-6080
spring 2011
Excluding
Factors
The ideal candidate for
minimally invasive surgery
is a healthy patient who
has never had previous
surgery. Despite how frequently the term is used, 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.
johns hopkins health | 11
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INTL SURFACE AIR LIFT
U.S. POSTAGE PAID
ST PAUL, MINNESOTA
PERMIT NO. 02365
Johns Hopkins Medicine International
5801 Smith Ave., Suite 305
Baltimore, MD 21209 USA
We’re here for you
To find this issue online
or e-mail it to a friend,
visit hopkinsmedicine.org/
international
For comments, requests or
changes of address:
E-mail
[email protected]
NEW YORK
PHILADELPHIA
BALTIMORE
Johns Hopkins Medicine
International coordinates
the highest-quality
care for thousands
of patients from more
than 100 countries, so
we understand and
anticipate your cultural
expectations. A
caring, knowledgeable
international care
coordinator will be there
to assist you during all
phases of your medical
visit, tailoring each step to
your individual needs.
WASHINGTON, D.C.
Before Your Visit
n Appointment scheduling
n Financial counseling
n Accommodation arrangements
n Ground transportation
During Your Treatment
n Personal escort to medical appointments
n 24/7 language interpretation
n Care management nurse during inpatient stay
n Equipment and/or home care arrangements (if needed)
n Private duty nurse arrangements (if needed)
n Follow-up appointment(s) scheduling
n Concierge services for dining and entertainment
n International newspapers and Internet access
n Relaxing, hospitable executive lounge
After Your Departure
Assistance with medical records
n Assistance with prescriptions
n Follow-up with clinical and administrative staff
n Future appointment scheduling
n Consolidated final bills
Write
Johns Hopkins Health
c/o Johns Hopkins Medicine
International
5801 Smith Ave., Suite 305
Baltimore, MD 21209 USA
Call
+1-443-287-6080
Kathy Smith
Director, Market Development
Steven J. Kravet, M.D.
Physician Adviser
n
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.