Medicine on the March

Quarter Century of Stories from Hopkins Medicine, 1976-2001:
25 Years of Medicine

[Related Articles: "25 Years on Campus," "25 Years at the Bench," "25 Years of Building"]

1988: It took 22 hours, an army of 70 doctors and technicians and no less than five dress rehearsals for neurosurgeon Ben Carson and his team to separate 7-month-old Patrick and Benjamin Binder, West German twins joined at the head.

January 1977
A Division of Internal Medicine
A new Division of Internal Medicine has been established within the Department of Medicine at Hopkins. Philip Tumulty, has been named director. A medical internist, says Tumulty, is someone who "realizes that effective communication with patients and their families transcends all of his other activities, and that his ability springs from his capacity to understand human nature, and to feel deeply for it and with it."

September 1977
Reviving Heart Attack Victims
Hopkins cardiologists have developed a new approach to cardiopulmonary resuscitation. The main advantage is that blood flow and blood pressure in the arteries supplying the brain are increased, so more blood reaches the brain. "Our studies show that the duration of chest compression is more important than the rate of those compressions," says Myron Weisfeldt, director of cardiology.

May 1978
No More Diapers for 8-Year-Old
Eight-year-old Tommy Zybell recalls his diaper days well. They only ended in December. Because of a birth defect commonly known as spina bifida, Tommy lacked the nerves which control bladder function. In the words of Robert Jeffs, head of pediatric urology, "He leaked, constantly."

Jeffs implanted a device which not only eliminated the need for diapers, but permits Tommy to urinate normally by squeezing a plastic bulb located in his scrotum.

"Gee! I can pee!" he told Diana Pillas, counselor-coordinator for the Birth Defects Treatment Center.

January 1981
Balloons and Male Infertility
Silicone balloons are being used by a team of Johns Hopkins physicians to treat one of the most common causes of male infertility, a vein abnormality in the testes that interferes with sperm production.

Robert I. White Jr. is inserting tiny balloons, via a hollow, threadlike tube, into the blood vessels of the scrotum, to reduce the size of varicose veins there.

July 1981
A Brain Operation to Prevent Stroke
A 2-by-3 inch piece of cheeselike plaque was scraped from the inside of a straw-sized artery near the delicate nerves in the back of the skull. The yellowish substance was blocking the blood flow to the brain, causing dizziness and hallucinations in the 60-year-old patient, Sister Regina Marie Albert. She had suffered from transient ischemic attacks, mini-strokes, for nearly a year, signs of an impending stroke.

Peering through an operating room microscope that magnified the artery up to 10 times its size, George Allen, associate professor of neurosurgery, removed the block of cholesterol with exact, deliberate movements of microsurgical instruments that resemble long needles.

"No one has performed this operation inside the head before," says Allen, "because of the location and the fact that the vertebral artery is so small."

A Defibrillator sans Major Surgery
A battery-powered device that corrects irregular heartbeats with mild electric shock can now be implanted in the human body without major chest surgery, using a procedure developed by cardiologist Levi Watkins Jr., assistant professor of surgery.

The nine-ounce defibrillator, about the size of a cigarette pack, was developed last year by Michel Mirowski, associate professor of medicine at Hopkins and head of the Coronary Care Unit at Sinai Hospital in Baltimore.

September/October 1981
Nation’s First Swallowing Center
Swallowing crises in restaurants have become common enough to earn the label "café coronaries." "There are many opportunities for things to go wrong," says Martin Donner, director of the nation’s first Swallowing Center—at Hopkins.

It’s Implantable and It Stops Pain
Neurosurgeon Donlin Long has developed an implantable electrical device that can stimulate nerves to relieve patients of severe pain and uncontrollable tremors. The device, a Human Tissue Stimulator, or HTS, is similar in design to certain spacecraft batteries. Worn internally, the HTS can be recharged by matching a special magnetic field generator next to the area where the device is implanted. The device can be worn indefinitely, unlike many stimulators of the past whose batteries had to be replaced surgically every few years.

Summer 1984
Inaugurating Heart Transplants
A four-hour heart transplant for 27-year-old Michael Harris of Virginia inaugurated the Johns Hopkins Heart and Heart-Lung Transplantation Service. Orlando DeFelice, the second transplant patient was taken to the Coronary Care Unit where he was prepared for surgery. "I wasn’t scared," DeFelice says. "There were plenty of people to talk to, and they carefully told me what was going to happen."

Balloons Instead of Heart Surgery
Twenty-two young patients have undergone an innovative treatment using balloons—instead of open-heart surgery—for pulmonary valve stenosis, a congenital heart defect which can result it an enlarged and weakened heart. The treatment may make major surgery unnecessary for as many as 1,000 children a year in the United States. The technique, called balloon valvuloplasty, was developed by Johns Hopkins physicians, including Jean Kan, assistant professor of pediatric cardiology, and Robert I. White Jr. professor of radiology, assistant professor of medicine and director of the Cardiovascular Diagnostic Laboratory.

Fall 1984
The GI Tract Goes Live
A small TV camera lowered into a patient’s gastrointestinal tract at Johns Hopkins projected images seen simultaneously by reporters in Baltimore and physicians at a medical convention 1,000 miles away in New Orleans. This technological achievement, demonstrated by William J. Ravich, will make it possible for physicians in distant cities to consult on a patient’s case. These observers saw the inside of a 67-year-old woman’s upper digestive tract.

Summer 1987
Three-way Transplant
"No, we are not in the business of heart swapping, as I heard on the radio this morning," joked cardiac surgeon William Baumgartner the day after a living donor gave up his healthy heart to a patient who needed one, in order to receive a new set of heart and lungs.

The donor, a 28-year-old refrigeration mechanic whose lungs were ravaged by cystic fibrosis, had been waiting for a transplant for about a year. As lungs-only transplantation is still experimental, Hopkins doctors believed the best chance to save the patient Clinton House, was through total heart-lung replacement. House and his doctors decided that his heart should not be wasted and would go to a patient with heart disease.

Fall 1989
New Drug Fights Sickle Cell

1989: George Dover comes up with the first effective treatment for sickle cell anemia. The medication came too late for two of Dover's patients. Donald Paul and his brother John (in the photograph) both eventually died from the brutal condition.

A prescription drug normally used to treat leukemia patients and a hormone that stimulates red blood cell production are being tested in patients against sickle cell anemia and may offer the first effective treatments for the disease—not just the symptoms. "What we have is a form of gene therapy," says Hopkins pediatrician George J. Dover, who has been treating two patients with hydroxyurea at Hopkins since 1983.

Spring 1990
Two Transplants, and Mother and Baby Are Fine
Martha "Dee-Dee" Maynor grinned at her 5-day-old son and held him up to the cameras. "I was worried that I wasn’t going to make it," she told reporters at a press conference in October. Two months earlier, Maynor, 21, had undergone two successive liver transplants within four days at Hopkins, something her physicians believe had been done only once before in the United States. Surgeons transplanted the organ in Maynor on July 27 but it failed, necessitating a second transplant. Maynor was about 22 weeks pregnant at the time.

"There was no way of knowing how the fetus would respond to the immunosuppressive drugs Maynor had to take to prevent organ rejection," says Andrew Klein. Maynor’s prognosis now is "excellent."

Fall 1991
A Giant Water Balloon
Hopkins surgeons removed a benign 180-pound ovarian cyst, almost three feet in diameter, from a West Virginia woman. The ovarian cyst, believed to be the fourth-largest on record, was "like a giant water balloon, so big I couldn’t get my arms around it," says John L. Currie, director of gynecologic oncology, "and I have 35-inch sleeves."

Repairing Holes in the Skull
The surgeons have done their work; the operation is nearly finished. But the radical approach has left the patient with a large hole in the skull—too large to pack with fat or bone fragments and let nature take its course.

"It’s only recently that cranial surgery has forced us to come up with something outside of our standard repertoire," says plastic surgeon Craig DuFresne, who’s part of Hopkins’ skull-base team. "We’ve had to be innovative in finding free tissues to restore these larger openings." If the patient is prone, muscle from the back may be transplanted. If large portions of bone and musculature are missing, equally sized sections of latissimus dorsi muscle serve as free transfer tissue. When the patient is face up, the surgeons may use rectus abdominis muscle.

1992: With the opening of the Kathryn and Alan C. Greenberg Center, specializing in skeletal dysplasia, Hopkins became one of the world's premier facilities for medical problems associated with dwarfism.

Winter 1992
Then Came Pat Walsh
The operation to remove the prostate, called a radial prostatectomy, is not new. Hugh Hampton Young, known as the founder of modern urology, developed it nearly 90 years ago at Hopkins. But the technique—though known to cure the disease—never gained widespread popularity because of its two devastating side effects. Then came Pat Walsh, dubbed by colleague Donald Coffey the "Michelangelo of prostate surgery."

Says Walsh: "We used to say, if you’re going to need surgery, it may make you incontinent and impotent. And patients said, Hold the phone, I’d rather have the disease. Now I tell patients I have three goals: removing all the tumor, preserving urinary control and preserving sexual function."

Winter 1993
Boy Gets Part of Mother’s Liver
In a life-saving 12-hour operation, Hopkins surgeons successfully replaced 14-month-old Tyler Smith’s diseased liver with a portion of his mother Dara’s healthy one. "Dara’s liver is expected to regenerate over a one- to two-month period, and will regain normal size within a year," says Andrew Klein, director of the liver transplant program.

Spring 1994
The Whipple
One approach surgeons usually consider in treating advanced pancreatic cancer is a pancreaticoduodenectomy—removal of part of the pancreas, all of the duodenum, the gallbladder and bile duct and occasionally part of the stomach. But as recently as the 1960s, one in four people who underwent the operation—called the Whipple procedure—didn’t survive the hospital stay.

Now according to John L. Cameron,  chairman of the Department of Surgery, Hopkins surgeons have demonstrated that the Whipple can be a safe and effective procedure when it is performed with precision. Technical improvements, many introduced here, have reduced the hospital mortality rate to about 2 percent, and last year Cameron and colleagues reported they had performed 145 consecutive Whipples.

Affairs of the Heart

1994: Cardiology chief Ken Baughman sent a 29-year-old patient for a bold new operation to save his dying heart.

Idiopathic cardiomyopathy had left Kevin Crabtree’s heart "like a sponge," as Kenneth Baughman, chief of cardiology, described it. Crabtree was not a candidate for transplantation. But, Baughman told him, he was an excellent prospect for another procedure called cardiomyoplasty.

Surgeons detached one end of the latissimus dorsi muscle in his back, threaded it through his ribs and wrapped it around his heart. Then, they implanted a pacemakerlike device in his abdomen to stimulate the back muscle into contracting in synchrony with the heart and help it pump. Within days, Crabtree was up and walking.

Fall 1995
An Implant That Brings the Voice Back
Kate Everding’s surgery to remove the tumor in her neck had paralyzed a nerve on the left side of her vocal cords and left her unable to speak above a whisper. Then, several months later she got an early Christmas present—the return of her voice. She could talk again, thanks to a tiny device implanted in her throat that had been designed by Hopkins otolaryngologists.

The implant comes in five standard sizes, allowing surgeons to "tune" individual voices.

"You have to cooperate during the operation," says Everding. "You have to talk and sing," as surgeons decide which size sounds best.

Winter 1996
The Miraculous Excimer Laser
The excimer laser was originally developed as an improved method for correcting nearsightedness. But when Walter Stark, who heads Hopkins’ cornea and cataract service, observed its capability, he understood it could offer an alternative to corneal transplant. By using the excimer to slice away the opaque bits in the cornea layer by layer, Stark achieves fine control over their removal with relatively little trauma to surrounding areas.

Simpler Kidney Removal
Last summer Louis Kavoussi and Lloyd Ratner revolutionized organ transplantation by making it simpler to donate a kidney. In the world’s first laparoscopic, live-donor nephrectomy, the surgeons removed a whole, healthy organ from Baltimorean Larry Butts through a hole slightly larger than a silver dollar and implanted it in his wife Chestina, whose own kidneys had been destroyed by diabetes. Butts was out of the hospital in two days and nearly recovered within a few weeks.

Fall 1996
Becoming Minimally Invasive
Among the increasingly complex operations that Hopkins performed endoscopically last year were:

• reshaping parts of patients’ stomachs into valves to stop acid back flow to the esophagus
• removing sections of intestine damaged by Crohn’s disease
• removing herniated spinal discs (some patients now opt for local anesthesia in this procedure and undergo it as outpatients)
• "stapling off" emphysema-damaged sections of lung to increase breathing capacity
• bypassing blocked coronary arteries in a minimal approach that still uses a heart-lung machine

Winter 1997
Esophageal Cancer
"Our results in treating esophageal cancer are the best in the country," says Arlene Forastiere. She attributes successes to an aggressive approach in singling out a relatively rare cancer. A radiation therapist, two surgeons, a gastroenterologist and medical oncologist all see each patient. "We’re extremely careful in staging the cancers," Forastiere explains, "because treatment can vary." Nationwide, the five-year survival rate for this cancer is 10 percent. For Hopkins patients, it’s 40 percent.

Chemo Straight into the Brain Tumor
"I had high hopes and expectations, but not much else to go on," says neurosurgical oncologist Henry Brem of his first tests, in 1987, of small, drug-impregnated polymer wafers that can deliver chemotherapy directly to a malignant brain tumor. Now, almost 10 years later, Brem is pleased that the wafer technique has rounded the bend to full FDA-approval for patients with recurring malignant gliomas. It is the first commercially available brain cancer treatment to work this way.

Winter 1998
A Half a Brain that Works
When you first hear about the surgery known as hemispherectomy—removing half a person’s brain—it sounds too drastic to even consider as a treatment. But between 1968 and 1996, that operation was performed 58 times, 57 of them at Hopkins, on patients between 2 months and 20 years old with uncontrollable seizures.

Parents know to expect some long-term disabilities from the procedure: vision defect and some paralysis of the limbs on the side opposite the operation. But the surgery’s benefits far outweigh its drawbacks, says John Freeman, director of Hopkins’ pediatric epilepsy center.

Spring-Summer 1998
Moving Hearts Are a Different Story
MRIs should be able to tell right away if the heart’s threatened by an imminent attack. But hearts move, and the most narrow coronary vessels defy clear imaging. MRI head David Bluemke, Department of Radiology director Elias Zerhouni and their team have worked to overcome these problems. "To say we’ve had to be clever," says Bluemke, a modest man, "is an understatement."

Their latest software produces high-quality angiograms in the vessels of beating hearts. With a few touches of the console, the monitor reveals systems as intricate as the blood vessels in a teen-age girls’ lungs.

Fall 2000
Saving Stefanie

2000: Two surgeons from the Comprehensive Transplant team performed a brand new procedure and save the life of 11-year-old Stefanie Allen.

What transplant surgeon Paul Colombani was proposing was unprecedented. He knew Steve Yang was gearing up to do lung transplants in which living adults would be able to donate part of their lower lobes to save the life of a relative. Why not adapt the procedure to save 11-year-old Stefanie Allen? Colombani rushed to a phone and paged Yang.

On the other end, Yang contemplated turning theory into reality. "We haven’t done this before," he said, knowing that adapting part of an adult lung to a child’s needs was uncharted territory.

"Well, we have two choices," retorted Colombani. "We either do it, or she’s going to die in the next 24 to 48 hours."

"You’re right," Yang said. "Let’s do it."

Spring-Summer 2001
One Tiny Cut to Replace a Hip
At a medical meeting in Miami, James Wenz floored fellow orthopedic surgeons with a videotape of the hip replacement procedure he’s been using. What staggered the group was Wenz’s  small incision.

Small in his case means a 7 centimeter cut—about 3 inches—compared with the foot-long slit used in conventional hip replacement surgery.