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"]
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.
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."
Heart Attack Victims
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
Diapers for 8-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
and Male Infertility
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.
Operation to Prevent Stroke
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."
sans Major Surgery
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
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.
First Swallowing Center
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 Centerat
and It Stops Pain
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.
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."
of Heart Surgery
young patients have undergone an innovative treatment using balloonsinstead
of open-heart surgeryfor 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
GI Tract Goes Live
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.
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.
Drug Fights Sickle Cell
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 diseasenot 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.
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.
Transplants, and Mother and Baby Are Fine
"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."
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."
in the Skull
have done their work; the operation is nearly finished. But the radical
approach has left the patient with a large hole in the skulltoo
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.
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.
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 techniquethough known to cure the diseasenever
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."
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.
One approach surgeons
usually consider in treating advanced pancreatic cancer is a pancreaticoduodenectomyremoval
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 operationcalled the Whipple proceduredidn’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
Affairs of the
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
Cardiology chief Ken Baughman sent a 29-year-old patient for a
bold new operation to save his dying heart.
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
That Brings the Voice Back
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 presentthe
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.
Miraculous Excimer Laser
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.
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.
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
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.
into the Brain Tumor
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.
a Brain that Works
first hear about the surgery known as hemispherectomyremoving half
a person’s brainit 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
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.
Hearts Are a Different Story
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.
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.
Two surgeons from the Comprehensive Transplant team performed a
brand new procedure and save the life of 11-year-old Stefanie Allen.
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."
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 cutabout 3 inchescompared with the foot-long
slit used in conventional hip replacement surgery.