MEDICAL NEWS TIPS: SEPTEMBER 1995

September 1995
Media Contact: name, phone number and e-mail addresses are listed below each individual story

Listed below are story ideas from the Johns Hopkins Medical Institutions. To pursue any of these stories, call the contact person listed.

ARTHROSCOPIC DISC SURGERY CUTS COSTS AND PAIN

Surgery for herniated discs used to mean a lengthy hospital stay and long rehabilitation, but new outpatient spine surgery using an arthroscope should reduce costs and pain and let patients return to normal activities in half the time, says a Johns Hopkins physician.

"Since there's less tissue damage during surgery, recovery time is shorter," says Cameron Huckell, M.D., assistant professor of orthopedic surgery.

Arthroscopic discectomy -- using video images to guide removal of damaged disc tissue through a small incision in the back -- is still experimental and performed at only a few medical centers nationwide. Huckell recently performed the first such operations at Hopkins on inpatients under general anesthesia with nerve monitoring, but he expects future surgeries to be done on an outpatient basis with local anesthesia.

The procedure is most effective on lateral herniated lumbar discs, or discs that have slipped toward the side of the spine in the lower back, allowing surgeons to take an easier approach from the back of the spine. These slipped discs often pinch nerves and cause pain in the leg, buttock and back. Spinal endoscopy allows tubes carrying fiber optical and surgical instruments into the body for diagnosis and treatment.

Nearly four million Americans have low back herniated discs that pinch a nerve, including many with lateral discs who may be candidates for arthroscopic discectomy. As the technique is improved and more surgeons gain training and experience, it may one day benefit many of these candidates, says Huckell.

As part of Hopkins' creation of a minimally invasive spine program, surgeons also are developing methods to use endoscopes for spinal fusions to treat degenerative disc diseases and to treat scoliosis, or curvature of the spine. For scoliosis, several small openings would be made for an endoscope instead of the traditional large incision in the chest. For degenerative disc diseases, the surgeon would use an endoscope to approach the front of the lower back. For media inquiries, call John Cramer at (410) 955-1534 or jcramer@welchlink.welch.jhu.edu

UPSET ABOUT MEMORY LOSS? YOU CAN PROBABLY FORGET ABOUT IT

Persons who worry the most about symptoms of memory loss are actually less likely to have serious memory impairment problems, according to Barry Gordon, M.D., Ph.D., director of Johns Hopkins' Memory Disorders Clinic.

"If you can eventually remember what you've forgotten, that shows that at least part of your memory is working quite well," says Gordon, whose new MasterMedia book, Memory: Remembering and Forgetting in Everyday Life, arrives at bookstores in November.

Damage to the brain from Alzheimer's disease and other serious disorders frequently affects areas of the brain that let people assess their own mental abilities, Gordon notes.

Such damage decreases the chances that sufferers will notice memory loss.

"Still, if you think your memory has worsened in the last year, it's quite reasonable to get yourself checked by a doctor," he adds.

Gordon's new book includes questionnaires designed to help the reader test his or her memory and memory loss symptoms.

The book also discusses what scientists know about how memories are formed, offers strategies for coping with normal memory loss, recounts stories of patients with unusual memory loss, and debunks popular memory myths, most of which have more to do with Hollywood scriptwriting traditions than with scientific evidence. For media inquiries, contact Michael Purdy at (410) 955-8725 or mpurdy@welchlink.welch.jhu.edu

DOCTOR'S BOOK RELATES UPS, DOWNS OF "AN UNQUIET MIND"

The coauthor of the standard medical textbook on manic-depressive disorder details her own struggles with the challenging illness in a new book, "An Unquiet Mind," out this month from Alfred A. Knopf.

"Many professionals who have this illness are very reluctant to talk about it publicly. My goal is to try to open up the public discussion," says Kay Redfield Jamison, Ph.D., a Johns Hopkins professor of psychiatry. Jamison had her first episode of manic-depression at the age of 17; her illness is now controlled through medication.

Approximately one in every 100 persons has manic-depressive disorder at some point in their lives, she says. Patients experience extreme emotional swings, and often are explosively elated or suicidally depressed.

"Hospitals need to acknowledge the risk that untreated doctors, nurses and psychologists [with manic-depressive illness] present," Jamison says. "But they also need to encourage effective and compassionate treatment and work out guidelines for safeguards and intelligent, nonpaternalistic supervision." For media inquiries, contact Michael Purdy at (410) 955-8725 or mpurdy@welchlink.welch.jhu.edu

PAIN ATTACKED FROM MANY ANGLES IN BLAUSTEIN CENTER

Pain is the main reason that people seek a doctor's attention, but pain medicine is often poorly taught, if at all, at most medical schools, says Peter Staats, M.D., chief of the Johns Hopkins division of pain medicine in the Department of Anesthesiology and Critical Care Medicine.

At Johns Hopkins, a fellowship in pain treatment begun in the early 1980s has been revamped and expanded to create what is considered one of the nation's top multidisciplinary pain medicine postdoctoral fellowships. Students, who come from all specialties, are trained in anesthesiology, neurosurgery, psychiatry, pediatrics, oncology and other disciplines. Physicians at Hopkins' Blaustein Pain Treatment Center initially try to diagnose and treat the cause of the pain. If a cure is not possible, they use a wide range of techniques to manage the pain, including injected solutions to block spinal nerves, stimulation of the spinal column with implanted electrodes, and pumps to deliver narcotics directly to the spine.

Physicians recently showed that cancer pain in children, especially pain caused by malignant abdominal tumors, can be relieved by injecting alcohol into abdominal nerves. Results of the case study were published in a recent issue of Journal of Pain and Symptom Management. Doctors injected the alcohol solution into the celiac plexus, or an abdominal network of nerves, of a 7-year-old girl with a terminal adrenal tumor that caused severe pain. The solution destroyed the nerves sending pain signals to her brain, and relieved nearly all of her pain for the three months before her death, says Staats, the study's lead author. Narcotics had been ineffective or caused severe side effects. It was only the third recorded use of neurolytic blocks -- or destruction of nerve tissue to relieve pain -- in children, and only the second time it was used in children with cancer. The results suggest this method, commonly used for uncontrolled cancer pain in adults, is safe and effective in children, says Staats.

The psychological behaviorism theory of pain is a new theory that classifies pain as an emotional response to a biological event, which means that treatment should emphasize psychological as well as biological measures, says Staats. "With this new framework, we search for an emotional and physical source of the problem, rather than just treating the symptoms," says Staats. A recent study that included Hopkins researchers measured pain tolerance in patients who put their hands in ice water. Patients trained to visualize positive images and repeat positive words reported far less pain than those using negative thoughts and words. "This has huge implications," says Staats, adding that further clinical trials are needed to confirm the findings. For media inquiries, call John Cramer at 410-955-1534 or jcramer@welchlink.welch.jhu.edu.


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