baylor innovations | fall 2008

8/14/2019 Baylor Innovations | Fall 2008

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all 2008 volume 2 no.4 a publication o baylor university medical center at dallas

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6 Baylor I n n o v a t I o n s : : all 2008

27

CONTENTS 2008 2 . 4

COVERSTORY27 Head fIrst

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all 2008 : : Baylor I n n o v a t I o n s 7

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news

Quality O lie iMPrOVes Or aMerican teenaGers, But

WOrK reMains tO iMPrOVe lie Or yOunGer cHildrenThe well-being o teenagers in the United States has

improved on a number o ronts, according to the 2008 Kids

Count project rom the Annie E. Casey Foundation. The report

documented improvements in the child death rate, teen

death rate, teen birth rate, high school dropout rate and the

number o teens not in school and not working. However, key

measurements or the well-being o inants stayed the same

or declined. There was no change in the inant mortality rate,

while our areas worsened: low-birth weight babies, children

living with jobless or underemployed parents, children in

poverty and children in single-parent amilies. Researchersnoted that the percentage o underweight babies born in

America has reached the highest point in nearly 40 years.

strOnG laVOrs can HelP dieters lOse MOre WeiGHt

aster By MaKinG tHe BOdy eel satisiedDieters may be able to lose weight aster by using calorie-

ree seasonings and sweeteners to eel ull and reduce the

amount they eat. In a study presented at the 2008 annual

meeting o the Endocrine Society, researchers used tastants

to stimulate the sense o smell and taste in overweight and

obese subjects. Researchers put salt-ree savory lavors, such

as cheddar cheese and onion, on salty oods and put sugar-

ree sweet crystal lavors, such as cocoa, spearmint, banana,

strawberry and malt, on sweet or neutral-tasting oods. A

control group did not add tastants to oods. Researchers

ound that the average weight loss over a six-month period

was more than 30 pounds, or 15 percent o the subjects

body weight, versus 2 pounds in the control group. Although

the specialized tastants are not available to the public,

dieters can use similar tactics to add lavor to low-calorie

oods. Strong smells and tastes can trick the body into eel ing

satisied, reducing the amount a person eats.

itness leVel, nOt WeiGHt lOss, HelPs Men Wit H

diaBetes enJOy a lOnGer lie

Regardless o their weight, men with type 2 diabetes

who are physically it have a greater chance o living longer

than their less-it counterparts. Researchers at two Veterans

Administration hospitals studied male veterans with diabetes

and rated their itness as low, medium or high. The subjects

also were classiied as normal, overweight or obese by body

mass index, a measurement o body at determined using

height and weight. Those subjects with the highest itness

level and normal body weight reduced their risk o death

by 60 percent, and those who were overweight or obese

reduced their r isk o death by 65 percent. Those classiied as

obese but in reasonably good shape cut their risk o deathby 52 percent, compared with those who had a lower level

o itness . Researchers said moderate exercise, the equivalent

o walking 30 minutes a day, ive days a week, would oer

similar health beneits or people with diabetes.

Men WitH lOW testOsterOne leVels liKely tO Be

untreated desPite access tO HealtH care

Men with low testosterone levels may not receive

adequate treatment, according to a study o more than

i B h BI s


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all 2008 : : Baylor I n n o v a t I o n s 9

1,000 men published in theArchives of Internal Medicine.

Researchers suspect this is because the condition may go

unrecognized or because o an unwillingness by doctors to

prescribe therapy. Among the 97 men in the study with low

male hormone levels, also known as androgen deiciency,

only 11 had been prescribed treatment. However, all the

men with untreated deiciency had access to adequate

health care. Men with androgen deiciency (both treated

and untreated) were ound to be more likely than men

without the condition to receive regular care and visit

their doctor more oten: 15.1 visits per year or those

with untreated androgen deiciency, 12 visits or those

with treated androgen deiciency, and 6.7 visits or those without the condition. Symptoms o androgen deiciency

include low lib ido, erectile dysunction, osteoporosis, sleep

disturbance and atigue.

usinG tHe BOdys OWn cellular systeM tO create

anestHetic WitHOut nuMBness

By combining the chemical that makes chili peppers

hot and a specialized local anesthetic, doctors have

learned to block pain without causing numbness. Doctors

at Massachusetts General Hospital used a derivative o

lidocaine, a local anesthetic, and capsaicin, the pain-

producing substance in chili peppers. The chili pepper

chemical caused channels in nerve ibers to open, and the

special anesthetic lowed into the pain receptor cells to

block their unction. This part icular anes thetic, which does

not aect the sense o touch or motor skills , is not eective

alone in injections. But capsaicin opens pathways into the

cells, allowing the pain killer to do its work. Researchers are

looking or other chemicals that will carry the pain killer

into the cells, because the chili pepper extract causes the

sensation o hea t. They note that this is the irst example o

using the bodys own cellular channels as a drug delivery

system, targeting treatment only at pain ibers.

neW BiOMarKers cOuld lead tO ea rly detectiOn

O Pancreatic cancer

Researchers have moved a step closer to developing a

blood test to identiy pancreatic cancer in its early stages,

when treatments are more successul. Researchers at the

Fred Hutchinson Cancer Research Center in Seattle and

other centers ound ive proteins or biomarkers that are

linked to pancreatic cancer, the ourth leading cause o

cancer death in the United States. By studying genetically

engineered mouse models o human cancer, researchers

ound proteins associated with the disease in humans at an

early stage. Researchers said the tests or the biomarkers

would be most eective when combined with an existing

screening that looks or another pancreatic cancer

biomarker. The combined tests could improve detection o

pancreatic cancer beore symptoms are evident. The test

could also help distinguish between cancer and pancreatitis,

a noncancerous in lammatory condition. Additional studies

are necessary beore biomarkers can be used routinely to

identiy pancreatic cancer in its early stages.


10/60

For a physician referral, call 1.800.4BAYLOR BaylorHealth.com

Physicians are members of the medical staff at one of Baylor Health Care Systems subsidiary, community, or affiliated medical centers and are neither

employees nor agents of those medical centers, Baylor University Medical Center at Dallas, or Baylor Health Care System. CE BUMC BI 7.08

Once again, U.S. News & World Report has ranked Baylor University Medical Center

at Dallas among Americas Best Hospitals. In the recent 2008 issue, they rated

Baylor one of the top 50 hospitals in five different specialties more recognitions

than any other North Texas hospital. This means you can always count on us for

quality health care. At Baylor, we are committed to developing new treatments

through leading research, and are dedicated to serving you, our patients.

Baylor. Recognized for 16 consecutive years.Ranked in 5 specialties.

NATIONALLYRANKEDFOR:


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all2008 : : Baylor I n n o v a t I o n s 11

Mental health

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Fli-FlCld alkig i i-s e the reas g ?by cyntHia Kincaid

self care

a study conducted by researcHers at

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exercise-induced astHma (eia) is one

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WHat do you imaGine WHen you Hear tHe Words

testosterone and men? You might think o muscle-bound

body builders or high-powered CEOs gracing the covers o

business magazines. Hear women and estrogen, and in all

likelihood you see less aggressive images.

Exploring the sources o power in women is the subject o

a recent study rom the University o Michigan.

The study by Oliver Schultheiss, a psychology proessor at

the University o Michigan who directs the Human Motivation

& Aective Neuroscience Lab, and researcher Steven Stanton

was recently detailed in the journalHormones and Behavior.

The teams indings suggest that estrogen may be or women

what testosterone is or men: the uel o power.

tHe driVinG Orce

The role o testosterone as a motivator in mens drive or

dominance has been well documented. Testosterone has

also been studied as a potential power-base or women,

but the results have been inconsistent. Estrogen, however,

is known to play a very strong biological role in women.

According to Renee Scola, M.D., an internist at Northwestern

Memorial Hospital in Chicago, hormones such as estrogen

Deig perEstrge ieces w w.by Joann milivoJevic

wOMens health


17/60


and testosterone are like chemical messengers. They are

produced in one area o the body and generally travel through

the bloodstream to aect dierent organs.

One o the main roles o estrogen is regulating menstrual

and reproductive cycles, explains Dr. Scola. It also has

cardiovascular, bone and central nervous system implications

and it does seem to play a role in emotions.

Given estrogens strong inluence in women, Schultheiss

and Stanton set up their study to test saliva levels o the

hormone against womens non-conscious desire or power.

The researchers deined power as a preerence or having

impact and dominance over others.

tHe WinninG HOrMOne

The study included 49 graduate and undergraduate women who competed in pairs in one-on-one computerized

dominance contests. Estrogen and testosterone levels were

determined beore and ater the contests, as well as the

womens non-conscious preerence or power.

In men, winners o dominance contests show an increase

in testosterone levels. Losers, on the other hand, have a

decrease in testosterone. The level o estrogen ound in the

study, however, depended on whether a woman won or lost

and her non-conscious desire or power. Contest winners

with the greatest desire or power had higher estrogen

levels ater they won. Losers with a high desire or power

showed a decrease in estrogen. Women with a low desire

or power did not experience this luctuation in estrogen

levels. Levels measured a day ater the contest ound that the

rise in estrogen remained high in power-motivated winners.

These indings parallel results in testosterone studies in men

leading researchers to suggest that estrogen is womens

power uel.

The sampling o women in the study included women who

were single, some in close relationships and a mix o those

groups taking oral contraceptives. The study noted that the

rise in estrogen was stronger in single women compared

to women in close relationships. Researchers theorize this

may have to do with estrogens role in a inding a partner:

Those in pursuit have higher levels to spur on their desire

or inding a mate. And unlike women on birth control, those

with natural menstrual cycles showed a higher positive link

between power motivation and estrogen.

It was quite interesting that i youre artiicially

supplementing estrogen, it didnt really have quite the

same eect as suicient levels o natural estrogen, says Dr.

Scola. Thats something we dont quite know. We just cant

artiicially give someone estrogen and have it increase their

power motivation.

While the clinical applications o this research are not yet

clear, it does suggest that estrogen and not testosterone is the

power driver or women. And that adds a resh dimension to

this much-studied hormone.

POINTSOfCONTACT:

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The level of estrogen found in the study depended on whether a woman won

or lost and her non-conscious desire for power. Contest winners with the

greatest desire for power had higher estrogen levels after they won. Losers

with a high desire for power showed a decrease in estrogen.

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cold can Kill. even in tHe Hot climate o texas, clinicians Have

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19/60

Introducing The New Skull Base Center at Baylor. Now patients have a valuable resource

to treat complex skull base disease. Our multidisciplinary team of health care professionalswork together to provide each patient with a customized treatment plan that might involve

radiosurgery, interventional neuroradiology or advanced surgical procedures all designed to

be as minimally invasive as possible. Our team of physicians on our medical staff consists of:

Physicians are members of the medical staff at one of Baylor Health Care Systems subsidiary, community or affiliated medical centers and are neither employees

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1-800-4BAYLOR BaylorHealth.com

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altHouGH many people tHinK video Games are a Waste

o time, researchers in the cardiac surgery department

at Childrens Hospital in Boston would disagree. Using

technology borrowed rom the world o computer gaming,

theyve made it possible or surgeons to peer inside the body

without opening the chest cavity, using 3-D technology to

operate within a living, beating human heart.

You eel like youre really inside the cardiac chamber,

working on these moving structures, says Nikolay Vasilyev,

M.D., a surgeon in the hospitals department o cardiac

surgery. When you approach them with instruments, you

can actually see the length and depth o the instrument

much like open-heart surgery.

The technique uses ultrasound, or echocardiography, to

look inside the heart and depict its movements in real time.

The use o ultrasound in surgery isnt new; it has been used

or diagnostic purposes since shortly ater the end o World

War II. Even 3-D ultrasound imaging has been around or a

while. The dierence, explains Pedro del Nido, M.D., chie

o cardiac surgery at Childrens, is that the older method

produces only a static image.

Thats great or diagnostic work, says Dr. del Nido. You

have plenty o time. You can examine any plane and image

you want and spend hours going through the data to decide

which is the proper way to view and display it.

But a surgeon operating on a heart doesnt have hours.

tecHnO-tracKinG sOund WaVes

Thats where video-game technology intersects with health

care in the orm o stereoscopic glasses and blazing ast,

commercially available video cards. But instead o zapping

aliens and monsters with various exotic weapons, the

technology allows surgeons to navigate the maelstrom that

is the interior o a human heart. When married to a high-end

ultrasound machine and attached to a computer, the glasses

give surgeons a moving image showing them exactly where

their instruments are located within the hearts chambers,

displaying the depth needed to precisely target a problem area.

Those 3-D glasses arent the type you may remember rom

old movies, with their headache-inducing red and green

lenses. Todays stereoscopic glasses employ LCD shuttersto display alternating images or each eye, oset by a ew

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degrees to mimic the eyes own binocular vision. I youve

ever watched a 3-D movie at a major theme park or IMAX

theater, youd recognize them.

When used in cardiac surgery, the glasses give the surgeon

the extra dimension thats so critical in the placement o

instruments. Depth perception is important because you

need to know i something is closer to you or arther away,

explains Dr. del Nido. When you advance an instrument a

knie or a needle toward a structure in the heart, you need

to know i youre in ront o it or behind it, so that you dontaccidentally collide into it.

tHree-diMensiOnal Wizardry

In Hollywood, 3-D movies are created using two cameras,

or a camera with two lenses to create a separate image or

each eye. But in modern ultrasonic imaging, inormation is

streamed out o the machine in the orm o data. Working

with the Childrens Hospital researchers, Robert Howe,

Ph.D., came up with a way to essentially split the data in two.

First, the ultrasound signal rom the machine is captured as

a dataset then divided in two one or each eye. A sotware

program called a volume renderer creates two separate imagesrom the data, oset by a certain number o degrees that

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Theres no heart-lung machine and no stopping the heart. So all of that

trauma would be eliminated. Recovery is much quicker as well more akin torecovering from angioplasty than open-heart surgery. Pedro del Nido, M.D.

correspond to the distance between each eye. Those images

are then displayed to the surgeon using the LCD glasses. All

o this takes place at a rate o 70 rames per second, aster

than most o todays video games. As reported in the June 2008 issue o the Journal of

Thoracic and Cardiovascular Surgery, the teams early

testing on pigs with atrial septal deects, or holes in their

hearts, was very promising. Dr. Vasilyev managed to place

patches over the holes 44 percent aster than with lat

imaging techniques. Placement was also more accurate.

Although the technique is a quantum leap over the open-

heart method, there will be an inevitable learning curve or

surgeons new to the procedure. Its diicult, because you

dont have a direct view o the structures, says Dr. Vasilyev.

Youre looking at the heart using 3-D ultrasound data, and

thats not how surgeons are trained to operate. You have to

get used to the imaging and understand what structures you

have on the screen in ront o you.

Thats where the stereoscopic glasses really shine, notesDr. Vasilyev: When you put the glasses on, its actually

much more comortable to visualize the structures and

gain depth perception. And theyre still comortable ater

two or three hours.

One Giant leaP Or Heart Patients

Although the 3-D method may be a bit challenging or doctors,

it promises to be a revolutionary boon or cardiac patients.

Consider a typical operation to repair a hole in a patients

heart: Under general anesthesia, the chest is cut open at the

breastbone, and the ribs are spread so the surgeon has access

to the chest cavity. The patient is put on a hear t-lung machine

and the heart is stopped while the operation is completed.

Ater the procedure, the heart is restarted and the patient is

taken o the heart-lung machine.

Although this traditional method o cardiac surgery is

considered relatively sae and eective, it is still an invasive

shock to the body that carries the risk o several side eects

and complications, such as inection, serious bleeding,

kidney ailure and stroke. Ater the operation, the patientis generally observed in an ICU or a day or more, and ull


23/60


recovery may take three months or longer. During that time,

pain and swelling are also actors.

Three-D cardiac surgery eliminates all that, says Dr. del

Nido. We envision making a small incision on the chest(eventually it may be catheter-based, although we havent

developed those tools yet) and introducing the instruments

directly into the heart. Theres no heart-lung machine and no

stopping the heart . So all o that trauma would be eliminated.

Recovery is much quicker as well more akin to recovering

rom angioplasty than open-heart surgery.

The beneits o the procedure become even more apparent

when operating on a heart valve, says Dr. del Nido, because

the surgeon can see the valve in operation, something thats

not possible with traditional open-heart techniques. I you

have an area o the valve thats prolapsing, or instance, you

can move the lealet patch to where you think it should go,

he explains. I it stops the leak, youve solved the problem.

Dr. del Nido and his team are currently planning

clinical trials, and hope to begin using the technique ona limited basis within the next year. In addition, Dr. Howe

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is attempting to take the technology even urther. Hes

working on a way to robotically move the instruments to

match the hear ts rhythm, says Dr. del Nido. To the surgeon

looking through the 3-D glasses, it will look as though the

heart is not moving at all.

So the next time you see a riend or relative ensconced in a

comy chair immersed in a video game, take heart: He or she

may be ield-testing the next big medical breakthrough.

imaGecourtesyofcHildrensHospital

boston


24/60


25/60


that enhances activity in processing pain signals, making

people with ibromyalgia physically more sensitive.

Previous studies with bromyalgia patients showed

excitement in a part o the brain called the insula. Based on

their unctional magnetic resonance imaging (MRI) studies,

researchers hypothesized that the increased activity was related

to increased levels o glutamate. To test their theory, researchers

used a non-invasive brain imaging technique called proton

magnetic resonance spectroscopy to measure pain symptoms

over a period o our weeks. Results showed decreased

glutamate levels that coincided with pain reduction.

Consequently, treatments targeting glutamate pathways

may be ruitul, says Dr. Harris. The insula is a region known

or its involvement in somatic stimuli [sensations rom

muscles and skin] in addition to internal sensations like the

bowel. This connection may explain an association betweenibromyalgia and some o its associated conditions, such as

irritable bowel syndrome. Because ibromyalgia patients

have a heightened level o sensory processing, it ollows that

glutamate may play a role in that, says Dr. Harris.

irst Medicines aPPrOVed

As a result o similar research, the Food and Drug

Administration (FDA) has approved the irst two drugs or thetreatment o ibromyalgia: pregabalin and duloxetine. Both

drugs work central ly, but through di erent mechanisms, says

Andrew Holman, M.D., rheumatologist and clinical assistant

proessor o medicine at the University o Washington.

Pregabalin targets neuropathic pain by reducing the number

o pain signals produced by damaged nerves. Duloxetine

aects production o serotonin and norepinephrine, two

naturally occurring brain substances, and was used as an

antidepressant beore the FDA approved the drug to treat

ibromyalgia symptoms.

The most intriguing science is in looking at dopamine

deiciencies in the hippocampus, an area o the brain that

modulates pain and also controls autonomic responses

like ight or light, says Dr. Holman. Associated conditions

like irritable bowel syndrome and anxiety seem to also be

managed by the autonomic nervous system and may be

linked. Excessive arousal in the brain stem rom a dopamine

deiciency may also be responsible or the inadequate sleep

in ibromyalgia patients, researchers believe.

ManaGed aPPrOacH

Fibromyalgia is not a condition where you can do one thing

and then youre done, says Dr. Harris. Patients need to be

aware o their symptoms and manage them appropriately

through medications, cognitive behavioral therapy and

exercise. But this new research gives patients hope and real

options or relieving chronic pain.

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1-800-4baylor.


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by debra Wood, r.n.

feature


28/60


anGela Harris o cedar Hill, texas, elt tinGlinG in Her

arm, and then the let side o her body became numb and

weak. She couldnt walk. At irst she thought it might have

been a stroke or a heart attack. But her neurologist sent her

or magnetic resonance imaging (MRI), which picked up a

benign tumor at the base o her skull.

The bones o the skull base enclose the brain and separate

it rom the eyes and oral cavity. Blood vessels supplying

the brain and nerves that control sight, smell, hearing and

acial unction pass through the skull base. Tumors in the

skull base are diicult to reach by traditional methods, but

physicians on the medical sta at the Skull Base Center at

Baylor Neuroscience Center employ minimally invasive

techniques to reach and remove such lesions.Harris consulted with several physicians beore turning to

physicians on the medical sta at the Skull Base Center at the

Baylor Neuroscience Center.

I was scared, Harris says. Each doctor told me how

diicult it was to get to. But when I ound Baylor, the

physicians were conident they could remove the tumor and

get all o it out.

The tumor was located at the back o Harriss brain, near

her pineal gland. The physicians on the medical sta at Baylor

successully removed the tumor and more than a year later,

she remains disease ree.

sKull Base surGery

Skull base conditions are rare and include meningiomas,

acoustic neurinomas and pituitary tumors that develop

deep inside the head. They oten can progress until quite

advanced without the patient being aware, due to their

relatively hidden location. However, as the masses grow,

they can compress nerves in the brain.

Benign tumors can cause a loss o unction and deathi let unattended, says otolaryngologist and acial plastic

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29/60


surgeon Yadranko Ducic, M.D., a physician on the medical

sta at Baylor University Medical Center at Dallas and Baylor

All Saints Medical Center at Fort Worth, and co-medical

director o the Skull Base Center.

Besides tumors, skull base specialists perorm

procedures to remove vascular lesions, such as cerebral

aneurysms, and repair malormations o the occipital-

cervical junction or shiting o the vertebrae as a result

o rheumatoid arthritis. But as with skull base tumors,

removing lesions and correcting malormations in this

area presents challenges.The diiculty is because o the complex anatomy o the

skull base, says Caetano Coimbra, M.D., a physician on the

medical sta at Baylor Dallas and Baylor All Saints and co-

medical director o the Skull Base Center. Our approach is

minimally invasive treatment. It may include surgery and

radiation therapy in the orm o the Gamma Knie.*

a teaM aPPrOacH tO careThis March, the Skull Base Center opened in two locations

at Baylor Fort Worth and Baylor Dallas. It brings together a

team o sub-specialists on the hospital medical stas who

ocus on a comprehensive range o procedures including

neurosurgery, head and neck surgery, otolaryngology,

neuro-otology, orbital surgery, neuro-oncology, radiation

oncology, radiosurgery, neuropathology and interventional

neuroradiology that contribute to an optimal plan o care

to preserve a patients unction and quality o lie.

Base-o-skull tumors are diicult to access, and it usually

takes a combination o neurosurgery and head and neck

surgery to get them out, Dr. Ducic says.

Surgeons requently enter through the skull or nose, but

sometimes may open the ace to reach structures behind it.

Several types o surgeons oten stand by on cases, ready to

assist as needed.

Physicians rom throughout Texas and the United States

reer patients with skull base tumors and malormations to

the Skull Base Center at Baylor. Other people ind the centeron their own.

The bones of the skull base enclose the brain and separate it from the eyes

and oral cavity. Blood vessels supplying the brain and nerves that control

sight, smell, hearing and facial function pass through the skull base.

*Gamma Knife and Leksell Gamma Knife are U.S. federally registered

trademarks of Elekta Instruments, S.A., Geneva, Switzerland.

feature


30/60


A lot o the patients we have seen have been told there

is nothing that can be done, that the tumors are unable to

be removed with surgery, Dr. Ducic says. But the tumors

are resectable. There is plenty we can do, and there can be

problems i they do not have something done.

The physicians on the medical sta at the center

evaluate lab tests and existing imaging studies. Then, based

on the location and type o tumor, they develop a plan

o treatment. Traditional surgery sometimes is not the best

option. Some patients may need radiosurgery. The Gamma

Knie and CyberKnie target beams o radiation at the

tumor to destroy it, without signiicant ly damaging healthy

surrounding tissue. Patients may receive radiosurgery as

the sole treatment or in combination with surgery.

For an aneurysm, a patient may need interventional

neuroradiology to place a coil to prevent rupture.Interventional neuroradiology also may be employed to

block blood low to a tumor with a high blood supply beore

surgery. Such procedures make the operation saer with less

blood loss. A cancer patient also may need chemotherapy,possibly in conjunction with surgery.

Surgical patients receive a complete workup beore the

procedure, which may take a couple o weeks. Speciic testing

depends on the lesion but may include imaging studies to

precisely identiy locations o blood vessels and nerves.

aPPrOacHinG tHe lesiOn

The skull has di erent access points rom above and below,Dr. Ducic says . Above has traditional ly required a craniotomy,

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31/60


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an incision in the skull. From below, its minimally invasive. When the surgeon approaches rom above the goal is to

remove as little bone as possible just enough to allow

direct access to the lesion. A skilled skull base surgeon avoids

cutting into brain tissue, using ocused skull base approaches

to reach under the brain. Depending on the location o the

tumor, these approaches include an eyebrow incision, small

incisions around the ear or entering through the rontal sinus

cavity. Use o special instruments with miniature cameras

allows the surgeon to see tissue inside the skull without

opening it.

Alternately, the surgeons may use endoscopes through the

nasal passage to remove a pituitary tumor or other lesions,

avoiding any retraction or manipulation o the brain.

It decreases discomort and trauma to the bone and

muscle, Dr. Coimbra says. Yet it still allows us to navigateexternally, outside the brain, or direct access to the tumor.

The nasal approach avoids any brain retraction and sottissue trauma.

In other cases, a surgeon may ind it necessary to

temporarily remove parts o the ace to access the area.

Once the lesion is out, the surgeon restores the ace,

ocusing on unction and aesthetics. The procedure may

take several hours.

Sometimes, we have to do airly drastic things, where

we open the ace like a book to get to tumors behind

the ace or at the base o the brain, Dr. Ducic says. Even

those [cases] we do with no incisions on the ace. They

are all hidden inside the nose or the lip. Patients generally

look and eel pretty good ater their surgery.

Dr. Ducic explains that human anatomy places almost

all o the vital parts o the body o center, on the side,

including the eyes, arteries and nerves, which acilitates acentral approach.

A skilled skull base surgeon avoids cutting into brain tissue, using focused

skull base approaches to reach under the brain. Depending on the location

of the tumor, these approaches include an eyebrow incision, small incisions

around the ear or entering through the frontal sinus cavity.

feature


34/60


POINTOfCONTACT:

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We mobilize the eye sockets, the upper jaw and the lower jaw, Dr. Ducic says. We can protect those structures and

access the brain with really nothing much vital in our way.

Then we put it all back together, rebuilding the nose, the eye

sockets and the midace.

Patients are typically discharged within a week. They will

eat sot oods or six to eight weeks.

an OPeratiVe successI was really blessed, Harris says. I knew everybody. My

amily was there, and I was able to talk. I could remember

things. About three days ater the surgery, the doctor

brought in a newspaper, and I could read. I could walk.

Harris did not even require rehabilitative services.

Three months ater her surgery, she returned to work

perorming accounting unctions or the U.S. Department

o Homeland Security.

It was my irst t ime at Baylor, and I had a good experience,

Harris concludes.


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lIvInG well


36/60


the truh abu

antioxBY aMY M. avERY

oly reerch c epe rel beef,fle clm, fuure prme.


37/60


claims concerninG tHe purported poWers o

antioxidants receive a barrage o challenges rom bothpublished research and the popular press. Motivated by

scientiic curiosity and by concern about unsubstantiated

claims, scientists and physicians expend great amount s o

energy to unlock the secrets o antioxidants.

With all the data or and against antioxidant claims,

understanding what the medical community knows and

does not know about antioxidants is not a simple matter.

Identiying actionable inormation research that is

meaningul on an individual level is more diicult still.

But researchers and clinicians are intrigued and excited

about how antioxidants, oxidative stress and ree radicals

impact health, and they want the public to beneit rom

the knowledge.

Because o all the published reports and claims,

some people are desensitized to antioxidants and their

beneits, says Peter Campochiaro, M.D., Eccles proessor o

ophthalmology, researcher and practicing ophthalmologist

at Johns Hopkins University Medical Center.

Researchers have identiied very clear ingerprints o

oxidative damage, and theyve demonstrated that certain

antioxidant treatments can reduce the progression o

speciic eye disease, or example, he says. Research into awide variety o antioxidant treatments is exciting.

ree radicals, OxidatiOn

Antioxidants work by oering protection rom oxidativestress, a condition that occurs when cells are damaged at

the molecular level when the body metabolizes, or breaks

down, oxygen. Damage occurs during natural processes such

as digesting ood and metabolizing medications, and rom

exposure to environmental toxins such as cigarette smoke,

pollution, pesticides and even sunlight.

These damaged cells, called ree radicals or oxygen-ree

radicals , are missing an electron, which they attempt to

replace rom healthy cells. When healthy cells lose an electron,

they can become open to disease processes by causing

extensive damage to proteins, membranes and DNA. Research

ocuses on when, where and how antioxidants either stabilize

the ree radicals or prevent them rom causing harm at all.

researcH, treatMents, cures

Even a quick review o clinical research reveals dozens

o peer-reviewed studies debunking the broad cancer-

prevention claims o antioxidants such as vitamins C

and E and coenzyme Q10, or example. Research has also

revealed surprising evidence that supplements with beta-

carotene, another antioxidant, can actually cause harm to

people who smoke. And though the antioxidant lycopene

has been touted or prevention o prostate cancer, researchhas not corroborated the claim.

idants


38/60

Comprehensive health and fitness assessment

From the minute you arrive for your Personal Edge Assessment at Baylor,youll find the treatment first class all the way.

It begins with your own well-appointed examination suite where you can conductbusiness or just relax throughout the day, enjoying the ultimate in privacy and comfort.Of course, youll receive a thorough medical physical and fitness assessment. And should

the results indicate a need for further care, youll have prompt access to an appropriatespecialty physician.

To make an appointment, please call 214.363.2745

A program of the Baylor Health Care System411 North Washington, Suite 3000, Dallas, TX 75246

www.personaledgehealth.com

Physicians are members of the medical staff at one of Baylor Health Care Systems subsidiary, community or affiliated medical centers and areneither employees nor agents of those medical centers nor Baylor Health Care System. 2008 Baylor Health Care System CE-PE BI 2.08

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40/60


Another trial showed a reduction in occurrence of new

tumors in patients with bladder cancer who took a speciic

tuberculosis vaccine combined with vitamin C.

Two studies suggest benefits in combining certain

antioxidant vitamins, including E and C. One showeddelays in the progression o Alzheimers disease, and

the other showed reductions in the risk o coronary

heart disease.

In contrast to these results, however, other researchers

concluded rom a randomized controlled trial o women that

vitamin E supplements alone provide no overall beneit or

either cardiovascular disease or cancer.

100,000 Patients

In the interest o clariying the acts behind antioxidants

and cancer, Dr. Bardia led a research team to perorm a

systematic review o all randomized clinical trials that had

assessed the eicacy o antioxidants or cancer prevention.

Ater reviewing a dozen trials that involved a total o more

than 100,000 patients, Dr. Bardia and his colleagues oundsurprising results.

From our research, we concluded that antioxidants

overall are probably not helpul in supplement orm,

he says. Beta-carotene was actually ound to be har mul

or smokers.

On the positive side, selenium might be helpul or males,particular ly or prevention o prostate cancer. However, more

evidence is needed beore selenium can be recommended

or general use, but a large trial assessing this is currently

under way.

clear directiOn

Today, antioxidant research provides more direction to

scientists and perhaps the amily physician than it does

to people interested in embracing antioxidants or their

own preventive or curative powers. Even when studies

show strong evidence o antioxidant beneits, ew lead to

speciic recommendations about when and how much o

an antioxidant to take and in what orm.

Its hard work to determine which is the most eective

dosage and rom which source, says Dr. Campochiaro. Buttranslational research, research that provides actionable

Damage occurs during natural

processes such as digesting food

and metabolizing medications,

and from exposure to

environmental toxins such as

cigarette smoke, pollution,

pesticides and even sunlight.

a c uderstadig the classes f atixidats ad the fdsassciated ith the is the est ay t ack a er lch


41/60


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inormation or patients, is critical to determine what is

most eective or patients.

A urther problem in creating translational research is

that the public today does not have access to regulated

supplements. Those used in clinical trials are tested or

purity; those in the general marketplace usually are not. This

creates great variances in content rom brand to brand, with

sometimes 100-old dierences in active ingredients.

deinitiVe adVice

While the use o supplements is open to much debate,

studies have determined that certain oods do prevent

cancer, Dr. Bardia says.I encourage people to eat lots o ruits and vegetables , he

says. They have many beneicial eects, not just or cancer,

but or heart disease, diabetes and other diseases.

Many ederal and private organizations concur and

oer deinitive advice. The American Heart Association,

American Cancer Society, National Cancer Institute and

the Food and Drug Administration all recommend dietshigh in ruits and vegetables.

cOlOr cOdes

In part because o their antioxidant content, the Mayo Clinic

places several oods on its top 10 list: apples, almonds,

broccoli, blueberries, red beans, salmon, spinach, sweet

potatoes, vegetable juice and wheat germ.

Nutritionists note that some types o antioxidants are

ound in oods with distinct colors. Perhaps most well known

today are antioxidants ound in bluish-purple ruits like

blueberries, blackberries and purple grapes, plus eggplants.

Other hints or antioxidant -rich oods are the reds o cherries

and tomatoes, the orange o carrots and the yellows o corn,

mangos and saron.

Ocus On tHe uture

Top researchers call or more study to understand how dietary

antioxidants are absorbed and metabolized and how these

processes change as people age. Today, multidisciplinary

teams bring in the expertise o researchers in the ields

o nutrition, biochemistry, physiology, epidemiology

and molecular biology to better deine the relationships

between nutrition and health. Through such teams, animpressive body o translational research is under way.

The Cure for the CommonChildrens

Kid Biz

Fashion & ClothingBetty Reiter


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H E R E , E V E R Y S T O R E H A S A S T O R Y . TM

PRESTON R OAD AT NORTHWEST HIGHWAYtheplazaatprestoncenter.com

Shopping Experience.Betty ReiterCaf Coton

CalypsoCarla Martinengo Boutique

Jos. A. Bank Clothierslucy

Mel CrewsNew Balance DFW

Pickles & Ice CreamPriscilla of Boston

The BizTootsies

Viva a Paris

Jewelry & AccessoriesBachendorfs

Castle Gap JewelryRebecca Collins

Naomi Fine Jewelry LoungeMarnie Rocks

Food & Restaurants

Baskin RobbinsCaf R+D

Corner BakeryHoustons

Sprinkles CupcakesTaco Diner

Tin StarTom Thumb

Health & BeautyMontana Salon

Park Plaza Salon

Specialty ShopsApples to ZinniasThe Cultured Cup

Lili Padlucky dog barkery

Occhiali Modern OpticsOrvis DallasSwooziesTiecoon

Waterworks

ServicesAmerican Express Travel

E*Trade Financial

Fidelity InvestmentsComet CleanersLa Jolla Bank

The UPS Store


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Pain Free

3500 Gaston Ave . Dal las, T X 75246

1.800.4BAYLOR www.BaylorHealth.com

Physicians are members of the medical staff at one of Baylor Health Care Systems subsidiary,

community or affiliated medical centers and are neither employees nor agents of th ose medical

centers, Baylor University Medical Center or Baylor Health Care System. CE BSC B I 7.08

I came in unable to walk, Mike Holley says. They fixed me. Mike was experiencing debilitatingpain from a degenerative disc. At Baylor, he had spinal discectomy and fusion, complex

procedures for treating conditions of the spine. Specialists on the medical staff at Baylor

University Medical Center at Dallas are skilled in advanced spine care solutions. Now Mike

is free of pain and free to enjoy life. Im here because of what Baylor did for me and Ill

personally never forget that.

Mental health


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rebuildinG memory in tHose WitH coGnitive impairment,

improving IQ, and relieving psychotic symptoms in

individuals with chronic schizophrenia all without drugs

summarizes some o the promising new research on brain

plasticity. We now understand that the brain is continuously

making adjustments, says Michael Merzenich, Ph.D., proessor

emeritus at the University o Caliornia San Francisco. Every

time you acquire a new ability, its accounted or by physical

and unctional changes in the brain. Its a dierent brain than

beore you had this ability youve changed the local [neural]

connectivity. Conversely, a unctional loss is also expressed

by changes in the brain.

Through various stimuli or lack o stimuli, these changes

may also be reversed or improved over time. At any point

in time, the brain can drive itsel in a corrective direction,Dr. Merzenich says. Based on this platorm, he and other

researchers prove veriiable and oten astounding

results rom what was once considered sot science. We

now know we can get the brain to correct itsel i thats

possible in a par ticular case, which it is in many situations,

says Dr. Merzenich.

deininG PlasticityPlasticity, as it reers to the brain, describes its ability to

respond to new circumstances and to new learning. Gray

matter can shrink or thicken and neural connections may

be created, weakened or destroyed. Learning how to play

a new musical instrument or studying a new dance step,

or example, orges new wiring, or neural pathways in

the brain, relecting a change in the physical brain itsel.

Forgetting a persons name relects a dierent change in

wiring, indicating a possible degradation or even severing o

a pathway connected to memory. We associate learning and exploring with youth and

young adulthood, a time to discover and learn new things.

On the other hand, older adulthood is linked with memory

loss and other symptoms signaling a slowing down o

cognitive abilities. Normal aging may bring about substantial

operational degradation o the brain, says Dr. Merzenich.

Youre less precise and your memory slows as your brain

becomes less ecient. You dont process what you hear, see

and eel as well as you once did. But the new research shows

that, given the right stimulus and conditions, even the aging

brain can grow.

Plasticity-Based treatMent

Based on knowledge o the brains plasticity, scientists

are inding great success with drug-ree techniques

that help the brain to heal itsel. These techniques

th s-Hg braiIcreasig id ery thrgh etal exercise h h g.

by linda melone

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Mental health


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rely on the retraining o the brain through repetitious,

challenging activity. In an era where drug side eects and

adverse reactions coincide with our increasing reliance

on medications, its exciting to think the next great

breakthrough may come rom a less-invasive source, notes

Dr. Merzen ich.

luid intelliGence

Research led by Swiss post-doctoral ellows Susanne M.

Jaeggi and Martin Buschkuehl, working at the University o

Michigan Ann Arbor, demonstrates the plast icity or luidity o

the brain when it comes to IQ testing. Studying a persons IQ,

or intelligence quotient, involves measuring a combination o

crystallized and luid intelligence. Crystallized intelligence,

also known as long-term memory, draws on existing skills,

knowledge and experiences to solve problems or access

inormation. Fluid intelligence, on the other hand, relies on

short-term memory and constitutes working memory. We rely

on luid intelligence to recall phone numbers or memorize a

piece o inormation or a short time.

Jaeggi and Buschkuehl studied our groups o volunteers

using a complex training task, oering both auditory and

visual cues used to train their working memory. Hal-hour

sessions were held once a day or eight, 12, 17 or 19 days.

The trained groups not only improved signiicantly rom the

control group, but gains in intelligence increased according

to the length o time trained.The indings showed that memory task training led to

an increase in luid intelligence and an improvement in

general intelligence as measured by IQ tests. Although they

say urther studies are needed, the researchers surmise that

this type o memory training may also help children with

developmental problems and adults acing memory decline.

rOle O nutritiOn

Part o brain health and the prevention o cognitive and

memory decline includes a diet rich in nutrients such as

omega-3 atty acids, vitamin E, antioxidants and olic acid.

For example, DHA [docosahexaenoic acid], ound in ish, is

also the pr imary a tty acid ound in the brain, says Andrea N.

Giancoli, R.D., M.S., spokesperson or the American Dietetic

Association. A study published in the journal Archives of

Neurology showed a 10 percent slower decline in cognitive

abilities in people who consumed one ish meal a week;

those who consumed two or more ish meals a week

experienced a 13 percent slower decline. I you eat ish

or heart health, youre likely helping your brain health as

well, Giancoli says. Its best to eat a variety o ish, although

salmon and sardines have the highest levels o omega-3s;

strive to eat ive ounces o omega-3-rich ish a week. In

lieu o salmon, laxseed and walnuts also contain healthy

amounts o omega-3s.

Moreover, antioxidants, such as those ound in ruits and

vegetables, may also help slow down the breakdown o

brain cells; berries contain particularly high amounts oantioxidants. Flavanols, ound in cocoa, are also reputed to

Crystallized intelligence, also known as long-term memory, draws on

existing skills, knowledge and experiences to solve problems or access

information. Fluid intelligence, on the other hand, relies on short-term

memory and constitutes working memory.


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POINTSOfCONTACT:

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have brain-healthy properties, as does olate (olic acid),

present in dark green leay vegetables like kale, spinach and

collard greens. (Learn more about antioxidants on page 36.)

A low-at diet with the addition o these healthy oods may

help prevent or slow down rates o cognitive decline due tonormal aging.

HelP Or aBnOrMal Brains

In severe cases o age-related cognitive decline, plasticity-

based approaches work well, as noted previously. Yet

research in patients with schizophrenia and other genetic

and trauma-induced brain abnormalities has shown that the

plasticity approach also yields dramatic improvements inthese populations.

Scientists at Yale University and the University o Caliornia

San Francisco recently conducted large trials among patients

with chronic schizophrenia. The technique uses a complicated

orm o training, addressing problems in the rontal lobe

that relate to how the brain records working memory

(fuid intelligence). Basically, with schizophrenia, the brain is

poisoned by an overexpression o two chemicals: dopamine

and noradrenaline, Dr. Merzenich explains. This causes the

person to lose track o associations across time they dont

know i they did something or someone else did. We try to

rebuild that working memory by doing things that strengthen

these associations.

In its current orm, the training takes around 100 hours, with

patients sitting in ront o a computer in one-hour sessions.The results: Every imaging, every blood chemistry test done

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g h iQ.

so ar is substantial and all directed towards renormalization,

says Dr. Merzenich. Although its still a work in progress,

the training is better and more eective in its impact than

anything else done thus ar.

In addition, the results appear well sustained and enduring.

We may still need to assess behavior over time, and somepatients may need additional training later on to maintain

their abilities, notes Dr. Merzenich. But you could never do

this with a drug. He cites similar results with those suering

cognitive loss rom chemotherapy, AIDS, Lyme disease, West

Nile virus and brain inections. Were developing strategies

customized to each one o these conditions and have had

signiicant results we can see by imagery or elemental

psychophysical measures, he says. We want people to see

this as medicine. Were teaching the brain to ix itsel.

Mental health


50/60


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This isnt some parlor trick that psychologists play on people, this is a real

effect that inuences how efcient people are with their market transactions,

and it can cost them a lot of money. Brian Knutson, Ph.D.

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baylor university medical center at dallasHasannounced

the expansion o the Baylor Charles A. Sammons Cancer

Center at Dallas.

Construction on a new 450,000 square-oot outpatient

cancer center expansion began earlier this year and is

expected to be completed by 2010. When the outpatient

cancer center is complete, a dedicated 120-bed cancer

hospital will be developed in the Collins Building at Baylor

Dallas with an expected completion in 2012.

We decided on the expansion because there is a huge

community need or cancer services, says Donna Bowers,

J.D., vice president o Baylor Health Care System. The

incidence o cancer continues to grow as the population

ages; the projected increase or cancer diagnosis is 19 to 21

percent over the next ive to 10 years.

To support a decision to expand the now 32-year-oldBaylor Sammons Cancer Center, Baylor conducted a thorough

analysis, looking at national cancer rates as well as regional

and local needs. The analysis ound that the United Stateshas been successul in reducing cancer mortality, so death

rates are going down, but the incidence rates o cancer are

going up. We have increasing rates o cancer incidence, but

we are treating it more eectively, says John McWhorter III,

president o Baylor University Medical Center at Dallas.

We want to reduce cancer to a chronic disease. The net

result o successul treatment is that a lot o cancer survivors

are going to need continual care or the rest o their lives.

According to Marvin Stone, M.D., a physician on the medical

sta and chie o oncology at Baylor Dallas, and medical

director o the Baylor Sammons Cancer Center, the strategic

planning process identiied the necessity o enlarging the

program as well as acilities. Advances in cancer care have

accelerated rapidly, and Baylor is accepting this challenge to

provide our patients with advanced treatment, he says.

treatMents and PrOGraMs

In addition to oering the current traditional cancer

treatments, the expanded cancer center will eature more

choices in complementary medicine and clinical trials or

patients. One o our goals is to increase the number o clinical

trials provided to our patients, says Bowers. Our patients want

to go to acilities where clinical trials are being conducted.

Baylor Sammons Cancer Center already oers patients

access to more than 150 clinical trials (including national

bne Cacer CeterExadig r cacer care visi h .by cyntHia Kincaid

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trials) and innovative cancer treatments or all cancer types

including leukemia, lymphoma, myeloma, lung cancer, breast

cancer and colon cancer. We want that number to climb

signiicantly, says Bowers.

The new cancer center expansion will also allow or a

more comprehensive molecular medicine program, more

commonly known as personalized medicine, including

promising areas o research such as targeted therapy. With

targeted therapy, were going to be able to look at a pat ients

DNA and determine what type o treatment is going to

work best with their particular genes, says Bowers. We

can tailor medicine more toward the individual and end up

with better outcomes. Its going to revolutionize medicine

over the next 10 years.

Dr. Stone says that the expansion o our cancer care vision

will help Baylor in developing and expanding its current

targeted therapeutic approaches. I think these approaches

are going to advance the entire ield, and were already

applying them in certain kinds o leukemia, breast, lung and

colon cancer, he says. Theres going to be a tremendousincrease in our ability to make more accurate diagnoses

and target therapy in individual patients. These will be more

eective and produce ewer side eects.

The new cancer center will also develop a physical

medicine program designed speciically or oncology

patients and a new pain management department will be

created to ocus only on cancer patients. The cancer centers

boutique, Ernies Appearance Center, also ocuses on cancer

patients by providing special clothing, prostheses and wigs.

Ernies has been a huge success, and its something thats

tremendously needed, says Bowers. Baylor has done a

superb job in this area.

Patient-centered treatMent

Ultimately, the new cancer center will continue to support

Baylors overall mission o patient-centered treatment. We

talked to patients and their amilies to ind out what they

wanted in the new center, says Bowers. We are building our

new cancer center based on their eedback.

Dr. Stone agrees. At Baylor Dallas , we have always el t

that compassionate patient care was the central part oour mission, he says. Here, individualized patient care

is what we have always elt was most import ant, and that

continues to be the case. Baylor will also continue to

emphasize strong educational and research programs to

stay abreast o current medical advances, according to

Dr. Stone.

Baylor has emphasized a multidisciplinary interaction among

various specialists rom the beginning; that interaction, Dr.

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Stone says, has become the linchpin o the modern practice o

oncology. The expansion o the Baylor Sammons Cancer Center

will underscore and enhance this emphasis. As evidence to

our devotion to that concept, we have more than 200 dierent

site tumor conerences per year, all o which are participated

in by medical oncologists, surgical oncologists, radiation

oncologists, pathologists and various other specialists,

depending on which cancer type is being discussed, says Dr.

Stone. We have more than 6,000 physicians, trainees, nurses

and paramedical people attend those per year. They all grant

CME credit or physicians, and they are a very important part

o the activities at Baylor Sammons Cancer Center.

The ocus on patient care, according to Bowers, rests on

the cornerstone philosophy o treating all aspects o the

person not just their physical health. When someone is

told they have cancer, their needs go beyond traditional

medical treatment. At Baylor we work to address the mental

and spiritual aspects o living with cancer not only or the

patient but also or the amily. Therapies oered include

massage, acupuncture, music and art, journaling educational

programs and support groups, she says.

In 1999, Espenola Pinckney experienced Baylors patient-

centered attention irst-hand when she was diagnosed andtreated or colon cancer. Now in remission, Pinckney cant

say enough about her experience at Baylor Dallas. The

doctors were wonderul, she says. They ran a lot o tests; I

had chemotherapy and radiation over a three-month period,

and it worked.

Everyone at Baylor was just so caring, and I w

baylor innovations | fall 2008

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