The Power of Radiology to Diagnose and Heal

Posted by Brigham and Women's Hospital January 19, 2017

Dr. Alexandra Golby, Director of Image-Guided Neurosurgery at BWH, is pictured with patient Brett Johnson.

In 2009, Brett Johnson was a healthy 47-year-old enjoying his life as a singer, teacher, and pianist when he began to suffer from nagging headaches.

As a precaution, his physician ordered an MRI (magnetic resonance imaging) scan of his brain. When the test revealed a cancerous tumor, Johnson recalls feeling shocked, then devastated. On a scale of I–IV, where IV is the most serious, the tumor ranked a Grade III. Johnson’s distress was compounded when he learned the tumor—called an oligodendroglioma—was located in an area of the brain associated with creativity and emotion.

“Creativity is my whole life and career,” Johnson says. “I thought, ‘Please, not that.’”

Within three weeks of his diagnosis, Johnson’s tumor was removed by neurosurgeon Alexandra Golby, MD, at Brigham and Women’s Hospital (BWH). After two months of oral chemotherapy and 33 sessions of radiation, physicians told Johnson that while some cancer cells would always be there, his cancer was stable.

“I was so grateful and happy to have my life back,” says Johnson, who resumed his career with no negative effects on his creative abilities.

Part of Johnson’s new routine meant having follow-up MRIs for the rest of his life. In 2012, something new appeared on a scan. Johnson’s care team could not tell if it was new tumor growth or scar tissue, so they recommended a second surgery.

A Vision for Image-Guided Procedures

In the three years between Johnson’s surgeries, BWH opened the Advanced Multimodality Image Guided Operating (AMIGO) suite, designed to guide complex treatments and procedures with navigation tools and imaging technologies including MRI, CT (computed tomography), PET (positron emission tomography), fluoroscopy, angiography, and ultrasound (see Radiology 101).

“Second only to my wedding day, my second surgery was the most profound day of my life,” Johnson says. “Dr. Golby explained that AMIGO would allow her to use imaging during surgery, which would help her be much more precise.”

“With the naked eye, a tumor looks nearly identical to the brain,” says Golby, BWH’s director of image-guided neurosurgery. “The most dangerous part is when you’re trying to remove the last 10 to 15 percent of the tumor, at the very edges. AMIGO gives us images during surgery, which helps us accomplish a more complete removal without damaging healthy tissue surrounding the tumor.”

The results of Johnson’s surgery in AMIGO were encouraging. Golby found scar tissue—no new cancer growth.

AMIGO was the brainchild of the late Ferenc Jolesz, MD, a BWH radiologist whose peers and students called him the father of modern day image-guided therapy. Since its opening in 2011, AMIGO has hosted more than 1,200 procedures for the brain, head, neck, spine, lungs, abdomen, and pelvis. The suite also doubles as a translational research lab and is the centerpiece of the National Center for Image Guided Therapy, funded by the U.S. National Institutes of Health, based at BWH, and led by Clare Tempany-Afdhal, MB, BAO, BCh.

Read more about the many benefits of advanced imaging in this issue of Brigham Health magazine.

 

 

An Alternative “Approach” to Hip Replacement Surgery

Posted by Brigham and Women's Hospital January 13, 2017

Dr. Gregory Brick and Dr. John Ready are experienced in using the anterior approach in hip replacements, a technique that has demonstrated reduced length of hospital stay, less risk of dislocation, faster recovery, and less post-operative pain.

Contributors: Dr. Gregory Brick and Dr. John Edward Ready are orthopaedic surgeons in the Department of Orthopaedic Surgery at Brigham and Women’s Hospital (BWH). Dr. James D. Kang is Chairman of the Department.

Orthopaedic surgeons have several ways of reaching the hip joint during a hip replacement surgery. The traditional technique, known as the “posterior” approach, reaches the hip joint through the buttock muscles. Less commonly used is the “anterior” approach, which makes a small incision at the front of the hip. Only 15 percent of surgeons in the U.S. employ the anterior approach, and few surgeons in Boston use the method.

Currently, the only surgeons in the Harvard Combined Orthopaedic Residency Program to use the anterior approach are Dr. Gregory Brick and Dr. John Edward Ready – orthopaedic surgeons in the Department of Orthopaedic Surgery at BWH. They use the anterior approach in 95 percent of their hip replacement surgeries.     Read More »

Treating Movement Disorders: Parkinson’s Disease, Essential Tremor and Dystonia

Posted by Brigham and Women's Hospital January 6, 2017

For some people with movement disorders, deep brain stimulation can offer an effective treatment for symptoms that don’t respond to medications. Above: Imaging in the AMIGO Suite at Brigham and Women’s Hospital.

Contributor: Michael T. Hayes, MD, is Neurological Director of the Functional Neurosurgery Program for Movement Disorders at Brigham and Women’s Hospital (BWH).

Movement disorders are a group of neurological conditions that cause abnormal voluntary or involuntary movements, or slow, reduced movements. These disorders can affect movements such as walking, and complex tasks like playing the piano or writing.

“No two patients with a movement disorder are alike, so treatment must be tailored to the individual. In order to achieve the best outcome each patient must be continually evaluated to decide the appropriate treatments, which may involve injections, medications, or in some cases surgery,” said Dr. Michael T. Hayes, the Neurological Director for Functional Neurosurgery at BWH. Read More »

Breast Tumors: Study Shows New Drugs Expose Vulnerability

Posted by Brigham and Women's Hospital January 4, 2017

Researchers at Dana-Farber/Brigham and Women’s Cancer Center led a study of a drug agent that can make some breast tumors vulnerable to drugs known as PARP inhibitors. Photo by Sam Ogden.

“If it’s not broke, don’t fix it” may be a valid philosophy in general, but not in dealing with the molecular machinery of cancer cells. There, the applicable motto might be might be, “If it’s broke, keep it that way.”

That’s the approach taken by a class of targeted drugs known as PARP inhibitors, which hinder cancer cells from repairing certain kinds of damage to their DNA. In tumor cells whose DNA-repair system is already hobbled, PARP inhibitors can lead to such a buildup of DNA damage that the cells can no longer survive.

But the drugs have limitations: they are effective only in cancers that already are poor at DNA repair, and their effectiveness tends to lessen over time, as cancer cells find alternate routes for fixing DNA damage. This has prompted scientists to look for other compounds capable of disrupting DNA repair, potentially by interfering with cell proteins that play a role in the process. These drugs could potentially turn PARP inhibitor-resistant cancers into inhibitor-sensitive ones.

In a recent study, scientists at Dana-Farber reported success with one such agent, the chemically unique drug dinaciclib. The research was conducted in laboratory samples of triple-negative breast cancer and in mice carrying tumor tissue from human patients. When investigators treated the samples and the animals with a PARP inhibitor and dinaciclib, tumors that previously hadn’t responded to PARP inhibitors stopped growing, as did tumors that initially did respond to the drugs but had become resistant to them. Read More »

Weight Loss Success in the New Year

Posted by Brigham and Women's Hospital December 29, 2016

Many people begin a new year with a resolution to lose weight. To help support your goals for 2017, specialists in the Center for Metabolic and Bariatric Surgery at Brigham and Women’s Hospital (BWH) have compiled resources with information about weight loss.

 

Controlling the Hunger Hormone

Have you ever thought about what makes you feel hungry or full? There are many signals in the body that help to control the amount of food we eat. Ghrelin, which is sometimes called the hunger hormone, is one of these signals. Learn more about this important hormone in this blog post.

 

 

 

Improving Quality of Life after Bariatric Surgery

Weight loss surgery, or bariatric surgery, is about much more than weight loss. In fact, it’s often called metabolic and bariatric surgery because it can lead to an improvement in many health conditions. Find out more about the benefits of weight loss surgery in this blog post.

 

 

Walk from Obesity – Raising Awareness

In late spring, the Boston Walk from Obesity will begin and end at Brigham and Women’s Faulkner Hospital (BWFH) and wind through the beautiful Arnold Arboretum. Funds raised through the event are used to support obesity-related research, education, and awareness programs promoted by the American Society for Metabolic and Bariatric Surgery Foundation. Read more about prior events and learn how you can get involved.

 

 

Is Weight Loss Surgery Right for You?

This video features members from the BWH Center for Metabolic and Bariatric Surgery, including Scott Shikora, MD, Director, Bariatric Nutrition Coordinator Laura Andromalos, MS, RD, LDN, and Bariatric Program Manager Kellene A. Isom, MS, RD, LDN. Viewing our New Patient Information video is the first step in considering whether bariatric surgery makes sense for you.

 

How to Spot and Treat Lyme Disease

Posted by Brigham and Women's Hospital December 22, 2016

Lyme disease is an infection that is transmitted through the bite of a tick infected with a bacterium called Borrelia burgdorferi.

Lyme disease is an infection that is transmitted through the bite of a tick infected with a bacterium called Borrelia burgdorferi.

Lyme disease is the most common vector borne illness in the U.S. According to the Centers for Disease Control and Prevention, over 300,000 new cases are diagnosed yearly, making Lyme disease more common than previously thought.

Lyme disease is primarily focused in the Northeast, the upper Midwest, and regions of the Pacific Northwest, though you can contract it in other parts of the country. The most common seasons to develop Lyme disease are spring, summer, and fall, but it is possible to contract Lyme in the winter.   Read More »

A New Year – A Healthier You!

Posted by Brigham and Women's Hospital December 21, 2016

A New Year’s resolution to increase exercise can go a long way for your bones, joints, and many other aspects of your health. Starting a plan by setting small achievable goals every six-to-eight weeks is a great way to track your progress throughout the year. You should never increase your mileage or minutes spent exercising more than 10 percent per week.

Authors: Dr. Elizabeth Matzkin, Surgical Director of the Women’s Sports Medicine Program at Brigham and Women’s Hospital and Team Physician for Stonehill College Athletics, and Emily Brook, a research assistant in the Women’s Sports Medicine Program.

With a new year right around the corner, many of us are thinking about a New Year’s resolution. One of the most common New Year’s resolutions is to lose weight, exercise more and be healthy! Bones and joints appreciate weight loss, because for every pound you lose, pressure is taken off of your hip, knee, and ankle joints. However, losing weight and transitioning to a healthy lifestyle takes time, and many people who do too much, too soon, wind up with an overuse injury in the first 8-12 weeks of the year.

If you are thinking about weight loss or increasing your exercise as a New Year’s resolution, follow these simple tips to start your year off right and be on your way to an injury-free healthier lifestyle. Read More »

Of a Certain Age? Time for a Colonoscopy

Posted by Brigham and Women's Hospital December 16, 2016

The American Cancer Society recommends that both men and women undergo a colonoscopy every 10 years, beginning at age 50.

Colorectal cancer is the third most common cancer in both men and women in the United States. The gold standard screening procedure for colon cancer is a colonoscopy, a test that allows your doctor to examine the inner lining of the large intestine (rectum and colon) for polyps, ulcerations, diverticulosis and early signs of cancer.

“Unlike other screening tests, a colonoscopy actually prevents cancer by allowing us to find and remove lesions before they become problematic,” said Dr. Jessica R. Allegretti, a gastroenterologist in the Division of Gastroenterology, Hepatology and Endoscopy at Brigham and Women’s Hospital (BWH).

In fact, due to increased awareness about screenings, the death rate from colorectal cancer has been dropping for more than 20 years. Read More »

What Are Carcinoid Tumors?

Posted by Brigham and Women's Hospital December 14, 2016

Carcinoid tumor cells.

Carcinoid tumor cells.

Carcinoid tumors are rare, often slow-growing tumors that form from neuroendocrine cells found throughout the body. Carcinoid tumors most commonly arise in the gastrointestinal system, including the appendix, small intestine, or rectum, but may occur in other sites, including the lungs.

In most cases, there is no clear cause of carcinoid tumors. There does not appear to be a strong association between cases of these tumors and typical cancer risk factors such as smoking and exposure to environmental toxins. In rare cases, carcinoid tumors can be linked to hereditary conditions such as multiple endocrine neoplasia types 1 and 2 and Von-Hippel Lindau disease.

Read More »

Could Loneliness be an Early Sign of Alzheimer’s Disease?

Posted by Brigham and Women's Hospital December 9, 2016

Loneliness may be an early sign of brain changes that lead to Alzheimer’s Disease.

In people with Alzheimer’s, the disease process—involving abnormal protein accumulation in the brain—begins 10 or 20 years before the onset of cognitive impairment.

In November, researchers at Brigham and Women’s Hospital (BWH) published a study that examined whether certain emotional or behavioral changes were associated with the accumulation of abnormal proteins, such as amyloid—a protein believed to be a precursor of Alzheimer’s.

“We thought loneliness could be an early signal of amyloid accumulation, because in epidemiologic studies lonely people have accelerated cognitive decline,” said study leader Dr. Nancy Donovan, a psychiatrist in the Department of Psychiatry and Neurology at BWH.   Read More »