Best Docs 2009 - Breakthroughs

A New Drug Helps Expand Diets
Thanks to a new medication called Kuvan, patients with PKU (phenylketonuria) can now expand their restrictive diets to include some proteins that were previously prohibited. The FDA approved Kuvan in December 2007. (Its clinical trials included one at Akron Children’s Hospital that was led by clinical geneticist Dr. Thaddeus Kurczynski and followed 10 patients.) PKU, a genetic metabolic disease in which people can’t process the amino acid phenylalanine, can cause a buildup of the amino acid in the blood and result in slowed neurological development and permanent brain damage. “All we’ve had is dietary treatment,” Kurczynski says. “And that’s still important.” But now doctors have one more option. “Most patients still need to continue with their dietary treatment, because not everyone has a dramatic response,” he says.
An Alternative to Knee Replacements
Active middle-aged adults who have worn out their knees often had to face a dilemma: treat the pain with injections or get a total knee replacement. Now there’s another option — the UniCAP. In a minimally invasive surgery, a small device is inserted into the knee as a partial replacement. Anthony Miniaci, executive director of Cleveland Clinic Sports Health, developed and performed the first surgery in March 2008 and has done about 30 since. While there have been partial joint replacements in the past, the UniCAP saves much more of the bone, cartilage and soft tissue in the knee — parts typically removed in a traditional knee replacement. “The goal is to restore function without doing too much destruction to the normal structures of the knee,” says Miniaci.
Heide Aungst
Repairing Broken Bones Sooner
Traumatologists often debate about how quickly to operate on multiple-fracture victims — right away or after they’re stable. New research still ongoing at MetroHealth and due to be published later this year is finding that surgery within 24 hours of injury “leads to fewer complications such as pneumonia and pulmonary problems, shorter hospital stays and less expense,” says Dr. Heather Vallier, the orthopedic surgeon who’s leading the study. Vallier’s findings will change treatment protocols at Metro and likely at other hospitals throughout the country.
Genetic Link in Kidney Disease
Dr. John Sedor of MetroHealth has spent the last decade working with a team of U.S. researchers to identify the genes associated with kidney disease. In 2008, Sedor and his team announced a major discovery —they’ve uncovered a genotype that explains almost all of the excess risk of kidney disease in African-Americans. “Knowing these genes will better help us in diagnosis, management and treatment of kidney disease,” says Sedor.
Better Treatment for Gestational Diabetes
Four percent of women develop gestational diabetes during pregnancy, but “in the past, some [physicians] didn’t believe that treating women with mild gestational diabetes was worthwhile,” says Dr. Patrick Catalano, MetroHealth’s chair of obstetrics and gynecology. Catalano was Metro’s principal investigator in a national study published in May 2008 that turned that notion on its head, finding that even mild cases put women at a greater risk of increased birth weight, cesarean delivery and other adverse outcomes.
 Prevention Tool for Cerebral Palsy
Of the 10,000 annual diagnoses of cerebral palsy in babies and infants, about a third are associated with premature birth. But new research conducted at MetroHealth and 19 other U.S. medical facilities released in January 2008 found that administering inexpensive and easily accessible magnesium sulfate to a mother during preterm labor can substantially reduce the risk of her child developing cerebral palsy. “We anticipate this will change practice in obstetrics,” predicts Dr. Brian Mercer, Metro’s lead researcher in the study
Earlier Detection for Lung Cancer
Breathalyzers aren’t just for roadside checkpoints any more. Doctors are attempting to use similar technology to detect lung cancer at an early stage. “When you have cancer in the lung, we’ve found you have abnormal breath,” explainsDr. Tarek Mekhail, director of the lung cancer medical oncology program at the Cleveland Clinic. Along with pulmonologist Dr. Peter Mazzone, he has been testing cards with 36 colored spots in a breathalyzer machine to pinpoint a specific color pattern or “footprint” of lung cancer. Mekhail says the “electronic nose,” as it’s been dubbed, is not yet “ready for prime time.” In preliminary studies, it’s been right about 73 percent of the time.
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