Primary Pulmonary Hypertension News - Menu Medical Team Performs 2,000th Surgery for Life Threatening Lung Disease Chronic thromboembolic pulmonary disease (CTE) rings an ominous death knoll for most people, with blood clots clogging the network of pulmonary arteries that carry blood from the lungs to the heart. But when diagnosed and treated with a pulmonary thromboendarterectomy (PTE), an intricate surgery to remove the clots, many patients can return to a normal life. Newswise — In the fall of 2004, Ernestine Smith, mother of five and grandmother of nine, began having breathing problems. She underwent numerous tests and started medical treatment but her health continued to decline. Ten months later an angiogram revealed extensive clots lodged in her pulmonary arteries. As she progressively grew worse Smith sensed she did not have long to live. “I knew I couldn’t live through another year,” says the 74-year-old resident of Fredericksberg, Virginia. “The doctors didn’t have to tell me. I knew. Every day it took more and more oxygen to breathe.” Chronic thromboembolic pulmonary disease (CTE) rings an ominous death knoll for most people, with blood clots clogging the network of pulmonary arteries that carry blood from the lungs to the heart. But when diagnosed and treated with a pulmonary thromboendarterectomy (PTE), an intricate surgery to remove the clots, many patients can return to a normal life. Smith’s pulmonologist referred her to the University of California, San Diego Medical Center. As pioneers and the world’s foremost experts in this procedure, UCSD Medical Center’s pulmonary and cardiothoracic surgery team has successfully treated more patients through its PTE program than any institution in world. Recently the UCSD PTE team performed its 2,000th procedure. Diagnosis is key, says Stuart Jamieson, M.B., FRCS, chief of UCSD Medical Center’s Division of Cardiothoracic Surgery, though the disease is often misdiagnosed. “Patients with breathing problems are often misdiagnosed with asthma or allergies. It is not until they can barely walk that the real problem is found,” he says. “PTE can not only renew but restore their life.” The dominant symptom of CTE is the insidious onset of exertion-related shortness of breath, which doctors unfamiliar with the disease often diagnose as primary pulmonary hypertension, coronary artery disease or exercise-induced asthma. The UCSD PTE team correctly diagnoses the disease through careful analysis of lung scans, combined with other tests. William Auger, M.D., UCSD Medical Center pulmonary specialist,and Medical Director of the PTE Program said physicians call him every day, to refer patients for CTE evaluation and PTE screening. After reviewing a prospective patient’s history and x-ray studies, Auger determines PTE suitability. If suspected, physicians perform additional tests including the pulmonary angioscope, developed at UCSD, which examines the pulmonary artery’s interior. In the past 20 years, Auger and his UCSD Pulmonary Critical Care colleagues have analyzed over 3,000 people for suspected CTE. According to Auger, the clots are not easily recognizable and detection experience is key. Smith arrived in San Diego in late April 2006, underwent more tests and finally entered the operating room on May 2. In preparation, Smith told her husband, five daughters and grandson gathered around her bed where to find the funeral service notes she wrote for herself. She couldn’t imagine she would survive. Not only did she survive but the day after surgery Smith sat up in bed and asked for a slice of pizza. She has been recovering swiftly ever since. Smith is getting stronger everyday and figures she won’t be needing her funeral plans for a long time. “That team saved me,” Smith says. “They gave me back my life. Before, I had no hope, I wasn’t going to live and now I’m going to live a very long life.” The 8-to-15 hour PTE procedure involves opening the chest, attaching the patient to a heart-lung bypass machine and cooling the patient’s body to about 73 degrees Fahrenheit. The cold temperature reduces the body’s need for oxygen by 95 percent. Surgeons then turn off the heart-lung machine, stopping circulation for up to 20 minutes, to create a bloodless surgical field. The on-off process is repeated until surgeons remove all of the webbed, clot substance from the pulmonary artery walls. The clots, often more than 10 inches long, frequently appear as casts of the pulmonary arteries. UCSD Medical Center’s PTE team began performing this unique operation in 1970 and has performed more of these operations than all other PTE programs combined. The team averages two to four operations per week. Only a handful of other medical centers perform PTE. Latest weight-loss pill offers modest results, blocks 'munchies' A new drug billed as a magic bullet for obesity -- rimonabant (Acomplia) -- does help people lose weight, although not that much weight, and also helps lower cardiac risk factors, according to a review of studies. Rimonabant went on sale in Europe in July, and U.S. approval is pending before the Food and Drug Administration. The drug works in a new way, suppressing the appetite by targeting the brain cells involved in the "munchies" familiar to marijuana users. "The use of rimonabant after one year produces modest weight loss of approximately 5 percent" of body weight, found reviewers led by Cintia Curioni, at the State University of Rio de Janeiro, in Brazil. "Compared with placebo, a 20-milligram pill produced a 4.9 kilogram greater reduction in body weight in trials with one-year results." This translates to weight loss of a little under 11 pounds. The review looked at four randomized controlled trials comparing rimonabant at two dosages and with placebo, after one or two years of treatment. Participants, all overweight or obese, followed a "mild" low-calorie diet, adjusted for individual body weight. Only the higher dose -- 20 milligrams -- had significant impact on weight, waist circumference, cholesterol levels and blood pressure. However, the higher dose brought on more, and more serious, side effects than both the lower dose and placebo. The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic. The rimonabant studies took place in 350 trial centers in the United States, Canada and Europe. The 6,625 participants were at least 18 years old and overweight or obese. One study focused solely on people being treated for type 2 diabetes; another comprised people with high cholesterol or high blood pressure -- important factors in heart disease risk . The authors described the weight loss pattern: "After the 36th week, the level of weight loss decreased and the body weight was maintained practically until the end of the studies." One study evaluated data after two years: "Patients who stayed on 20 mg rimonabant seemed to maintain their weight loss, while those who were re-randomized to placebo gained significant weight." People on the larger dose lost an average 1.5 inches on their waistlines. They also showed a slight dip in blood pressure. The higher drug dose significantly lowered blood lipids (fats) and increased high-density lipoprotein ("good" cholesterol) by 3.5 mg/dl compared to placebo. But on the flip side, side effects included nausea, dizziness, headache, joint pain and diarrhea. More serious side effects included psychiatric and nervous system disorders. Obesity drugs, which often come on the market with great fanfare, can end up being withdrawn in a flurry of lawsuits -- like Fen/Phen -- or simply produce underwhelming results for people expecting a magic bullet. "Every time a new drug comes along, it gets a lot of attention. The natural course is that people who want it will try it, and people with have some lackluster results," said Kelly Brownell, Ph.D., director of the Rudd Center for Food Policy and Obesity at Yale University. "Few people lose enough weight to make themselves happy, more lose enough weight to get some medical benefit but overall results for most treatments for obesity are disappointing," Brownell said. Rimonabant has been billed for several years as a potential panacea for the most troublesome of habits – obesity, smoking and possibly alcohol addiction. Studies on its use in smoking-cessation studies are currently under way. Curioni's team compared its results to a previous review of orlistat and silbutramine, the only drugs approved in the United States for long-term obesity treatment: "The weight loss associated with rimonabant was slightly greater compared to that related to silbutramine use, with more positive impact on cardiometabolic risk. The effects compared with orlistat appear to be greater weight loss and less frequent adverse effects." No head-to-head comparisons had been done at the time of the review. The biggest difference may be in how rimonabant works, by blocking the cannabinoid receptors in the brain. Brownell called rimonabant's ability to suppress munchies "an interesting finding. The issue of food and addiction hasn't been explored very much; it should be." The review authors noted that the four reviewed studies were sponsored by Sanofi companies. With the studies all being sponsored by the drug-maker, results "probably represent a best-case scenario," Brownell said. None of the studies analyzed drug costs. "The fundamental problem is that even if one of these drugs caused significant weight loss, the cost would be so prohibitive that it wouldn't be worthwhile on a public health basis," Brownell said. "And only a few people would be able to afford them." ### FOR MORE INFORMATION: Health Behavior News Service: Lisa Esposito, Editor, at (202) 387-2829 or www.hbns.org. Curioni C, André C. Rimonabant for overweight or obesity (Review). The Cochrane Database of Systematic Reviews 2006, Issue 4. The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information. |