| Summary: | Volume1/2003_Fall UPdate University of Utah Health System Fall 2003 W H A T ' S I N S I DE Facial Nerve Center Offers Individualized Treatment page 4 Novel Surgery for a Rare OB- GYN Condition page 6 Continuing Medical Education Schedule page 8 New Magnetic Resonance Imager Offers Peace of Mind to MS Patients By Phil Sahm From the day she was diagnosed with multiple sclerosis ( MS) five years ago, Cathleen Frome has lived with uncertainty. Aside from numbness in her face, which led to the diagnosis of MS, Frome has experienced no physical symptoms and continues to enjoy her work and life. But MS is an insidious disease, and tracking its course is difficult, especially when obvious symptoms are absent, as in Frame's case. The best tool neurologists have for seeing MS, an inflammation of the brain and spinal cord that disrupts communi-cation between nerve fibers, is magnetic resonance imaging ( MRI). MRI is a technique that takes pictures inside the human body, allowing physicians to see disease, organs, bones, and more. Although MRIs were a giant technological leap from X- rays, it's only been in the past few years that they've become powerful enough to show subtle details that may signal change or progression in disease. That left Frome, 55, who works in the University of Utah Health Sciences Center Development office, and others continued on page 2 The University of Utah's new 3T scanner, the only one in the Intermountain West, is twice as powerful as most MRIs. New MRI Helps In Diagnosis, Treatment of MS MS patient Cathleen Frome is reassured by detailed brain images produced by the 3T. worth a thousand words, the 3T is an encyclopedia of information for U of U physicians and researchers. Twice as powerful as most MRIs, the 3T will have a huge impact on clinical care, research, and teaching at the U, according to Edwin A. " Steve" Stevens, M. D., professor and chair of radiology at the School of Medicine. " We're going to see and understand the human body better than we ever have," Stevens said. There isn't another 3T from Denver to San Francisco and from the North Pole to Phoenix, and Stevens expects the U of U will be treating patients from a sizeable territory. Longtime philanthropists and U of U benefactors Ian and Annette Cumming donated the $ 3 million MRI in honor of David G. Bragg, M. D., former chair of radiology, and J. Richard Baringer, M. D., professor and former chair of neurology. The 3T Experience The 3T was barely up and running before Frome's physician, John W. Rose, M. D., professor of neurology, took a scan of her brain. Aside from being a little noisier, a 3T scan isn't much different from other MRIs, according to Frome. But the results are amazing, and the 3T's images of her brain were the most clear and detailed that she or Rose had seen. MS shows up as spots, or lesions, in the white matter of the brain. After examining the images of her brain, Rose gave Frome something she hadn't felt in a long time- reas-surance. The scans of her brain confirmed in greater detail than ever before that the MS was not progressing. " It certainly has allowed me to focus my thoughts and energy elsewhere," Frome said. " I am so grateful to the Cumming family for donating the 3T." Manufactured by Siemens Medical Solutions, the 3T provides superior images of spinal abnormalities, cardiovascular disease, body tumors, brain biochemistry, . continuedfrom cover with MS in an uncomfortable spot- never quite sure whether their disease is advancing. But University of Utah Hospitals & Clinics now can offer Frome and others some peace of mind. In July, the U Hospital introduced the Magnetom 3T Trio System, a powerful new MRI that is one of the most advanced in the world and the only one in Utah and the Intermountain West. If one picture is Four Primary Types of MS anatomy, organs, and more. Doctors, for example, can view a 3T image and know whether a patient's heart wall is getting enough blood, how well the heart is pumping, and if the coronary artery is blocked. The 3T can reveal whether a tumor is recurring or responding to treatment, and, in some cases, even whether it's benign or cancerous. Problems with joints, cartilage, and degenerative diseases are easier to identify, and the 3T even sees minute changes in brain biochemistry, which opens vast possibilities for studying MS. MS strikes no two people exactly the same. Some it debili-tates, taking away motor skills to speak, walk, or perform other everyday tasks. Some it treats less severely, allowing them to maintain varying degrees of a normal life. The 3T is a powerful new MRI that is one of the most advanced in the world and the only one in Utah and the Intermountain West. MS Research With the help of the 3T, Rose and other U researchers expect to advance MS research considerably. Along with physicists Dennis L. Parker, Ph. D., professor of radiology, and Eun- Kee Jeong, Ph. D., research associate professor of radiology, Rose and other researchers at the Utah Center for Advanced Imagery Research have applied for a grant to study how to develop spinal cord imaging in MS patients. The role of the spinal cord in MS is a research area that has received little notice and is ripe for discovery, according to Rose. " We are looking forward to applying the full technology of the 3T," he said. " We're going to raise the bar considerably." MS is still a long way from being cured or prevented, according to Rose. Right now, as with many diseases, it would be a victory to be able to stop MS from getting worse in those it strikes. Rose hopes the 3T may help with that by pro-viding images that allow earlier diagnosis and show how well treatments are working. Eventually, Rose would like to use the 3T to develop a battery of tests to diagnose MS earlier. Among those placing hope in the 3T is John Cumming, whose parents donated the new MRI. Diagnosed with MS 3 1/ 2 years ago, Cumming, 36, joked that his first 3T scans immediately brought good news: " I still have a brain." More images showed areas of his brain where he and Rose knew there were MS lesions, but also showed spots they didn't know MS had affected. The scans gave much more detail about damage to his optic nerve and upper spinal cord, and these new pictures are allowing Cumming to make subtle • Relapsing/ Remitting: A type of MS in which the disease manifests itself goes into remission, and then relapses, often with new symptoms. • Secondary Progressive: This is characterized by a gradual worsening of the disease between relapses, and eventually no real recovery between episodes. • Progressive Relapsing: A form of the disease that progresses from the start, with periodic relapses. • Primary Progressive: MS that progresses gradu-ally and never shows any remission. changes in his medication and medical regimen. Cumming has spent four or so " blissful" hours in the 3T and expects to get a scan every six weeks for the next half- year. Although he wants the 3T to help doctors and researchers learn more about treating his MS, Cumming has a broader view. He hopes his role in MS research will benefit others with this mysterious disease. " It's a pretty lonely walk to have MS," he said. " I'm proud to know I'm helping." @ For more information, call the Department of Neurology, ( 801) 581- 6871. University of Utah Hospitals & Clinics toll- free referral and consultation: I - 8 I - 5 8 1 - 2 8 9 7 in Utah, I - 8 6 6 - 8 5 O - UUMD ( tollfree) outside Utah Facial Nerve Disorders U Specialty Center Offers Individualized Treatment Steven whose By Cindy Fazzi Imagine one side of your face going so numb that you have difficulty breathing. You can't close your eye. You drool and you can't even smile. Your entire right side, from face to foot, is so weak that you can't walk very well. Driving is out of the question. This is what 36- year- old Linda Weber of Belgrade, Montana, endured for a year because of a facial nerve disorder. " I kept waiting for the feeling in my right side to come back again, but it just didn't," said Weber. Finally she turned to University of Utah Hospital's Center for Facial Nerve Disorders for help. Last year, Weber was diagnosed with acoustic neuroma, a non- cancerous growth on the acoustic nerve, which connects the inner ear to the brain. The acoustic nerve is important to hearing and the sense of balance. Surgeons removed Weber's tumor, which she described as the size of a " golf ball and a half." While surgical removal of this type of tumor can occur without any impairment to the facial nerve, the larger the tumor, the higher the risk. The facial nerve is like a telephone cable that contains thousands of nerve fibers delivering impulses to specific facial muscles, allowing a person to laugh, cry, smile, frown, or make a face. When some of these nerve fibers are interrupted, weakness, or in the case of Weber, paralysis can occur. Facial Surgery In July, Steven R. Mobley, M. D., a facial plastic and reconstructive surgeon and assistant professor in the U medical school's Division of Otolaryngology- Head and Neck Surgery, performed three procedures during a five- hour surgery to treat Weber's facial nerve disorder. Mobley said the first procedure involved putting a gold weight the size of a Tic Tac breath mint in Weber's right upper eyelid to restore her ability to close it, which is essential in keeping her eye moist and healthy. In the second procedure, called nasal valve suspension, a tiny anchor was implanted in Weber's right cheekbone to The Center for Facial Nerve Disorders offers services ranging from physical therapy to in- office procedures and surgery. correct sagging cheek tissue and lift the nostril back to its pre- paralysis position. This dramatically improved her ability to breathe. The third procedure involved rotating a muscle from the side of her face not affected by the paralysis and then sewing that to her mouth. The procedure, temporalis muscle transfer, increased Weber's muscle tone so that the right side of her mouth no longer droops. " Immediately after the surgery, I started to breathe better," said Weber. " I'm looking forward to smiling again when my face heals completely." Specialty Center Mobley is part of U Hospital's Center for Facial Nerve Disorders, which offers services ranging from physical therapy to in- office procedures and surgery. " Facial nerve disorder affects not just a patient's face and looks, but his or her ability to eat, breathe, and do other things that determine quality of life," said Mobley. The center has 10 doctors and nurses who treat Bell's palsy patients, stroke victims, and those who suffer from facial paralysis as a result of a tumor or skull trauma. Many patients, like Linda Weber, travel long distances because the center is one of the few in this part of the country. There are similar clinics in Los Angeles and San Francisco. Clough Shelton, M. D., professor in the U School of Medicine's Division of Otolaryngology- Head and Neck Surgery, started the center in 1994 by enlisting the services of doctors and nurses with different specialties necessary to treat facial nerve problems. The center is based in the U Hospital, but it has access to services of experts from other hospitals. " Most patients with this kind of problem need a number of doctors with different specialties and that's why the center crosses institutions," said Shelton. " We needed one place where patients can get all the services they need." Mobley said the advantage of having the specialty group is that the U Hospital is able to individualize treatments. " Facial nerve disorder is a complex problem- there's no one- size- fits-all solution for our patients. We want to be able to offer our patients a comprehensive treatment program that involves a spectrum of possible interventions," said Mobley, whose practice includes cosmetic surgery. Weber used to be a food service worker at Montana State University and a nurse's assistant at a nursing home in Bozeman, Montana. She hasn't worked since the surgery that removed her tumor. " I can't work right now," she said. " I can't even drive anymore." Weber, however, remains positive about the future. She's thinking of moving to Salt Lake City to pursue treatment. She's currently undergoing facial physical therapy. " I'm just glad that I found doctors who can do something about my condition," Weber said. For more information, call Steven Mobley, M. D., ( 801) 585- 3535. University of Utah Hospitals & Clinics toll- free referral and consultation: I - 8 O I - 5 8 1 - 2 8 9 7 in Utah, I - 8 6 6 - 8 5 O - UUMD ( toll free) outside Utah A Novel Surgery For a Rare OB- GYN Condition By Cindy Fazzi Chelsea Law talked about her recent trip to France animatedly, showing snapshots of her enormous teddy bear atop a baggage cart, and laughing at the memory of her effort to learn French from two nurses she had befriended. She's a wellspring of cheer and affability, a typical teen- ager. This is remarkable, considering that the 18- year- old has had four surgeries in the past three years- not so typical after all. Law, of Kaysville, Utah, was 15 and had not reached puberty when she first experienced symptoms of cervico- vaginal atresia, a rare condition in which the uterus is not attached to the vagina. " My stomach and my back hurt a lot," she recalled. " It happened once a month, so I thought it meant I was going to start having a period." The symptoms persisted for two years, but Law still did not menstruate. Her doctor referred her to C. Matthew Peterson, M. D., professor and chief of the University of Utah School of Medicine's Division of Reproductive Endocrinology and Infertility. The imme-diate diagnosis was endometriosis and hematometra associated with the absence of struc-tures that allow blood to flow out of the uterus. Endometriosis occurs when tissue that normally lines the inside of the uterus grows on pelvic structures. In this case, endometriosis occurred because of reverse menstruation. In women who are not pregnant, endometrial tissue builds up inside the uterus, then breaks down into blood that flows out of the body during monthly menstruation. Peterson explained to Law that her endometriosis was caused by cervico- vaginal atresia, an unusual condition that, while not life- threatening, causes severe pain and discomfort. Sometimes it can cause scarring to the pelvic area, resulting in infertility. Little is known about what causes the problem. " When Dr. Peterson told me how rare my condition is, I got really scared," said Law. By the time Law was 17, she'd had three surgeries to drain her uterus of backed- up blood. Her life had been utterly disrupted. " I was home- taught part of the time," she said. " I gave up volleyball, Softball, and even color guard." C. Matthew Peterson, M. D., chief of the U School of Medicine's Division of Reproductive Endocrinology and Infertility, is pioneering in Utah a procedure considered novel in the United States. The surgeries gave Law some relief, but did not cure her condition. Peterson initially recommended what most doctors in the United States would suggest- hysterectomy, an operation to remove the uterus and stop retrograde menstruation. Law, the oldest of five children, was devastated. " I just cried and cried because hysterectomy would mean I wouldn't be able to have a baby someday." Novel Surgery Fortunately for Law, Peterson had another option: a surgery that would reconnect the uterus with the vagina. This procedure is considered novel and unproven in the United States, but had been performed successfully in France. " We searched around the world and found a group that had a fair number of successful cases and we immediately set up a collaboration," said Peterson. Last July in the Paris suburb of Creteil, Peterson performed the surgery in collaboration with Drs. Bassam Haddad and Barnard- Jean Paniel of Intercommunal Hospital. Prior to the trip, Law was eager to have the surgery, but panic hit her as soon as she set foot in France. Her fears were compounded by culture shock. Cervico- vaginal atresia is an unusual condition that, while not life- threatening, causes severe pain and discomfort. " The hospital there didn't even look or smell like a hospital," she said. " The doctors and nurses spoke little English and I couldn't speak French at all. It was all very scary." The surgery took three hours; Law recuperated in the hospital for four days. " Everybody in the hospital was very good to me," she said. It was during this time that she befriended two nurses who taught her one French word in exchange for one English word at a time. Law remembered the day of her discharge from the hospital with a hearty laugh. She and her parents decided to walk to their hotel, a few blocks away. " I was excited to get back on my feet, but it turned out, I wasn't ready. A walk that would normally take 20 minutes took us 55 minutes," she said. " It was the longest walk of my life." A month after the trip, Law said she felt great. As a result of the operation, she's expected to have regular menstrual flow. " This is something that other girls won't be excited about, but for me it means the end of abdominal pain," she said. Law, who's a freshman at Weber State University in Ogden, Utah, hopes to become a teacher someday. She doesn't begrudge the time she must spend in clinics and hospitals, or the fact that she had to give up sports and other activities. Having been spared a hysterectomy, she's hopeful about one day having children. Peterson, who's also director of the Utah Center for Reproductive Medicine, said the clinic is one of the few in the Intermountain West that can help patients like Law. Located in Research Park in Salt Lake City adjacent to the University Health Sciences campus, the clinic is a collaborative effort of the U medical school and Intermountain Health Care. It houses the most advanced infertility laboratory in the region and performs more than 300 in vitro fertilization procedures every year. The success of Law's surgery is good news to other patients with similar conditions. Peterson is treating four other women who could benefit from the procedure. " We plan to get all the necessary equipment so we can perform the procedure here," said Peterson. iS For more information, call the Utah Center for Reproductive Medicine, ( 801) 587- 3506. University of Utah Hospitals & Clinics toll- free referral and consultation: I - 8 O I - 5 8 1 - 2 8 9 7 in Utah, I - 8 6 6 - 8 5 O - UUMD ( tollfree) outside Utah U N I V E R S I T Y OF UTAH S C H O O L OF M E D I C I NE C O N T I N U I N G M E D I C A L E D U C A T I ON December 2: Posterior C1- 2 Transarticular Screw Fixation & Fusion Techniques for Pediatric Neurosurgeons Site: Primary Children's Medical Center Course Director: Douglas L. Brockmeyer, M. D. Credit: 4.5 AMA Category 1 hours Contact: Pamela Foote ( 801) 588- 3429 ( phone) - ( 801) 588- 3423 ( fax) pamela. foote@ hsc. utah. edu December 6: Antithrombotic Therapy 2004: Current Management Strategies & Medical- Legal Implications Site: University of Utah Fort Douglas Officers' Club Course Directors: Barry Stultz, M. D., Bob Pendleton, M. D. Credit: 6 AMA Category 1 hours Contact: Enrique Gonzalez- Bernal ( 801) 585- 9242 ( phone) - ( 801) 581- 9166 ( fax) Enrique. Gonzalez@ hsc. utah. edu February 8- 13, 49th Annual Utah Postgraduate Course in Anesthesiology: 2004: Advances in Anesthesia Transesophageal Echocardiography ( Core Concepts and Practice) Site: Park City Marriott Hotel, Park City, UT Course Director: Theodore H. Stanley, M. D. Credit: 24 AMA Category 1 hours Contact: Patricia Earl ( 801) 581- 6393 ( phone) - ( 801) 581- 4367 ( fax) Patricia. Earl@ hsc. utah. edu February 1- 4: Site: Course Director: Credit: Contact: February 6: Site: Course Directors: Credit: Contact: April 26- 30: Site: Course Director: Credit: Contact: Postgraduate Course in Surgery The Canyons Resort, Park City, UT Edward W. Nelson, M. D. 12 AMA Category 1 hours Terri Ostlund ( 801) 581- 7738 ( phone) ( 801) 585- 7392 ( fax) terri. ostlund@ hsc. utah. edu Utah Diabetes Center Annual Symposium Salt Lake Hilton, Salt Lake City, UT Dana Clarke, M. D., Mary Murray, M. D. 6.25 AMA Category 1 hours Cathy Bradley ( 801) 587- 3921 ( phone) ( 801) 587- 3920 ( fax) cathy. bradley@ hsc. utah. edu Intensive Interactive Head & Neck Imaging Course Marriott University Park Hotel, Salt Lake City, UT H. Ric Harnsberger, M. D. 20.5 AMA Category 1 hours Janet Holman ( 801) 581- 4624 ( phone) ( 801) 585- 7330 ( fax) Janet. Holman@ hsc. utah. edu University of Utah Hospitals & Clinics Office of Public Affairs 50 North Medical Drive Salt Lake City, Utah 84132 Nonprofit Organization U. S. Postage PAID Salt Lake City, Utah Permit No. 1529
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