Winter 2010 Department of Surgery In affiliation with ALL THE POSSIBILITIES OF MODERN MEDICINE NewYork-Presbyterian Hospital Adrenal Surgery Selective venous sampling identifies patients whose hypertension may be surgically curable. In his mid-fifties, JM hypertension.” In many o i z i r b had been struggling for a cases, physicians perform F a d a years to keep his high blood J surgery based on assump - pressure under contro l. tions such as this. However, Medications weren't working some times appearances well, leaving him at contin - may be deceiving . ued risk for kidney failure, To be certain that the heart disease, and other tumor was the cause of serious health problems. His JM's hyperaldosteronism, endocrinologist performed Dr. Morrissey performed blood tests , suspecting an James A. Lee, MD, Director, another test, called selec - atypical cause might be Columbia Adrenal Center tive venous sampling. This o i z i r b involved. The results a test compared the levels of F a d a IN THIS ISSU E explained why JM's hyper - J aldosterone that were tension wasn't responding secreted by JM's right and 1 Adrenal Surgery Selective venous sampling to t ypical medications – left adrenal glands. “The his body was producing sampling showed that the 2 Cosmetic Surgery Age maintenance procedures excessive amounts of side with the tumor (the 3 Pediatric Cancer aldosterone, a hormone right side) was not over- New treatment options which can cause hyper - secreting aldosterone, but tension as well as clinical that the left adrenal gland symptoms. was actually the problem,” JM's endocrinologis t said Dr. Morrissey. “The healthpoints is published by th e Columbia University referred him to the Adrenal tumor was just a benign Department of Surgery as Center at NewYork-Presby - lipoma, which required no a service to our patients. terian Hospital/Columbia treatment.” You may contact the University Medical Center, Nicholas Morrissey, MD, holding a flexible He was referred to Office of External Affairs catheter that is used to perform selective where a CT scan of the venous sampling of the adrenal gland James A. Lee, MD, Director, for additional information, abdomen revealed a tumor Columbia Adrenal Center. to be added to our mailing list, and to request additional copies. on JM's right adrenal gland. Dr. Lee removed JM's left adrenal gland i n a Please call 1-800-543-2782. “It would be reasonable to assume that laparoscopic procedure after which he went the adrenal tumor was the culprit,” said home the next day, and his symptoms disap - For physician referrals, please call Nicholas J. Morrissey, MD, Assistant peared. Had his doctors not performed 1- 800-227-2762 Professor of Surgery and Director of Clinical selective venous sampling, JM probably Trials, Division of Vascular Surgery. “If an would have been incorrectly (and unsuccess - Deborah Schwarz, RPA, CIBE Executive Director adrenal tumor is over-secreting aldos - fully) treated. Office of External Affairs terone, surgical removal of the tumor has Of the 50 million people who have hyper - Sherry Knecht a good chance of curing the patient's tension in the U.S., a subgroup of 2.5 to 5 Managing Editor ~ continued on page 4 Cosmetic Surgery Staging of 'age maintenance' procedures through adulthood provides superior results. Have you ever wondered why certain celebrities seem to age to help them understand what will work best when, and help them better than their contemporaries? Why they look so good for so choose the least invasive, most effective options. “Embarking on a long? It may be because they understand the importance of 'age lifelong plan for addressing one's skin health and appearance is like maintenance,' and have taken continuous small steps to care for an investment in one's future,” he says. “By taking less invasive steps their appearance. at an earlier stage, women can avoid the need for more dramatic, When people wait until later in life to care for their appearance, aggressive procedures in the future, maintain a more effective, they may end up playing catch-up with cosmetic surgical proce - rejuvenated look longer, and save both money and recovery time in dures, requiring such extensive changes that they look unnatural or the long term.” “overdone,” according to Robert T. Grant, MD, MSc, FACS, Plastic Patients may want to consider the following steps to maintain a Surgeon-in-Chief, NewYork-Presbyterian Hospital. Dr. Grant recom - youthful appearance: mends a more incremental approach, and specializes in helping In their 20's: patients maintain or enhance their natural appearance over the v Medical approaches including sun block, acne control, and course of their adult lives. topical creams and ointments that incorporate retinols and In the case of women, hormone changes associated with vitamin C; menopause significantly affect the skin, says Dr. Grant. “It is far v Minimally invasive skin procedures such as dermabrasion; better to begin age maintenance treatments before menopause v Laser hair reduction; occurs than after.” Because menopause significantly reduces the v Reduction of spider veins; elasticity of a woman’s skin, cosmetic procedures may not last as v Commitment to personal fitness and weight control. long as if they had been performed prior to menopause. More 'nipping and tucking' might be required than would be the case in In their 30's: the same procedure performed on a younger woman. In addition, v Minimally invasive and non-surgical procedures including fillers fullness of the tissues under the skin of the face declines as a and Botox in the face; woman's hormone levels decrease in perimenopause, and a v Surgical correction of abdomen, breast, or other tissues after cosmetic procedure’s tightening of the skin across a face with less pregnancy; youthful plumpness underneath the surface can sometimes lead to v Discreet surgical procedures for the eyes, face, and neck, which a look that is unnatural or extreme. can prolong the period of time that a woman looks her best as Dr. Grant consults with patients through all stages of adulthood menopause approaches; v Light-based facial treatments including laser resurfacing, intense o i z i pulsed light or plasma. r b a F a d a J In their 40’s, 50’s and beyond: Chronological age becomes less important than a woman's physiologic age, says Dr. Grant: “Some skin is old at 40, and other skin not until later.” As patients age, procedures such as face lifts or neck lifts may be recommended according to their corrective benefits, rather than for prevention. Daily maintenance, lifestyle, rest, and stress management are essential to looking one's best. In addition, patients may consider medical skin care, fillers, and “judicious use” of Botox to reduce wrinkles. "Plastic surgery is about quality of life, and about a woman's overall health and well-being,” says Dr. Grant. “I partner with each of my patients to identify and reach that balance of inner and outer Robert Grant, MD, encourages patients to take incremental steps at earlier stages so beauty that is uniquely theirs, and to maintain that balance through that they can avoid more aggressive procedures in the future. every life stage." n For more information visit: www.columbiasurgery.org 2 healthpoints • winter 2010 Pediatric Cancer: Bench to Bedside Laboratory research at Columbia yields new treatment options for some of the most difficult-to-treat tumors in children. Cancer treatments involve multiple be vacizumab (Avastin), the first agents, including the well-known options of anti-angiogenesis therapy approved by chemotherapy and radiation. Most recently, the FDA to treat cancer. Today drugs that target very specific parts of the bevacizumab is widely used, along cancer growth process have moved to the with chemotherapy, to treat forefront of researchers' attention. Of these, cancer in adults. Results of the a highly fruitful approach is one that blocks team's phase I trial in children angiogenesis, the growth of the bloo d were published in 2008. vessels, which in this case supply tumors. Bevacizumab by itself is not Since 1998, Jessica Kandel, MD, R. Peter a cure for cancer, but it can be Altman Professor of Surgery & Pediatrics (in used with chemotherapy to effec - the Institute for Cancer Genetics), and tively treat some cancers, and in Darrell Yamashiro, MD, PhD, Associate other cases to help extend patients' Professor of Pediatrics and Pathology & Cell lives. It may have milder side Biology, have pioneered this field of research effects than some chemother - at Columbia University. They began with apy, and is very well tolerated efforts to inhibit angiogenesis using one by children. It is gaining specific antibody. This antibody, which increasing use in a range of targeted a key protein involved in the devel - adult cancers, based on encour - opment of human tumor blood vessels, aging results so far in trials of adults vascular endothelial growth factor (VEGF), with colon, breast, lung, and other tumors. was synthesized by a biotechnology The effectiveness of bevacizumab varies company and was called A4.6.1. “We were depending on the type of tumor, according children include the following: particularly interested in treating refractory to Dr. Kandel, because the growth of blood v phase I trials (to determine safety and tumors for which there were no good thera - vessels is not the same in all tumors. “Differ - dosage) of sorafenib and VEGF-Trap; pies available,” says Dr. Kandel. Since that ent tumors are more or less susceptible to v A phase I trial of sunitinib in children; time, they have focused their research on being destabilized by bevacizumab than v A phase II trial (to determine efficacy) of finding new therapies for pediatric cancers others,” she explains.