15. How to Improve: Bone-Marrow Transplant Matches
A new procedure at Jefferson Hospital’s Kimmel Cancer Center
In typical bone-marrow transplants, donor and recipient have to match up for human leukocyte antigens, or HLA, which we inherit from our parents. Fewer than half of whites and only 10 percent of minorities find closely matched donors among siblings or registry volunteers, says Neil Flomenberg, an oncologist at Jefferson Hospital’s Kimmel Cancer Center. So researchers began experimenting with half-matches—donors with only one matching set of HLA. This worked for mice, but proved problematic in humans: “They became like HIV patients, with their immune systems devastated,” Flomenberg says.
So he began tinkering with a two-step process. First, he’d collect marrow from the donor, then separate out and transplant just the immune cells. He’d administer chemo, wait for the drug to clear, and then collect and administer the donor’s “baby cells”—cells that can grow into new marrow—to spare them the effects of the chemo drug. Not only did this reduce donor/host rejection; surprisingly, the mismatched donor cells appear to have more ability to fight off cancer recurrences. “It’s exceeded my wildest expectations,” Flomenberg says.
It worked for Anderson Love, 56. “I have 16 children. I figured one would be a match,” he laughs. But the ones who were tested were all half-matches. His eldest daughter Keona wound up as his donor, in February. “She came through it just fine,” he says. “I feel fine, too. I can’t wait for my hair to grow back.” Now he’s cancer-free, with a lot more time to enjoy those 16 kids—and his 27 grandkids.
Philadelphia hospital behind this medical breakthrough: Jefferson Hospital’s Kimmel Cancer Center
16. How to Improve: Laparoscopic Surgery
Single-port access at Fox Chase Cancer Center
Surgeons Paul Curcillo and Stephanie King were performing a laparoscopic procedure that normally requires five “ports,” or incisions, when they figured out how to do it with just four. Which got them thinking—why not three ports? Or two? Today, they’re down to one, and are teaching their technique to other surgeons around the world, for gall bladder operations, bariatrics, hysterectomies—“Everything!” King says. The Philly natives are thrilled to see their hometown out ahead of the curve—and patients get a psychological boost, Curcillo reports, from waking up from surgery with “just a small Band-aid on their belly button and nothing else.”
Philadelphia hospital behind this medical breakthrough: Fox Chase Cancer Center
17. How to Treat: Mesothelioma
Photodynamic therapy at Penn Presbyterian Medical Center
Thoracic surgeon Joseph Friedberg says this incurable cancer caused by exposure to asbestos offers “a lot of opportunity—it can’t get any worse, right?” That attitude helped him develop a photodynamic therapy that’s turning the deadly cancer into a manageable disease. Patients are given a drug that sensitizes their cells to light. Friedberg excises the visible cancer from around the lung, then zaps the chest cavity with a laser that penetrates into tissue and activates the drug. The blood vessels feeding any remaining cancer are fragile and more sensitive to light than normal cells, so they get zapped. And, unexpectedly, the photodynamic therapy triggers the patient’s immune system to fight off more cancer. “Survival is usually only a few months after diagnosis,” Friedberg says, “but we’re seeing up to three and four years.”
Philadelphia hospital behind this medical breakthrough: Photodynamic therapy at Penn Presbyterian Medical Center
18. How to Treat: Autism
Magnetoencephalography at Children’s Hospital of Philadelphia
Researchers at CHOP are using a high-tech machine to measure the brain activity and auditory processes of autistic kids. To date, radiologist Timothy Roberts and his team have mapped about 300 brains, and have learned that autistic kids respond to sounds 10 to 20 milliseconds later than typical kids. Those split-second delays accrue over the course of a conversation, creating a traffic jam of information and making it difficult to make sense of words and sentences. “If you have to work extra hard to understand a conversation, you’ll probably give up trying to follow along,” says Roberts, adding that the auditory delay could help explain a host of behavioral problems seen in autistic kids—anxiety, depression, irritability. He hopes his work will lead to earlier diagnoses, and therapies that are tailored to particular needs: “It’s personalized medicine at its best.”
Philadelphia hospital behind this medical breakthrough: Children’s Hospital of Philadelphia
19. How to Treat: Fractures From Osteoporosis
Balloon kyphoplasty at Delaware County Memorial Hospital
As we age, more and more of us are going to suffer the awful pain of vertebral fractures that cause that telltale elderly hunch; currently, there are as many as a million such fragility fractures in the U.S. each year. Surgeon Richard Levenberg uses fluoroscopy to insert a balloon into the spine, expands the balloon to reshape the space, and injects a quick-hardening cement that fills it. “I’ve had people say they’d rather die than live with the pain,” says Levenberg. “With this, they wake up pain-free. It’s the best, most successful thing I’ve ever done.”
Philadelphia hospital behind this medical breakthrough: Delaware County Memorial Hospital
20. How to Treat: Coronary Disease
Catheter ablation at Albert Einstein Medical Center
When Army Sergeant Leonard Wilson experienced shortness of breath and fatigue during a workout, he thought he was out of shape. Instead, he learned he had a heart condition called atrial fibrillation, in which the heart beats too fast and out of rhythm. Doctors tried using a defibrillator to shock his heart back in sync, but the effects only lasted a few weeks. So two years ago, Wilson, then 41, began researching other solutions. He found Sumeet Mainigi, a cardiac electrophysiologist at Albert Einstein Medical Center who’s focused much of his practice on understanding—and correcting—irregular heartbeats.
Mainigi had long suspected arrhythmias could signal more serious conditions, like heart failure, lurking below the surface. So in 2009, he spearheaded a study to see if aggressive treatment of arrhythmias through a procedure called catheter ablation—in which electrical wires are fed to the heart through veins in the legs, then used to destroy the cells causing the arrhythmia—could forestall heart failure. Two-thirds of his patients experienced substantial improvement in heart function; 20 percent were cured. “This is a problem that can be treated and cured through a minimally invasive procedure that leaves an incision the size of a pencil point,” says Mainigi. “It’s a very exciting advancement for us.”
Wilson was one of the successes. After he underwent the procedure, his condition completely reversed, and his heart has been beating normally ever since. He’s able to run, bike and work out at the gym just like he used to. “I took a PT test this week and got a 270 out of 300,” he says. “That’s pretty good for an old guy like me.”
Philadelphia hospital behind this medical breakthrough: Albert Einstein Medical Center
21. How to Improve: Doctor/Patient Communication
The drawMD app at Fox Chase
Like most doctors, surgeon Alexander Kutikov used to jot sketches on the exam-table paper and rip them off for patients to take home. But the quest for better doctor/patient communication led him to develop drawMD (drawMD.com), a new app that lets doctors sit shoulder-to-shoulder with patients and show, on an iPad, exactly what they’ll be doing where, with full-color anatomical backgrounds and a palette of “stamps” (catheters, needles, tubes, etc.) and drawing tools like arrows to customize the display. Doctors can even print images or send them home via email. “It makes us more efficient, and it also engages the patient,” Kutikov says. “A picture’s worth a thousand words, right?”
Philadelphia hospital behind this medical breakthrough: Fox Chase Cancer Center
22. Childhood Blindness
Gene therapy at Penn Medicine
Children with Leber congenital amaurosis are born legally blind, afflicted with a gene mutation that blocks the production of Vitamin A required by light receptors in the retina. Penn Medicine scientist Jean Bennett and ophthalmologist Albert Maguire, with CHOP’s Katherine High, led a clinical trial that inserted a non-mutated version of the gene into 12 patients’ retinal cells. Kids noticed a difference in about two weeks, and improvement continues: “One little boy we injected three months ago was just in,” Bennett says. “He told me, ‘Now I can see if people are smiling or frowning.’” The kids are attending normal classes, taking part in sports, even riding bikes. Bennett hopes to apply the technique to other forms of congenital blindness.