23. How to Treat: Uterine Fibroids
Fibroid embolization with “MRA” fusion at Paoli Hospital
Amy Howse always knew she wanted a family. But after an unsuccessful pregnancy left her with an arteriovenous malformation—a dense tangle of veins and blood vessels in her uterus—doctors weren’t sure she’d ever be able to. They were afraid she would bleed out and die during childbirth.
A respiratory therapist at Paoli Hospital, Howse had heard of an interventional radiologist on staff, Atul Gupta, who was using innovative techniques that enabled women with uterine issues to have babies. Most of his cases involve uterine fibroids, benign growths that can cause heavy bleeding, anemia, abdominal pain and digestive issues. Doctors typically treat the condition with hysterectomy.
Gupta uses a technique called fibroid embolization with “MRA” fusion that spares the reproductive organs. The 45-minute procedure involves inserting a catheter into the thigh, guiding it to the uterus, and injecting tiny particles of plastic microspheres to cut off the blood supply; over time, the fibroid dies and reabsorbs into the body. Gupta’s technique uses 3-D imagery rather than standard X-rays to map the growth, to cut down on radiation exposure to sensitive ovaries.
“Because Amy’s tangle was so dense, finding the right area to embolize would have been very, very challenging without the 3-D picture,” says Gupta. The trick was cutting off enough of the blood supply so that Howse wouldn’t hemorrhage during childbirth, but not so much that she wouldn’t be able to sustain life.
After the procedure, Howse checked in with a specialist and got the green light to try to become pregnant. The following April, her first daughter, Brianna, was born; last October, she gave birth to her second, Ashlyn. “It was really upsetting at first because I didn’t know if I would get my own children out of it. Now look what I’ve got,” says Howse. Next on her wish list: a son.
Philadelphia hospital behind this medical breakthrough: Paoli Hospital
24. How to Improve: Vascular Catheterization
Arterial catheterization at Deborah Heart & Lung Institute
If you’ve ever had a tube inserted in your groin and threaded all the way up through your femoral artery to your heart to get a stent put in place, then had to lie still for hours afterward to prevent blood loss, chances are you’ve wondered: Isn’t there a better way? Sure enough, there is. Interventional cardiologist Kintur Sangvhi now performs all his vascular catheterizations—more than 900 last year—through a catheter in the wrist. “Patients can walk out after an hour,” he reports. “There’s less bleeding, less pain, less need for blood transfusions, so it saves costs.” And it improves survival: “A lot of what we do doesn’t affect life expectancy. This does.”
Philadelphia hospital behind this medical breakthrough: Deborah Heart & Lung Institute
25. How to Treat: Liver Cancer
TheraSphere at Aria Health Torresdale Campus
Liver cancer is traditionally treated with chemotherapy. But when regular chemo doesn’t cut it, interventional radiologist Aaron Shiloh goes radioactive, using a catheter to guide miniature glass “seeds” impregnated with Yttrium-90 into the hepatic arteries that supply such tumors. The radioactive Y-90 decays, emitting beta particles that kill the cancer cells but leave normal cells unharmed. “We’re delivering radiation from the inside out,” Shiloh says. “There are very few options and very little hope for liver cancer. Now we can say: Here’s something we can offer you.”
Philadelphia hospital behind this medical breakthrough: Aria Health Torresdale Campus
26. How to Improve: Hip Replacement
The Hana surgical table at Abington Hospital
An anterior, or frontal, approach has advantages when surgeons are replacing hips, but it’s hard for them to get a clear line of sight to set the prosthesis. Enter the Hana surgical table: Movable graphite spars let doctors maneuver the patient into place and take x-rays as they work. “We don’t need to cut muscles,” says orthopedic surgeon Andrew Star, “and a minimum of ligaments and tendons get cut.” The result: fewer complications, faster discharge times, and almost no post-op restrictions on driving or crossing one’s legs. “We teach a lot of other doctors to do this,” Star says.
Philadelphia hospital behind this medical breakthrough: Abington Hospital
27. How to Treat: Lung Cancer
A “sniff test” at Fox Chase Cancer Center
Maybe you’ve heard about dogs who can sniff out cancer? Scientists have figured out how to mimic the amazing feat. Researchers here are conducting the first-ever pilot of a “sniff test” for lung cancer. Subjects breathe into a bag whose contents are then exposed to gold nanoparticles that react to certain volatile organic compounds. Lung cancer creates a signature “read.” Pulmonologist Michael Unger, who’s leading the study, says the technique can also distinguish patients with colon and breast cancer: “It’s an early, minimally invasive test that we need to validate.”
Philadelphia hospital behind this medical breakthrough: Fox Chase Cancer Center
28. How to Treat: Scoliosis
Anterior vertebral body tethering at Shriners Hospital for Children
Up to now, kids with severe curvature of the spine have had daunting treatment choices: Surgical fusion halts growth; growing rods require repeat operations; external braces bring social stigma. Because scoliosis has a strong genetic component, parents who themselves underwent such treatments face the wrenching prospect of signing off on them for their children. Neurosurgeon Amer Samdani offers another option: minimally invasive surgery that screws a flexible tether to the vertebrae, then tensions the tether to even out the unequal growth causing the spine to curve. He’s performed 15 by now—more than anyone else in the country—and has been “very lucky”: “The children are doing remarkably well.”