Of the nearly 27,000 American women predicted to be diagnosed with ovarian cancer in 1996, only 20 percent are expected
to survive. But a treatment developed by Wesley Fowler, UNC-CH professor of obstetrics and gynecology, may offer some
hope.
Following surgery to remove ovarian cancer, patients typically undergo another operation, called a "second look," that
allows physicians to assess whether the cancer is still present. But half of the patients who show no evidence of cancer
during the second look die of their ovarian cancer.
In a pilot study, physicians treated women during the second look even when they found no evidence of cancer. They
placed a fluid containing P-32, a radioactive form of phosphorus, in the abdominal cavity. "We turn people right and left,
up and down, so that the fluid washes the inside of the abdomen," Fowler says. "Hopefully, the P-32 will kill any cancer
cells that have been left behind.
"Instead of having fifty percent survival with negative second looks, our survival rate was in the neighborhood of eighty-five
percent," Fowler says. And use of P-32 usually had no negative side effects. But, Fowler cautions, the pilot study was small and
of anecdotal, rather than statistical, significance. But it was sufficient to convince the American College of Obstetricians and
Gynecologist's Gynecologic Oncology Group to sponsor the larger, national study that's being conducted now.
Testing New Diabetes Treatments
For most of the sixteen million people in the United States who have diabetes, the disease is inadequately controlled, says
John Buse, associate professor of medicine and director of the University's Diabetes Care Center. Eleven cents out of every
U.S. health-care dollar is spent on hospital care for complications of diabetes. "Having better treatments could dramatically change the health-care system in this country," Buse says.
Buse and other Carolina researchers have been involved in clinical trials of several new compounds with promise for
treating diabetes. For example, pimagedine appears to block the binding of excess sugar to tissues, helping to prevent
complications such as kidney disease, blindness, nerve disease, and cardiovascular problems.
"There's been a rapid expansion in the technology that we have to treat high blood sugar," Buse says. With the new
generation of drugs, Buse estimates, physicians will be able to control diabetes in more than 95 percent of patients.
A Teacher for Life
Pregnancy should be at least twelve months," says Robert Cefalo, professor of obstetrics and gynecology. "A pre-conception
history should be taken three months before conception." Cefalo is co-author of
Pre-Conceptional Care, a book that helps medical
professionals identify and treat potential risks in parents-to-be before they conceive a child
.
The book contains a screening questionnaire that Cefalo describes as "a detailed history of both the man and the woman,
not in the usual model of a medical history, but going outside the medical
model." Besides screening for medical conditions, the inventory assesses social and family life; diet; work and hobbies; and use of prescription, over-the-counter, and
social drugs.
"Prevention is a way of teaching," Cefalo says. "You become a good doctor by being a caring, competent individual. But, most
importantly, what you're trying to do is teachyour patients, your colleagues, yourself. You've got to be a teacher for life."
Speaking Out on AIDS
In Carolina's infectious disease clinic, "I'd say we see more than 30 patients a day," says Charles van der Horst, associate
professor of medicine. More than 90 percent of those people have HIV, the virus that causes AIDS.
At any given time, van der Horst and Joseph Eron, assistant professor of
medicine, oversee about 30 clinical trials. Several new compounds decrease the amount of HIV in the blood and increase the number of CD4 immune cells.
"I'm more optimistic than I've ever been," van der Horst says.
Van der Horst juggles his time among research, caring for patients one day a week in clinic, and speaking out about AIDS.
He routinely testifies in AIDS discrimination cases. "One of the reasons I like being in the field of HIV," he says, "is that it
allows me to do all these different things. I can have wonderful relationships with my patients; I can do research; and I can
be an outspoken activist. "
Journals Aren't Enough
Professor of Surgery Harold Pillsbury sees about 100 patients a week. So when he does research, he studies a problem
that directly affects his patients. For example, he has found that children between the ages of one and three who have
fluid in their ears for six or more consecutive months are at greater risk for developing learning disabilities. Ear
infections, Pillsbury explains, may prevent children from learning how to single out and listen to a particular sound
in the midst of other noises, making it difficult for them to pay attention to a teacher in a classroom.
Pillsbury also speaks often at other universities or meetings of physician organizations. He says his travels allow him not
only to share the results of his research and practice, but to learn.
Relying on medical journals for information isn't enough, Pillsbury says. "By the time someone does research, writes an article,
submits it, and the journal accepts and publishes it, the findings are two or three years old," Pillsbury says. "If we're going to
make things better for our patients here, we've got to go out and learn what other people are doing."
Stimulating Growth
Louis Underwood, professor of pediatrics, recently started treating a boy with a rare growth disorder called Laron Syndrome.
"The boy was 12 years old, and he had the height of a two-and-a-half-year-old and weighed 25 pounds," Underwood says.
Although children with Laron Syndrome have growth hormone in their blood, the protein on cell surfaces that recognizes
growth hormone is either missing or malfunctioning. Underwood has succesfully stimulated growth in these patients by giving
them insulin-like growth factor 1 (IGF-1).
Normal cells, when stimulated by growth hormone, make IGF-1. "IGF-1 is what actually produces most of the growth,"
Underwood says. "We're bypassing the need for growth hormone by giving them IGF-1."
Underwood treated the first patient with IGF-1 in 1991. Until then, there was no treatment for patients with Laron
Syndrome and another type of growth hormone insensitivity syndrome. Today, Underwood is working to understand the
growth promoting actions of IGF-1 and how diet and other factors affect levels of IGF-1.
Aging Better
Most any conversation with Mark Williams, associate professor of
medicine, will come around to one subject--how to help
people live healthy, independent lives as they grow older. Williams, who directs the Program on Aging in the School of
Medicine, has treated older people in his clinical practice for more than 16 years and is author of
The American Geriatrics Society's Complete Guide to Aging and Health
, published in 1995. He's also spent years developing and refining the timed
manual performance test, a measure of hand function that can predict when an elderly person may soon be needing help
with daily tasks. To learn more about Williams' views on aging, please
see our story on aging well.
Seeing Young Lungs
Almost 20 years ago, Robert Wood, professor of pediatrics, was involved with the development of the flexible bronchoscope for use in children. This diagnostic tool is a thin, flexible tube which is passed through the nose, down the throat, and
into the lungs, allowing doctors to see and even videotape the inside of the lungs. Now Wood and his colleagues at UNC
Hospitals perform between 350 and 400 flexible bronchoscopies in children each year, about half of these in children less
than one year old.
Wood also teaches the technique each year in a four-day, post-graduate course at UNC-CH. "It's the only course I know of
that is offered to teach flexible bronchoscopy techniques in children," Wood says. "My best guess is that half to two-thirds
of the people around the world who do flexible bronchoscopy in children got their start from the course that we teach."
