Sound Medicine -- February 22, 2003

Hosts Barbara Lewis and Dr. Mike Koch talk to researchers about:

The C-reactive protein (CRP) test

Enhanced External Counterpulsation treatment for angina

Gamma knife treatment for epilepsy

CRP screening test

Last month the American Heart Association and the Centers for Disease Control issued recommendations for clinical use of the C-reactive protein, (CRP) test to assess heart disease risk. The new recommendations do not place the test in the same category as blood pressure or cholesterol screenings; instead they state the test should be used to further determine risk and appropriate treatment in individuals where some risk has already been identified. Joining us to put the matter into perspective is Dr. Mark Deeg, associate professor of medicine, biochemistry and molecular biology at the IU School of Medicine.

Dr. Deeg describes CRP as a marker found in the blood that indicates tissue inflammation. Everyone has it, and several studies have shown that increased concentrations of it are associated with increased risk for coronary heart disease, peripheral arterial disease, and sudden death.

He says that along with tests for cholesterol level, high blood pressure, and family history, CRP test helps identify people who need to be treated. When other risk factors go down, so do CRP levels. Although this test is a good predictor, Deeg says, it still cannot not tell physicians what therapies to use. For one thing, we are still missing data on populations other than Caucasians. Deeg discusses who should be screened for coronary disease, including those with pre-diabetic conditions.

Resources:

Read more about the AHA/CDC recommendations from the American Heart Association. Also from the AHA, find out how CRP predicts risks and get specifics on testing pre-diabetic women.

Read more about the the C-reactive protein and how the test works in the MEDLINEplus encyclopedia.

Enhanced External Counterpulsation (EECP) treatment for angina

A lesser-known treatment for patients with angina doesn't involve medication or surgery. Instead, patients lay on a table with three pairs of pneumatic cuffs strapped to their legs that pump in synchronized fashion with the heart, helping to increase blood flow and oxygen to the heart. Called enhanced external counterpulsation, or EECP, the treatment is gaining popularity. Our guest, Georgiann Linnemeier, MD, is medical director of the EECP patient registry based at the University of Pittsburgh.

Dr. Linnemeier details how this unusual treatment works, why it works, its history, and who benefits from it. The EECP is a series of 35 one-hour treatments over a period of 7 weeks. Surprisingly, it provides a sustained effect, and three out of four patients receive definite improvement of angina symptoms, dramatically improving their quality of life. Patients take less nitro glycerin, experience less chest discomfort and are more active. The treatment is approved by Medicare.

Dr. Linnemeier discusses how EECP can be used in conjunction with other treatments, including heart bypass. And she explains how the international registry gathers data to draw general conclusions about its effectiveness.

Resources:

Vasomedical Inc., the commercial developer of this therapy, provides excellent information on EECP -- including a slide show.

WebMD provides another overview.

The American College of Cardiology discusses a 1999 study of the technique.

Dr. Linnemeier is medical director of the International EECP Patient Registry.

Gamma knife treatment for epilepsy

A new tool used to reduce epileptic seizures is being studied in Indiana. Called the gamma knife, it's a machine that points radiation beams to the area in the brain where the seizures originate. The study began last summer in Indiana and at five other medical centers around the U.S. For an update on the study, Dianne Willis and Dr. David Crabb talk with Dr. Robert Worth, professor of neurosurgery at the IU School of Medicine and co-director of the the school's neurosurgery program.

Dr. Worth describes the machine, a system for focusing radiation in the brain. It is not a knife at all, but more similar in looks to a CT or MRI scanner. Patients wear a special, 300-lb helmet that lets in tiny, weak beams of radiation that meet in the precise spot in the brain where the seizures originate. Dr. Worth stresses the importance of identifying this site. Worth also compares the traditional, surgical treatment for epilepsy with the gamma knife technique, which is much less invasive. His study aims to verify that the technique is effective, the proper dose of radiation needed, and what the risks are. Earlier tests, he says, have shown positive results with few risks.

The form of epilepsy most amenable to gamma knife treatment is focal epilepsy, the most common form of the disease in adults.

Resources:

Dr. Worth discusses brain surgery at the IUSM Mini Medical School, Tuesday evening, February 25.

Read more about the study Dr. Worth refers to in the IUSM newsroom.

Find out more about the gamma knife device at the manufacturer's Web site.

Is there a medical topic you'd like us to cover? Reach us by email: soundmed@iu.edu
or by phone:
(317) 274-4848.

Lobotomy was first performed by a Swiss physician in 1892 and gained popularity in the United States after World War II. The procedure involves removal of the frontal lobe of the brain. What health condition provoked the use of lobotomy?

a. brain tumors
b. mental illness
c. Parkinson's disease

Find out!

Medical mystery — What causes baldness?

You've heard some theories no doubt: wearing hats causes baldness, for example. Or if you brush your hair a hundred times a day you won't go bald. Neither of these is true. Nor is it true that baldness genes come only from the maternal side of your family. What then, causes baldness?

Find out!

With humans losing the battle against obesity, new research involving skinny mice offers promising news.

Dr. C. Ronald Kahn of the Joslin Diabetes Center and a team of researchers from Harvard University studied genetically altered mice in which the insulin receptor in fat cells was knocked out. These mice ate as much as they wanted, and at times were stimulated to overeat, but never gained weight.

Insulin is needed to help fat cells store fat. But with the insulin receptors knocked out, the mice's fat cells couldn't respond to the insulin. The result was a 50 to 70 percent reduction in fat mass. The mice stayed lean and were protected from obesity that occurs with aging and overeating and also were protected against type 2 diabetes, a common result of obesity. In addition, the mice lived longer than the unaltered control mice, having a life span increase of 18%.

What does this mean for fat humans? Well, don't throw away those diet books. It's not known if the same outcome would occur in people. But the findings open the door for pharmaceutical researchers to create a drug that blocks insulin action in human fat cells.

Dr. Kahn was a guest on Sound Medicine in November 2002. Listen to his interview or read more about this latest research from the Harvard University Gazette.