Pioneers of Discovery
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By Melissa Hendricks
In 1987, Hopkins neurosurgeon Henry Brem surgically implanted a
quarter-size biodegradable polymer containing a chemotherapeutic
drug directly into the site of a patient's brain tumor. The
surgical implant, developed at Hopkins and approved by the FDA in
1996, is now the standard of treatment for brain tumors. Compared
to conventional chemotherapy, it results in fewer side effects
and achieves a significant improvement in patient survival.
Hopkins ophthalmologist Eugene de Juan recently innovated a new
procedure that is saving the vision of many who have the "wet"
form of age-related macular degeneration, the major cause of
blindness in people over 55. In these patients, blood vessels
underneath the retina grow and bleed. The surgery involves moving
the most light-sensitive region of the retina a few millimeters
away from the diseased area.
A radical approach to breast cancer
While surgeons before William Halsted had performed mastectomy,
their patients had a high rate of cancer recurrence. In the 1880s
and 1890s, Halsted devised a more extensive operation that
entailed removal of the breast and underlying muscles, and lymph
nodes under the arm. He eventually achieved an unprecedented 72
percent five-year cure rate for patients whose disease had not
spread to adjoining glands.
Relief for aching backs
In a paper published in 1929, Walter Dandy introduced the
practice of removing an intervertebral disk to alleviate lower
back pain, sciatica, and other symptoms caused by a ruptured
disk. Dandy performed the procedure on two patients whose
symptoms had been mistakenly attributed to a tumor of the spinal
Shaping success for expectant moms
A minority of women have an unusually shaped uterus, which
prevents them from carrying pregnancies to term. Gynecologist
Howard Jones devised a surgical procedure called metroplasty for
remedying this disorder, enabling many women to deliver healthy
Infection prevention in the O.R.
In early attempts to prevent infections in the operating room,
nurses dunked their hands in strong antiseptic solutions such as
mercuric chloride. This practice caused nurse Caroline Hampton in
1890 to develop a severe rash. So surgeon William Stewart Halsted
(who later married Hampton) asked the Goodyear Rubber Company to
make her a pair of thin rubber gloves. Medical latex (or vinyl)
gloves are now standard issue in the operating room.
A new route to the pituitary
During his years at Hopkins (1896-1912), Harvey Cushing developed
many operations on the brain and nearby organs including finding
the first surgical passage to tumors of the pituitary gland:
transphenoidally, or through the nasal passage. He also
discovered the pituitary's complex role in secreting hormones.
During his career, which lay the foundation for modern
neurosurgery, mortality from brain tumor surgery plummeted from
more than 90 percent to less than 10 percent.
Seeing the way toward tumor removal
Curing brain tumors was a radical notion when Hopkins surgeon
Walter Dandy first proposed the idea in 1921. But Dandy silenced
his many naysayers in 1925 when he successfully removed an entire
two- to three-inch tumor from the posterior fossa. Dandy's
success was due in part to his innovation called
ventriculography, which involved X-rays and injecting a gas into
the brain's cerebral ventricles for visualizing the tumor.
A "blue baby" breakthrough
"Blue babies" have a congenital defect that prevents their hearts
from pumping sufficient amounts of blood to their lungs. On
November 29, 1944, Hopkins surgeon Alfred Blalock saved the life
of a 15-month-old with the defect by creating an artificial
channel between the aorta and pulmonary artery. The procedure,
developed in conjunction with Hopkins pediatrician Helen Taussig
and surgical assistant Vivien Thomas, ushered in a new era for
heart surgery, once deemed risky and unfeasible.
The first living heart donor
The first living heart donor In 1987, Clinton House became the
first living heart donor in the United States. House, whose lungs
had been damaged by cystic fibrosis, received the heart and lungs
of a man who had died in a car accident. (The heart-and-lung unit
offered a better prognosis than the lungs alone.) Then, House's
heart was transplanted into John Couch, a patient with congestive
heart failure. Hopkins cardiac surgeons Bruce Reitz and William
Baumgartner performed the procedures.
Kidney donation, less invasively
In 1995, Hopkins urologist Louis Kavoussi and transplant surgeon
Lloyd Ratner performed the first laparoscopic live-donor kidney
transplant. Using sharp-edged hollow cylinders, the team removed
a kidney from Baltimore resident Larry Butts through an incision
a few inches wide. They then used conventional surgical procedure
to transplant the kidney into Butts's wife, Chestina, whose own
kidneys had been ravaged by diabetes. Laparoscopy reduces
hospital and recuperation time. Since it was introduced at
Hopkins, live donor kidney donations have tripled.
Sparing nerves in a prostatectomy
Prostate cancer affects more than 330,000 men in the U.S.
annually. But at one time, surgical removal of the prostate for
cancer involved cutting the nerves that control erection; the
vast majority of men who underwent this procedure were left
impotent, and many were incontinent. Hopkins urologist-in-chief
Patrick Walsh developed a nerve-sparing method of prostate
removal. The procedure, which he has refined over the past 20
years, dramatically reduces the risk of postsurgical impotence
APRIL 2000 TABLE OF CONTENTS.