Johns Hopkins Magazine -- April 2000
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APRIL 2000


A sampling of surgeries and surgical innovations pioneered at Johns Hopkins.
APRIL 2000
Pioneers of Discovery

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First Cuts
By Melissa Hendricks

Implantable chemotherapy
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.

Preserving sight
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 column.

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 babies.

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 and incontinence.