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Anchor lead: Can a new method of assessing cysts in the pancreas help identify cancer? Elizabeth Tracey reports
Cancer of the pancreas is deadly, with limited ways to catch the disease early. Now a new test integrating a number of characteristics of cysts found in the pancreas may help predict which ones may be cancerous. Anne Marie Lennon, a pancreas cancer expert at Johns Hopkins and one of the test’s developers, explains.
Lennon: What we’ve set about doing is developing a comprehensive pancreatic cyst test, which we call CompCyst for short. We used alterations in DNA and combined it with protein markers and clinical features to develop a combination test to identify these three groups of patients: those who had cysts that are noncancerous which need no follow up, those who have precancerous, mucin producing cysts who benefit from surveillance, and those who have cancerous cysts who benefit from surgical resection. :32
Lennon says many cysts are found in the pancreas when people have imaging for other reasons, and determining whether they are potentially dangerous is important. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Nurses may take the lead when it comes to palliative care and end of life issues, Elizabeth Tracey reports
Do you have advance directives in place if you are critically ill and unable to communicate your wishes? How about a health care proxy who knows what you want? Most Americans want to die at home but often don’t, recent data show, yet when nurses get involved in the discussion such goals may be met more frequently. Patricia Davidson, dean of the Johns Hopkins School of Nursing, isn’t surprised.
Davidson: Nursing is a discipline that’s about the whole person. It’s not about a organ, and it’s not about a biomedical approach. Certainly the nurses, and physicians, and social workers, and chaplains, anybody who works in palliative care, is truly committed to that approach. Sometimes the length of time spent with the patient, the length of time of engagement in the clinical encounter, directly relates to the amount of meaningful information you get. :30
Davidson says a team approach to care renders all valuable members united in their goal to provide the best care for patients. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Pancreatic cancer is moving up in causes of cancer deaths, Elizabeth Tracey reports
The rankings are shifting when it comes to leading causes of cancer death, the American Cancer Society reported, with pancreatic cancer moving up. Ann Marie Lennon, a pancreas cancer expert at Johns Hopkins, says the uptick is due to better screening and treatment of other types of cancer, such as colorectal cancer.
Lennon: Pancreatic cancer was the fourth leading cause of death due to cancer in the United States. In the last year or two its actually become the third commonest cause, and within the next ten years its predicted to become the second commonest cause of cancer death in the United States. One of the things this shows is how successful surveillance can be, which is really nice to see, for example for colorectal cancer. And what it highlights is what we really need is some way to screen for pancreatic cancer in an effective way. :29
Lennon and colleagues have recently developed a test called CompCyst to help identify cancerous lesions in the pancreas, with an eye toward earlier diagnosis. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Treatment of blockages in the arteries of the neck may start with medication, Elizabeth Tracey reports
You’ve just been told you have a blockage in your carotid artery going to your head, and you’re at increased risk for stroke. Chris Abularrage, a vascular surgeon at Johns Hopkins, says surgery may be needed but treatment should most often start first with medications.
Abularrage: As soon as you identify carotid stenosis, the first thing you want to do is get medical management on board. So you start them on antiplatelet therapy and statin therapy as statin therapy stabilizes plaque. That effect is completely separate from its cholesterol lowering effects. I tell my patients I don’t really care what your cholesterol is I just want to make sure that you’re on a statin and some sort of antiplatelet before we really consider doing anything else. Whether they just have mild carotid stenosis or severe carotid stenosis and they’re going to need some sort of surgery. :27
Surgery may involve removing plaque from the artery directly or placing a stent, a type of scaffold to hold the vessel open, with the newest approach making an incision directly in the neck to do so. Abularrage says your surgeon can help you determine which is best for you. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: When ultrasound is done on your neck, what exactly are they looking for? Elizabeth Tracey reports
Ultrasound is the modality of choice when it comes to evaluating potential blockages of the carotid arteries, those that travel through the neck and into the head. Such blockages increase the risk of stroke. Caitlin Hicks, a vascular surgeon at Johns Hopkins, describes what the test is about.
Hicks: The test basically looks at both of the patient’s carotid arteries to see if the flow through the carotid artery, from the base of the neck all the way up to the skull of the head, is normal, looks for narrowings in the internal carotid specifically and it compares the rate of blood flow in the internal carotid artery compared to the common carotid artery, which is at the base of the neck. We usually look for a ratio of 4 between those before we offer treatment for someone who has no symptoms. If a patient comes to us reporting symptoms, which can include a stroke, transient ischemic attack or vision changes, we may offer it sooner. :30
Hicks notes that there are three potential procedures to manage blockages, and says a personalized approach helps determine which is best for an individual. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: A sound heard through a stethoscope on the neck may indicate a blood vessel problem, Elizabeth Tracey reports
If you’ve had a recent physical exam your clinician may have used a stethoscope to listen to your neck. That’s because a sound called a ‘bruit’ may indicate blockage there, putting you at very high risk for a stroke. Bruce Perler, a vascular surgeon at Johns Hopkins, says further evaluation is needed if a bruit is heard.
Perler: Carotid bruit is really the only physical sign that there may be carotid disease but it’s a pretty insensitive and nonspecific physical finding. Many patients have bruits for a number of reasons. It may be a transmitted heart murmur or it may be from a vessel other than the internal carotid artery and conversely there are patients with severe carotid blockages who don’t have bruits. So while we look for bruits and its certainly an indication for getting a carotid ultrasound, if you just rely on a bruit you may miss patients who have significant carotid disease. :29
Perler says it is critical to have an ultrasound at an accredited center that regularly performs such studies as he sees many results that must be repeated. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: High fat diets may help cognition but what about other health issues? Elizabeth Tracey reports
High fat low carb diets work by changing the body’s energy source to fat, and producing something called ketones in the process. A recent Johns Hopkins study showed such a diet improved cognition in people who were mildly cognitively impaired. Jason Brandt, the study’s lead investigator, says the diet did not compromise heart health, as some thought it might.
Brandt: We saw that people who were in the modified Atkins group did not show an elevation of their triglycerides, low density lipoproteins and other markers of cardiovascular risk, so eating a high fat diet can be good for you if keep your carbohydrates low. The ultimate question is if you do this lifelong, if you start in middle age, if you start on a ketogenic diet, or a low carb, high fat diet, over the long term will you reduce your risk? :30
Brandt says no long term studies have been done to assess the impact of such a diet over a lifetime. At Johns Hopkins, I’m Elizabeth Tracey.
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