P&S Annual Report
Clinical Advances

Devices, Therapeutics, Procedures

Advances in medical treatment seem to happen slowly because of the thorough process by which ideas or preliminary lab successes are tested before physicians throughout the world can offer new therapies to patients. Clinical research is the means by which the practice of medicine is advanced. Through new procedures, devices, therapeutics, or diagnostics, health care advances with caution and ethical oversight, moving from ideas to animal models, and, ultimately, to humans. 

At P&S this past year, health care was advanced notably in the areas of cardiology, psychiatry, pediatrics, and cancer. Many clinical advances came in areas that cannot be easily categorized and are contained in the following pages under the general heading of Improvements in Diagnosis and Treatment. 

Many clinical advances result from interdisciplinary inquiry and research and are best applied in centers that consolidate the expertise of clinicians from several disciplines. Among such centers at P&S are the Kreitchman PET Center, the new Thyroid Center, the new Peripheral Neuropathy Comprehensive Care Center at Columbia-Presbyterian/Eastside, the Eleanor and Lou Gehrig MDA/ALS Research Center, the Comprehensive Epilepsy Center, and the Huntington's Disease Center. 

Another new center, the Center for Intestinal Dysfunction, offers patients with irritable bowel syndrome a compassionate place to be evaluated and receive treatment. 

P&S has a proud tradition in clinical advances: from development of the oxygen tent in the 1920s to development of the APGAR score in the 1950s to development of the first vaccine for Rh disease in newborns in the 1960s to the first successful pediatric heart transplant in the 1980s to the development of a new blood test that identifies prostate cancer cells in the 1990s. The examples on the following pages illustrate how this strong clinical tradition continues. 

Programs in academic medicine are rarely solitary endeavors. The names listed with these summaries represent, in most cases, leaders of the projects. Use these names when contacting the editors with queries about specific projects. 

Relief for Emphysema Sufferers 

The ability to breathe is often taken for granted. For the estimated 1.93 million Americans afflicted with emphysema, however, the simple function of breathing becomes increasingly difficult until each breath is a laborious chore. In extreme cases, emphysema sufferers will do anything to breathe easier--even undergo surgery. 

Patients with the most advanced cases of emphysema are usually left with little hope of recovery, let alone the capability to carry out everyday activities without frequent breaks to catch their breath or inhale supplemental oxygen. For patients who face continued discomfort and possibly premature death, surgery first introduced in the 1950s and improved in the 1990s may be the answer. 

Dr. Mark Ginsburg has made adjustments to the procedure known as lung reduction surgery, in which 20 percent to 40 percent of the patient's lung volume is excised to improve ventilation. By reducing the volume of hyperinflated lung and removing portions with poor circulation, patients experience increased exercise tolerance and decreased dyspnea, and many are able to discontinue use of oxygen. 

Although the surgery does not cure emphysema, it may prolong life and become an alternative to lung transplantation or a bridge to transplantation. 

So far, Dr. Ginsburg has used his updated surgical technique in about 100 lung reduction surgeries. The updated technique has a much lower mortality rate than the original 1950s procedure. "The surgery is difficult, but we are now better able to predict which patients will have the most success." 

At this time, CPMC is the major center for the surgery in New York City. The program will continue to study outcomes to track success and learn from individual cases. In addition, NIH is conducting a randomized trial in which lung reduction surgery is compared to standard treatments. 

Changing Seasons Got You Down? Turn on a Light. 

For about 36 million people in the United States, winter brings seasonal affective disorder (SAD), which ranges from clinical depression to less severe winter doldrums. An electronic dawn/dusk simulator developed at P&S and the New York State Psychiatric Institute mimics the dawn's early light of spring or summer to treat the depression that sometimes accompanies shorter daylight hours that start in the fall. 

The system, developed by Dr. Michael Terman and colleagues, imitates the lighting patterns of spring and summer, which make people feel more upbeat and energetic. The patented invention consists of a computer program that drives a light simulation device, a light diffuser, trademarked under the name Pillow Light, that bathes a sleeping area in a naturalistic dawn and dusk of summer and spring even during the pitch black of night. The program calculates the changing pattern of outdoor light for any latitude, longitude, and day of the year. The dawn/dusk simulator functions like an automated light dimmer and reproduces the gradually increasing light intensity of daybreak and the decreasing light of dusk. 

About 100 patients have been evaluated in dawn simulation studies at CPMC and at Harborview Medical Center in Seattle. Treatment success for depression has been similar to that obtained using post-awakening artificial light therapy (for which Dr. Terman holds another patent), but the dawn/dusk simulator works while the patient is asleep, penetrating the eyes when they are closed, so patients do not need to set aside time for daytime treatment sessions. Within a few days, the person adapts and, in most cases, patients who relied on antidepressant drugs no longer need them. 

Based on success of the device, the researchers are exploring expanded uses, including development of a simplified, portable home consumer model that uses Pillow Light and is driven by a chip in a small control box rather than by a computer. The investigators are also examining the possible uses of dawn/dusk simulation for people who are not clinically depressed but who could benefit from simulated light patterns, such as people who oversleep, patients with chronic fatigue syndrome, demented elderly patients with disrupted sleep, night shift workers, and people who suffer jet lag. 

LVAD: A Bridge Becomes a Permanent Alternative 

Doctors at P&S implanted the first permanent left ventricular assist device (LVAD) in the United States in a clinical trial designed by Dr. Eric Rose. The trial tests LVADs as a cardiac replacement therapy for patients with severe congestive heart failure. LVADs previously were used only temporarily by patients awaiting heart transplants. The device assists in pumping oxygenated blood from the heart's left ventricle--the heart's major pump--to the aorta, where it travels to the rest of the body. The 1.5 pound titanium mechanism is basically an electric pump with an electronic controller and a power supply. The LVAD is implanted in the abdominal cavity and attached to the heart at two points. The device can run six to eight hours on a pair of rechargeable batteries that are connected to the pump by a pair of wires passing through a small hole in the abdomen. P&S will coordinate clinical trials that will implant these devices in 130 to 150 people who, because of their age or other ailments, are poor candidates for a heart transplant. The Cleveland Clinic Foundation and Texas Heart Institute are other clinical trial sites. LVADs have been used as an alternative to heart transplant in Britain, Germany, and Sweden. The device was approved by the FDA last year for use as long-term therapy. This milestone is only the latest in an impressive cardiology record P&S has built, beginning in the 1920s when doctors developed the first practical oxygen tent to treat patients with severe heart and lung disease. In the 1940s, cardiac catheterization was developed, winning P&S researchers Dickinson W. Richards and Andre F. Cournand the Nobel Prize in 1956. In the 1980s, P&S surgeons performed the first successful pediatric heart transplant in the United States. Today, Columbia-Presbyterian has the nation's most active heart transplant program. 

More From the Heart

 Dr. Myron Weisfeldt, chairman of medicine and a renowned cardiologist, is leading a national campaign to prevent 100,000 deaths a year from cardiac arrest through public access to portable defibrillators. The American Heart Association-endorsed public access defibrillation campaign would put defibrillators in the hands of people most likely to respond to emergencies--police officers, rescue unit personnel, employee health service staff, security guards. Schools, retirement communities, and sporting arenas might be venues for portable defibrillators, better life savers than CPR, which must be followed immediately by defibrillation. Several companies are working on prototypes of a defibrillator that could be used even by untrained bystanders. The ultimate goal is to have a defibrillator connected to an emergency telephone line, which would automatically alert authorities to the location of the emergency where the defibillator is in use. 

Clinical trials have shown that beta-blockers are effective and well-tolerated in patients with mild to moderate heart failure, and more recent research has shown significant improvement in cardiac function and clinical outcome in patients with advanced forms of heart failure who were treated with the beta-blocker carvedilol. In addition to an improvement in cardiac function, patients treated with carvedilol benefited from improved symptom scores and exercise tolerance. The combined risk of death, worsening heart failure, and life-threatening ventricular tachyrarrhythmia was lower in the carvedilol group than in the placebo group. Researcher: Milton Packer 

Current treatment options for primary pulmonary hypertension--vasodilators, anticoagulants, or transplantation--have not been shown to improve survival in a prospective, randomized study of patients with this rare but progressive disease. New hope comes in the form of a continuous intravenous infusion with prostacyclin (epoprostenol). Researchers at P&S and 13 other sites investigated the effects of 12 weeks of continuous infusion of epoprostenol combined with conventional therapy on 41 patients with severe primary pulmonary hypertension compared with 40 patients on conventional therapy alone. Patients on epoprostenol plus conventional therapy showed an improvement in exercise capacity, quality of life, and clinical and hemodynamic measures. In addition, the epoprostenol significantly improved survival compared with conventional therapy alone. Researcher: Robyn J. Barst 

In many ways, the modern era of cardiovascular surgery began when Arthur B. Voorhees, former chief of vascular surgery at CPMC, developed the first clinically successful artificial blood vessel. Today, the Vascular Surgery Service achieves clinical results unsurpassed by any other service in the country and has an ever-increasing clinical volume. The service boasts the country's most experienced and accomplished interventional radiology teams. Dedicated to the ongoing campaign by cardiovascular physicians and surgeons to reduce disability and death from vascular diseases, the service reached a new high in clinical volume in 1995 with 1,925 operative procedures. The increases were most evident in aortic aneurysm surgery (34 percent increase) and carotid endarterectomy (40 percent increase). Although national studies, which included P&S researchers, have defined acceptable operative stroke/mortality complication rates of 3 percent for asymptomatic carotid stenosis and 5 percent for symptomatic carotid stenosis, no strokes developed in 120 consecutive carotid endarterectomy operations performed in 1995 in the Vascular Surgery Service. In aortic aneurysm surgery, the service has a 99 percent success rate for the surgical repair of infrarenal aortic aneurysms over the past five years. The service's retroperitoneal approach to treat inflammatory aortic aneurysm, which has a high operative mortality rate, was responsible, in part, for the 100 percent success rate achieved with these aneurysms. 

Turning Mental Illness into Mental Health 

* Successor to ECT-The use of magnetic pulses to stimulate the brain holds promise as a successor to electroconvulsive therapy, now considered the most effective treatment for depression. P&S and Psychiatric Institute researchers are at the forefront of investigation into this therapy, known as transcranial magnetic stimulation (TMS). ECT is considered more effective than antidepressant medications but, because of its many drawbacks--such as getting the electric current past the skull, an excellent insulator--ECT is used mainly for severe cases of depression that do not respond to other treatment. TMS, however, may overcome some of the drawbacks of ECT while still retaining its effectiveness. TMS can deliver a controlled, precise dose, unlike ECT, which can result in an overdose. Researcher: Harold A. Sackeim 

* Eating disorders-The Eating Disorders Clinic, part of clinical psychopharmacology at the Psychiatric Institute, is a nationally recognized outpatient treatment/research program and an inpatient facility staffed by psychiatrists, psychologists, social workers, nurses, and research personnel, all with training and experience in the treatment of eating disorders. The clinic studies bulimia nervosa, anorexia nervosa, and binge eating disorder to find more effective treatments. Researchers: Kathleen Pike, Michael Devlin, B. Timothy Walsh, Evelyn Attia 

* Children's Mental Health-The Child Research Center at the Psychiatric Institute serves children and adolescents who are medically healthy but suffer from depression, anxiety, or suicidal feelings. A new center, the Ruane Center for the Early Identification and Treatment of Mood Disorders, was established in the Child and Adolescent Psychiatry Division. 

* Schizophrenia-The Psychiatric Institute's Schizophrenia Research Unit provides extensive and state-of-the-art inpatient evaluation and clinical treatment for patients suffering from schizophrenia and schizoaffective disorders. 

* Late Life Depression-This clinic offers free treatment for depression to individuals age 60 or older who meet research criteria. Three types of treatment protocols are available, including one specifically geared toward patients with cardiac disease and depression. 

* Smoking Cessation-A Psychiatric Institute program uses individual behavior counseling and medication therapy and studies nicotine dependence to find effective ways to help smokers quit and not relapse. 

* Psychoanalysis-The Center for Psychoanalytic Training and Research offers consultation and psychoanalytic treatment to the general public of the greater metropolitan area. When psychoanalysis is not appropriate, referral to other forms of treatment is arranged. Robert A. Glick 

Cancer: Integrated Treatment 

Cancer treatment at CPMC is best described in the words of Dr. Karen Antman, who was appointed director of the Herbert Irving Comprehensive Cancer Center this year: "We treat the whole patient. Our cancer center is an integrated part of a major medical center. We have the best consultative services." 

These clinical advances in cancer treatment marked the 1995-96 year: 

* Funding from the National Cancer Institute enabled CPMC to join a national consortium of hospitals participating in research focused on improving treatment of malignant brain tumors. Researcher: Michael Fetell 

* Eight patients participated in a novel gene therapy program to treat breast cancer and other cancers. Persistence of the transgene has been demonstrated. Researchers: Karen Antman, Arthur Bank, Charles Hesdorffer 

* Large-scale clinical studies are under way to test a new method of detecting PSA-positive prostate cancer cells in the blood of patients with prostate cancer. The method, developed in the urologic malignancies program of the cancer center, is a highly sensitive method based on nucelic acid amplification. Researchers: Aaron Katz, Ralph Buttyan, Robert Ennis 

* Cancer center researchers are leading a multi-institutional study to identify causes of the high incidence of breast cancer on Long Island. Researchers are looking at air pollution, exposure to pesticides, electromagnetic radiation, and dietary factors. Serum and tissue samples will be collected, studied, and analyzed using the cancer center's Biomarkers Shared Core Facility. After the Long Island study is completed, data collected will continue to be used to test future hypotheses about breast cancer causation and prevention. Researcher: Marilie Gammon 

* The Department of Radiation Oncology became affiliated with the Nassau Radiation Oncology Center of Garden City, N.Y., enabling CPMC to be the main referral site for Nassau County patients requiring specialized cancer treatment unavailable at the Nassau Radiation Oncology Center. The agreement established the Nassau Radiation Oncology Center as a site for graduate and undergraduate medical education and participation in CPMC clinical trials. 

Health of Children 

The Pediatric Neurology Ambulatory Care Unit provides comprehensive and compassionate care for infants and children with neurological and developmental disorders, including seizure disorders (epilepsy), cerebral palsy, neuromuscular conditions (muscular dystrophy), headaches, spina bifida, stroke, disorders of metabolism, and brain tumors. Patients with developmental delay, autism, attention deficit disorder, neurofibromatosis, and tuberous sclerosis receive care from physicians, nurses, allied health professionals, and social work service personnel. Clinician: Abba L. Cargan 

Pediatrics clinicians have designed plans to upgrade nutrition screening and treatment at Babies & Children's Hospital, to link the malnutrition service with a not-for-profit home care provider, and to establish a continuum of care in the nutrition services of the hospital. Clinicians: Richard Deckelbaum, Amy DeFelice 

The General Pediatric Group Practice moved off the CPMC campus to four community facilities in Washington Heights and Inwood. The group practice recorded 47,000 visits in 1995. A survey of parents showed widespread satisfaction with the quality of pediatric care; 87 percent of families said they would recommend their friends and relatives to the practice. Director: Matilde Irigoyen 

The Injury Prevention Program at Harlem Hospital Center has succeeded in reducing the number of children admitted to Harlem Hospital for major injuries. The program develops ways to teach community kids about safety, fights for and builds safe places for kids to have fun, and identifies strategies for preventing and coping with violence. The current grant from the Robert Wood Johnson Foundation will replicate the injury prevention program in other U.S. cities. Director: Barbara Barlow 

Through pediatrics, the city health department's immunization project had its first full year of operation in 1995. Washington Heights/Inwood recently had one of the city's highest rates of underimmunized children. The program successfully addresses barriers to immunization and offers free immunization services in two neighborhood elementary schools. More than 1,300 children have been vaccinated and referred to primary care and other health services. Director: Matilde Irigoyen 

New York City's first hospital-based Child Advocacy Center opened at CPMC in 1995 to provide comprehensive medical evaluations for physical and sexual abuse, psychosocial assessment, and case management. Cases of suspected child abuse are referred to the center, where investigations are coordinated with local police, child protective services, and prosecutors. The center is part of a nationwide child advocacy center movement. Director: Jocelyn Brown 

Babies & Children's Hospital has the largest childhood lead poisoning screening program in New York City. More than 8,000 children were tested last year. The screening program's data have been used by the Centers for Disease Control and Prevention to prepare statements on lead poisoning in children. Director: Sergio Piomelli 

Chicken pox, which affects more than 95 percent of the population, results in approximately 10,000 hospitalizations and 50 to 100 deaths each year. The virus that causes chicken pox--varicella-zoster virus--may reactivate later in life as shingles in older adults. The vaccine licensed last year for chicken pox resulted from pivotal clinical studies conducted by Columbia pediatricians. The vaccine should eradicate chicken pox, the last of the common childhood diseases, and decrease the number of cases of shingles in the elderly. Columbia's Anne A. Gershon has been recognized for the past 25 years as an expert in human herpesvirus infections and the varicella-zoster virus. Her pioneering work on the cellular biology, pathogenesis, and immune response to the virus has contributed to advances that led to the vaccine, which the American Academy of Pediatrics has recommended be given universally to healthy children at age 1. 

The clinical genetics division in pediatrics coordinates the New York State Newborn Screening Program at Babies & Children's Hospital and the Allen Pavilion. Nearly 500 infants tested were given further testing and follow-up services for metabolic diseases, hypothyroidism, sickle cell anemia, or other problems. Director: Kwame Anyane-Yeboa 

Community physicians are visited regularly through the pediatrics consult-liaison service to facilitate referrals to Babies & Children's Hospital specialists. This program reduces the use of the emergency room for referrals. The project recruits children from the emergency room in an effort to reduce use of emergency care for later episodes. A health educator works with families on home management of asthma and strategies to avoid asthma attacks. Roy Brown, Mildred Tavares 

Each year for three years, alumni of the pediatric intensive care unit of Babies & Children's Hospital have reunited to celebrate their successful stays in the unit. The 1995 reunion hosted more than 200 patients and 400 family members. 

CPMC is a member of the Children's Cancer Group, a consortium of 35 of the best academic pediatric services in the country. Members use standardized management to advance the success rates in the many types of childhood cancer. Each year, the protocols strive to improve on the successes of the previous year. Patients throughout the country benefit from treatment protocols developed by the best minds in pediatric oncology working together. This year, Babies and Children's Hospital was among a group of institutions that gathered to commemorate the 40th anniversary of the founding of the Children's Cancer Study Group. The founding investigators--including Dr. Anneliese Sitarz of P&S--were recognized for their contribution to the study, which led to better treatments for leukemia. 

Applying Technology to Health Care 

CPMC obtained the first Cordis HawkVision Neuroendoscope, an apparatus designed specifically to apply endoscopy to neurosurgery. The new technology allows novel techniques for performing endoscopic neurosurgical procedures. 

Epilepsy surgery has been improved through use of a novel workstation linked with a digitizing camera that identifies cortical regions that cause epilepsy and pinpoints important functional areas (such as language, motor, and sensory function). This method improves on traditional methods for identifying these critical areas intraoperatively. 

Inhalation of nitric oxide, a pulmonary vasodilator, has been introduced by anesthesiology clinicians as treatment of pulmonary hypertension in a variety of conditions, including the Eisenmenger syndrome and the meconium aspiration syndrome.

A major breakthrough in the diagnosis of depression was among the first clinical applications of PET technology. PET was used to provide the first direct visualization of blunted regional brain responses to serotonin release in the brains of patients with major depression. The technology could be applied to diagnose other psychiatric disorders, such as schizophrenia, anxiety disorders, obsessive-compulsive disorder, and Alzheimer's disease. Researcher: J. John Mann 

A four-year National Library of Medicine grant for the study, "Access to Medical Information Through Natural Language," will design, implement, and evaluate a user interface based on natural language that will allow busy professionals to access information without learning complicated programs. A resource mediator will be developed to provide access to MEDLINE--a standard data base of medical literature--and to the pharmaceutical data base, Physicians' Desk Reference. The resource mediator will be improved to access a data base of clinical information. When completed, this project will translate user requests into transactions against various information resources. The project will perform evaluation studies throughout to compare the ability of professionals to access medical information using this natural language interface with their ability to access this information using a high-level access language. Stephen B. Johnson 

Improvements in Diagnosis and Treatment 

A team led by a vascular surgeon has developed a novel, minimally invasive procedure that may allow physicians to treat abdominal aortic aneurysms early and without the risks of surgery. An endovascular graft-stent prosthesis is placed at the site of the aneurysm, taking the place of the enlarged vessel and preventing blood flow through the aneurysm, which then clots. Researcher: Timothy A.M. Chuter 

Some epilepsy patients--20 percent to 30 percent--have seizures that are uncontrollable with medication. Surgery is often indicated, but the area of the brain generating the seizures must be pinpointed and then excised, removing enough brain tissue to eliminate seizures without damaging critical brain function. The Comprehensive Epilepsy Center excels at developing techniques to identify operable lesions in epilepsy patients. One such technique is the selective Wada test, a highly specialized test used only at CPMC. After a battery of tests have been used to localize the epileptic brain region, physicians must determine if it is safe to remove that portion of the brain. The Wada test, and now the selective Wada test, can tell physicians whether removing the hippocampus would result in destroying a vital function, such as the patient's memory. Since its creation, the Comprehensive Epilepsy Center has operated on more than 120 patients with epilepsy. In more than 70 percent, disabling seizures have stopped; most of the remaining 30 percent have had a substantial decrease in the frequency and severity of their seizures. Researcher: John Pile-Spellman 

Two dermatology faculty members at St. Luke's-Roosevelt Hospital Center are contributing to important advancements in skin disorders. A 20-year population study is yielding insights into the mechanisms and genetics of porphyrin metabolism disorders, which result from inherited or acquired deficiencies in the activities of various enzymes involved in the production of heme. St. Luke's-Roosevelt is one of the few centers in this country studying and treating the diseases, including erythropoietic protoporphyria, a disorder that begins in childhood and is characterized by a type of skin sensitivity to light and dysfunction of the bone marrow and liver and bile systems. Other work in dermatology has resulted in an assay that reduces the need to use animals to test the skin irritation potential of certain consumer products. Researchers: Maureen B. Poh-Fitzpatrick, Vincent A. DeLeo 

A new procedure developed by microbiology and pathology researchers amplifies immunohistochemical tests used to detect cancer and infectious diseases to markedly enhance test sensitivity while significantly reducing cost of the test. The amplification procedure is more sensitive to the presence of markers of infectious diseases or neoplastic cells and, for example, is able to pick out a few cancerous cells in a sample that, in the absence of amplification, would be missed. The procedure produces few false positive results and is easily used in automated testing systems found in most pathology labs. Researchers: Bernard F. Erlanger, Bi-Xing Chen, Matthias J. Szabolcs 

A new, highly sensitive test to detect thyroid cells in the bloodstream can help determine whether thyroid cancer has spread and identify people who need additional therapy. The new PCR test is only one of several advances that fall under the auspices of CPMC's new Thyroid Center. Researchers: Beth Ann Ditkoff, John Chabot, Carl Feind, Paul Lo Gerfo 

Two innovative genetic therapies are helping Columbia doctors develop treatment options for epidermolysis bullosa, an inherited blistering disorder that affects 100,000 people a year in the United States. The effects range from mild skin blisters to death in the first six months of life. A P&S researcher is studying the prevention of EB by preimplantation diagnosis and treatment; CPMC is one of only three or four centers in the world that will offer preimplantation diagnosis. The research also seeks the efficacy of gene therapy for EB. Researchers: Angela M. Christiano, Mark V. Sauer 

Columbia's first gene therapy treatment for neoplasms is under way in a clinical protocol conducted by neurological surgery researchers with the Irving Center for Clinical Research and sponsored by Genetic Therapy Inc. The protocol uses Herpes Simplex thymidine kinase-1 gene and intravenous ganciclovir to treat recurrent malignant glioblastoma, a brain tumor. Researchers: Michael Fetell, Jeffrey Bruce 

The Department of Anesthesiology created a division of regional anesthesia and acute pain treatment to promote use of regional blocks, improve the availability of sustained pain relief postoperatively, and promote teaching. 

The Urban Health Institute at Harlem Hospital Center is a multidisciplinary program directed toward improving the effectiveness of health care services for minority populations. The institute, one of 11 research centers in the country, is a collaborative effort of P&S, the School of Public Health, and the New York City Health and Hospitals Corporation. The Institute has made progress toward its goal of becoming a community, local, regional, and national resource, a clearinghouse for data on minority health, and a source of information on health practices effective in improving the health status of urban African-Americans. 

A multidisciplinary team at CPMC's Male Reproductive Center/Sexual Dysfunction Unit and other sites are seeking less invasive delivery mechanisms to treat such sexual dysfunction as impotence and premature ejaculation. Trials are under way to test an orally administered penile vasodilator accidentally discovered by a team of British researchers trying to develop a coronary vasodilator. If the drug proves efficacious, it could be a major breakthrough in treatment of impotence. Other trials under way: The Medicated Urethral System for Erection, a novel method for delivering prostaglandin E1; use of apomorphine, a dopamine agonist found to stimulate the sexual center in the brain; use of the antidepressant Prozac, or fluoxetine, to treat premature ejaculation. Researcher: Ridwan Shabsigh 

Some babies born with meconium aspiration syndrome--babies who have passed their first fecal discharge into the amniotic sac, which causes pulmonary hypertension--start to recover in the first few days after birth. It is a life-threatening situation for others. P&S physicians now treat this potentially deadly condition easily and inexpensively with nitric oxide gas. Administration of nitric oxide has been shown in clinical trials to relieve pulmonary hypertension and respiratory distress syndrome. Clinician: Arthur Smerling 

The Department of Anesthesiology began providing anesthesia services at Columbia-Presbyterian/Eastside as the facility expands to offer more services in midtown. 

The Orthopaedic Research Laboratory has developed a way to identify early stages of osteoarthritis by using the 3B3(-) monoclonal antibody epitope and other proteoglycan components in the synovial fluids of knees and shoulders. The lab also applied autologous periosteum-bone constructs to repair large osteochondral defects. Researcher: Van C. Mow 

Improved Surgical Interventions 

CPMC's Neurological Institute is the state's leader in craniotomies for aneurysms and vascular malformations affecting the brain and spinal cord. NI has the state's highest volume and the best mortality rate and length of stay for cerebral aneurysm patients. 

Neurological surgery and radiation oncology clinicians have performed stereotactic radiosurgery, a new method of delivering very focused radiation using a 3-dimensional technique, on more than 300 patients. 

Recent advances allow some patients with advanced drug-resistant Parkinson's disease to benefit from surgical intervention--use of pallidotomy and thalamotomy. At CPMC, the pallidotomy program incorporates a novel method for using MRI to target lesions (using a computer workstation that allows improved use of MRI to plan stereotactic procedures) and a sophisticated customized method of microelectrode monitoring to identify the target brain area. Clinician: Seth Pullman 

The Neurological Institute is a regional referral base for the microsurgical removal of spinal cord tumors and vascular malformations and for complex stabilization procedures required to manage complicated, unstable fractures and systemic cancer that has metastasized to the spine. 

Centers for Clinical Care 
Kreitchman PET Center-opened in 1994 but until recently was used almost exclusively for research purposes. Medical literature and research have increasingly supported the use of positron emission tomography (PET) for clinical situations in which difficult treatment alternatives can be a matter of life or death, so PET's clinical applications have increased and now supplement uses of PET for research. It is the first complete state-of-the-art PET/Cyclotron facility in the New York metropolitan area to be opened for clinical use. 

Thyroid Center-staffed by endocrinologists, surgeons, radiologists, pathologists, and ophthalmologists with a major interest in diseases of the thyroid. Columbia was the first to use radioactive iodine to treat thyroid disease and one of the first to use fine needle aspiration biopsy for diagnosis of thyroid disease. A blood test for thyroglobulin, a marker for thyroid cancer, was developed at Columbia. 

Peripheral Neuropathy Comprehensive Care Center at Columbia-Presbyterian/Eastside-offers an integrated approach to the treatment of the disorder characterized by muscle weakness and numbness, tingling, or pain in the extremities. Columbia's is the first major center in New York and one of only a few in the nation. Columbia is also one of the leading institutions in the research of neuropathies. Researchers here first identified a class of autoantibodies that cause peripheral neuropathies and have licensed assays for detecting such autoantibodies. 

Eleanor and Lou Gehrig MDA/ALS Research Center-clinical research program that features a multidisciplinary team of neurologists, research scientists, pulmonologists, research clinicians, speech therapists, and other rehabilitation therapists who offer comprehensive diagnostic and clinical management, clinical trials, referrals, support services, and educational programs. 

Comprehensive Epilepsy Center-serves adults and children and works with community physicians and other hospitals to provide optimal treatment and appropriate comprehensive services for patients with uncontrolled seizures. 

Huntington's Disease Center in the departments of neurology and psychiatry-is staffed by three physicians, one nurse practitioner, one social worker, and one clinical psychologist and offers neurological and psychiatric evaluations, treatment, regular follow-up exams, support group services for early Huntington's disease patients, information, and referrals to speech, swallowing, occupational, physical, and nutritional therapists. 

Neuro-oncology and Brain Tumor Center-one of 10 in the United States designated as a Brain Tumor Co-Operative Center by the NIH and the only one in the tristate area. The multidisciplinary group treats more than 350 new patients each year for tumors of the brain, skull base, or spinal cord. 

Center for Child and Adolescent Nutrition and Prevention-treats patients and prevents illness through nutritional interventions. 

Comprehensive Sickle Cell Center-one of 10 NIH-supported sickle cell centers in the country. Research focuses on molecular genetics of sickle cell diseases and prevention and treatment of stroke. The center offers prenatal diagnosis of sickle cell diseases to all families at risk in New York. With more than 800 diagnoses made, the center is the largest and most effective in the world. 

Cutaneous Ulcer and Wound Care Center-multidisciplinary approach uses specialists in vascular surgery and dermatology to treat cutaneous ulcers and non-healing wounds. The center is investigating the use of topical retinoids and deltanoids as adjunctive treatment for chronic cutaneous ulcerations and studying novel approaches to wound management to improve patient care preoperatively in preparing wounds for grafting, postoperatively in aiding engraftment, and non-operatively in stimulating healing that may eliminate the need for surgical intervention. 

Osteoporosis Prevention and Treatment Center-supports state-of-the-art bone density technology, patient care, research, clinical trials, and education for patients and health care professionals. Half of all individuals who suffer a hip fracture due to osteoporosis never return to an independent mode of living, and the cost of health care for osteoporosis-related fractures is estimated at $10 billion a year. CPMC has expanded its osteoporosis program to provide individualized screening, nutrition counseling, referral to physical therapy, and treatment with a variety of medications. Clinical trials are under way at CPMC for two new drugs, raloxifene and tiludronate.