[Congressional Record (Bound Edition), Volume 145 (1999), Part 21]
[Extensions of Remarks]
[Pages 31279-31281]
[From the U.S. Government Publishing Office, www.gpo.gov]



   THE UNIVERSITY OF MISSISSIPPI MEDICAL CENTER CONTINUES PIONEERING 
                            MEDICAL ADVANCES

                                 ______
                                 

                           HON. FLOYD SPENCE

                           of south carolina

                    in the house of representatives

                      Thursday, November 18, 1999

  Mr. SPENCE. Mr. Speaker, I rise to bring to the attention of the 
House exciting medical advances that are taking place at The University 
of Mississippi Medical Center (UMC), in Jackson, Mississippi. During 
the last thirty years, UMC has gained an international reputation as a 
leader in the development of landmark medical procedures. In 1964, the 
first heart transplant in the world was performed at UMC. In 1988, I 
received a double-lung transplant there, which saved my life. At that 
time, the procedure that I underwent was not being performed anywhere 
else in the United States.
  Most recently, UMC Assistant Professor of Vascular Interventional 
Radiology and Body Imaging, Dr. Patrick Sewell, has pioneered a 
revolutionary procedure that offers great promise for the treatment of 
cancer patients. This innovative work combines Magnetic Resonance 
Imaging (MRI) and cryosurgery techniques to destroy tumors. This 
``cryoablation'' has been successfully performed by Dr. Sewell on 
cancer patients, with amazing results.
  Additionally, Dr. Sewell, and Dr. Ralph Vance, another UMC physician, 
have traveled to China, to share another new ``cutting-edge'' 
technology with medical practitioners in that country. The procedure, 
which was developed by Dr. Sewell, and which is known as 
``radiofrequency of the lung tumor ablation,'' utilizes a 
radiofrequency probe with an Interventional CAT scan to perform lung 
cancer surgery.
  Mr. Speaker, I am very proud to have a connection, through my 
transplant experience, to the ongoing pioneering efforts at UMC that 
are making significant breakthroughs in medicine. I would like to 
include in the Congressional Record two articles that elaborate on 
these impressive efforts, which are changing the way cancer is treated.


[[Page 31280]]

             [From the Medical Post News 2, Oct. 12, 1999]

 New MRI Great Renal Tumour Destroyer--Open Magnet MRI Provides Almost 
                    Real-Time Images During Surgery

                           (By Andrew Skelly)

       Jackson, Miss.--MRI-guided cryosurgery looks like a 
     promising way to destroy renal tumours, say doctors at the 
     University of Mississippi Medical Centre.
       The centre is one of only a handful worldwide using a new 
     type of ``open magnet'' MRI that provides almost real-time 
     images during surgery.
       The technique takes advantage of the temperature 
     sensitivity of MRI and the availability of new nonmagnetic 
     cryosurgical equipment.
       Doctors at the Centre Hospitalier Universitaire de Quebec 
     are using the same equipment to destroy breast tumours (see 
     the Medical Post, Aug. 11, 1998).
       The Mississippi team has treated 13 renal cancer patients 
     so far. All of them had already had one kidney removed and 
     had developed a tumour in the other.
       Traditional surgery would have involved removing the entire 
     remaining kidney; but the MRI-guided approach allowed the 
     surgeons to destroy the tumour while leaving the functioning 
     part of the kidney intact, thus sparing the patients 
     dialysis.
       ``We've been successful in every one so far, without a 
     great deal of difficulty,'' said assistant professor of 
     radiology Dr. Patrick Sewell in a telephone interview. 
     ``We've had no complications, no bleeding, no blood in the 
     urine, and one patient's renal function actually improved. We 
     actually expected everybody's to get a little worse but so 
     far no one's has. We don't quite understand that, but we 
     definitely like it.''
       General anesthetic was used in all but one patient, who 
     could not tolerate sedation because of pulmonary disease.
       The patients are being followed with CT scans at one week, 
     one month, three months, six months and one year post-
     surgery, and then every year thereafter. Their post-surgical 
     renal function is also being monitored.
       The longest followup is only about six months, but so far 
     no patient has shown evidence of residual tumours after the 
     surgery: ``Time is the true test, whether the procedure is 
     totally effective or partially effective,'' Dr. Sewell 
     stressed.


                          Significant advance

       ``The procedure appears to be a significant advance in the 
     minimally invasive surgery field,'' commented Dr. Joseph 
     Chin, professor and chairman of the division of urology at 
     the University of Western Ontario, when reached by e-mail. 
     ``But standardization of techniques, quality control, proper 
     patient selection and longer-term followup are as yet 
     unavailable.''
       The interventional MRI, manufactured by GE Medical Systems 
     of Waukesha, Wis., resembles a pair of vertical doughnuts--
     the patient slides through the doughnut hole and the surgeon 
     stands between the doughnuts, watching a video monitor 
     displaying the MRI images--which can be updated as quickly as 
     twice per second.
       Because the magnet is configured to allow the surgeon 
     access to the patient, the field strength is less than a 
     regular diagnostic MRI--0.5 versus 1.5 Tesla--so the 
     resulting image quality is not as good. High-quality 
     preoperative CT or MRI scans are still required to 
     familiarize oneself with the anatomy and look for subtle 
     lesions, Dr. Sewell said.
       The intra-operative MRI is used to localize the kidney, 
     then plan and monitor the path of the cryosurgical probe as 
     the surgeon inserts it through a 4 mm incision into the 
     centre of the tumour.
       The probe--called Cryo-Hit and designed by Tel Aviv-based 
     Galil Ltd.--is nonmagnetic, so it doesn't interfere with MR 
     imaging.
       Dr. Sewell uses three cycles of freezing and thawing to 
     rupture the tumour cell membranes.
       Pressurized argon gas is used for freezing, producing a 
     temperature of -186  deg.C at the tip of the probe, creating 
     an ``ice ball'' whose growth can be monitored on the video 
     screen.
       Pressurized helium gas then heats the tissue to up to 80 
     deg.C.
       ``The MRI allows me to see where the probe tip is and move 
     around and get three dimension views,'' said Dr. Sewell. 
     ``It's just like slicing through the body. It's a virtual 
     surgery, essentially.''
       In just over an hour, the tumour is a shrunken mass of 
     inert cellular debris and the patient goes home the next day.
       ``You just put a Band-Aid on them and we're finished. In a 
     couple of months, you can't even find the scar--it's so 
     small,'' said Dr. Sewell. Ordinary naked-eye surgery, he 
     added, involves a 10-inch incision, removal of surrounding 
     tissue and weeks of recovery time.
       The technology, said Dr. Sewell, could one day replace 
     nephrectomy, if it has the same end result.
       ``If you're faced with having your kidney removed and going 
     on dialysis because you have a tumour, this is certainly of 
     great benefit.''

                                  ____
                                  

             [From the Mississippi Medical News, Nov. 1999]

        UMC Physicians Pioneer New Lung Cancer Surgery in China

       Two physicians from the University of Mississippi Medical 
     Center (UMC) have been in China treating its overwhelming 
     number of lung cancer patients--and teaching China's doctors 
     to do the same. If this medical undertaking is successful, it 
     could change the way lung cancer surgery is performed 
     worldwide.
       The UMC physicians used a new surgical procedure which was 
     performed for the first time in the world at UMC and, since 
     then, has been practiced only at the Jackson medical center 
     for the past six months.
       Surgeon/radiologist Dr. Patrick Sewell and oncologist Dr. 
     Ralph Vance taught China's physicians how to perform the new 
     surgery to battle lung cancer. In the process, the UMC 
     physicians are conducting study of the results, which 
     eventually could benefit patients in the United States and 
     worldwide.
       ``China has 300 million smokers, which is more than the 
     entire population of the United States,'' says Sewell, an 
     assistant professor of radiology at UMC. ``So they need a 
     cost-effective way to treat lung cancer. This is a fast and 
     cheap way to destroy tumors in the body.''
       Sewell pioneered the new surgical procedure, called a 
     radiofrequency of the lung tumor ablation, at UMC. He is 
     considered the world's authority on the procedure. Vance, a 
     UMC professor of medicine, is designing and directing the 
     related study and its joint research by UMC and academic 
     institutions in the People's Republic of China.
       Sewell visited three cities--Beijing, Xian, and Shanghai--
     to lecture, demonstrate, and perform the surgeries. He went 
     to China Oct. 4 and returned Oct. 17. Vance set up the 
     patients and the study in advance, visiting China Oct. 1 
     through Oct. 8.
       Sewell also is nationally known for developing new surgical 
     procedures using UMC's interventional magnetic resonance 
     imaging (MRI) unit, which involves procedures very similar to 
     the China procedure. (UMC is one of three test sites in the 
     United States for the vertical twin-magnet interventional 
     MRI; the other are at the teaching hospitals of Harvard and 
     Stanford Universities.)
       The interventional MRI displays magnetic resonance images 
     in real-time during surgery so the physician can see a 
     surgery's progress and whether tumors are being destroyed. 
     The China radiofrequency tumor ablation surgeries, in which a 
     hot probe is used for tumor removal, employ an interventional 
     CAT scanner instead of the interventional MRI.
       In both procedures, a tiny incision in the patient's skin 
     enables the physician to insert a probe into the body to 
     destroy the tumors. In the pioneering interventional MRI 
     procedures, a cold CryoHit (freezing) probe most often is 
     used. The interventional CAT scanner surgeries in China used 
     a hot (laser/radiofrequency) probe to destroy tumors, Sewell 
     says.
       In China, the procedure also received a new application; it 
     was performed for the first time to treat primary tumors of 
     the lung, ideally to cure the cancers. (Primary tumors are 
     nonmetastasized tumors, or tumors from which the cancer has 
     not spread.) Sewell notes that, in the United States at UMC, 
     the procedure only has been used to treat metastasized tumors 
     of the lung that have spread to other parts of the body as a 
     means to prolong life and relieve suffering from incurable 
     cancer.
       Since conventional surgery can successfully remove primary 
     tumors of the lung, Sewell can point to no compelling reason 
     in the United States to test whether the CAT scanner 
     procedure also is a cure. He says he is not willing to let a 
     patient forgo conventional surgery here to test the results 
     of the new procedure. But in China, where medical resources 
     are insufficient to treat the overwhelming number of lung 
     cancer patients through conventional means, this new 
     procedure could be a viable means to turn the tide against 
     lung cancer. Vance explains that ``only 15% of China's 
     population with lung carcinoma'' undergoes conventional 
     surgery for tumor removal.
       If indeed the CAT scanner procedure works on primary tumors 
     in China, it could be adopted in the United States and 
     worldwide. Not only are interventional-type lung cancer 
     surgeries less expensive and quicker than conventional 
     surgery, but the patient also has a much shorter recovery 
     period after interventional-type surgeries; they also involve 
     less trauma to the body, Sewell explains.
       Sewell performed 10 radiofrequency ablation surgeries on 
     patients in China, while training surgeons there. The 10 
     surgeries involved five primary lung tumors, three 
     metastasized lung cancers, one fibroid tumor, and one cancer 
     of the liver ``so they'd know how to do that procedure, 
     too,'' Sewell reports.
       Vance served as an epidemiological expert on the China 
     trip. He selected lung cancer patients in China to receive 
     the surgery and set up parameters for studying the medical 
     outcomes.
       After being trained by Sewell, China's surgeons immediately 
     began performing the new lung cancer surgeries on both 
     primary and metastasized tumors. ``They could eventually 
     perform hundreds of those lung surgeries per month,'' Sewell 
     estimates. We'll

[[Page 31281]]

     know soon whether this procedure worked to treat primary 
     tumors'' if the cancers have not returned, he says.
       That's part of phase II of the China project. In four to 
     six weeks, Vance will choose 10 more patients in China to 
     have primary tumors of the lung removed and Sewell will 
     perform their surgeries. A month later, those 10 patients 
     will have positron emission tomography (PET) scans to 
     determine whether their cancers are indeed destroyed. Since 
     lung cancer is aggressive, about a month after surgery is an 
     ideal time to evaluate the outcomes, Vance says.
       ``We will evaluate the effects of radiofrequency ablation 
     with and without combined chemotherapy and radiation ther-
     apy . . . to assess overall survival,'' states Vance. Both 
     mid- and late-stage lung cancer are being treated in the 
     China project.
       ``We'll collect the data, publish it, and hope to prove our 
     hypothesis--that this will be an effective way to treat a 
     variety of lung tumors,'' Sewell concludes.

     

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