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Issue 22013

In Brief

PET/MRI scans expose patients to significantly less radiation than is required for PET/CT scans.

Hospital receives certification from Centers for Medicare & Medicaid Services for all solid-organ transplants

Dr. Charles D. Fraser, Jr., prepares a donor heart and lungs for a patient’s double transplant surgery.

Dr. Charles D. Fraser, Jr., prepares a donor heart and lungs for a patient’s double transplant surgery.

Texas Children’s Hospital has earned a national certification from the Centers for Medicare & Medicaid Services (CMS) for heart, liver and lung transplants. The hospital also has been recertified by the agency for kidney transplants.

“These children will no longer have to worry about whether their state-funded health care programs will cover the cost.”

“This new certification will allow the sickest children to come from anywhere in the U.S. to seek treatment at Texas Children’s — where we have outcomes among the best in the nation — for lifesaving organ transplantation,” said John Goss, M.D., medical director of Texas Children’s Hospital Transplant Services. “These children will no longer have to worry about whether their state-funded health care programs will cover the cost.”

CMS, a U.S. Department of Health and Human Services agency, oversees and administers health care programs such as Medicaid and the Children’s Health Insurance Program (CHIP). As part of the CMS certification process, hospitals must meet stringent standards of care. The agency obtains outcome data from the United Network for Organ Sharing and conducts a site visit as well.

“An important facet of any transplant program, and a must for those who earn CMS certification, is having a multidisciplinary team including physicians, surgeons, nurses, dietitians, transplant pharmacists, financial counselors, social workers and child life specialists who provide full-service care for the needs of our patients throughout the entire transplant process,” said Jennifer Hiser, director of Transplant Services.

Texas Children’s Health Plan creates premier health care facility for its members

The Center for Children and Women serves the greater Greenspoint area.

The Center for Children and Women serves the greater Greenspoint area.

In August, Texas Children’s Health Plan opened The Center for Children and Women — an entirely new kind of health care facility for its members. The approximately 50,000-squarefoot facility includes pediatricians, advanced nurse practitioners, OB/GYNs, certified nurse midwives, optometry, imaging, a laboratory and an onsite pharmacy. Dentistry also will be added in the coming months.

The Center is revolutionizing the way CHIP and Medicaid patients receive health care.

Designed to address the shortage of primary medical care for the Medicaid and CHIP (Children’s Health Insurance Program) populations, The Center is revolutionizing the way CHIP and Medicaid patients receive health care.

The Center for Children and Women is a primary care physician practice and medical home for Texas Children’s Health Plan members.

The Center for Children and Women is a primary care physician practice and medical home for Texas Children’s Health Plan members.

Traditionally, families who do not have a permanent medical home and who live in medically underserved neighborhoods have a high number of visits to the emergency room for non-emergent medical needs.

As a result, the cost of health care is higher for all patients, and wait times in already overtaxed emergency rooms can be extremely long.

“At Texas Children’s Hospital, we like to say that we ‘run toward a problem,’” said Texas Children’s President and CEO Mark A. Wallace. “When we see that women and children have a need, but they don’t have the resources, to the greatest degree that we can, we like to come up with a solution.”

New PET/MRI scanner offers improved imaging and diagnostics with less radiation exposure

Texas Children’s is the first children’s hospital in the United States to use a PET/MRI (positron emission tomography/magnetic resonance imaging) scanner, state-of-the-art technology that will help in early and accurate diagnosis of various cancers, heart diseases and degenerative neurological disorders.

PET/MRI is a hybrid imaging technology that incorporates MRI soft-tissue morphological imaging and PET functional imaging. This new imaging device sequentially performs PET and MRI scans, producing more detailed images than either technique alone. Hybrid PET/MRI scans eliminate the need to move patients from one imaging unit to another, making it easier to combine data from both scans and produce enhanced details.

“Being able to study the structural and functional changes in the body may allow us to detect abnormalities, even before the clinical symptoms of a disease begin to show,” said George S. Bisset, M.D., chief of Texas Children’s Pediatric Radiology and immediate past president of the Radiological Society of North America. “This technology holds so much promise, and we’re anxious to see where it takes us.”

PET/MRI will help provide new insights in the field of neuroscience and neurological disorders such as neurodegeneration, brain ischemia and seizures. It also will be used to diagnose other illnesses, including head and neck tumors, many types of cancer, liver tumors, pelvic tumors, musculoskeletal tumors, and heart diseases. PET/MRI may be able to replace the PET/CT scans now used to investigate cancers and other problems in pediatric patients. If so, PET/MRI scans will expose patients to significantly less radiation than is required for PET/CT scans.

“Radiation exposure is a source of concern for any patient, but it has to be watched with particular care in pediatric patients who are still growing and developing,” Bisset said. “An opportunity to get information essential for medical care at half the radiation exposure would be particularly welcome both in pediatric patients and in adults who need multiple scans during treatment.”

Baylor pediatric HIV/AIDS program in Botswana celebrates 10th anniversary

Zero versus 6,000.

Those figures represent the number of children in Botswana who received lifesaving HIV/AIDS treatment before and after the Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital opened its first clinic 10 years ago in the region of Africa hardest hit by the disease.

“Today, BIPAI has more than 168,000 HIV-infected children and family members in care and treatment — more than any other organization worldwide.”

“We began working in Botswana 15 years ago, when many medical and public health experts were saying that the situation with HIV/AIDS in Africa was hopeless,” said Mark W. Kline, M.D., Texas Children’s physician-in-chief, chair of Pediatrics at Baylor College of Medicine and founder of BIPAI. “We were able to establish a family-centered model of HIV/AIDS care delivery that now has been replicated across the African continent, saving the lives of tens of thousands of children. Today, BIPAI has more than 168,000 HIV-infected children and family members in care and treatment — more than any other organization worldwide.”

In June 2003, BIPAI, coming off the success of its pilot program in Romania, set its sights on the region of sub-Saharan Africa with the highest prevalence of HIV/AIDS — 39 percent. With support from the Bristol-Myers Squibb Foundation, the BIPAI team renovated two old storerooms to set up an HIV/AIDS clinic at the Princess Marina Hospital in Gaborone, Botswana. This clinic later became the Botswana-Baylor Children’s Clinical Center of Excellence.

Center for Cell and Gene Therapy receives $11.3 million NIH grant

The Center for Cell and Gene Therapy at Baylor College of Medicine (BCM), Texas Children’s Hospital and Houston Methodist Hospital received an $11.3 million renewal grant from the National Institutes of Health to advance the development of more effective and less toxic targeted T cell therapies for children and adults with cancer.

Center for Cell and Gene Therapy members Helen Heslop, M.D., professor of medicine and pediatric hematology-oncology at BCM and director of the Adult Stem Cell Transplant Program at Houston Methodist Hospital, and Cliona Rooney, Ph.D., professor of pediatric hematology-oncology, molecular virology, and microbiology and immunology at BCM, serve as co-principal investigators of the project.

“Harnessing T cells (white blood cells in the immune system) to treat cancer more effectively remains a leading biomedical research goal and has produced encouraging results in hematologic malignancies, but extending the approach to solid tumors is a more challenging task,” Heslop said.

“T cells can have potent and long-lasting anti-tumor activity without the toxicities associated with standard therapies,” Rooney said. “If we can harness these benefits in standard treatments for cancer, this will dramatically improve outcomes and quality of life for cancer patients.”

“Obstacles include lack of target antigens, as well as negative regulation of the immune system within tumors and their microenvironments.”

With the new funding, Heslop, Rooney, and their team at the Center for Cell and Gene Therapy are building on advances made possible through the initial funding grant established nine years ago to further address these problems and to reach a wider spectrum of cancers. The team has already made significant advances using T cell approaches that are tumor-specific and has obtained complete remissions in patients with advanced/relapsed lymphoma, nasopharyngeal cancer and neuroblastoma.

Their work led to an orphan drug designation, granting special status from the U.S. Food and Drug Administration for treatment of rare diseases, for the treatment of post-transplant lymphomas and the development of advanced-stage studies of lymphoma and nasopharyngeal cancers.

“T cells can have potent and long-lasting anti-tumor activity without the toxicities associated with standard therapies,” Rooney said. “If we can harness these benefits in standard treatments for cancer, this will dramatically improve outcomes and quality of life for cancer patients.”

First-of-its-kind clinic in Texas will treat children who are most susceptible to kidney stones

Texas Children’s new pediatric Stone Clinic opened this summer to provide comprehensive care for children and adolescents with kidney stones. The clinic includes a multidisciplinary team of specialists who evaluate, diagnose and treat children who previously had kidney stones, as well as patients at risk for developing them.

“In children with kidney stones, there can be underlying metabolic, genetic or anatomic causes,” said Nicolette Janzen, M.D., pediatric urologist at Texas Children’s and assistant professor of urology at Baylor College of Medicine. “That is why we recognized the need and importance of opening a specialized clinic for children affected by this condition.”

The Stone Clinic at Texas Children’s Hospital combines the expertise of pediatric urologists, pediatric nephrologists (kidney specialists) and registered renal dietitians who evaluate patients with kidney stones in a single visit.

New center focuses on women dealing with menopause

The new Menopause Center at Texas Children’s Pavilion for Women is dedicated solely to the care and treatment of women with menopause symptoms, conditions and related health issues.

The practice is staffed by board-certified Baylor College of Medicine (BCM) physicians with specialized proficiency in the latest menopause therapies, trends and research. It offers treatments for a wide variety of menopause symptoms, from night sweats, sleeplessness and bladder irritability to depression, sexual dysfunction and pelvic floor disorders. Patients have access to a wide array of specialists in reproductive psychiatry, urogynecology, vulvovaginal health, hormone replacement therapy and gynecologic oncology.

“The average woman spends about one third of her lifetime in menopause, facing the distinctive health care challenges that accompany the stages of reproductive aging.”

The practice is co-directed by Lucy Puryear, M.D., and Ronald Young, M.D., associate professors of obstetrics and gynecology at BCM. Their combined expertise addresses both mental and physical aspects of this stage of women’s health.

“The average woman spends about one third of her lifetime in menopause, facing the distinctive health care challenges that accompany the stages of reproductive aging,” Puryear said. “It is important that we provide this group of patients with the care, treatment and guidance necessary to make this time of their lives enjoyable and to allow them to feel their best for years to come.”

Dedicated pediatric robotic surgery program debuts

The da Vinci robot performs minimally invasive procedures using 3-D cameras for enhanced visibility.

Dr. Chester Koh helps position the da Vinci Surgical System prior to the hospital’s first robotic surgery.

Texas Children’s recently acquired the da Vinci Si Surgical System to establish the hospital’s first dedicated pediatric robotic surgery program. Chester Koh, M.D., an internationally recognized expert in minimally invasive surgery, leads the pediatric robotic surgery program.

“Robotic surgery is increasingly becoming the standard of care for many pediatric patients since the numerous benefits include smaller incisions, shorter hospital stays, decreased postoperative pain medication requirements and smaller scars,” said Koh, who has been instrumental in developing cutting-edge techniques with both the laparoscope and the da Vinci robot.

Through the use of robotic surgery, surgeons can perform minimally invasive reconstructive procedures in patients of all ages using the robot’s 3-D visualization, intuitive computer-enhanced motion control, smaller instruments and increased range of motion for delicate surgical procedures, including:

  • Ureteropelvic junction (UPJ) obstruction / hydronephrosis (pyeloplasty)
  • Vesicoureteral reflux (VUR) (ureteral re-implantation)
  • Kidney removal
  • Kidney reconstructive surgery
  • Ureter reconstructive surgery
  • Bladder reconstructive surgery
  • Cholecystectomy (gallbladder removal)
  • Nissen fundoplication (esophageal reflux surgery)
  • Pelvic organ removal and reconstruction

“The da Vinci Si Surgical System provides our surgeons with significant advancements in the way we treat our patients, including unparalleled precision, agility and control for a minimally invasive approach,” said David Roth, M.D., chief of Pediatric Urology at Texas Children’s.