Health Scan: Cauterization of bronchi

Each year, between 100 and 150 Israelis – an astounding figure – die of strangulation in severe asthma attacks. Yet until now, only drug therapy has offered even partial relief.

New technology developed in Vancouver and sold by the Boston Scientific company offers hope to the five percent of asthma sufferers who have severe cases that could become life threatening. It is a device that warms and cauterizes unnecessary tissue inside the bronchi so that when they contract, air can still reach the lungs.

Now, after only 1,000 patients in less than two dozen centers around the world have undergone the treatment – carried out only three times within three weeks – and it has been proven safe and successful, Hadassah University Medical Center in Jerusalem’s Ein Kerem has obtained the equipment. Boston Scientific chose Hadassah to perform the first procedures with the equipment, which costs $70,000 to $100,000, with three disposable catheters costing a total of $15,000.

However, says Prof. Neville Berkman, head of the hospital’s invasive pulmonary disease unit, that cost is less than repeated hospitalization and treatment with antibodies every few weeks and steroid medications for years (or even for life). The US company has agreed to pay for the treatment of the first Israeli patients at Hadassah, and the Rabin Medical Center-Beilinson Campus in Petah Tikva will be the second site to offer the treatment here.

“Most patients who are hospitalized and die tend to be older women,” Berkman told The Jerusalem Post. There is not one asthma, but many types. This kind has a strong genetic component.”

Boston Scientific bought the technology from Canadian developers for $170 million two years ago. Excellent premarketing studies were done.

The hour-long, non-surgical procedure in which the bronchi – first the lower lobe of one, then the bottom of the other and then the two upper lobes – are cauterized with heat is performed once weekly for three weeks. It could be done with only sedation, but for the first two successful treatments a few weeks ago, the patients were put under general anesthesia just in case.

Boston Scientific brought in a leading expert from the Czech Republic to perform the procedure along with Berkman, who previously had attended practical workshops on the technology but had not treated patients before. “It’s a straightforward, innocuous procedure and has been approved by the Health Ministry,” he commented. “From foreign follow-up studies over the last five years it has been proven safe, with sustained clinical benefits and no longterm complications,” the Hadassah pulmonologist said.

“The principle of cauterization is revolutionary. Asthma is a disease of the airways, which in asthmatics involves hyper-responses. Heat from the catheter reduces the amount of tissue in the bronchi, which has a coating and must not be injured.”

Next year, the US government’s Medicare/Medicaid health plans will include it in their basket of services for relevant patients, thus there will be an enormous demand for it. For all Israelis who need it to benefit, it would have to be included in the state’s basket of health services after the committee that recommends new technologies becomes convinced that it is cost-effective.

Research into autism causes

A research study to determine the causes of autism is being conducted jointly in Jerusalem and the US. Scientists are seeking pregnant women or those planning to become pregnant in the near future who have at least one child or a sibling with autism. Researchers would like to collect and test, after delivery, a small amount of blood from the umbilical cord of the newborn. A free medical consultation will be provided during pregnancy as well as a follow-up neurological exam that would be performed when the baby becomes a toddler. Details will be kept confidential, and there is no risk to mother or child, the researchers said. For information, contact the research coordinator at Hadassah University Medical Center at 050-404-8251 or by email at aresearch2012@gmail.com.

Relieving rage

Some psychologists believe that chronic playing of video games can increase violence. But now, research at Boston Children’s Hospital suggests that children who have difficulty controlling their anger show a drop in their fury after playing a game called “Rage Control.”

A study published in a recent issue of the journal Adolescent Psychiatrywas launched after Dr. Jason Kahn and Dr.

Joseph Gonzalez-Heydrich noted that children with angercontrol problems were often uninterested in psychotherapy but very eager to play video games. The fast-paced “Rage Control” involves shooting at enemy spaceships while avoiding shooting at friendly ones. As children play, a monitor on one finger tracks their heart rate and displays it on the computer screen. When heart rate goes above a certain level, players lose their ability to shoot at the enemy spaceships. To improve their game, they must learn to keep calm.

“The connections between the brain’s executive control centers and emotional centers are weak in people with severe anger problems,” explained Gonzalez-Heydrich, chief of psychopharmacology at the pediatric hospital and the chief investigator in the study. “However, to succeed at the game, players have to learn to use these centers at the same time to score points.”

The study compared two groups of nine- to 17-year-old children with normal IQs who had not changed their medication during the five-day study period and had been admitted to the hospital’s psychiatry inpatient service for high levels of anger. One group of 19 children received standard treatments for anger, including cognitive behavioral therapy, presentation of relaxation techniques and social skills training for five consecutive days. The second group, with 18 children, got these same treatments but spent the last 15 minutes of their session playing the game.

After five sessions, the video gamers were significantly better at keeping their heart rates down. They showed clinically significant decreases in anger scores. The gamers also had a decrease in suppressed, internalized anger that reached marginal statistical significance. In contrast, the group that had undergone standard treatment showed no significant change. The researchers are also developing toys to enhance emotional regulation skills in children too young to play “Rage Control.”