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Setting standards in innovation and quality

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Emory medical faculty provide care in the largest, most comprehensive health system in Georgia and in affiliate hospitals that include Grady Memorial Hospital, Children's Healthcare of Atlanta, and the Atlanta VA Medical Center (see hospitals and clincs). As practitioners in academic medicine, they are charged simultaneously with developing and testing new drugs and procedures and finding new ways to improve quality and decrease costs—all while treating the sickest of the sick who routinely are referred and entrusted to their care. Following are some examples of ways they are meeting this charge. 

Fluorescence-guided brain tumor removal

One difficulty in removing glioblastoma tumors is that tumor cells often look like normal tissue. Emory is the first site in the U.S. to test a drug, widely used in Europe, that lets neurosurgeons clearly see the difference. Before surgery, the patient swallows the drug Gliolan, which is absorbed by malignant tissue. Under a blue light operative microscope, tumor cells glow bright violet-red. Ability to visualize clearly defined margins permits more complete tumor removal. Following this study of 33 brain tumor patients, Emory researchers plan a multi-center phase 3 randomized clinical trial that could lead to FDA approval of Gliolan.

Repairing formerly irreparable aneurysms

Patients with large, wide-necked brain aneurysms once deemed untreatable now have a therapy option. Emory neuroradiologists are first in Georgia and among the first in the U.S. to use a pipeline embolization device. Connected to a catheter, the device redirects blood flow away from the aneurysm, causing blood that remains in the aneurysm to form a clot to prevent rupture. More invasive procedures have greater risk for complications, making them inapplicable in medically fragile patients.

Sparing the knife

To combat esophageal cancer or the premalignant Barrett's esophagus that can progress to cancer, Emory gastroenterologists increasingly use minimally invasive approaches. With endoscopic mucosal resection, for example, a band is applied around the area containing premalignant cells. This band bunches the tissue into a kind of polyp, which can be removed by radiofrequency ablation, cryotherapy, or other endoscopic methods, leaving deeper esophageal tissue intact. To remove tumors, Emory gastroenterologists and surgeons teamed up to develop an approach combining thin laparoscopic instruments and flexible endoscopes. They recently reported success in five of seven patients: complete removal of tumors without open incisions or major surgical resection. 

Overcoming type 1 diabetes

Patients with severe type 1 diabetes are discovering how good it feels when their own body regains the ability to maintain healthy blood sugar levels. No more precipitous drops in blood sugar, loss of consciousness, or wild mood swings. The Emory Transplant Center, the only program in Georgia with islet cell transplantation experience, is participating in a multi-year national study. After patients complete a course of immune suppression, interventional radiologists access a vein in the liver, and transplant surgeons infuse islet cells harvested from an organ donor's pancreas. The transplanted cells then begin producing insulin, reducing or eliminating the need for insulin supplement, at least temporarily. 

Controlling hypertension without medication

For patients whose blood pressure remains high even though they take three or more medications to lower it, there's new hope. The Emory Heart & Vascular Center is the first in Georgia to offer a minimally invasive procedure in which a tiny catheter device delivers low-power radiofrequency energy to deactivate overactive nerves in the arteries leading to the kidney. When working correctly, these nerves signal the kidney to regulate the body's water and salt balance. When overactive, they ramp up blood pressure. The procedure is part of a 60-institution phase 3 clinical trial. Earlier studies in Europe and Australia found safe, significant, and sustained reductions in blood pressure, on average more than 30 mmHg, following deactivation. 

Palliative care—not just for the dying

Emory's Palliative Care Center is leading an initiative to increase palliative care in emergency departments nationwide, a sometimes underappreciated site for seriously ill patients to receive specialized care focused on relief from symptoms, pain, and stress. Emory emergency medicine is already a leader in palliative care, and leaders of the IPAL-EM initiative (Improving Palliative Care in Emergency Medicine) hope Emory's experience will help promote more palliative care in emergency departments nationwide, improving symptom control, reducing anxiety, making care plans more realistic and consistent with patient preferences, lowering conflicts about use of life-sustaining treatments, and enabling earlier transitions to appropriate settings. 

A new take on autoimmune disease

There's only one mesenchymal stromal cell for every 100,000 cells in human bone marrow, but thousands are growing like weeds in a new research core facility, the first to be shared between the medical school and Emory Healthcare, with additional collaboration and funding from Children's Healthcare of Atlanta. Hematologist Jacques Galipeau established the Emory Personalized Immunotherapy Center (EPIC) based on research showing that the rare stromal cells, once multiplied, become potent weapons against many autoimmune diseases. Since cells come from the patient, immune incompatibility isn't a problem. Since the cells go to work only if they recognize a problem, there are virtually no side effects. A clinical trial began this year at Emory for their use in patients with Crohn's disease. This study, led by pediatric gastroenterologist Subra Kugathasan, is only the first of a series planned to develop personalized cellular therapies for patients facing catastrophic autoimmune and other diseases. 

An "executive Summary" of the genome

Emory Genetics Lab is gearing up to offer whole exome sequencing as a clinical diagnostic service. Faster and cheaper than sequencing the entire genome, this "executive summary" technique is efficient for reading the parts of the genome believed to be the most important for diagnosing disease. Most disease-causing mutations (about 85%) are believed to be located within the regions of the genome that encode proteins, the workhorse machinery of the cell. Whole exome sequencing reads only the parts of the human genome that encode proteins, leaving the other 99% unread.