The functional MRI Research Center at Columbia, only 4 years old, is being widely used by researchers and physicians both at CUMC and in other parts of the country who need neurological mapping services. The center has 72 projects under way.
fMRI Center Provides Broad Range of Brain Mapping Services
"As of Jan. 1, the use of fMRI for a standard battery of mapping for neurosurgical planning prior to surgery has been approved, so many insurance companies now reimburse for this service. We’re taking on patients on a much more regular basis than we were ever able to do before,” says Joy Hirsch, Ph.D., professor of functional neuroradiology and center director. “The landscape has changed with respect to functional mapping in that it’s now a mainstream standard of care."
The center has received referrals from as far away as Colorado and Texas. “We are a leading center in clinical functional MRI because we have the most experience. Our reputation in mapping has led the way,” Dr. Hirsch says.
CUMC began its functional imaging program with Dr. Hirsch’s recruitment in 2002. It took a year for the laboratory, located at the Neurological Institute, to get up and running. Dr. Hirsch describes the lab, which now has a staff of seven, as a “hub of research activity for both the university and the medical school.”
The fMRI center is being utilized for studies in psychiatry to try to unravel what happens in the brains of people with anxiety disorders, phobias, post-traumatic stress disorder, social anxiety, generalized anxiety, and eating disorders. For example, Laurel Mayer, M.D., Herbert Irving Assistant Professor of Clinical Psychiatry, is using fMRI to look at the brains of anorexic patients both before and after treatment. “This study is providing enormous insight into how current anorexia treatments affect the brain and how effective they are,” Dr. Hirsch says.
In other areas, Rudolph L. Leibel, M.D., professor of pediatrics and medicine and co-director of the Naomi Berrie Diabetes Center, is exploring the role of leptin, a hormone produced in fat cells that plays a role in body weight regulation. He and colleague Michael Rosenbaum, M.D., an associate director of the Irving Center for Clinical Research, use fMRI to study how the administration of either leptin or a placebo affects the brain.
Bradley Peterson, M.D., the Suzanne Crosby Murphy Professor of Psychiatry and director of the 3 Tesla MRI Research Program in the Department of Psychiatry, is conducting one of the largest and most comprehensive studies on children with Tourette syndrome, a neuropsychiatric disorder characterized by tics (involuntary, rapid, and sudden movements or vocalizations). Findings show that basal ganglia structures are dysfunctional in young children with Tourette’s and the frontal cortex increases in size and activity to help control tic symptoms.
Dr. Peterson also is conducting fMRI studies on patients undergoing psychoanalysis to attempt to better understand the brain changes that take place with treatment. “Imaging may be able to help us understand how psychoanalytic therapies affect brain processes such as projection and transference and help us identify people who will be optimally responsive to psychoanalysis and those who will not,” Dr. Peterson says. “It may allow us to adapt certain therapeutic techniques to specific individuals to achieve the greatest therapeutic effect.”
The fMRI facility can be reached at 212-342-0299.
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Complete Care for Children with Short Bowel Syndrome
Children born with short bowel syndrome, in which a significant portion of the small intestine is missing, face a lifetime of challenges. Long-term problems include malnourishment, diarrhea, abdominal bloating, and weight loss. Many who suffer from this condition are not able to eat and must be nourished intravenously. Some patients eventually require intestinal and/or liver transplants.
Physicians at Columbia’s Center for Liver and Small Bowel Disease and Transplantation (a sub division of the Center for Hepatobiliary and Abdominal Transplantation) have developed a broad approach to what is often a multisystem disorder. The center offers medical and surgical care plus education and support for patients from infancy through age 18 and their families. Center physicians consider transplantation a last resort. Columbia’s program is one of the largest, most comprehensive, and most successful in the country.
“We are an intestinal rehabilitation center that offers transplant when necessary, but we do everything possible not to perform a small bowel transplant, and the key to avoiding transplant is early referral,” says Steven Lobritto, M.D., associate clinical professor of pediatrics and medicine, interim chief of pediatric gastroenterology, and pediatric medical director for the center. “We encourage smaller medical facilities to refer children before transplant becomes the only option. We can evaluate children, then send them back to their local referring hospital with a comprehensive plan to improve their health.”
Though many short bowel sufferers are nourished by total parenteral nutrition, via an intravenous line, the method can contribute to liver failure. Center physicians, therefore, encourage some oral feeding. If that is not effective, several surgical options are available, including two that elongate the bowel a serial transverse enteroplasty, which lengthens and reshapes a segment of the intestine so it becomes longer and thinner, and the Bianchi procedure, in which the bowel is bisected and one end is sewn to the other.
“These can improve the situation in about 50 to 60 percent of patients, and they can sometimes tolerate food through the mouth better,” says Dr. Lobritto.
When those options are not viable, intestinal and/or liver transplant may be necessary. Dominique Jan, M.D., professor of clinical surgery, was recruited from a large transplant center in Paris. Dr. Jan has performed more than 90 of the approximately 1,300 cases of intestinal transplants that have been performed worldwide, Dr. Lobritto says, adding that transplants are successful in about 75 percent of cases.
The center’s staff reflects the all-encompassing nature of caring for children with short bowel syndrome. In addition to its two surgeons, two hepatologists, three nurse practitioners, and two fellows, it also employs a social worker and a nutritionist.
“What the families of some patients may not realize at the outset is that with this disorder they take on a life-long commitment to interacting with hospitals in a high-tech venture,” Dr. Lobritto says. “That’s why we’re building a service where we have educational support groups and involve the family as a member of the team.”
The Center for Liver and Small Bowel Disease and Transplantation can be reached by contacting Steven J. Lobritto, M.D., at SJL12@columbia.edu or 212-305-3000.
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Weight Loss Center Takes Medical Approach to Treating Obesity
After a lifetime of yo-yo dieting, Maria Barrett’s internist told her in late 1999 that she had sugar in her urine and needed to lose weight.
“This was my introduction to being diabetic, and I had no real help,” Ms. Barrett said, until she saw a nutritionist who recommended Judith Korner, M.D., Ph.D., assistant professor of clinical medicine in the division of endocrinology and director of CUMC’s new Weight Control Center. “The first time I went to see her, she took my history thoroughly, and, when I told her I’d been diagnosed with polycystic ovaries, she explained that some of the side effects of my condition were obesity and insulin resistance.”
Since then, Dr. Korner has helped Ms. Barrett reverse the onset of diabetes, lose and keep off 157 pounds, and incorporate regular physical activity into her busy professional life.
“Though Maria Barrett isn’t a ‘typical’ patient, it is not infrequent that we can identify a medical condition or a medication problem that is contributing to a weight problem,” says Dr. Korner. “We take into account all factors that contribute to weight loss. You can’t just hand someone a diet pill or prescription and expect optimal results.”
Dr. Korner and colleague Michelle Lee, M.D., instructor in clinical medicine, offer patients a complete picture of their health and develop strategies for treating obesity and its associated problems by communicating closely with referring and other treating physicians.
Most of the patients being treated have a body mass index BMI of 30 to 40 and usually have been through several cycles of losing weight and gaining it back. (A BMI of 18.5 to 25 indicates a healthy weight; 25 to 30 is considered overweight, and 30 or higher is obese.) Drs. Korner and Lee have helped even the sickest patients, such as those with heart failure who cannot be placed on a heart transplant list until they have lost weight.
The center also recognizes the unique requirements of obese patients with specialized equipment such as bariatric scales and larger blood pressure cuffs. “The scales in most physicians’ offices only go as high as 300 or 350 pounds, so those who weigh more don’t even know their weight. This way we can properly monitor patients’ progress,” Dr. Korner says. Working with each patient, the doctors form a program that is specific to that person’s needs. In some cases, patients are also referred to a nutritionist or a specialist who focuses on behavioral therapy.
The physicians see about five new patients per week and receive referrals from internal medicine, cardiology, psychiatry, endocrinology, pulmonology, and the Naomi Berrie Diabetes Center. The center also is a site for clinical research that focuses on the regulation of appetite, insulin resistance, and body composition. The physicians also plan to work with pharmaceutical companies by enrolling patients in clinical trials for weight-loss drugs. “Though not many drugs exist currently for obesity, we try to be at the forefront of whatever new therapies are available for these patients,” Dr. Korner says.
The Weight Control Center can be reached at 212-305-5568.