UCLA Clinical Updates Pediatric Epilepsy Surgery While medication can control seizures in the majority of pediatric epilepsy patients, epilepsy surgery remains an underutilized option that can be highly successful in treating carefully selected children with medical-refractory seizures. Learn about the Latest Advances from UCLA High-Intensity Focused Ultrasound for Prostate Cancer UCLA’s Department of Urology offers a new, minimally invasive alternative for treating prostate cancer. HIFU destroys diseased prostate tissue by delivering ultrasound energy, not radiation, to the targeted tissue without the need for an incision. MR-Targeted Biopsy in Prostate-Cancer Diagnosis Targeted MR-guided biopsy via either magnetic resonance-ultrasound (MR-US) fusion or direct MR-guided biopsy is emerging as the best way to detect, grade and stage prostate cancer. UCLA Dementia and Memory Disorders Clinic UCLA Fetal Care Program The UCLA Fetal Care Program provides comprehensive, state-of-the-art screening, monitoring and medical management of high-risk pregnancies before, during and after delivery. With UCLA’s NICU adjacent to labor and delivery, newborns can immediately receive full medical and surgical treatment, while mothers can remain close to their babies. Preserving Childbirth Options in Female Cancer Patients The UCLA Department of Obstetrics and Gynecology includes a team dedicated to counseling reproductive-age patients facing imminent cancer treatment and to devising a plan for fertility preservation. Fertility preservation may also benefit women with other conditions affecting reproduction. California Rehabilitation Institute Link Between Inflammation and Prostate-Cancer Risk UCLA researchers have discovered a previously unrecognized type of progenitor cell that is found in uncommonly high numbers in inflamed areas of the prostate gland. These progenitor cells have the ability to initiate prostate cancer in response to genetic changes. uclahealth.org/increasedrisk UCLA is committed to providing quality care for people with all types of dementia through a rigorous diagnosis protocol, an active and expanding clinical trials program, and a focus on basic and translational research. UCLA General-Surgery Practice Opens in Northridge The UCLA Department of Surgery recently expanded into the San Fernando Valley and opened a new general-surgery practice in Northridge. UCLA Orbital Disease Center The Orbital Disease Center of the UCLA Stein Eye Institute is one of only a handful of institutions in the United States to offer a dedicated orbital-disease center. Integrated Approach for Children with Thyroid Problems UCLA’s Pediatric Thyroid Program is one of the few centers in Southern California that specializes in the diagnosis, treatment and care of children with all types of thyroid problems, including thyroid nodules, thyroid cancer and other thyroid disorders. A partnership among UCLA Health, Cedars-Sinai and Select Medical has created the largest inpatient physical medicine and rehabilitation hospital on the West Coast. News from UCLA Health To download these and other clinical advances at UCLA Health, go to: Antibiotic-Resistant Bacteria Hinders Treatment of Kidney Infections UCLA researchers recommend development of new medications and new guidelines to address the increase in illnesses and deaths linked to medication-resistant bacteria that are making it more difficult to treat pyelonephritis, a common but severe kidney infection that can cause sepsis and death. uclahealth.org/resistantkidneyinfection Drug Shows Promise for Treating Alcoholism UCLA researchers have found that an anti-inflammatory drug primarily used in Japan to treat asthma could help people overcome alcoholism. uclahealth.org/treatingalcoholism uclahealth.org/clinicalupdates New Tuberculosis Therapy Preserving childbirth options in female cancer patients UCLA offers high-intensity focused ultrasound treatment for prostate cancer UCLA Orbital Disease Center offers comprehensive care for eye socket disorders Informing patients of their options Targeted biopsy for prostate cancer A hub of orbital disease expertise Reproductive-age women need to receive timely oncofertility counseling after receiving a diagnosis of cancer, says Zain Al-Safi, MD, a reproductive endocrinologist and assistant clinical professor. UCLA’s expertise in high-intensity focused ultrasound (HIFU) builds on the foundation of its successful targeted prostate biopsy program for diagnosing prostate cancer. “The Orbital Disease Center of the UCLA Stein Eye Institute strives to offer the highest level of care to patients with disorders of the eye socket,” says Daniel Rootman, MD, assistant professor of orbital and ophthalmic plastic surgery. Targeted prostate biopsies employ advanced MRI (magnetic resonance imaging) technology, developed at UCLA, to visualize prostate cancer, then fuses MRIs with real-time ultrasound to guide systematic tissue sampling. “It’s important to counsel these women prior to treatment,” he says. “Research shows that informed decision-making reduces reproductive regret in these patients.” Each year in the United States, about 100,000 reproductive-age women are diagnosed with cancer. In addition to the distress of receiving a cancer diagnosis and anxiety over treatment and survival, these young women often grapple with the unsettling possibility that life-saving treatment may impair future fertility. The field of oncofertility has experienced significant progress over the past decade in addressing the risk of cancer-treatment-related infertility and providing solutions to improve reproductive success. The Department of Obstetrics and Gynecology at UCLA includes a team dedicated to counseling reproductive-age patients facing imminent cancer treatment and devising a plan for fertility preservation. Fertility preservation may also benefit women with other conditions, such as surgeries that may cause damage to the ovaries, risk of premature ovarian failure due to a chromosomal abnormality and genetic mutations that require oophorectomy to reduce the risk of cancer (such as BRCA mutations). Fertility preservation may also be requested by patients who have personal reasons for postponing pregnancy. UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) UCLAHEALTH.ORG Reproductive endocrinologists are sensitive to the patient’s desire to quickly address the threat of cancer and its treatment. Thus, oncofertility consultations are given the highest priority. All members of the patient’s medical team contribute to the decision on whether fertility preservation is possible and which method to pursue, Dr. Al-Safi says. “It’s a team approach,” he says. “We communicate with the oncologist and the surgeon. I want to make sure they agree with the fertility preservation plan and if it is acceptable to slightly delay cancer treatment to allow for fertility preservation. With ovarian stimulation, we would expect increasing estrogen levels. We want to make sure that’s acceptable and would not affect the prognosis. Together, we agree on a treatment plan and proceed with it.” UCLA’s Department of Urology is offering a new, minimally invasive alternative for treating prostate cancer — high-intensity focused ultrasound (HIFU) — which uses sound waves to selectively target and destroy diseased tissue. UCLA participated in the first HIFU clinical trial in the United States in 2009 and was the lead enroller in the multi-center trial, which assessed the effectiveness of HIFU in the treatment of prostate cancer that has recurred following radiation. The results of that trial led to U.S. Food and Drug Administration (FDA) approval in October 2015 of the first clinical use of HIFU in the nation for the ablation of prostate tissue. HIFU has been in clinical use outside the U.S. for over a decade, and has now received regulatory authorization in over 40 countries. Prostate cancer treatment is the technology’s leading application. The FDA previously approved the use of focused ultrasound for treating uterine fibroids in 2004 and for pain from bone metastases in 2012. Targeted and non-invasive HIFU’s chief advantages are its precision and non-invasive nature. It destroys diseased prostate tissue by delivering ultrasound energy, not radiation, to the targeted tissue without the need for an incision. The sound waves are transmitted through the UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) 1-844-4UCLADR (1-844-482-5237) Before MRI, doctors could not see the location of prostate cancer and had to perform biopsies essentially “blind.” Using the image-fusion technology, UCLA biomedical engineers create virtual 3D models as road maps to guide urologists directly to the suspect spot — which often results in the urologists finding tumors missed by conventional prostate biopsy. The same software is used in the targeted biopsy program and the HIFU technology, strengthening UCLA’s experience with the new treatment option. “Our goal, both in diagnosis and in treatment, is individualized treatment and localization of any cancerous tissue,” says Leonard S. Marks, MD, professor of urology and the Jean B. deKernion, MD, Chair in Urology. “This is true precision medicine at work.” “The treatment team performs procedures that are not usually available in the community, including orbital decompression microsurgery, vascular tumor management and reconstruction to address traumatic or congenital defects. The Center also has an active program for patients with Graves’ disease and is conducting outcomes research to evaluate new surgical techniques. The orbit or eye socket is the small, bony cavity in the skull that houses the eye and surrounding structures including the muscles that move the eye, the lacrimal (tear) glands and the bones of the skull that protect the eye. Diseases of the orbit range from minor discomforts to life-threatening conditions and can arise from within the socket itself or as part of a systemic illness affecting multiple organs. Orbital-disease symptoms can include eyeball protrusion, pain, double vision, loss of vision and numbness around the eye. The Orbital Disease Center of the UCLA Stein Eye Institute has been a leader since 1992 in the treatment and study of orbital disease arising from inflammation, cancer, infection and trauma. UCLA is one of only a handful of institutions to offer a dedicated orbital-disease center. Management of orbital diseases Mild cases of orbital disease can often be managed conservatively with artificial tears or lubricating ophthalmic ointment, or with no therapy at all. Treatment of more severe cases may involve corticosteroid medications, external-beam radiation or a combination of treatments. Not infrequently, surgical intervention is indicated. UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) “Having seen as many of this group of patients as any orbital center in the world, UCLA receives referrals and requests for second opinions from around the globe,” says Dr. Rootman. “The more complicated the case, the more likely an individual is to end up here and the more privileged we feel to be able to work with these patients.” Taking a new approach toward tuberculosis therapy, a UCLA-led research team has devised a potential drug regimen that could cut the treatment time by up to 75 percent, while simultaneously reducing the risk that patients could develop drug-resistant TB. uclahealth.org/tbtherapy