Mending a Broken Heart Skilled surgeons and an ingenious tool work together to repair young hearts.
		Select text to jump ahead in the clip: When your whole body was no bigger than this and before your mother even realized she was pregnant your heart began to beat even though it was no more than a tiny crooked tube. With luck and a little care and attention it should beat 2½ billion times before it eventually gives out. For many of us, though just as the heart was the first organ to go to work it's also the first to fail us. In the next hour we're going to see some broken hearts get mended and find out how to keep them from breaking too young. We're starting here at Boston's Children's Hospital with a heart that's still an infant's and that only a few years ago might never have grown older. Zachary's heart problem was diagnosed before he was born. WOMAN: We first found out that he had some cardiac issues on a routine ultrasound on February 19, 1998. Basically, his heart looks like it was put together in a kindergarten art class. ALDA: Zach's heart started to go wrong just a few weeks after he was conceived. Instead of forming two main pumping chambers-- one pushing blood to his body, the other to his lungs-- his heart formed only one. He's still alive today because of two operations that have replumbed his heart allowing its single chamber to keep blood flowing throughout his body. MOTHER: That was good! You got it in there! The first surgery he had got him till he was five months old. At that point, we had to have the next surgery or he wouldn't have lived much longer. And that surgery, which he's under right now would probably allow him to live until he was four or five, six or seven years old but not much longer than that because his body's going to outgrow this procedure. And this procedure's going to get him until he's an old man. ALDA: So for the third time in his young life Zach is prepared for open-heart surgery. The operation he's about to have here at Children's Hospital in Boston is called the Fontan procedure. In a normal heart blood that is pumped around the body by the left ventricle arrives back at the right ventricle to be pumped to the lungs. But in Zach's heart, there is no right ventricle. So to get blood to the lungs a new route has to be built-- and that's what the Fontan does-- it creates a tunnel for the returning blood that burrows straight through the heart. Now, a single heartbeat can push blood around the body through the tunnel and on to the lungs. SURGEON: You all set there, Bob? Let's go on. ALDA: The operation begins when a heart-lung machine takes over from Zach's own heart. DOCTOR: Now the heart is stopped right now and is not getting any blood. So that's why we need to move along at this part of the operation. ALDA: Surgeon Richard Jonas has performed scores of Fontan procedures-- perfecting his tailoring as well as his surgical skills. JONAS: Now we're going to shape this Gore-tex patch... ALDA: With Zach's heart cut open Jonas starts to sew the patch of cloth along its inner wall. We've got to think about how this is going to be folded over in a minute. When you fold it over, is that... It's going to make a tunnel, yeah. That's how it becomes a tunnel. Yeah, so this is the bottom end of the tunnel starting to take shape now. ALAN: I can't quite tell why it isn't in the shape of a tunnel when you put it in. Why do you have to sew it into the shape of a tunnel? JONAS: I guess it's not really possible for manufacturers to pre-form something for us since every child is a different shape and size so we really do have to custom-build components to fit into an individual child. It really is sort of tailor-made specifically for a child's situation. Okay, well at this point we're going to make the fenestration. ALDA: With the cloth sewn in place Jonas uses a punch to makes a small hole-- called a fenestration-- in the side of the tunnel. Creating a deliberate leak like this seems strange right now but in the days to come this little hole is to play a critical role in saving Zach's life. But for the moment, there's no hint of trouble. After being stilled for 90 minutes Zach's heart is slowly stirring back to life. JONAS: As the heart starts to get that warm blood it will gradually start to beat. You can see the first blip-- the top line there is the EKG. There's a beat there. There's another one. There's another one. Yep, there we go. ALDA: Twenty minutes later Zach's rebuilt heart is beating vigorously. We're going to be off the heart- lung machine in about a minute. ALDA: Zach's single ventricle is now able to pump blood around his body and through his lungs almost like a normal heart. But it's about to face perhaps its greatest challenge-- getting Zach through the critical few days following surgery. As it turns out his rebuilt heart comes close to being overwhelmed by a simple cold. ALDA: How is Zach doing now? He's had one complication following the surgery which is he developed a lung infection. It's the... And that made it hard for the heart if he hadn't had the fenestration? It makes it hard for blood to go through the lungs and in this adjustment period after the Fontan without the fenestration, he could have gotten very sick. He could have been, oh... stuck on a ventilator for a long time. And we've had children who've had a Fontan operation and this kind of lung infection who have died. So the fenestration... The fenestration was vital. I think so. ( coughing ) ALDA: Zach's cold lingers for days but it never becomes life-threatening thanks to the fenestration. Here's why: His infection is making it hard for blood to flow through his lungs, so hard that his heart may simply have been forced to a halt. But by allowing the backed-up blood to spill out into the heart's main chamber the fenestration is relieving the pressure and allowing his heart to keep pumping. Of course, not all his blood is now going through his lungs so it has a little less oxygen than it should-- it's a little bluer. But right now, that's a small price to pay. MAN: This infection is exactly the kind of situation-- if he didn't have a Fontan fenestration-- would have resulted in a very high mortality rate. It's not unlikely he wouldn't have made it if he didn't have a fenestration. So the fenestration probably saved his life. Now he has lived through this... this cold which could have been fatal, possibly. Now there comes a point where you want to close that hole eventually, right? Why do you need to close the hole? Because children can tolerate being blue pretty well for a period of time. But it's not well tolerated life-long. And so if we left that hole open eventually he would suffer complications from being blue. So that's why you've got to close it and that's why you invented this? ALDA: "This" is a deceptively simple little device that closes holes in hearts without surgery. LOCK: And the whole thing now folds up into something quite small. When I was a kid I used to do amateur magic and that's how you fold flowers that appear out of nowhere. You're kidding. Yeah, the whole bouquet. You just fold it up like that and you could get it into a small space like that. ALDA: The small space in this case is the tip of a catheter. LOCK: That's what goes inside the body. And we thread it up through a vein in the leg and up into the heart, and we watch it under an X ray fluoroscopic machine and we know where the hole is. And let's pretend that this is the hole here. ALDA: Like my magic flowers-- or a tiny umbrella-- the device springs open. LOCK: See it snap? Yeah. Then I pull it back like this pushing it back... like that. Wow. ALDA: This is nine-year-old Josh. He's lived with a fenestration for six years now-- and it's time to close it. The doctor was telling us it's kind of like a fine-tuning-- they got to tune him up before they send him out. ALDA: Josh's blueness is visible in his lips and fingernails. LOCK: The drill in a patient with a Fontan circulation is to give them the best possible circulation for the rest of their life because it's a little bit tenuous-- they only have one ventricle. And what we need to do is to optimize that circulation you know, so that they can be pretty asymptomatic and be very productive citizens into their 40s and 50s and pay taxes. ALDA: Josh's tune-up will all be done through a tiny hole in his groin. Okay, let's take this picture just like this, guys. Inject. ALDA: Injecting a liquid that shows up black on the fluoroscope reveals Josh's blood vessels including the pulmonary artery taking blood to his lungs. LOCK: So you notice the diameter here is probably seven millimeters and it drops to four millimeters and then it goes to nine millimeters. That's not a very severe obstruction-- it's really only mild-- and if he had a normal circulation, we'd ignore it. ALDA: But since Josh's heart already has a hard enough time pumping blood to his lungs Jim Lock plans to use this metal coil-- called a stent-- to open up the constriction. LOCK: He's going to hold this with his beefy fist... so that it don't move. And with my thin, delicate fingers I'm going to push it up. See it there? Coming in... coming in, coming in... Okay. Blow the little balloon up for me. Right, now slowly... ALDA: A balloon inflated within the stent expands it to permanently hold open the route from the heart to the lungs. LOCK: Okay, so this should be very close to perfect. ALDA: Now it's time to close the fenestration. The twin umbrellas are loaded into their catheter and threaded up into Josh's heart. LOCK: Let go of the wire. ALDA: The tunnel and its hole are invisible in this picture but the first umbrella's arms are unfolding on the outside of the hole. LOCK: It's fully open. ALDA: Then the second umbrella is released. LOCK: We're going to take a picture now with all eight arms open-- one on the left side and one on the right side-- and make sure it's in the right place. You ready, guy? Inject. ALDA: Now the tunnel is visible on the left side of the picture. Some blood is leaking past the umbrellas but that's because their cloth mesh is still porous. In the coming months Josh's cells will grow into the mesh, sealing the hole tight. The final act is to release the catheter leaving the umbrellas behind. LOCK: And there it is! NURSE: It's all done, okay? You're in the recovery room. It's all over, all right? ALDA: Josh's blood oxygen-- which for years has been at 70%-- has jumped to the mid-90s. Hey, big guy, how'd you do? ALDA: Just minutes after the procedure and already Josh's lips and nails are pinker. He's pink! For the first time. Look's good-- a little dirty, but good. ( both chuckling ) ALDA: For Josh and his parents nine years of living with his broken heart are almost over. The odds are good that his rebuilt heart will now allow him a normal life. Meanwhile, Zachary is home in Texas having fun. One day, his fenestration will also need closing. The fact that it can be now done with Jim Lock's little folding umbrellas means that, like Josh, a tune-up is all he'll need for his heart to take him into ripe old age. Jim Wenzell flies planes for a living or, at least, he used to before his airline grounded him when he was diagnosed

				Robot Heart Surgeon Tiny robotic instruments replace doctors' hands and make surgery less invasive.
		Select text to jump ahead in the clip: with a dangerously narrowed coronary artery. Today he's at the Ohio State University Medical Center where he's about to be operated on by a robot. Jim Wenzell is one of the first patients in the United States to benefit from a technology that promises to revolutionize surgery yet whose origins can be traced back to a now distant war. ( theme from MASH playing ) It was a war that also formed the background for a television series. MASH was set in a mobile army surgical hospital during the conflict in Korea. The real MASH units represented a major breakthrough in battlefield medicine. Before the early 1950s and the helicopter many soldiers wounded in battle didn't survive simply because they couldn't be treated by a trained surgeon quickly enough. Fast-forward to the 21st century as viewed through a promotional video made for the Pentagon's Advanced Research Projects Agency. WOMAN: Med MASH check. ALDA: In the mid-1990s, the goal of a research program aimed at bringing new technology to battlefield medicine was to shorten still further the time between a soldier's being wounded and getting expert medical attention. Five years ago, we visited a mobile surgical unit parked in peaceful Palo Alto, California. If this person had been wounded in the battlefield and he happened to be lucky enough to have a surgeon here... What's wrong with him? ALDA: Jon Bowersox, himself a surgeon was working with a team of scientists and engineers on a way to project his expertise into the battle zone while he remains miles away. BOWERSOX: What it looks like is there's about an inch-long hole in the small intestine. If we didn't treat that, what would happen is the casualty would develop a severe infection and die in a relatively short period of time. So what's needed to take care of this is emergency repair of the intestinal injury. ALDA: These were actually pig intestines from a local butcher's shop. Poised above them was a pair of mechanical hands. What do these things do? How do they... They get right down in the wound? This is the machinery? As you'll see... Why don't we move them into position here if you'd just move our position control. That's this red button? It is. ( machine whirring ) Stop, please. Good. So as you can see, just like the surgeon's hands they're placed right over the site of the wounding and these are instruments that the surgeon normally uses. ALDA: The armored operating room was connected to this tent by a cable. But the plan was for a wireless link so that O. R. and surgeon could be many miles apart. So this is a surgeon's workstation. Instead of being at the patient's side in the normal operating room I put on these polarized glasses that give me 3-D vision. Instead of talking directly to my assistant I put on a pair of stereo headphones. And instead of picking up the actual surgical instrument handles I put my hands in the half of them that are attached to the console. And now it's like being at the patient's side. ALDA: Jon was seeing a 3-D version of the image shown in the monitor that I was watching. How much like the real experience is it when you were over there? Well, I think the most telling thing is every surgeon that's used the system after working with it for about 15 or 20 minutes will move their hand out of the instrument handle and try to push bowel out of the way. It's getting in the way. ALDA: Jon appeared to be as dexterous with the remote instruments as he was with the normal ones-- aided as he would be in a regular operation by a skilled assistant. Jon could see Michelle in a small monitor in his workstation and together they speedily repaired the wound. BOWERSOX: As you can see now, I am able to tie the knots in the suture just as if we were in the actual operating room. So would you like to have a go at this? ALDA: Uh, yeah. Let me try. I can't wait. This is going to be the first time I've ever done this. ALDA: Despite years of doing fake operations in a fictional MASH unit, this was the first time I'd tried anything like the real thing. And you need a pair of glasses. Right, okay. ALDA: Fortunately, it wasn't the real thing. ALDA: Oh, oh, my God! Oh, wait a minute. ( crew laughing ) I'm terribly sorry. I banged into the instrument and jammed it into the guy's intestines. ALDA ( over monitor ): Now, Michelle, control yourself. Snip, snip, okay. MICHELLE ( over monitor ): Alan? You're ruining my image of you as Hawkeye, you know that. ALDA ( over monitor ): I am not a real doctor, I just play one on TV. ( laughing ) ALDA: Now, I need to pick this side up. MICHELLE: Yeah, pick it up, right where you are. Okay. Now... have I got it? Um... Okay. ALDA: Okay... oh, okay, it went through. Do I have too little of it? No, that's just fine. Oh, pull it with this? Yes. Oh, I see, I see, pull it with the right hand, okay. And I can sort of ease this down with the left hand. Grab the tissue. Pull it out. ALDA: I was just one of many visitors to the Pentagon-funded project who got to try it out for themselves. ALDA: There, I did it. Yes, you did great. I made a stitch, but the poor guy-- I mean, he's going to have cramps from that stitch. ALDA: Another visitor to the project in the mid-1990s was an entrepreneur who saw in the system the answer to a surgeon's dream-- the ability to operate right inside a patient with a pair of miniaturized hands-- to project their hands not so much across space as down into the patient's body. And it's this idea that five years later is being tested here at Ohio State University-- as a camera plunges through the chest wall of the coronary bypass patient. MAN: That's the heart beating. And we're looking at the chest wall and there's the artery that we want. The artery... that particular artery runs up underneath the breastbone along the ribs. We plan on using that artery. It's a little blue streak there. ALDA: The plan is to free the artery from the chest wall and sew it onto the patient's coronary artery just beyond the blockage. This approach to coronary bypasses is becoming increasingly common. What's different here is that the job of harvesting the chest artery will be done by a pair of robot hands. While operating, my hands... all that motion will be transferred to this miniature hand, if you will, inside the chest. This is the working end of the system. If you think about it, why do we make big incisions? We're working on small arteries, we're using tiny suture. Because our hands are large-- that's why we make big incisions. And what this system allows us to do is feel like our hands are inside the chest but we haven't made the big incision. The first thing I do is, I take off my shoes. So I'll be using both feet and both hands. So I take off my shoes and then pull up to the screen. You can see that it's binocular vision. We're going to activate this now. ALDA: Randy Wolf's workstation is the commercialized version of the one I checked out five years ago. The controls for moving the instruments are now much more sophisticated. WOLF: When I turn my left hand like this, it does it. When I pinch my fingers together this pinches together. It feels very natural. I pinch, I let go. I turn right, I turn left. Any angle my wrist makes, it makes at the tip. And this is very helpful in sewing vessels, like this. You grab a suture, you can run it like this. I'll give you a more panoramic view. Any wrist motion is replicated. ALDA: As Randy moves his hands at the controls across the operating room, his actions are mirrored by the arms of a robot inside the patient's chest. WOLF: The vessel is in this tissue right here. So I'm very gingerly, or gently, pulling down on it to open that up. And the first rib, the highest rib, is right here. Rib number one... number two here... number three here... number four here. MAN: This is, in simple terms, fun. It's fun because it allows us to do something that we love doing which is heart surgery but allows us to do it in a manner that is creative in a manner that we think is going to benefit the patient by producing less trauma. MICHLER: Okay, we're finished with mobilization. Note the time. So an hour-- exactly an hour and 30 minutes. Okay? All right? Now that's long for us but again, we were working under more unusual circumstances than usual. You didn't say extenuating, did you? ( laughing ) We were working under friendly fire. ALDA: With the chest artery freed the next job is to clip it so that it can be safely severed. Robert Michler inserts the instrument holding the clip. MICHLER: How about right there? ALDA: The clips will seal the artery until it can be sewn to the coronary. MICHLER: We'll give you scissors to divide it. Okay? WOLF: Yep. That looks good, don't you think? Yep. Let's have the scissors back. There it is. See the artery? That tube? So that's what we're going to sew onto the surface of the heart. ALDA: At this point in the operation, the robot's job is over. Right now, the Ohio State team has the F. D.A.'s permission only to harvest the artery with the robot. Sewing it on to the heart still has to be done by hand. In the next phase of the trial even this attachment of the artery to the coronary will be done by the robot. MICHLER: The whole sewing onto the heart took us about ten minutes to perform. So once we have developed the technology with the robot to the point where we can take the artery off of the chest wall in ten or 20 minutes it could shorten this operation dramatically from the several hours to really under an hour. ALDA: As well as being far less traumatic for the patient the robot system could also make a big difference in the way surgeons learn new techniques. Right now, Randy Wolf spends a lot of time on the road training surgeons in the new technology. But that will change. WOLF: Let's say a Japanese surgeon wants to learn this system and they've got their first case, they want me to help them I don't have to fly to Japan. We can go Internet 2, we can bring the image up we can hook up my system to their system and I can mentor them, tele-mentor them while I'm sitting here at Ohio State University in Columbus, Ohio and they may be in Tokyo, Japan. I'll get a lot less frequent-flyer miles but I think I'll live longer. ALDA: The next step for the robot surgeon here at Ohio State is to do a complete coronary bypass operation-- something Randy Wolf has already done with a robot in Germany. Following that, there are still more ambitious possibilities including doing heart surgery inside an unborn child. WOLF: What's exciting to me is it's all imagination. You really need to act like a little kid with this technology and use your imagination, because that's the only limit. ALDA:

				The Heart Factory In the quest for the most reliable artificial heart, one device offers hope.
		Select text to jump ahead in the clip: This is the story of a 20-year effort to develop an artificial heart. Luckily, for one of the players in this volleyball game it was an effort that began to hit its stride in the early 1990s. Today the attempt to build a permanent artificial substitute for a failing heart may be on the brink of success. Whoa! That's it! ALDA: Back in 1993, Mike Dorsey's heart was so diseased that he was on the brink of death. DORSEY: I was very sick. If I'd have walked from here to you I'd have been out of breath for that time. You know, I couldn't do nothing. It gets a little frustrating when your wife comes and takes things from you, you know and you can't carry them, you know. She would take them and carry them in for me. I wanted to do it, but just wasn't able to do it. ALDA: Mike Dorsey was rescued from death by a pump implanted under his own heart that helped propel blood around his body. It was almost 12 years earlier that the artificial heart first hit the world's headlines. But Barney Clarke's brave struggle to live and his death after four months cooled the early enthusiasm for his artificial heart-- the Jarvick-7. After a few more unsuccessful implants the device was abandoned. But research on mechanical hearts continued. The most promising were pumps that weren't intended to replace the heart but boost it. One of them was called the Heartmate. The designers of the Heartmate took a novel approach to a major problem of the Jarvick-7: blood clots that would form inside of it and that could kill when they broke off and traveled to the lungs or brain. The Heartmate's interior was roughened so that a thin layer of blood clots over its entire surface and sticks there firmly. Mike Dorsey's problem-- one that he shares with thousands of others each year-- was a weakening of his heart muscles so that the main pumping chamber, the left ventricle could no longer pump blood around his body. Installing the Heartmate begins with cutting a hole in the left ventricle and sewing in a short tube. Then the electric pump itself is implanted in the upper abdomen. Blood flows from the heart through the pump then back to the patient's aorta. By February 1993, Mike Dorsey's heart was near total failure. His doctors estimated he had just hours to live. Only weeks before, the Heartmate had been approved by the Food and Drug Administration for use at Fairfax Hospital in Virginia to keep a dying patient alive until a heart transplant could be found. The operation began with sewing into Mike's left ventricle the tube that connected with the pump. Then the Heartmate itself was slid into place. The connection was made between the pump and the heart it would assist. Finally, the pump's outflow tube was plumbed into Mike's aorta. The pump was switched on. And at this point, no one knew for how long it would need to keep pumping. Right now this device is approved by the Federal Drug Administration as a bridging device-- that is, as a temporary bridge to help a otherwise dying patient to make it to heart transplantation. We're hoping that its long-term role will be much greater than that and that actually serve as a substitute for heart transplantation. ALDA: Powered by batteries and controlled by a small computer at Mike's waist the Heartmate clearly had the potential to be an alternative to heart transplantation. Seven months after the operation it was still working fine and Mike was still waiting for a transplant. The hospital exercise room had become only too familiar. DORSEY: It's not really me. I'd rather be moving where I have a destination to go to instead of standing in one spot, looking at the same old scenery. This is the battery charger here. In order to be more mobile, I take two batteries-- these-- and just connect the power source from here. ( bell ringing ) ALDA: That's the alarm that went off if there was ever a problem. If you do not have it right, they do not go. You just drop them into the pouch like this fold the flap down. Now I'm ready for traveling. ALDA: Mike's traveling was confined to the hospital where he'd become a familiar figure. Hi, Michael. ( phone ringing ) Transplant Center. ALDA: To pass the time and make himself useful Mike helped out in the transplant center. He became an invaluable source of knowledge, advice and reassurance for other heart patients-- especially those who might also need transplants. I've been here since January 27th. Six months... seven months already? Yeah. Have you been out yet, been outside the hospital? Haven't left the grounds. I've threatened to, but I haven't left yet. DORSEY: The staff, the nurses and everything have been great but it's almost like being in prison. I mean, you got to ask permission to do this and do that, you know, instead of... I can't just go outside my door and outside and get a breath of fresh air without asking first and stuff like that. It's the little things you miss in life. He was desperately ill and dying when we put the device in. The unit has allowed him to recover so that he feels well, perfectly well now-- completely different then when he entered the hospital and, of course, he feels like he shouldn't be in the hospital. ALDA: But the care and maintenance of the systems that kept Mike alive meant that leaving the hospital even for a short trip, was a very big deal. A lot of things could have gone wrong. This tube down here is for the vent line so the... allows the pump to breathe... in and out. The circle around, up here and this little sock on here filters it. And you can feel the air coming in and out. ALDA: The pump sucked air in and out with every beat and if the air tube became blocked, the pump would slow and eventually stop. ( mechanical beeping ) So one night I had rolled over on this side and it had got kinked over like that and I'm looking at the screen up here and the numbers start dropping down and I'm wondering what's going on and all of a sudden, the alarm went off. And, you know, as soon as I sat up, the alarm stopped. Mike, we're going to go over... ALDA: But the air tube could also be a lifeline-- offering the hope of at least a brief break from the hospital. This hand pump could be connected to Mike's air tube and it would keep the Heartmate pumping blood even if its power supply or computer control failed-- which is what happened unexpectedly during a routine check. ( alarm ringing ) You're all right-- go ahead. ( alarm still sounding ) How are you feeling, Mike? Okay. ALDA: During the five or six minutes it took to figure out the problem-- a loose connection-- Mike's artificial heart was kept beating with the hand pump. Oh, just another day here, I guess, to me. ALDA: As long as the hand pump went everywhere he went Mike had at least partial freedom and he was able to stroll the hospital grounds. Mike was one of the first of what has become several hundred patients whose lives have been extended by the Heartmate while on the waiting list for a human heart. DORSEY: You got to look at it both ways. Unfortunately, somebody's got to pass away in order for you to have a donor. You know, and... I'm not going to wish that on anybody but at the same time, I would like to be transplanted and released, too. ALDA: Mike's first taste of freedom came with a short trip with his family-- along with plenty of medical backup. Too cumbersome to itself be a permanent solution the Heartmate was an important bridge not only for those like Mike awaiting human hearts but also to the future of mechanical alternatives. Mike got his heart transplant only three weeks after this trip and seven years later, he's still alive and well. Meanwhile, the Heartmate itself has been reborn and it's now small and efficient enough so that it could soon be a practical alternative to heart transplantation. Like its predecessor, however, the Heartmate II is designed to assist a failing heart-- not substitute for it. But these chambers are incubating a device that is intended not just to help a heart but to replace it entirely. We visited the factory where mechanical hearts are being manufactured by the hundred just a few months before the first one was scheduled to be implanted in a human patient. The Abiomed artificial heart is modeled on the human one with two main pumping chambers and valves to control blood flow. ALDA: As the blood goes through there it pushes its way through but it can't come back the other way, right? MAN: Correct. Can that be relied on after it pumps thousands of times after you pass through after it flexes thousands of times to maintain that same resiliency? The answer is yes and it's not thousands of times. It's approximately 100,000 times per day. Oh, boy! Which is close to 40 million times per year. 40 million times? You can flex this material 40 million times... Without it breaking. Not only breaking, but just weakening and softening and fluttering and that kind of thing. Correct. So this is where you test the valves? Yes, this is where we test. We have many, many valves under test. And we test them under very severe conditions and at an accelerated rate so we can demonstrate 20 years equivalency in one year. ALDA: Just like its rival, the Heartmate, the Abiomed heart is designed to avoid the danger of blood clots forming inside. But while the Heartmate has a deliberately roughened interior surface the Abiomed heart aims to be completely smooth and seamless. Clotting is also avoided by swirling the blood-- simulated here by fish scales in water-- so that it doesn't pool anywhere inside the pump. But it's not until I get to hold the heart while it's pumping that I really appreciate how powerful it has to be to substitute for a human heart. I can really feel the beating. Now, interestingly, when you see a heart pumping the outside of the heart is going like that-- you see motion on the outside. Here, all the motion is inside this device. I've held onto this heart long enough. Would you mind holding that for a day or two? So right now I'm going to take away the skin. ALDA: This is a C. T. scan of a potential patient. Converted to computer graphics the patient's body can be stripped of its major organs-- including most of the diseased heart. Then a technician at Abiomed can insert a virtual artificial heart into the virtual patient helping the surgeon plan how best to fit the heart to the real patient during the operation. The Abiomed heart gets its power from rechargeable batteries that transmit their energy through the skin-- avoiding the tubes and wires that so plagued Mike Dorsey seven years ago. As well as being tested in tanks the entire system-- heart and power supply-- has been implanted in cows. LEDERMAN: Through the telephone lines we're dialing into one of our implanted cows somewhere in the United States. This one happens to be in Kentucky. And it's standing near a window? What does that mean? This means there are several cows and one happens to be near the window so we're monitoring... So it's literally near the window. We haven't given them a name yet, so... Now, this is fascinating. So you're going to see now information coming in from a particular cow whose using one of these artificial hearts. And there it is. ALDA: Similar real-time data from the artificial heart will also be gathered from the first human patients. ALDA: How do they get a signal that something's going wrong? They're having dinner and all of a sudden they get a phone call from you and you say, "Lie down immediately"? What happens? My first comment to you with regard to that question is wouldn't it be nice if we could do that with our natural heart? Yes, it would, yeah. It would be very nice if we could have remote monitoring of our hearts. If anything goes wrong we would have an alert that tells us "Gee, we can fix it, just get to the hospital. " Now, how do you do that? We have cell phone technology, so the patient has a cell phone. Now we can call the patient and say, "You know, the output of your heart "is not quite what we think it ought to be so why don't you come back to the hospital? " ALDA: During our filming, Abiomed was already manufacturing hearts ready for implantation-- and was opening a new plant to scale up production further. Meanwhile, five medical teams in hospitals around the country are on standby awaiting only approval from the F. D.A. before one of the teams implants the first of these hearts in a human patient. ALDA: Are you going to be extending a lot of people's lives because now they'll be able to have an artificial heart? We hope, yes. The fact is that 2,000 years ago the average life span was 30 years and a hundred years ago, the average lifetime was 47 years and today, the average lifetime is 75 years. And there are a large number of people who reach 75 and beyond who are neurologically intact, who are very productive and the only thing that is wrong is a hip which we replace today, or a muscle like the heart which we should be able to replace. And there is no reason why the end of life should come prematurely. And it doesn't matter what the age. You can be 80 or 90-- if you are productive, you should be able to live longer. ALDA: Twenty miles west of Boston is a town whose chief claim to fame was once that it housed the world's first shopping mall.

				How's Your Heart? Thanks to a Massachusetts town, science now knows how to keep hearts healthy.
		Select text to jump ahead in the clip: But today it can claim another honor: that collectively its inhabitants have saved more lives-- running perhaps into the millions-- than any other group of ordinary citizens in the world. The town is Framingham. Just over 50 years ago, 5,000 of its people signed up for what became known as the Framingham Heart Study. ( heart monitor beeping ) Year after year, those 5,000 have allowed themselves to be hooked up to machines that monitored anything and everything that might conceivably have a connection with heart disease. Over the years, they've even recruited a few guests. MAN: Your blood pressure and heart rate are normal. They're responding in a very normal way to the exercise. You look extremely comfortable and you're not having any symptoms. There are some people that we put through here who do develop symptoms even just during this minor amount of effort. ALDA: The data from all those thousands upon thousands of tests are stashed away in the basement. Here are the medical records of both the original 5,000 participants as well as the records of a second generation-- another 5,000, who are the sons and daughters of the first volunteers. ALDA: You can find the very first person who was a participant in the study? Sure. ALDA ( laughing ): This is like a James Bond movie. This is participant number 0001. How old was this person when the study began? She was about 30 when the study began and she died about 30 years after that. We're able by going back to look at the relationship between blood pressure or cholesterol or smoking habit and risk for developing cardiovascular disease over time. How often did she come in for a round of tests? The original 5,000 participants were brought back every two years. In fact, right now we're in the midst of our 25th cycle of exams on the original study participants. And about 80% of our original participants have died. 20% though are still alive. I was only 39. I was working for Eric Sloan, the car dealer. But I was raising my children she and I, Lorraine. ALDA: You were only 32 when it started? We've been going over 50 years now. Yeah, been going over 50 years. And we've been going every two years, for exams. And has that been a bother for you? JOSEPH: No, it's great-- I love it. You get used to it. We had a $500 exam for nothing. You know what he says, "I feel great when I go in there and they always find something. " ALDA: We're having lunch with the Pavia family. From them and the others in the study we've learned most of what we know about the risk factors for heart disease-- things like high blood pressure, cholesterol, smoking. Indeed, the very term "risk factors" comes from the Framingham study. Half the men and women watching this program are going to die from some kind of a vascular disease in the United States. ALDA: Bill Castelli ran the Heart Program for over 15 years, from 1979 to 1995. CASTELLI: The average person who's, you know at a risk to get a heart attack feels fine until the day they actually get the heart attack and then they learn too late. Well, I guess that's what so important about having figured out that there are such things as risk factors because the risk factors are the ones that can tell you before you ever have a sign that you have a problem. That's right. See, if the motor's going good you're not going to look under the hood. Exactly. Mr. Alda, I'm going to tell you about this test. I'm going to inflate this blood pressure cuff for five minutes, and... ALDA: The Heart Study is always on the lookout for new and better predictors of trouble ahead. One of the latest candidates has Birgitta Lehman checking out the springiness of the artery in my arm-- a process which appears to involve first putting my arm to sleep by choking off its blood supply. ( laughing ) Why do you put that cloth there-- to help my arm go to sleep-- what is it? Somehow it reminds people that they shouldn't move it because they feel it if they start moving their fingers they feel that they are moving it because it has... a towel effect. Just my own invention. Very good. A little thing like that, you see? A simple invention like that will save millions of lives eventually. So let me find your brachial artery. There, you have a beautiful artery. You don't see any bumps or any white stuff. It's just as clear and smooth as I've ever seen it. I'm going to inflate the cuff now, on your arm. It's going to be very, very tight and it happens very, very suddenly. Right... now. That sudden enough? That was pretty sudden, yeah. ALDA: After about five minutes of pins and needles... I'm going to release the cuff. ( machine clicks ) ( rhythmic whooshing ) You hear that? That's a great return. That's a great blood flow. It was like opening up a dam when I released the cuff and the blood was just rushing forward. With very thick arteries... there's almost no change. There's almost no change. It takes so long for these stiff, stiff arteries to bounce... open that maybe takes them two to three minutes. So I don't get that... ( imitates hissing ) sound. ALDA: Another test being explored in the Framingham Heart Study is a little more elaborate but its goal is the same-- to find early warning signs of cardiovascular disease long before there are any symptoms. This magnetic resonance machine is at Beth Israel Deaconess Medical Center in Boston. Happily, they provide music. ¶ Bom-bom, bom-bom, bom-bom-bom... ¶ MAN: We are going to start your first scan. It lasts for about a minute. ALDA ( over speaker ): Okay. MAN: Okay, Mr. Alda, take a breath in... blow it out... and hold it, don't breathe. ALDA: While I hold my breath the machine is making snapshots of my heart and chest. By taking pictures repeatedly as the heart is at different points of its beat over time, the computer can build up a movie of the heart in motion. MAN: Well, first we have good news. Everything looks very normal. ALDA: What do you mean, first you have good news? Is there going to be bad news later? ( laughing ): No, no, everything looks very good. These are some images we first took of your heart. And if this is your breastbone we have your heart contracting right here. And this is the front part of your heart and you can see it's contracting vigorously and the heart is the gray part and the blood inside your heart is this white cavity right here. And you can see that all the walls-- this is the bottom part of your heart-- are contracting vigorously squeezing, squeezing, squeezing. That all looks very good. These are some images of your aorta... ALDA: It was fun seeing my heart beating but the real goal of the test is to get an image of my aorta the big artery that carries blood from my heart to the lower half of my body. MANNING: This is your aorta, it's a nice black tube. And you can see that the thin white line surrounding the aorta is normal vessel wall. We don't see any plaques; looks very nice. ALDA: My aorta looks so good I'm going to start sending this picture out instead of an 8 x 10. ( Manning laughing ) It's really nice. We can give you a picture of it if you like. Yeah, that'll be great, you know because I believe it's what's inside that counts, you know? ALDA: In contrast to my impeccable aorta this one has a visible buildup of plaque-- which while it's unlikely to cause problems itself could be a warning sign that plaque is building up in more vulnerable blood vessels-- like the coronary arteries of the heart itself. When the day comes that we'll use this for screening the whole population-- if that day comes-- not only will you be able to tell me I'm liable to develop symptoms soon but you can use this picture to actually design a drug therapy that's just right for me? That's our long-term hope. For example, today we know that if your cholesterol is high that we should treat you. We should treat all people who have high cholesterol. But it may be that we find from studies like the one going on in Framingham that if your cholesterol is high but you don't have any plaque on your M. R. that we don't have to be as aggressive. Just diet therapy alone without taking pills is sufficient. Similarly we know that some people with low cholesterol still have heart attacks, still have strokes. It may be that those people actually have plaques in the aorta and it's not the cholesterol we should be monitoring but actually the plaques themselves. ALDA: In an even more ambitious project Warren Manning-- as well as many other researchers-- is working on an M. R. technique to visualize directly the coronary arteries themselves. So what do you think, do you think someday this is going to be so predictive that we'll be crazy if we don't regularly get an M. R.I.? I hope so-- I think at some point people will blow out the birthday candles when they reach 40 or 50 and say, "It's time to have a screening M. R." That day is not here today but I believe it will be here in the future. ALDA: Bill Castelli, who headed the Heart Study for over 15 years now runs a clinic to motivate people to change their risk factors. It turns out that his simplest advice is also advice most of us don't want to hear. CASTELLI: Most Americans would do okay if they just got the portion sizes down. I mean, I go to France a lot. The French, you say, "Oh, they eat such rich foods... " But they give you such little teeny portions. Yeah, you go to dinner in France and you think it's the hors d'oevres. It's the whole meal. That's right, yeah. That's why I stay away from France. ( laughing ) You ever go to Italy? Now thats... That's a little better. ALDA: For over 50 years, the Pavia family and their neighbors in Framingham have helped write the rules for avoiding heart disease. As it enters its second half-century and begins recruiting a third generation the Framingham Heart Study will be refining those rules to the point where we'll each know precisely our risks for heart disease. Then, as it is as now, but more so-- it will be up to us. Come visit us at PBS on-line. Scientific American Frontiers can be found

Take a look at these related stories from the Frontiers Archive:

				Medical Decade 10 years of Frontiers medical highlights -- progress against heart disease, new cancer therapies, high-tech surgery, traditional medicine, and more.
		Select text to jump ahead in the clip: OUR NEXT SEGMENT IS ABOUT MEDICINE. I LOVE DISCUSSING MEDICAL PROBLEMS AT DINNER. DURING OUR DECADE TWO IMPORTANT AND CONTRASTING TRENDS BECAME CLEAR. IN THE FIRST, WE'VE SEEN COMPUTERS AND HIGH-TECH METHODS REALLY TAKE HOLD IN ALMOST EVERY BRANCH OF MEDICINE. WE NOW ROUTINELY IMAGE AND MAP THE BODY WITH UNPRECEDENTED ACCURACY, FOR EXAMPLE AND I DON'T THINK THERE'S A LAB I'VE VISITED THAT HASN'T MADE SOME KIND OF COMPUTER ANALYSIS A CRUCIAL PART OF ITS WORK. THE SECOND TREND IS OMINOUS. DISEASE ORGANISMS ARE FIGHTING BACK DEVELOPING RESISTANCE TO ONCE-RELIABLE THERAPIES. AS WE SAW IN STORIES ON TB AND MALARIA THIS IS AN EXTREMELY SERIOUS WORLDWIDE THREAT. SO THERE WAS A LOT OF ACTION IN MEDICINE. LET'S TAKE A LOOK. Alda: IN A RECENT STORY ON HIGH-TECH MEDICINE I WAS IN THE OPERATING ROOM AS LINDA TOLVE HAD A LARGE TUMOR REMOVED FROM HER BRAIN-- A TUMOR THAT SOME DOCTORS HAD JUDGED TO BE INACCESSIBLE. A 3-D COMPUTER GRAPHIC IMAGE WAS SUPERIMPOSED ON LINDA'S BRAIN TO GUIDE THE SURGERY. Man: I THINK WE'RE PRETTY HAPPY WITH THAT IN TERM OF THE RESECTION. I THINK NOW IT'S JUST A MATTER OF MAKING SURE EVERYTHING'S NICE AND, UH, DRY. BUT WE'RE ESSENTIALLY DONE. Alda: CONGRATULATIONS. Alda: SOPHISTICATED IMAGE PROCESSING WAS ALSO BEHIND THIS PROTOTYPE AID FOR THE PARTIALLY SIGHTED THAT LEONARD PERRA TESTED, WITH HIS GRANDSON HELPING OUT. Perra: ALL I'VE EVER SEEN WAS SHAPES, NOT FACES. NO FEATURES. AND NOW I CAN SEE THEIR FACES AGAIN. Man: AND DOWN A LITTLE BIT. Alda: THE PROGRAM'S LONG-TERM GOAL WAS TO CONTINUOUSLY TRACK AN EYE'S DEFECT AND THEN HAVE A WEARABLE COMPUTER LITERALLY FILL IN THE BLANK. WE SAW THE SAME IDEA-- USING HIGH-TECH TO COMPENSATE FOR PROBLEMS-- AS WE CONTINUED TO FOLLOW THE STORY OF KARA A VIBRANT YOUNG VICTIM OF CEREBRAL PALSY. HERE, INFRARED LASERS SURREPTITIOUSLY TRACK KARA'S EYE IN THIS EXTRAORDINARY RESEARCH PROGRAM COMPUTER CONTROL OF MUSCLES THROUGH IMPLANTED ELECTRODES BROUGHT PARALYZED LIMBS BACK TO LIFE. RIGHT NOW IT'S A CRUDE SIMULATION OF NATURAL NERVES BUT IT ENABLED DAN TO STAND ON HIS OWN FOR THE FIRST TIME. ALL RIGHT. WHOO. HOW'S IT FEEL DAN? WHOO, IT FEELS VERTICAL. ( laughs ) IT'S BEEN A LONG TIME SINCE I'VE SEEN HIM THAT TALL. Doctor: THERE'S ABOUT AN INCH-LONG HOLE... Alda: IN ONE HIGH-TECH OPERATING ROOM, THE PATIENT WAS A DUMMY WITH PIG'S INTESTINES DYED BRIGHT RED. BEING DEVELOPED AS A WAY TO RAPIDLY APPLY THE BEST CARE ON THE BATTLEFIELD IT'S A PROTOTYPE FOR REMOTE SURGERY IN WHICH DOCTOR AND PATIENT ARE IN DIFFERENT PLACES LINKED ONLY ELECTRONICALLY. Alda: DO I HAVE TOO LITTLE OF IT? Alda: IN RUSSIA, SURGEONS DISPLAYED A SPECIAL ALLOY FOR THE WIRE SUPPORTS CALLED STENTS COMMONLY USED TO KEEP CLOGGED ARTERIES OPEN. THE COLLAPSED STENT IS EASY TO INSERT WITH A CATHETER INTO A LEG ARTERY IN THIS CASE. THEN THE ALLOY SPRINGS INTO SHAPE AS IT WARMS UP OPENING THE ARTERY AND ALLOWING BLOOD TO FLOW. OUR CAMERAS FILMED AN IMPORTANT MILESTONE IN THE TREATMENT OF HEART DISEASE WHEN AN IMPLANTABLE PUMP WAS PLACED ALONGSIDE A FAILING HEART. ( monitor beeping faintly ) JUST DROP THEM INTO THE POUCH LIKE THIS AND PULL THE FLAP DOWN. Alda: MIKE DORSEY DEMONSTRATED HOW HE CARRIED THE PUMP'S BATTERIES. NOW I'M READY FOR TRAVELING. Alda: AFTER SEVEN MONTHS, MIKE GOT A HEART TRANSPLANT AND THE PROGRAM HAS BEEN A KEY STEP TOWARDS THE EVENTUAL GOAL OF PERMANENT ARTIFICIAL HEARTS. HI, MICHAEL. Alda: WAIT, WHAT IS THIS? THIS IS CARTILAGE. IT'S A SCAFFOLD OF... YOU SEE THE NOSTRILS? OH, YUCK! WAIT A MINUTE! Alda: WELL, IT MAY HAVE LOOKED GROSS TO ME BUT THAT THE NOSE REPRESENTS A BIG PART OF MEDICINE'S FUTURE: SPARE PARTS GROWN TO ORDER IN THE LAB LIKE THESE HEART MUSCLE CELLS, ALIVE AND BEATING. THIS IS THE NEXT REVOLUTION IN MEDICINE IN THE MAKING. THIS STORY WAS ABOUT ANOTHER POTENTIAL REVOLUTION GENE THERAPY. LILLIAN COOPER TOOK PART IN A TRIAL WHICH INSERTED INTO HER LEG THE GENES FOR BLOOD VESSELS TO SEE IF SHE COULD ACTUALLY GROW NEW ONES BYPASSING A BLOCKED ARTERY. THIS TRIAL WAS AN UNPRECEDENTED SUCCESS BUT OTHER GENE THERAPY TRIALS HAVE SINCE GONE BADLY WRONG SO THE FUTURE OF GENE THERAPY IS RIGHT NOW UNCERTAIN. BUT ALONGSIDE THE PROMISE OF NEW IDEAS OLD DISEASES WE THOUGHT WE'D DEFEATED-- LIKE TB OR SIMPLE INFECTIONS-- MADE A COMEBACK. BUENOS TARDES. Alda: THE PROBLEM IS RESISTANCE TO ANTIBIOTICS. IT DEVELOPS WHEN DRUGS ARE MISUSED OR OVER-PRESCRIBED OR NOT TAKEN CORRECTLY. ... WHEN HE TAKES THE RED PILLS WHEN HE TAKES THE WHITE ONES... Alda: SOME RESISTANCE IS ALMOST INEVITABLE AS WE FOUND OUT IN AFRICA WHERE THE MALARIA PARASITE IS NOW RESISTANT TO SOME DRUGS AND MALARIA-CARRYING MOSQUITOES HAVE DEVELOPED RESISTANCE TO INSECTICIDES. THE DECADE SAW, IN THE WEST AN INCREASE IN INTEREST IN TRADITIONAL MEDICINE. ON OUR TRIP TO CHINA WE SHOWED HOW ANCIENT HERBAL REMEDIES ARE PRESCRIBED ON A LARGE SCALE. WESTERN DRUG COMPANIES ARE NOW SYSTEMATICALLY SCREENING THOSE REMEDIES FOR USEFUL COMPOUNDS. TRADITIONAL MEDICINE IS USED BY MOST PEOPLE IN THE WORLD AND WILD RAW MATERIALS ARE GETTING SCARCE. IN A SOUTH AFRICAN TOWNSHIP, I VISITED A TRADITIONAL HEALER WHO HAS HAD TO START GROWING HIS OWN, RATHER MYSTERIOUS, SUPPLIES. Alan: WHAT IS THIS? DO YOU EAT THIS? IN ENGLISH, I DON'T KNOW HOW TO CALL IT. I'VE NEVER SEEN ANYTHING LIKE THIS. BUT IT'S POISONOUS. IT'S POISONOUS? THANK YOU-- I'M SORRY I PICKED IT UP. I HAD TO PUT MY HAND ON IT NOW. I'LL NEVER... WHEN YOU EAT IT. NOT THE SKIN, HUH? YOU SURE ABOUT THAT? SURE. OTHERWISE YOU MAY HAVE TO GIVE ME ANOTHER PLANT TO GET RID OF THAT. TO GET RID OF IT, YES. WHAT DOES THIS DO? WHY WOULD YOU SELL A POISON PLANT? WELL, IT'S FOR THOSE WHO KNOW HOW TO CONTROL IT. ( laughter ) WHAT DOES IT DO FOR YOU... IT'S FOR ENEMA. IF YOU TAKE JUST THE RIGHT AMOUNT. AN ENEMA-- OH, GREAT, I'M GLAD, GOOD. Alda: IN THE FORESTS OF THE PACIFIC NORTHWEST, TAXOL WAS DISCOVERED. WE SHOWED SOME OF THE FIRST TRIALS OF THIS PROMISING NEW CANCER DRUG. TAXOL WAS FOUND IN THE BARK OF SCARCE YEW TREES SO THE AIM WAS TO SYNTHESIZE THE DRUG, STARTING WITH YEW NEEDLES. THE TRIALS AND THE SYNTHESIS WERE SUCCESSFUL AND NOW TAXOL IS AN IMPORTANT WEAPON AGAINST MANY DIFFERENT CANCERS. WE SHOWED CHINESE MEDICINE'S DIRECT INFLUENCE ON THE WEST IN A STORY ON THERAPEUTIC TOUCH IN WHICH PRACTITIONERS CLAIM TO MANIPULATE THE PATIENT'S SO-CALLED ENERGY FIELD. THEN IN AN EXCLUSIVE REPORT WE SHOWED HOW 11-YEAR-OLD EMILY ROSA PROVED THAT THE PRACTITIONERS COULD NOT DETECT THE ENERGY FIELD THEY CLAIMED EXISTED. EMILY USED A RIGOROUS EXPERIMENTAL DESIGN. Emily: I GOT 4.1 FOR AN AVERAGE OF CORRECT GUESSES. FIVE IS CHANCE AND THEY GOT BELOW CHANCE. Alda: EMILY'S PAPER ON THE EXPERIMENT ENDED UP IN A PEER-REVIEWED MEDICAL JOURNAL. EATING MUCH LESS WAS ONE STORY IN AN EPISODE ABOUT LIVING LONGER THAT ENDED OUR MEDICAL DECADE. LOW-CALORIE, HIGH NUTRITION DIETS SEEM TO BE ONE WAY TO EXTEND LIFE. RESULTS OF MONKEY STUDIES, STILL IN PROGRESS ARE POINTING IN THAT DIRECTION. THEN WE SAW MICE WITH CELLS GENETICALLY ENGINEERED TO AGE MORE RAPIDLY THAN NORMAL OPENING UP WAYS TO POSSIBLY SLOW THE PROCESS IN HUMANS. AND WE SAW TINY NEMATODE WORMS WITH GENETIC MUTATIONS INDUCED IN THE LAB WHICH MULTIPLY THE WORMS' LIFE SPAN UP TO FOUR TIMES. OH, MY GOD THAT REALLY IS... Woman: THIS IS A MUTANT WORM. THIS IS THE EXACT SAME AGE. THIS IS THE SAME AGE! I'M NOT KIDDING YOU. ISN'T THAT AMAZING? I MEAN IT'S JUST UNBELIEVABLE-- YOU CHANGE ONE GENE AND ESSENTIALLY YOU CURE THIS DISEASE OF AGING. Alda: EXTENDED HUMAN LIFESPANS REALLY ARE AROUND THE CORNER AND THAT SEEMED A PRETTY GOOD IDEA TO ME... IT'S VERY GOOD. Alda: ALTHOUGH VERY LOW-CAL DIETS DIDN'T LOOK SO EASY. THIS WOULDN'T BE BAD FOR A DESSERT OR AM I DENIED DESSERT NOW? NO, THAT WOULD BE FINE, SURE. AN APPLE IS A GOOD DESSERT. YEAH, YOU WOULD... YOUR HEART WOULD SINK IF I TOOK OUT THE FROZEN YOGURT, PROBABLY. WELL, NO, YOURS WOULD. ( laughing ) SOME OF OUR MOST FASCINATING STORIES ON FRONTIERS

				Eat Less - Live Longer Can a very low calorie diet extend life, and if so how? Animal studies seem to say yes, and one scientist is trying it out on himself.
		Select text to jump ahead in the clip: I BROUGHT MY LUNCH. OH, YOU DID, GREAT. Alda: I'VE COME TO SEE ROY WALFORD IN VENICE, CALIFORNIA. FOR 30 YEARS, DR. WALFORD HAS BEEN STUDYING THE RELATIONSHIP BETWEEN FOOD AND LONG LIFE. I THINK IT WOULD BE BETTER IF IT WERE, LIKE, WHOLE WHEAT BREAD. WHOLE WHEAT BREAD. I WOULD SAY THAT'S TWO SLICES OF WHITE BREAD. WELL, LET'S SEE WHAT ELSE I HAVE. YOU PROBABLY DON'T LIKE THIS. SOMETIMES I LIKE SOMETHING CRUNCHY WHILE I HAVE A SANDWICH. WELL, PRETZELS ARE EMPTY CALORIES SO I DON'T LIKE THAT. HOW ABOUT PICKLES? OKAY, THAT'S ALL RIGHT. WELL, THIS IS ALL JUST FOR TASTE. SO HOW DO YOU FEEL ABOUT MUSTARD? IT DOESN'T ADD MUCH IN THE WAY OF CALORIES UNLESS YOU USE A HUGE AMOUNT. ( laughs ) Alda: FOR WALFORD, WATCHING CALORIES IS ONLY ONE OF THE KEYS. HE BELIEVES IF YOU EAT LESS, YOU'LL LIVE LONGER SO LONG AS YOU MAKE SURE THAT WHAT YOU DO EAT HAS HIGH NUTRITIONAL VALUE. I'M AIMING TO MAKE A PRETTY LO-CAL LUNCH NO MORE THAN 500 CALORIES. YOU USE A LOT OF CALORIES GETTING THE PICKLE JAR OPEN, YOU KNOW. OH, YES, THAT'S THE WHOLE POINT. THIS IS ABOUT IT. THIS IS WHAT I COULD... NOW, LET'S SEE, THAT WOULDN'T BE ENOUGH, THOUGH. I MEAN, I'D STILL BE INTERESTED IN MORE. I'D PROBABLY EAT FIVE OR SIX OF THESE PRETZELS. YEAH. AND I WOULD TAKE THE SALT OFF THE PRETZELS BECAUSE I DON'T LIKE TO EAT A LOT OF SALT. THEN I WOULD HAVE PROBABLY, TO MAKE MYSELF FEEL BETTER I'D EITHER HAVE ABOUT FOUR OUNCES OF FROZEN YOGURT OR... IF I WAS FEELING REALLY HEALTHY, HEALTH-MINDED I'D HAVE AN APPLE. LET'S SAY AN APPLE. OKAY. I'LL GIVE MYSELF THE BENEFIT OF THE DOUBT. OKAY. Alda: NOW, LET'S SEE WHAT KIND OF NUTRITION MY LO-CAL LUNCH DELIVERS. LET'S SEE... TURKEY BREAST, NO SKIN, ROASTED IS ABOUT AS CLOSE AND YOU DIDN'T HAVE HALF A BREAST BUT MAYBE A QUARTER OF A BREAST. YOU ADDED A PIECE OF TOMATO IN THAT. YEAH, TWO LITTLE SLICES OF TOMATO. OKAY. Alda: WHEN YOU ADD IT ALL UP I DID FINE ON THE CALORIES, BUT THAT'S ABOUT ALL. WHAT YOU HAD IS DEFICIENT IN "A," B12, "C," "E" FOLIC ACID AND PANTOTHENIC ACID. AMONG MINERALS IT'S DEFICIENT IN CALCIUM, COPPER, MAGNESIUM MANGANESE AND ZINC. Alda: AND WHAT'S THAT BIG TALL YELLOW ONE? I SEEMED TO BE DOING OKAY... WELL, THAT MEANS IT HAS A GREAT DEAL OF SODIUM. OH, I'M DOING FINE WITH THE SODIUM, YEAH, OKAY. AND YOU HAVE TOO MUCH CHOLESTEROL BECAUSE... WHERE'D I GET THAT FROM, THE TURKEY? FROM THE TURKEY PROBABLY, YEAH. Alda: BUT HERE'S WHAT GOES INTO WALFORD'S LUNCH. EVERY ONE OF HIS 500 CALORIES PACKS A HIGH NUTRITIONAL PUNCH. Alda: HOW'D YOU FIRST GET INTERESTED IN THIS? I GOT INTERESTED IN THIS KIND OF NUTRITION BECAUSE IT'S BEEN KNOWN SINCE 1935 THAT IF YOU KEEP ANIMALS ON A VERY LOW CALORIE DIET BUT ONE THAT IS NOT DEFICIENT IN VITAMINS AND SO FORTH YOU EXTEND THEIR MAXIMUM LIFE-SPAN AND THEIR AVERAGE LIFE-SPAN. Alda: IN THE 1960s WALFORD, WHO'S A RESEARCHER AT U. C.L.A. MEDICAL SCHOOL SET OUT TO REFINE THE LOW-CALORIE STUDIES. HE CONFIRMED THAT LABORATORY MICE LIVE UP TO TWICE THE NORMAL AGE IF CALORIE INTAKE IS REDUCED BY UP TO HALF. AT THE SAME TIME HE DETECTED INTRIGUING SIGNS OF IMPROVED HEALTH: LOWER BLOOD PRESSURE, LOWER INSULIN AND CHOLESTEROL AND STRONGER IMMUNE SYSTEMS. THEN IN 1991, WALFORD JOINED BIOSPHERE 2 AS THE PROJECT DOCTOR. HE WAS PART OF THE TEAM THAT SEALED ITSELF INSIDE A THREE-ACRE GREENHOUSE. THE AIM WAS TO BE SELF-SUPPORTING-- TO SUBSIST ENTIRELY ON THE MINIATURE ECOSYSTEMS GROWING INSIDE. THINGS DIDN'T TURN OUT AS EXPECTED. FOOD PRODUCTION WAS ABOUT 40% SHORT BUT FOR WALFORD IT WAS A LUCKY ACCIDENT. LIKE IT OR NOT THE TEAM FOUND ITSELF ON A LOW- CALORIE, HIGH-NUTRITION DIET. THE TEAM MEMBERS WENT HUNGRY. BUT IN REGULAR MEDICAL EXAMS, WALFORD DISCOVERED THEY WERE DEVELOPING THE SAME GOOD HEALTH PATTERNS AS THE LAB ANIMALS. BIOSPHERE 2 CONFIRMED FOR WALFORD THAT A LOW-CALORIE, HIGH-NUTRITION DIET IS LIKELY TO BENEFIT HUMANS AND HE'S BEEN FOLLOWING IT EVER SINCE. IT SOUNDED PRETTY GOOD TO ME. HOW DO YOU GET STARTED? Walford: WHAT YOU WANT TO DO IS LOWER THE CALORIE CONTENT SO THAT YOU LOSE WEIGHT GRADUALLY UNTIL YOU'RE 10% TO 20% BELOW YOUR SET POINT WHERE YOUR SET POINT IS DEFINED AS WHAT YOU WOULD WEIGH NORMALLY IF YOU ATE JUST KIND OF A NORMAL DIET. THAT SOUNDS LIKE... A LOT OF... WEIGHT LOSS. I MEAN, I'D BE A BEAN POLE WITHOUT THE BEANS, I THINK. I MEAN, THAT'S VERY... THAT SOUNDS SEVERE TO ME. Alda: THESE LIVELY RHESUS MONKEYS ARE ON JUST SUCH A SEVERE REGIMEN. I'M VISITING RICK WEINDRUCH AT THE UNIVERSITY OF WISCONSIN. IS THIS FOR MY PROTECTION OR FOR THE MONKEYS'? I THINK IT'S MUTUAL FOR BOTH, YES. OKAY. Alda: WEINDRUCH HAS ABOUT 80 MONKEYS-- HALF ON RESTRICTED CALORIES, HALF NORMAL. THE STUDY HAS BEEN RUNNING FOR A DECADE AND THE ANIMALS ARE NOW 20 YEARS OLD-- MIDDLE AGE FOR RHESUS MONKEYS-- SO THERE WON'T BE ANY RESULTS ON LIFE-SPAN FOR A WHILE. NOW, WHICH KIND... WHAT'S HE GET? Man: THIS GUY UP ABOVE... Alda: THE RESTRICTED DIET IS EXACTLY LIKE WALFORD'S. IN FACT, RICK WEINDRUCH WAS HIS STUDENT AT U. C.L.A. HERE YOU GO, PAL. Alda: THE MONKEYS' CALORIES ARE REDUCED BUT THEIR NUTRITION IS EXCELLENT. IT'S NOT IN ANY WAY A STARVATION DIET. SO WITHIN THE NEXT FEW YEARS, AS OLD AGE SHOULD BE APPROACHING THE EXPECTATION IS THAT THE NORMALLY FED GROUP WILL BEGIN TO LOSE ITS HEALTH WHILE THE CALORIE-RESTRICTED GROUP WILL STAY HEALTHY. Weindruch: WE'RE STARTING TO SEE SIGNS OF BETTER HEALTH IN OUR RESTRICTED ANIMALS. IT'S GOING TO REALLY BE SHALL WE SAY, SHOW TIME FOR THESE DIETS OVER THE NEXT FIVE YEARS. Alda: JUST LIKE WALFORD'S BIOSPHERE TEAM THE MONKEYS GET REGULAR CHECKUPS ALTHOUGH THEY'RE SEDATED FOR SOME PROCEDURES. THIS IS A SCAN FOR BONE MASS WHICH TENDS TO BECOME REDUCED WITH AGE. THEY ALSO EXAMINE TINY SAMPLES OF MUSCLE FROM THE MONKEYS LOOKING FOR SIGNS OF CELLULAR DAMAGE WHICH NORMALLY DEVELOPS WITH AGE. Alda: IS THIS A PART OF A CELL? Weindruch: THIS IS A COMPONENT OF A CELL AND THIS IS THE STUFF THAT MAKES YOUR MUSCLES CONTRACT BASICALLY. UH-HUH. Alda: THIS BLACK DOT IN THE MUSCLE OF A FOUR-YEAR-OLD MONKEY IS DAMAGE CAUSED BY THINGS CALLED FREE RADICALS. FREE RADICALS COULD EXPLAIN WHY EATING LESS HELPS YOU STAY HEALTHIER AND LIVE LONGER. NUTRIENTS FROM THE FOOD WE EAT GET ABSORBED BY EVERY CELL OF OUR BODY. THESE NUTRIENTS NORMALLY COMBINE WITH OXYGEN TO MAKE ESSENTIAL ENERGY-STORING CHEMICALS BUT AN UNAVOIDABLE BY-PRODUCT IS THE PRODUCTION OF FREE RADICALS: REACTIVE OXYGEN COMPOUNDS THAT DAMAGE WHATEVER THEY HIT. THE BODY MAKES CHEMICALS CALLED ANTI-OXIDANTS WHICH DEFEND AGAINST FREE RADICALS BUT DAMAGE STILL ACCUMULATES OVER THE YEARS LEADING TO ALL KINDS OF OLD-AGE DISEASES. THE EXCITING THING ABOUT WEINDRUCH'S STUDY IS THAT WHILE 20-YEAR-OLD MONKEYS ON NORMAL DIETS SHOW EXTENSIVE FREE RADICAL DAMAGE CALORIE-RESTRICTED MONKEYS WHO ARE THE SAME AGE LOOK LIKE YOUNG KIDS. SO THIS IS A 17-YEAR-OLD MONKEY WITH ABOUT THE SAME AMOUNT OF FREE-RADICAL DAMAGE AS HOW OLD A MONKEY? A FOUR-YEAR-OLD. A 17-YEAR-OLD AS HEALTHY AS A FOUR-YEAR-OLD. Alda: WEINDRUCH IS ALSO PURSUING THE FREE RADICAL THEORY WITH A LARGE-SCALE MOUSE STUDY. SO ONE BUNCH IS ON A RESTRICTED DIET AND ONE... I'LL TELL YOU SOMETHING THAT I SEE RIGHT AWAY. THESE ARE REALLY ACTIVE AND THESE ARE JUST SITTING AROUND. Alda: THESE ARE SENIOR-CITIZEN MICE-- ABOUT TWO YEARS OLD-- AND THEY'RE ON A NORMAL DIET. AND THESE ARE ON CALORIE RESTRICTION. BUT WEINDRUCH ALSO HAS FOUR OTHER GROUPS BEING FED NORMAL DIETS PLUS SOME SPECIAL EXTRA INGREDIENTS. HE'S ADDING COMBINATIONS OF THE ANTI-OXIDANT SUPPLEMENTS LIKE VITAMINS "C," "E," AND BETA-CAROTENE THAT SO MANY OF US ARE TAKING NOW. THE RESULT SO FAR-- NOT VERY ENCOURAGING. ANTI-OXIDANT DIETARY SUPPLEMENTS ARE NO SUBSTITUTE FOR CALORIE RESTRICTION. THEY DON'T SEEM TO AFFECT LIFE-SPAN ONE WAY OR THE OTHER. Weindruch: THE BEST SURVIVAL AT THIS POINT IN TIME IS GROUP FIVE-- OUR CALORICALLY RESTRICTED ANIMALS. WHO AREN'T TAKING ANY SUPPLEMENTS. NO-- NO, THEY'RE NOT. SO, SO FAR, TAKING SUPPLEMENTS IF YOU HAVE A NORMAL DIET, OR ANY KIND OF DIET IT DOESN'T MAKE YOU LIVE LONGER, SO FAR-- AND YOU HAVE A LOT OF TIME TO GO YET ON THIS-- BUT SO FAR YOU'RE LIVING THE LONGEST... JUST PLAIN OLD CALORIC RESTRICTION. WITH HIGH NUTRITION. RIGHT, BUT AGAIN, IT'S EARLY SO COME BACK IN A YEAR, PLEASE. YEAH, YEAH. WELL, MEANWHILE I'M TAKING THE PILLS. ME, TOO. Walford: SO, ALAN, I MADE FOUR SERVINGS IN THE WOODEN BOWL. THIS IS ONE SERVING AND IT'S ABOUT 500, 550 CALORIES. THIS IS ONE SERVING? THIS IS A LOT OF FOOD. THAT WOULD BE ONE SERVING, YES. AND THIS IS EQUAL TO THAT SANDWICH I MADE? MORE OR LESS, IT'S ABOUT EQUAL IN CALORIE CONTENT TO YOUR TURKEY SANDWICH. IT'S VERY GOOD. HOW OLD DO YOU THINK YOU'RE GOING TO BE... EVENTUALLY? WELL, OLDER THAN I WOULD BE. I'VE JUST BEEN ON THIS DIET FOR ABOUT TEN YEARS OR SO MAYBE A LITTLE MORE SO I CERTAINLY DIDN'T START WHEN I WAS YOUNG. IF MY DESTINY ON A NORMAL DIET HAD BEEN TO LIVE TO BE 90 THEN ON THE DIET I SHOULD ADD ANOTHER 15 OR 20 YEARS. SO THAT WOULD PUT ME OUT TO BE 110, STARTING AT 60. THAT'S WHERE IT WOULD PUT ME IF I STARTED AROUND NOW. A HUNDRED AND TEN. SEE, I ALWAYS THOUGHT IT'D BE NICE TO LIVE TO 106. 110 IS EVEN BETTER. THIS DOESN'T LOOK SO APPETIZING ANYMORE. I GOT PLENTY OF CRUNCH. I DIDN'T NEED THE PRETZELS. AND THIS WOULDN'T BE BAD FOR DESSERT OR AM I DENIED DESSERT NOW? NO, THAT WOULD BE FINE. SURE-- AN APPLE IS GOOD DESSERT. YEAH. YOU WOULD... YOUR HEART WOULD SINK IF I TOOK OUT THE FROZEN YOGURT PROBABLY. WELL, NO, YOURS WOULD. ( laughing ) Alda: FROM INFANCY TO OBLIVION-- IT'S THE NATURAL AND MYSTERIOUS TRAJECTORY OF OUR LIVES.

				Image-Guided Surgery Dramatic increases in computing power allow doctors to see inside the head of a brain tumor patient, helping them to remove the growth with new precision.
		Select text to jump ahead in the clip: MEDICINE, ALONG WITH THE REST OF SOCIETY IS BEING TRANSFORMED BY THE COMPUTER. AT THE HEART OF EVERY STORY WE'LL BE DOING IN THIS EPISODE IS THE COMPUTER'S ABILITY TO PROCESS VAST AMOUNTS OF INFORMATION. IN THE OPERATION BEING PERFORMED HERE TODAY THE CRITICAL INFORMATION IS THE EXACT LOCATION OF A BRAIN TUMOR THAT'S THREATENING THE LIFE OF A YOUNG WOMAN NAMED LYNDA TOLVE. WITHOUT THAT INFORMATION, THE OPERATION THAT'S ABOUT TO BEGIN AND THROUGH WHICH LYNDA WILL BE AWAKE MAY NOT EVEN HAVE BEEN ATTEMPTED LEAVING HER TWO YEARS TO LIVE. IT'S A FEW DAYS AFTER THE EAST COAST'S BLIZZARD OF '96. LYNDA, HER FIANCE AND PARENTS HAVE JOURNEYED FROM NEW JERSEY TO BOSTON'S BRIGHAM AND WOMEN'S HOSPITAL. FOR EIGHT MONTHS, LYNDA HAS HAD DAILY SEIZURES FROM A TUMOR THAT'S SLOWLY PUSHING INTO THE PART OF HER BRAIN THAT CONTROLS MOVEMENT AND FEELING. Tolve: WHEN I FOUND OUT THE TUMOR WAS GROWING THE DOCTORS IN NEW YORK DID NOT WANT TO TOUCH THE TUMOR. SO I WROTE TO DR. BLACK AND HE TOLD ME TO COME ON UP AND HE SAID WITH HIS NEW TECHNIQUE THAT HE COULD DO IT. AND THAT'S WHEN WE CAME UP HERE AND THAT'S WHAT WE'RE HERE NOW FOR. SO YOUR TRIP WAS OKAY? YEAH. I HEAR YOU'RE... Alda: NEUROSURGEON PETER BLACK IS READY TO TAKE ON LYNDA'S CASE BECAUSE OF A POWERFUL NEW TECHNIQUE FOR PEERING INTO HER BRAIN. IT'S A VERY INTERESTING PROCESS. I THINK YOU'LL LIKE SEEING HOW IT WORKS. Alda: THE PROCESS BEGINS WITH WHAT IS NOW A STANDARD TECHNIQUE FOR SCANNING THE BRAIN, MAGNETIC RESONANCE IMAGING. ( computer beeps ) THE M. R.I. MAKES CROSS-SECTIONAL PICTURES OF LYNDA'S BRAIN AND IN SEPARATE SCANS ALSO LOCATES ITS MAJOR BLOOD VESSELS. THE INFORMATION IS COMBINED AND PROCESSED TO CREATE A THREE-DIMENSIONAL IMAGE OF LYNDA'S HEAD REVEALING THE BRAIN INSIDE. THIS TECHNIQUE HAS BEEN PIONEERED AT BRIGHAM'S RADIOLOGY DEPARTMENT AS PART OF AN AMBITIOUS PROGRAM TO GIVE PHYSICIANS UNPRECEDENTED POWER TO SEE INSIDE THEIR PATIENTS, BOTH BEFORE AND DURING SURGERY. IN LYNDA'S VIRTUAL BRAIN, THE VEINS ARE COLORED BLUE AND THE TUMOR, LOCATED IN THE REGION THAT CONTROLS HER ABILITY TO MOVE HER BODY IS MARKED IN GREEN. Tolve: MY BIGGEST FEAR IN HAVING SURGERY IS THAT I MIGHT BECOME PARALYZED AND NOT BE ABLE TO WALK. THAT'S MY BIGGEST FEAR. Alda: THIS FEAR THAT CUTTING OUT THE TUMOR WILL DAMAGE HER MOTOR SKILLS LIES BEHIND ANOTHER INNOVATIVE TEST... OKAY, READY? Alda: AN ATTEMPT TO PINPOINT HER BRAIN'S MOTOR REGION WITH THE AID OF A MAGNETIC WAND. OKAY, FIVE, FOUR, THREE... TWO, ONE, GO. Alda: PLACED ON HER SKULL, THE WAND STIMULATES THE BRAIN BENEATH. IN THIS CASE, THEY ARE SEARCHING FOR THE SPOT THAT CONTROLS MOVEMENT IN HER LEFT HAND. ... THREE, TWO, ONE. ( machinery clicks ) Man: GOOD RESPONSE. Alda: BY MOVING THE WAND AND TRACKING ITS LOCATION WITH FLASHING LIGHTS LYNDA'S MOTOR REGION IS PRECISELY LOCATED. OKAY, VERY GOOD, LYNDA. WE FOUND THE MOTOR STRIP. WE'RE ALL DONE. PETER SAYS THIS IS WHERE THE TUMOR IS PUSHING DOWN. Alda: THIS IS THE FIRST TIME THIS METHOD OF MAPPING THE BRAIN HAS BEEN USED HERE AND AN EAGER CROWD OF RESEARCHERS AWAITS THE RESULTS. AND IF YOU START GOING DOWN TOWARDS WHERE THE EAR WOULD NORMALLY BE YOU SEE A LITTLE RED SPOT WHICH IS ALMOST SLIGHTLY OFF-CENTER ON THIS LITTLE STRIP OF CORTEX. Man: YEP, SO IT'S GORGEOUS. Alda: THE DAY BEFORE LYNDA'S SURGERY I SHARED THE REMARKABLE EXPERIENCE OF SEEING INSIDE HER HEAD WITH THE HELP OF 3-D GLASSES. Alda: IS THIS THE FIRST TIME YOU'VE SEEN THIS 3-D PICTURE OF YOUR BRAIN? YEAH, IT'S AMAZING... IT'S AMAZING. Alda: THE 3-D IMAGE, PLUS THE MAPPING OF THE MOTOR STRIP GIVES PETER BLACK MUCH MORE INSIGHT INTO WHAT HE WILL FACE TOMORROW. SO THIS IS HELPFUL IN MAKING SURE YOU DON'T INVADE THAT MOTOR AREA, RIGHT? THIS TELLS US THAT IT'S REASONABLE TO GO AHEAD ASSUMING THAT THE TUMOR IS NOW BEHIND THE MOTOR STRIP AND NOT IN IT. IF IT WERE IN IT, IT WOULD NOT BE A POSSIBLE OPERATION. SO THIS TELLS YOU WHETHER OR NOT TO DO THE PROCEDURE AND THEN IT ALSO GUIDES YOU DURING THE PROCEDURE SO THAT YOU DON'T HURT THAT. ARE THERE ANY OTHER PARTS OF THE BRAIN LIKE BLOOD VESSELS OR SOMETHING-- THIS WILL GUIDE YOU IN...? Black: YES, I THINK THAT THERE ARE TWO OTHER IMPORTANT AREAS. ONE ARE THE VEINS WHICH ARE EXTREMELY IMPORTANT NOT TO INJURE AND WE KNOW WHERE THEY ARE NOW. AND THE SECOND IS THE FACT THAT THE TUMOR ITSELF APPEARS TO BE IN THE SENSATIONARY OF THE BRAIN. AND THE QUESTION OF WHAT IMPLICATIONS THAT HAS FOR LYNDA'S RECOVERY AFTER THE SURGERY ARE FAIRLY IMPORTANT. ISN'T THAT SOMETHING? AMAZING. THANK YOU VERY MUCH. IT'S A GOOD THING YOU DID YOUR HOMEWORK, LYNDA. WHAT DO YOU MEAN, I DID MY HOMEWORK? DR. BLACK DID HIS HOMEWORK. Alda: 8:00 A. M. ON THE DAY OF THE SURGERY. LYNDA IS SEDATED BUT AWAKE HER HEAD UNCOMFORTABLY CLAMPED AT THE BEST ANGLE FOR GETTING AT THE TUMOR. Alda: WHEN I SAW YOU YESTERDAY I THOUGHT YOU HAD A TREMENDOUS AMOUNT OF COURAGE AND I STILL SEE IT IN YOU. I SEE YOU RIDING THIS. Woman: SHE IS AN EXCELLENT PATIENT. Alda: BY THIS POINT IN THE SURGERY A PIECE OF LYNDA'S SKULL HAS ALREADY BEEN REMOVED AND HER BRAIN EXPOSED. A VIDEO CAMERA HAS BEEN SET UP TO PEER OVER THE SURGEONS' SHOULDERS. IT'S NOW THAT THE COMPUTER IMAGE OF LYNDA'S BRAIN PUTS IN AN ALMOST MAGICAL APPEARANCE... Black: THERE, OKAY, I SEE THAT. Alda: BECAUSE BY CAREFULLY ALIGNING THE VIRTUAL BRAIN WITH THE REAL ONE THE TUMOR'S LOCATION IS REVEALED. CAN YOU SEE THE TUMOR YET? YES, IT'S RIGHT EXACTLY WHERE WE HAD PREDICTED THAT IT WOULD BE. THE ONLY AREA THAT I AM NOT SURE ABOUT IS AN AREA THAT WE THOUGHT WAS MOTOR STRIP AND THE QUESTION IS, "DOES THE TUMOR IMPINGE ON THAT? " AND WE'LL BE TESTING THAT IN ABOUT ONE MINUTE. LYNDA? WE WANT NOW TO TEST YOUR MOVEMENT, OKAY, HON? YOU'RE DOING GREAT. EVERYTHING IS GOING VERY WELL. WE SEE THE TUMOR. NO QUESTION ABOUT THAT AND IT LOOKS LIKE IT'S GOING TO BE REMOVABLE BUT WE WANT TO JUST CHECK SOME OF THE THINGS ABOUT MOVEMENT AND FEELING. I WANT YOU TO TELL ME NOW IF THERE'S ANY MOVEMENT IN YOUR HAND OR YOUR ARM ON THE LEFT SIDE, OKAY? Man: GOT IT, PERFECT-- RIGHT ON IT. THIS IS EXACTLY WHERE THEY FOUND MOVEMENT YESTERDAY BY THE WAY WITH THE MAG STIM. AND SO LET'S TRY FOUR HERE. LYNDA, HON? TINGLING WHERE, HON? Man: WHAT DID YOU FEEL, LYNDA? Tolve: I FELT TINGLING... TINGLING IN HER THUMB. WONDERFUL. Black: LYNDA, THIS IS VERY GOOD NEWS IN TERMS OF WHAT WE CAN DO HERE. Alda: THE TESTING CONFIRMS THAT THE MOTOR STRIP IS NEXT TO THE TUMOR BUT SEPARATE FROM IT. BUT NOW THERE'S ANOTHER CONCERN. THE TUMOR SEEMS TO OCCUPY A SPOT THAT NORMALLY WOULD ALLOW LYNDA TO FEEL SENSATION IN THE LEFT SIDE OF HER BODY. Black: WE'RE NOW STIMULATING HER WRIST AND THAT STIMULUS IS BEING PICKED UP BY THAT GRID. SO EACH OF THOSE LOCATIONS HAS A NUMBER ON IT SO YOU CAN TELL IF THE STIMULATION OF THE HAND IS BEING PICKED UP UNDER A NUMBER. YOU KNOW EXACTLY WHAT PART OF THE BRAIN IS RECEIVING THAT STIMULATION. EXACTLY. IF YOU FOUND THAT THE TUMOR WAS RECEIVING SIGNALS WHAT WOULD THAT DO TO THE OPERATION? THIS WOULD BE A SITUATION WE HAVE TALKED WITH LYNDA A LITTLE BIT ABOUT. WE TALKED BEFORE THE SURGERY ABOUT THAT ISSUE. AND SHE SAID SHE WOULD RATHER HAVE AS MUCH TUMOR TAKEN OUT AS POSSIBLE EVEN IF IT ENDED UP WITH SOME TROUBLE WITH SENSATION FOR A MONTH OR TWO. Alda: LYNDA'S WRIST IS STIMULATED. Alda: DO YOU FEEL ANYTHING, LYNDA IN YOUR THUMB, IN YOUR HAND? AN ELECTRIC SHOCK. AN ELECTRIC SHOCK? WE'RE GOING TO GO WITH THAT, PETER. Alda: SO THE FACT THAT YOU'RE GETTING THIS TYPICAL PATTERN ON EVERY PART OF THE GRID-- NONE OF IT'S ON THE TUMOR. NO, I THINK WE'RE PROBABLY BELOW THE TUMOR. Alda: AS THEY MOVE THE GRID AROUND, THEY GET MORE GOOD NEWS. PETER, THERE'S NO PHASE REVERSAL. Alda: THE TUMOR DOESN'T SEEM TO BE RECEIVING SIGNALS WHEN LYNDA'S WRIST IS STIMULATED. Alda: HE WAS VERY EXCITED WHEN HE GOT THAT REPORT OF WHAT AREAS WERE STIMULATED BECAUSE IT WAS WHAT HE HOPED IT WOULD BE. Tolve: Woman: SHE HAD A COMPLETE RESECTION WITHOUT ANY WEAKNESS AFTER THE SURGERY. SO IT WAS REALLY ALL VERY EXCITING. Tolve: Woman: IT'S REALLY A TEAM APPROACH AS YOU CAN SEE. Man: I HAVE TO SHOW YOU SOMETHING. OKAY, I'M COMING OVER. Alda: IT'S NOW ABOUT TWO HOURS SINCE THE OPERATION BEGAN. Black: WE OUTLINED THE TUMOR HERE IN BLUE BUT YOU SEE HOW IT'S LIFTING ITSELF OUT NOW ALMOST. IT'S REALLY BULGING OUT OF THE REST OF THE BRAIN ON ITS OWN. DRAMATIC. OKAY, SO THAT'S THE FIRST PART OF THE TUMOR THAT WE'VE JUST TAKEN OUT. Alda: HOW MUCH OF THE TUMOR DO YOU THINK THAT IS? THAT'S ABOUT A QUARTER TO A THIRD. Alda: PETER BLACK NOW SWITCHES TO AN INSTRUMENT THAT FIRST BREAKS UP TISSUE WITH ULTRASOUND THEN SUCKS THE SCRAPS AWAY. BY NOW THE HOSPITAL'S PATHOLOGY LAB HAS CONFIRMED THE TUMOR ISN'T MALIGNANT. Alda: NOW, I STILL SEE LITTLE WHITE SPOTS IN THERE. I PRESUME YOU'RE GOING AFTER THEM-- OTHER LITTLE SPOTS OF THE TUMOR. IT SEEMS IT'S NOT MALIGNANT. IS THERE LESS OF A NEED TO GET EVERY LAST DROP OF IT OUT OF THERE? WELL, IN A WAY YOU WANT EVEN MORE TO GET EVERY LAST DROP BECAUSE THE SURGERY IS THE DEFINITIVE TREATMENT IN THAT SITUATION. IN OTHER WORDS, YOU'RE SAYING THAT BECAUSE IT'S NOT MALIGNANT AND YOU WON'T BE RADIATING IT OR DOING ANYTHING TO IT... YOU WANT TO MAKE SURE... IF YOU LEAVE ANY IN THERE IT COULD GROW AGAIN. AND EVEN THOUGH IT'S NOT MALIGNANT IT STILL MAY TEND TO GROW AGAIN. SO THAT'S WHY WE WOULD LIKE TO SEE IF WE CAN'T GET ALL OF IT OUT AT THIS TIME. NOW, THE BIG QUESTION, ALAN IS THE ONE YOU ASKED YESTERDAY. HOW DO YOU KNOW HOW DEEP TO GO? THE ADVANTAGE OF THE THREE-DIMENSIONAL RECONSTRUCTION BECOMES PARTICULARLY APPARENT HERE BECAUSE THIS SMALL CYST IS SOMETHING THAT WE SEE IN THE THREE-DIMENSIONAL PICTURE WHICH YOU DON'T APPRECIATE SO MUCH IN THE REGULAR M. R.I. AND IT IDENTIFIES THE BASE OF THE DEEPEST PART OF THE TUMOR. Alda: USING THE VIRTUAL CYST IN THE IMAGE TO GUIDE THEM TO THE REAL THING IN LYNDA'S BRAIN PETER BLACK AND HIS COLLEAGUES OVER THE NEXT 40 MINUTES SCOUR OUT THE TUMOR. ALL THE WHILE, LYNDA'S MOTOR AND SENSATION RESPONSES CONTINUE TO BE MONITORED. Black: I THINK WE'RE PRETTY HAPPY WITH THAT IN TERMS OF THE RESECTION. I THINK NOW IT'S JUST A MATTER OF MAKING SURE EVERYTHING IS NICE AND DRY. BUT WE'RE ESSENTIALLY DONE. Woman: LYNDA, DR. BLACK HAS JUST COMPLETED THE RESECTION OF THE TUMOR. AND WE'RE GOING TO BE FINISHED VERY SHORTLY. Tolve: Woman: YES, WE'RE FINISHED. Tolve: THE TUMOR HAS BEEN REMOVED. Alda: THAT'S GREAT. CONGRATULATIONS. Tolve: THAT'S GREAT. Alda: JUST THREE WEEKS AFTER THE TUMOR WAS REMOVED WE MET WITH LYNDA AGAIN. Tolve: IT'S HARD TO BELIEVE THAT... NOT ONLY THAT THE SURGERY WAS THREE WEEKS AGO IT'S HARD TO BELIEVE THAT I'M ALIVE AND EVERYTHING WENT WELL, EVERYTHING WENT GREAT. I HAVE NO MORE SEIZURES AND I CAN GO TO SLEEP AT NIGHT KNOWING THAT I'M NOT GOING TO WAKE UP HAVING A SEIZURE. I CAN DRIVE A CAR KNOWING THAT I'M NOT GOING TO HAVE A SEIZURE. I CAN WALK OUT MY FRONT DOOR KNOWING I'M NOT GOING TO HAVE A SEIZURE. IT'S FANTASTIC. I'M GOING TO GET MARRIED AND I'M GOING TO HAVE CHILDREN AND I'M GOING TO GET RICH, HOPEFULLY. AND THOSE THINGS I COULD NEVER DO BECAUSE I WOULDN'T BE HERE TO DO THOSE THINGS. IT ALL SEEMS LIKE A DREAM, A DREAM THAT CAME TRUE. FOR A LOT OF PEOPLE WHAT I AM ABOUT TO DO IS PRETTY MUCH IMPOSSIBLE. Mechanical voice: Going up. THIS ELEVATOR GOES UP 47 FLOORS IN ABOUT 30 SECONDS

				Bypass Genes Gene therapy promotes new vessel growth, and allows a woman with blocked arteries in her leg to walk again.
		Select text to jump ahead in the clip: THIS SHOPPING MALL IN NATICK, MASSACHUSETTS IS ALREADY HUMMING WITH ACTIVITY. ONE OF THE MOST ENTHUSIASTIC OF THE MALL-WALKERS USED TO BE LILLIAN COOPER. Cooper: I STARTED ABOUT SEVEN YEARS AGO AND I COULD WALK FIVE MILES EVERY MORNING. I DON'T WANT TO BE IMMODEST, BUT I WAS A GOOD MALL-WALKER. I WAS USUALLY AT THE HEAD OF THE GROUP. Alda: BUT FOR TWO YEARS NOW, LILLIAN HAS BEEN SIDELINED BY A BADLY NARROWED ARTERY IN HER LEFT LEG. Cooper: IF I DON'T FIND A WAY TO GET IT FIXED I'M GOING TO LOSE THE LEG. I'VE BEEN ADVISED OF THAT BY TWO DOCTORS AND I'M NOT READY FOR THAT. Alda: LILLIAN HAS ALREADY HAD ALL THE STANDARD THERAPIES FOR HER BLOCKED ARTERY. BUT NOW THERE'S SOMETHING NEW, INVOLVING A FORM OF THERAPY MANY BELIEVE WILL REVOLUTIONIZE MEDICINE IN THE 21st CENTURY. AT BOSTON'S ST. ELIZABETH'S HOSPITAL HER DOCTOR IS JEFFREY ISNER. NOW, WE'RE ONLY NUMBING THAT BECAUSE WE LIKE YOU, LILLIAN. ( chuckles ) Alda: SHE'S BEEN THROUGH THIS PROCEDURE OFTEN. A CATHETER IS BEING SLIPPED INTO THE MAIN ARTERY OF HER LEG AND THEN A DYE THAT SHOWS UP ON X-RAYS IS INJECTED. THE RESULTING ANGIOGRAM SHOWS THE DYE REACHING THE BLOOD VESSELS IN HER LOWER LEG. Isner: THIS IS WHERE THE PROBLEM IS. IT TAKES A LONG TIME FOR THAT DYE TO WIND ITS WAY ALL THE WAY DOWN TO HER CALF MUSCLE AND FOOT. THAT'S WHY SHE'S HAVING ALL THE PAIN. AND SO THE NEED HERE IS TO FIND A WAY TO SOMEHOW DELIVER A SIGNIFICANTLY LARGER VOLUME OF BLOOD FLOW DOWN TO THE LOWER LEG. SO, LILLIAN, THE ANGIOGRAM... Alda: RESTORING BLOOD FLOW IN A BLOCKED BLOOD VESSEL IS USUALLY ATTEMPTED WITH BYPASS SURGERY OR BY INFLATING A SMALL BALLOON IN THE ARTERY. THE MAIN VESSEL, THE MAIN STREET IS TOTALLY BLOCKED. Alda: BUT FOR LILLIAN, THESE HAVE ALREADY FAILED. YOU'VE HEARD ABOUT GENE THERAPY... YES, I HAVE. AND IN THIS CASE WHAT WE ARE GOING TO DO IS USE GENE THERAPY TO TRY TO MAKE NEW BLOOD VESSELS GROW FROM THIS ARTERY THAT'S RIGHT ABOUT IN THE MIDDLE PART OF YOUR LEG. Alda: GENE THERAPY HAS BEEN HIGHLY TOUTED AS THE FUTURE OF MEDICINE. A HUGE RESEARCH PROJECT TO LOCATE AND READ ALL THE 100,000 OR SO HUMAN GENES IS NOW IN FULL SWING. IT'S ANOTHER DRAMATIC EXAMPLE OF HOW INFORMATION-- IN THIS CASE THE SPELLING OF THE OPERATING INSTRUCTIONS FOR THE HUMAN BODY-- IS TRANSFORMING MEDICINE. AND IT'S LED TO THE HOPE THAT HUMAN GENES CAN THEMSELVES BE USED TO TREAT PEOPLE. ONE OF THESE GENES MANUFACTURES A CHEMICAL THAT CAN MAKE BLOOD VESSELS GROW. JEFFREY ISNER'S IDEA IS TO SEE IF PUTTING THIS GENE INTO BLOCKED ARTERIES WILL CAUSE THEM TO DEVELOP SHOOTS THAT WILL BYPASS THE BLOCKAGE. Isner: THE IDEA THAT PEOPLE COULD GROW THEIR OWN BYPASS IS AN INTRIGUING ONE BECAUSE THERE IS NOTHING LIKE LETTING NATURE DO THE SURGERY. Alda: TO DELIVER THE GENE, ISNER EMPLOYS A NARROW BALLOON THAT CAN BE SLID INTO LILLIAN'S ARTERY TO A POINT JUST ABOVE THE BLOCKAGE AND INFLATED TO SQUASH THE GENE INTO THE BLOOD VESSEL'S WALLS. HUNDREDS OF MILLIONS OF COPIES OF THE GENE ARE COATED ONTO THE BALLOON AND THEN DRIED SO THAT THEY STICK THERE. Isner: IT SEEMS LIKE A LOT BUT WE KNOW THAT NOT ALL OF THE DNA IS GOING TO COME OFF OF THE BALLOON AND ONTO THE WALL OR INTO THE WALL OF THE ARTERY. AND EVEN ALL THAT GETS INTO THE WALL OF THE ARTERY WILL NOT NECESSARILY FIND ITS WAY INTO THE CELLS-- THE SMOOTH MUSCLE CELLS-- OF THE ARTERIAL WALL. AND EVEN THE AMOUNT THAT GETS INTO THE CELLS WILL NOT ALL BECOME OPERATIVE IN TERMS OF MAKING THE GROWTH FACTOR. Alda: EVERYTHING IS READY FOR THE GENES TO BE DELIVERED. ALL RIGHT, READY? HERE WE GO. Alda: A PUMP INFLATES THE BALLOON. NOW ALL EVERYBODY CAN DO IS WAIT AND SEE IF THE GENES GOT IN, IF THEY WORK IF NEW BLOOD VESSELS BYPASS LILLIAN'S BLOCKAGE. Cooper: MY IMMEDIATE DREAM IS TO GO BACK TO THE MALL-WALKERS AND BE ABLE TO WALK RIGHT IN. AND I'M SURE THEY'RE ALL GOING TO BE THERE HOPING FOR THE SAME THING. THAT MEANS I'LL START MY LIFE AGAIN DOING THE THINGS THAT I'VE ALWAYS WANTED TO DO. Alda: IF THE GENE THERAPY GROWS A BYPASS FOR LILLIAN'S BLOCKED LEG ARTERY IT HAS IMPLICATIONS FOR OTHER PLACES BYPASSES ARE NEEDED-- MOST OBVIOUSLY, THE HEART. JEFFREY ISNER'S ULTIMATE GOAL IS TO USE GENE THERAPY AS AN ALTERNATIVE TO BYPASS SURGERY IN PEOPLE WITH CORONARY ARTERY DISEASE. IT'S BEEN FOUR WEEKS SINCE LILLIAN'S TREATMENT. Cooper: YESTERDAY I WALKED FROM THE HOSPITAL DOWN THE MAIN STREET OVER A HALF A MILE, AND I KEPT GOING. I FEEL THAT THERE HAVE TO BE NEW BLOOD VESSELS FORMING BECAUSE WHAT ELSE WOULD CAUSE THIS? MY LEG IS BETTER, MY FOOT IS BETTER, I CAN WALK BETTER. HAS TO BE THAT. WE'LL HAVE TO USE THAT CANE AS KINDLING. ( laughing ) Alda: TO FIND OUT IF MORE BLOOD IS FLOWING TO LILLIAN'S LEG SHE HAS YET ANOTHER ANGIOGRAM. THE RESULT AT LEAST PARTIALLY JUSTIFIES HER OPTIMISM. WHILE BEFORE IT TOOK 15 SECONDS FOR BLOOD TO REACH HER CALF NOW IT TAKES ONLY NINE. Isner: WE'RE NOT SEEING TUFTS OF NEW VESSELS AND WE'RE NOT SEEING SPLASHES OF ARTERIES THAT WE NEVER SAW BEFORE. IT'S POSSIBLE THAT THE NEW ARTERIES THAT ARE DEVELOPING ARE OF A SIZE THAT THEY'RE JUST A LITTLE BIT TOO SMALL FOR US TO SEE ON THESE ANGIOGRAMS UM... BUT YET, THERE ARE STILL ENOUGH OF THEM AND THEY'RE STILL FUNCTIONAL ENOUGH THAT THEY'RE PRODUCING, YOU KNOW, NEW CONDUITS NEW AVENUES FOR BLOOD FLOW TO THE LOWER LEG. Alda: GENE THERAPY IS STILL IN ITS INFANCY AND SO FAR, MOST OF THE 100 OR MORE CLINICAL TRIALS USING GENES HAVE BEEN DISAPPOINTING OR INCONCLUSIVE. BUT THIS ONE JUST MIGHT BE DIFFERENT. Isner: WHENEVER YOU TRY SOMETHING LIKE THIS FOR THE FIRST TIME, YOU ALWAYS WONDER, IS IT SCIENCE FICTION OR IS IT GOING TO BE REAL THERAPY? UM... A LOT OF THINGS WE TRY TURN OUT TO BE SCIENCE FICTION-- MAKE GOOD MOVIES, BUT THEY DON'T HELP TOO MANY PATIENTS. I THINK THIS HAS THE POTENTIAL TO BE GREAT SCIENCE FICTION BUT NOW WE'RE SEEING A FEW INDICATORS THAT SUGGEST THAT IT ACTUALLY MIGHT BE USEFUL MIGHT ACTUALLY BE THERAPEUTIC FOR CERTAIN GROUPS OF PATIENTS. HOW MANY MILES DO YOU USUALLY WALK IN A DAY? I WALK A MILE AND A HALF EVERY DAY. THAT'S VERY GOOD, YEAH. Alda: SIX MONTHS AFTER LILLIAN'S GENE THERAPY AND SHE'S BACK AT THE MALL. Cooper: IT FEELS WONDERFUL TO BE WALKING AGAIN. THERE WERE TIMES WHEN I THOUGHT WALKING A FEW STEPS WITH A CANE WOULD BE ABOUT IT. BUT NOW I CAN WALK AROUND THE MALL, MOSTLY WITHOUT STOPPING. SO, I'M REALLY THRILLED WITH THE WAY EVERYTHING HAS TURNED OUT. AND I'M HOPING THAT IT WILL GET BETTER ALL THE TIME AND I'M SURE IT WILL. ... KNOW WHICH ONES TO COME BACK TO. ( laughing ) SAVE A LOT OF MONEY SHOPPING THIS HOUR. Alda: THERE WAS ONCE A TELEVISION SERIES SET IN A MOBILE ARMY SURGICAL HOSPITAL