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Format: 04/24/2014
Format: 04/24/2014


The Almanac: Drug helps to illuminate man's tumor

Monday, March 29th, 2010

By Terri T. Johnson

John Rotella of Bridgeville felt fine during the winter holidays.
His wife, Lillian, knew he wasn't, and asked two relatives who are nurses to observe her husband during a New Year's celebration.

After listening to Rotella speak for only a few minutes, everyone agreed he needed to go to the hospital and soon.

Five days later, Rotella, 73, was on an operating table in Allegheny General Hospital, Pittsburgh, undergoing surgery to remove as much as possible of the malignant tumor growing on his brain.

Two days later, on Jan. 7, Rotella was released.

 What makes the surgery even more remarkable is Rotella's was performed in one of only four medical centers in the country approved by the federal Food and Drug Administration to investigate use of an oral fluorescent compound.

Currently in clinic trials, 5-aminoevulnic acid (ALA) is used in patients, like Rotella, diagnosed with a glioma, to illuminate the malignant portions, making removal easier.

"Regardless of grade, removing as much of a glial tumor as possible is critical to the patient's outcome," said Matthew Quigley, a medical doctor and director of AGH's Division of Neurosurgical Oncology.

Rotella said he drank the fluid he described as tasting "Yuk" and like onions, and just relied on the skill of the surgeons.

Lillian, his wife of 49 years, said 97 percent of the offending tumor was removed. The remaining 3 percent was left as excising that portion of the tumor could have permanently affected his speech.

Rotella said he experienced no symptoms before his diagnosis-no dizziness, no memory loss, no blurred vision, no nausea. His wife said she noticed a difference in his speech patterns, but both just attributed that to his being 73.

On Jan. 7, Rotella was discharged from the hospital with just a crescent-shaped scar on the left side of his head-the only visible evidence he'd had a golf ball-size tumor removed two days earlier.

Three months later, Rotella has no residual effects. The scar is fading and a little puffiness remains from the ensuing medical treatments, such as radiation he completed in mid-March. He'll soon start on oral chemotherapy treatments.

"I feel very good," John Rotella said. "I can't run up any steps. Let's say, I'm 95 percent."

His wife agreed: "I think he's doing well," with John Rotella adding, "She sure is feeding me well," as he patted his ample stomach and laughed.

He officially retired and turned his engineering services company over to one of his two sons more than a year ago.

He still keeps his hand in the business and said he has not noticed any loss of fine-motor skills since the surgery.

He expects to spend his summer golfing every day he can, knowing he's lucky to be alive.

"These tumors are often difficult because the lack of easily identifiable tumor margins under normal, direct vision of the operating field confounds the surgeon's attempts toward total resection. Any technique that would enhance our ability to more precisely determine these margins could make a significant difference for the patient," said his surgeon, Khaled Aziz, Director of AGH's Center for Complex Skull Base Surgery. "That is why we are so excited about investigating ALA as an adjunct to our conventional surgical approach. The preliminary experience with this innovative procedure has been extremely promising."

To read more, visit The Almanac website.

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