Aixa Silvera-Schwartz, M.D., has joined WellStar Medical Group, Smyrna Pediatrics.
Dr. Silvera-Schwartz received her medical degree from the University of Panama School of Medicine in Panama City, Panama. She completed an internship at the Hospital Caja del Seguro Social and the Rafael Hernandez Hospital in the Republic of Panama. Following her internship, she started a residency at the Hospital Caja del Seguro Social in the Republic of Panama and completed her residency at the Woodhull Medical and Mental Health Center in Brooklyn, New York.
Dr. Silvera-Schwartz is board certified in pediatrics. Her specialties include early intervention and prevention in newborns to five years old, obesity and asthma.
Prior to joining WellStar Smyrna Pediatrics, Dr. Silvera-Schwartz worked as a lead pediatrician for the ambulatory department at Grady Health System. She is a fellow of the American Academy of Pediatrics and a chair member of the Georgia American Academy of Pediatrics for Early Education and Child Care.
For patients in acute liver failure, time is precious. In many cases, a patient’s only hope is a liver transplant, but the wait for a viable — and matching — organ can be too long.
The Emory Transplant Center now offers Molecular Adsorbents Recirculating System (MARS), a liver dialysis system approved by the U.S. Food and Drug Administration (FDA) to treat select patients with acute liver failure due to drugs or toxins. Acute liver failure often results from drug overdose or idiosyncratic medication reactions. The most common cause of acute liver failure is acetaminophen overdose.
“We have long had kidney dialysis to stabilize patients in renal failure, but until now, we have not had a corresponding method of treatment for patients in acute liver failure,” says transplant hepatologist and intensivist Ram Subramanian, MD, assistant professor at Emory University School of Medicine. “ MARS is a potential game changer for patients who either don’t qualify for transplant or who don’t have the time that is critical to wait for a transplant.”
Patients in acute liver failure are unable to clear certain toxins from their systems, so the MARS system does the work for them by drawing blood from patients and cleansing it with solution containing albumin. Albumin is produced by healthy livers and binds to certain medications and other bodily substances to transports them throughout the body. It also binds toxins, protecting the body from their toxic effects. The cleansed blood is returned to the patient’s circulatory system to attract more toxins.
While MARS currently is FDA approved only for treatment of acute liver failure, MARS has been used successfully in clinical trials to treat forms of chronic liver illness.
“Several studies in Europe have demonstrated that MARS is effective in treating chronic liver failure as well,” says Subramanian. “My hope is that it becomes another tool for us in offering hope to patients who are dealing with all kinds of liver failure.”
The Medical Center Foundation’s James H. Downey Society physician-giving club recently recognized James A. Butts, MD, with the Samuel O. Poole Award at their donor recognition event. The award, established in 2001, honors physicians who exhibit outstanding leadership, generosity and long-term service to the community such as that of the late Dr. Samuel O. Poole for whom the award was named. The Downey Society is co-chaired by Pepper Brown, MD, a surgeon with Northeast Georgia Physicians Group Surgical Associates, and Buddy Langston, MD, a pediatrician, retired from the Longstreet Clinic.
A North Georgia native who grew up in Blairsville, Dr. Butts trained in oncology at Winship Clinic in Atlanta, which later became known as Emory Clinic. In 1968, he moved his family to Gainesville to join the practice of Jennings, Stribling and Poole and was the first and only board-certified medical oncologist in Northeast Georgia for more than 20 years. Along with the practice partners, Dr. Butts became a founding member of Northeast Georgia Diagnostic Clinic.
Dr. Butts pioneered the specialties of oncology and hematology in the Northeast Georgia region. The first to utilize a computer in his practice, Dr. Butts obtained information from national cancer resources to keep up with advancements in the treatment of patients.
In addition to being a successful oncologist, Dr. Butts has been very involved in medical community outreach. After the passing of Dr. Poole, Dr. Butts accepted the role of Good News Clinics’ Medical Director in 2007 and today continues to champion high quality health care for the community’s underserved. Under his leadership, Good News Clinics has experienced continued growth and success, with 13 additional physicians joining Good News Clinics as volunteers and the production of a manual for other communities wishing to open a free clinic. As both mentor and educator, Dr. Butts oversees the training of medical students and nurses, as well as teaches classes through Brenau University’s BULLI program.
Dr. Butts has actively served in leadership roles on both the state and local levels, including his service as president of Georgia Medical Care Foundation and Northeast Georgia Medical Center Chief of Staff, as well as numerous other boards and committees.
The James H. Downey Society gives special recognition to physicians who generously support The Medical Center Foundation through charitable contributions. Downey Society members continue the tradition of healthcare excellence by providing funds for the latest medical technology, education, and delivery of service to our community that might not otherwise be possible.
Northeast Georgia Health System recently welcomed six new physicians:
Benjamin Akosa, MD
Psychiatry
Northeast Georgia Physicians Group Psychiatry
Elizabeth Atkinson, MD
Otolaryngology
ENT Institute
Peter Henderson, Jr., MD
Bariatric & General Surgery
The Longstreet Clinic Obesity Solutions
Grant Hsing, MD
Family Medicine
Northeast Georgia Physicians Group Cumming, Suite 100
From ATLANTA Medicine, 2012, Women’s Health, Vol. 83, No. 1
Cesarean section has been around for hundreds of years but not without serious consequences for the mother. Originally the procedure was used postmortem to satisfy religious and cultural requirements that the dead infant be buried separately from the mother. There are early reports of its use as a last resort to attempt to save the woman’s life, but historical record of success in this arena is absent. The first written record of a live birth and living mother after cesarean delivery originates from Switzerland in 1500. There is some question regarding the accuracy of the story, but it has been reported that a sow gelder, Jacob Nufer, was granted permission by local authorities to attempt the procedure after his wife spent several days in labor and was unable to deliver despite help from 13 midwives. The child lived to the age of 77 and his mother subsequently delivered five more children, including a set of twins, via vaginal birth.
Although the sixteenth and seventeenth centuries brought numerous works of art illustrating human anatomy in detail, it was not until the mid to late 1800s that human cadavers were available to medical students and practical experience allowed physicians to gain a true understanding of anatomy. Thereafter, cesarean sections were attempted in greater numbers. Until then, unsuccessful deliveries had been treated via craniotomy and a mutilating extraction of the fetus through the vagina in an effort to save the mother’s life. When ether was used for the first time in 1846 at Massachusetts General Hospital by dentist William T.G. Morton during surgery to remove a facial tumor, the future of cesarean section (and surgery as a whole), changed dramatically. There was initial reluctance to use anesthesia in obstetrics based upon the concept that women should suffer during childbirth to atone for Eve’s sin. However, once Queen Victoria was administered chloroform for the births of two of her children in 1853 and 1857, widespread acceptance of anesthesia for childbirth took hold.
Initial mortality rates for cesarean section were high. Germ theory was introduced in the mid 1860s but was not widely accepted. Physicians and hospital staff did not wash hands between patients and wore street clothes to operate. Additionally, surgeons did not suture the uterine incision for fear that the sutures would cause infection and promote uterine rupture in future pregnancies. Adherence to this theory resulted in high maternal death rates from hemorrhage and infection. For a brief time, hysterectomy in conjunction with cesarean was used to decrease those rates. Once Max Sanger’s monograph advocating silver sutures to close internal wounds was widely circulated in 1882, confidence in the procedure increased and hysterectomy was abandoned.
The more modern low cervical uterine incision was popularized by British obstetrician Munro Kerr in the early 20th century, and the surgical details were further refined after the widespread availability of penicillin in the 1940s. Population growth in the cities and the trend toward medical management of pregnancy in the 1940s led to a boom in growth of women’s hospitals. In 1938, about half of births in the United States were taking place in hospitals, rising to 99 percent by 1955. In 1965, the cesarean section rate was 4.5 percent.
Over the past 40 years, cultural shifts have changed the focus of obstetrics. Paternal involvement in the delivery process, the advent of fetal monitoring in the early 1970s, and the assessment of fetal development with ultrasound have led to a major shift in perspective. The delivery process is no longer centered on the mother; it is now an infant-focused condition. When comparing cesarean section to vaginal delivery, there is a small increase in risk for the mother but a decrease in risk for the fetus. As parents became increasingly involved in decision making surrounding the pregnancy, the impartiality of the physician’s clinical judgment was muted by the parents’ inherent bias in favor of their child. Parents began expecting perfect babies and healthy moms, and the cesarean section rate rose rapidly to 24.7 percent in 1988. A push for vaginal birth after cesarean (VBAC) began in the mid 1980s and eventually did lead to a decline in cesarean section rates in the 1990s to a new low of 21 percent in 1996.
In 1999 the American College of Obstetricians and Gynecologists released new guidelines requiring the presence of an obstetrician and anesthesiologist, as well as staff capable of performing an emergency cesarean section, for any patient undergoing a trial of labor after previous cesarean section. Many smaller hospitals were unable to meet these in-house requirements, and many physicians cover more than one hospital and are unable to be in the hospital during labor. The immediate impact of these guidelines was apparent. The cesarean delivery rate increased to 29.2 percent by 2004, and the VBAC rate decreased from 28 percent in 1996 to 8 percent in 2004. The cesarean section rate has continued to climb yearly to a high of 32.9 percent in 2009. Finally, in 2010, the rate fell very slightly to 32.8 percent. Only time will tell whether this downward trend will continue. 2010 ACOG guidelines relaxed the earlier requirements for VBAC somewhat, indicating that trial of labor after cesarean(TOLAC) should be undertaken at a facility capable of emergency delivery and stated that most women with prior low transverse incision are candidates for TOLAC.
Prominent causes of the high current cesarean rates include the epidemic of maternal obesity in the United States, excess weight gain in pregnancy, macrosomic infants resulting from increased weight gain during pregnancy, and the increase in gestational diabetes. There is also an increase in twin/triplet/multiple pregnancies and a significant increase in pregnancy rates in women over 40 years of age. Despite a decrease of 3% in total number of births between 2009 and 2010, there was a 2% increase in births in women over 40. Women over 40 have a cesarean section rate 21 percent higher than women in their early 20s. The desire of women to have control over their delivery schedule has led to a rise in the induction rate of labor. Induction is clearly associated with increased cesarean
section rates, particularly in patients with an unfavorable cervix. In a retrospective study done by Zhang, et. al., the cesarean section rate for women who were induced was twice that of women who went into labor spontaneously. Finally, the current legal climate and parental expectations for perfect neonatal outcomes promote quicker decision for cesarean section. There is some thought that maternal demand for elective cesarean section in the United States has had an impact on surgical rates, but a survey by Declor, et. al. in 2006, revealed only 1 of 1,600 patients requested an elective primary cesarean section.
Worldwide, the cesarean rate is increasing. In Asian and South American countries, women have been requesting elective cesarean sections in high numbers for social convenience and from a cultural desire to deliver on certain days. In a sampling done by the World Health Organization, 46 percent of births in certain areas of China were by cesarean, and half of those were patient-requested elective procedures. Vietnam has a 36 percent cesarean rate and Thailand’s is 34 percent. The cesarean rate in Latin America is 35 percent, but certain areas like Paraguay (42 percent) and Ecuador (40 percent) are even higher. Some of the lowest rates worldwide are found in India, 18 percent, and Cambodia, at 15 percent.
Although overall cesarean delivery rates have significant impact on the health care system in the United States as a whole, the practicing clinician must make decisions based on the individual patient, her needs, her desires and her risk factors. It remains to be seen what the future holds for cesarean delivery and how the newest ACOG guidelines will impact the latest statistics.
Kirsten Franklin, M.D., FACOG is a board-certified obstetrician gynecologist. She has been in private practice at Northside Hospital for the past 16 years and is a current member of the Medical Executive Committee.
As Saint Joseph’s Hospital moves forward in its new partnership with Emory Healthcare, new developments in the oncology department will allow Saint Joseph’s to collaborate with the Winship Cancer Institute of Emory University to provide cancer care through Georgia’s only NCI-Designated Cancer Center.
Beginning June 1, radiation oncology services at Saint Joseph’s Hospital will be provided by Emory’s Department of Radiation Oncology under the medical direction of Peter Rossi, MD. Dr. Rossi will be joined by Shannon Kahn, MD, and the two radiation oncologists will be fully devoted to the radiation oncology patients at Saint Joseph’s. They will become part of Saint Joseph’s existing team of community physicians who provide oncology care to Saint Joseph’s patients.
Dr. Rossi is board certified in radiation oncology and is an assistant professor of radiation oncology at Emory University. He has been on the Emory faculty for five years and is considered an expert in the care of patients with many forms of cancer, including prostate cancer and gynecological cancer. He has significant experience in Gamma Knife® radiosurgery from his prior work at Wake Forest University.
Dr. Kahn is board certified in radiation oncology and returns to Emory after working in a private practice setting in the Atlanta area. She has a strong interest in breast, thoracic and hematologic malignancies.
Children’s Healthcare of Atlanta has named Stuart Knechtle, MD, as Chief of Transplant Services. He adds this to his roles as Surgical Director of the Liver Transplant Program and the Carlos and Marguerite Mason Chair for Liver Transplant Surgery at Children’s. As Chief of Transplant Services, he will collaborate with other physician leaders to develop and implement strategic initiatives for the program. He will continue to enhance research and build Children’s programming, outreach and education efforts.
Knechtle also serves as Clinical Director at the Emory Transplant Center, Director of Liver Transplantation at the Emory Clinic, Chief of the Division of Transplantation and Professor of Surgery at Emory University School of Medicine.
He has designed and led a variety of clinical trials and is considered a leader in the field of liver and kidney transplantation. As a researcher, Knechtle has operated a National Institutes of Health (NIH) funded research lab for 20 years and continues research focused on the immunologic mechanisms of transplant rejection and immunologic tolerance. Prior to joining Children’s and Emory, he led a team at the University of Wisconsin-Madison that performed the state’s first living donor liver transplant and Wisconsin’s first combined liver and pancreas transplant.
Knechtle is a member of several professional and scientific organizations, including the American Surgical Association and the American Society of Transplantation. He has contributed to more than 300 research articles, publications, and abstracts in the areas of transplantation and transplant immunology.
