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Archive for June, 2013

Minimally-invasive Techniques and Custom-Made Endografts Result in Improved Outcomes

Friday, June 28th, 2013

by Helen K. Kelley

New minimally invasive techniques and custom-made endografts are making a difference for high-risk patients in the arena of vascular surgery. Several of Atlanta’s vascular surgeons are performing procedures that result in improved outcomes and shortened hospital stays for patients with abdominal aortic aneurysms.

Fenestrated aortic endografts for high-risk patients

It is estimated that 1.7 million Americans suffer from abdominal aortic aneurysms, a bulge in the main blood vessel that runs through the stomach and carries blood from the heart to the rest of the body. More than 50,000 repairs are performed annually in the United States on patients with this condition.

The condition, which can be life-threatening if the aneurysm bursts and causes severe internal bleeding, is relatively common in men and those aged 65 and over. Despite this, approximately half of those with abdominal aortic aneurysms may not be candidates for traditional repairs due to other risk factors and health conditions.

Those at risk for developing an abdominal aortic aneurysm include people who smoke, have a family history of aortic aneurysms, have high blood pressure, high cholesterol or a plaque buildup in and on artery walls restricting blood flow (atherosclerosis). Infection and trauma also can cause abdominal aortic aneurysms, according to the Centers for Disease Control and Prevention.

A new procedure, a fenestrated aortic stent-graft (or endograft) can help these high risk patients get the life-saving aortic aneurysm repair they need.

“Until now, repairing complex or ruptured abdominal aneurysms was risky,” said Eyal Ben-Arie, M.D., a vascular surgeon with Piedmont Heart Institute who has a particular interest in aneurysm repair. “With this minimally-invasive procedure, a fenestrated aortic stent-graft is used to reinforce openings and maintain blood flow to vessels that lead to other organs in the body.”

Instead of making a large incision in the stomach, doctors performing a fenestrated aortic endograft make a small cut near each hip. A small, fabric tube called a graft is inserted into the arteries and positioned in the appropriate blood vessel. Once in place, the graft seals off the aneurysm and makes a new path through which the blood flows.

“Patients who get this new procedure may go home after a very short hospital stay, generally do not require an ICU stay or a transfusion, and experience minimal pain after surgery,” said Dr. Ben-Arie.

Dr. Ben-Arie performed the procedure for the first time at Piedmont Atlanta Hospital on Feb. 6, 2013 in collaboration with the hospital’s entire vascular team.

Custom-modified endografts reduce wait time for patients in need

Joseph Ricotta, M.D., of Northside Vascular Surgery, is the first and only surgeon in the United States with FDA approval for an Investigational Device Exemption (IDE) to create and implant custom-modified endografts for high-risk patients with thoracoabdominal aortic aneurysms (TAAA).  Dr. Ricotta performed his first case, as part of his new MOSTEGRA (MOdified STEnt GRAft) clinical trial, Feb. 12, 2013 at Northside Hospital-Forsyth in Cumming.

Dr. Ricotta, who can make a custom-modified endograft in the OR in as little as 30 minutes, says one of the procedure’s advantages is the ability treat patients quickly.

“We keep all the necessary supplies and tools to make the endografts on hand and ready in the OR,” he states. “When a patient is admitted for TAAA, we can make a customized graft immediately, which is especially helpful in emergency situations.”

Since the entire aneurysm is repaired from the inside of the aorta, rather than cutting open the chest and abdomen, patients have a much shorter hospital stay and a quicker recovery time. In Dr. Ricotta’s Feb. 12 case, the patient was removed from the ventilator at the conclusion of the operation before she left the operating room and went home just two days after surgery.  A traditional open surgical procedure would have left her in the hospital for more than one week and on oxygen for most of that time.

However, construction of these devices requires that they be custom-made to fit the specific anatomy of each patient.

“The kidney arteries and intestinal artery all arise from different positions off the aorta,” Dr. Ricotta explains. “Angles, curvature and locations can differ from patient to patient — no two people are the same in terms of their blood vessels and aortic anatomy.”

Ricotta says that his technique has evolved since he began making custom-modified endografts in 2007, and will continue to change as new methods are discovered.

“The foundation of what I do is the same, but the way I do it has changed a lot in the last six years. You learn over time how to make improvements,” he states. “We’re always looking fore ways to make the procedures quicker, safer and easier for the patient.”

Minimally invasive treatment for Aortic Stenosis  

With an ever-aging population, identification and treatment of heart valve disease has become a primary focus in the treatment of cardiovascular disease. Aortic valve stenosis is of particular concern given the dismal prognosis of this condition as the valve worsens.

The normal aortic valve allows blood to freely exit the left ventricle, the main pumping chamber of the heart.  In aortic stenosis, the valve does not fully open, due to heavy calcium build-up, which decreases blood flow from the heart.  Without treatment, approximately 50% of severe aortic stenosis patients will not survive more than two years from the onset of symptoms. Historically, treatment was via open-heart surgery which requires a large incision or cutting through the entire breastbone. Yet, a patient’s advanced age or the presence of other medical conditions might often preclude them from traditional aortic valve replacement surgery.

Amar Patel, M.D., an interventional cardiologist and Medical Director of WellStar Hospital System’s Structural Heart and Valve Program, along with fellow interventional cardiologist Arthur Reitman, M.D. and cardiothoracic surgeons William Cooper, M.D. and Richard Myung, M.D., offers these patients a life-saving alternative called Transcatheter Aortic Valve Replacement (TAVR).

TAVR is an FDA-approved catheter-based procedure in which the new prosthetic aortic valve is implanted via a minimally invasive approach by either going through a small incision in the groin or left chest, underneath a rib. The TAVR approach greatly increases a patient’s survival rate, alleviates debilitating symptoms, reduces the likelihood of repeat hospitalizations and improves the quality of life for aortic stenosis patients who have no other treatment options.

Dr. Patel says that performing the procedure as a team of CT surgeons and interventional cardiologists is a critical part of a successful outcome for the patient.

“We do these procedures as a team,” he states. “Because one of the most important aspects of the TAVR procedure is a true multidisciplinary approach to managing the patient.”

In comparing like patients who do undergo TAVR versus surgical aortic valve replacement (SAVR), the length of stay and recovery time is shorter with similar procedure success, stroke risk and death. However, Dr. Patel warns that the TAVR procedure is not without its own risks.

“Vascular complications were higher in the TAVR group given the large sheaths that are used during the procedure when the valve is replaced by going through an artery in the leg,” he states. “Also, medical conditions such as significant heart failure, renal insufficiency, lung disease, liver disease and frailty may adversely impact the success of the procedure or post-procedural recovery.”


More Precise Blood Test Outperforms Traditional PSA Screen Test

Thursday, June 27th, 2013

Martin Sanda, MD, a member of the Winship Cancer Institute, chairman of the Emory Urology Department and internationally recognized prostate cancer scientist, delivered news about better prostate cancer diagnosis, at the American Urological Association’s 2013 Annual Meeting.

As corresponding and presenting author of the abstract “Prostate Health Index (phi) for Reducing Overdetection of Indolent Prostate Cancer and Unnecessary Biopsy While Improving Detection of Aggressive Cancers,” Sanda presented findings that represent a significant step towards better detection and diagnosing of fast-growing prostate cancers, and fewer unnecessary biopsies of indolent cancers.

The Prostate Health Index (phi), a blood test used to evaluate the probability of prostate cancer diagnosis, outperformed commonly used prostate-specific antigen (PSA) and free/total prostate-specific antigen (%fPSA) tests in predicting the presence of clinically significant prostate cancer and in improving prostate cancer detection, according to the new study.  The phi test focuses on measuring a subtype of PSA, called pro-PSA, that unlike the rudimentary total PSA, is preferentially made by aggressive prostate cancers and less so by normal prostate or slow-growing cancers.  Sanda and his collaborators found that among men being considered for prostate biopsy due to abnormal results on the traditional “total” PSA test, one in four had phi test results that indicated no aggressive cancer would be found and unnecessary biopsy could be averted.

The test was approved by the US Food and Drug Administration (FDA) in 2012 and is being prepared for release for general clinical use soon. The study also found using a specific phi benchmark level may help identify biopsy candidates and reduce over-detection of slow-growing prostate cancer.

“This investigation is a crucial step towards implementing better diagnostic tools for prostate cancer.  It will help us solve the well-recognized shortcomings of routine, prostate cancer screening with the traditional ‘total’ PSA test, by refining the process to avoid unnecessary prostate biopsies and overtreatment of slow-growing cancers, while allowing us to still detect those cancers for which treatment is appropriate,” said Sanda.

The study consisted of 658 participants who were 50 years of age or older with a biopsy-confirmed prostate cancer diagnosis, a final PSA between 4-10 ng/mL and a benign rectal examination. Study investigators evaluated prediction of clinically significant cancer (aggressive histopathology per Epstein criteria or Gleason 7+) based on pre-biopsy measures of pro-PSA, total PSA, fPSA, %fPSA and phi and evaluated prospects for eliminating unnecessary biopsies based on results of phi prior to biopsy.

The researchers found:

  • At 90 percent sensitivity, the specificity of phi was 31.1 percent, compared to 19.8 percent for %fPSA (p=0.024) and 10.8 percent for PSA (p<0.001).
  • At a moderate to high phi range of 27 to 55, the probability of cancer varied from 9.8 to 50.1 percent and the probability of clinically significant cancer extended from 3.9 to 28.9 percent.
  • One in four men had a phi level below 27, which is the 90 percent sensitivity cut-point, and thereby could be spared from undergoing unnecessary prostate biopsy or over-diagnosis of non-aggressive disease.

Study investigators concluded phi outperformed PSA and %fPSA in detecting clinically significant prostate cancer..


Leon Haley to Serve as Emory’s Executive Associate Dean for Grady

Thursday, June 27th, 2013

Leon L. Haley Jr., MD, MHSA associate professor of emergency medicine at Emory University School of Medicine, has been appointed the new Emory School of Medicine Executive Associate Dean of Clinical Services for Grady and Chief Medical Officer of the Emory Medical Care Foundation.

Haley will begin his new role on July 8, serving as the primary liaison between the Emory School of Medicine and the Grady Health System. In his new role, Haley will be responsible for executive oversight and the strategic vision and direction for Emory’s clinical, research and teaching practices at Grady.

Haley joined the Emory University School of Medicine faculty in 1997. A native of Pittsburgh, Pa., he received his undergraduate degree from Brown University, his medical degree from the University of Pittsburgh and his master’s degree in health services administration from the University of Michigan. Haley completed his residency, including a year as chief resident in emergency medicine, at the Henry Ford Health System in Detroit, Mich. Haley is Board-Certified in Emergency Medicine and a Fellow of the American College of Emergency Physicians and currently serves as an Oral Board Examiner for the American Board of Emergency Medicine

Haley’s honors and awards include a 2012 Fulton-Dekalb Hospital Authority Healthcare Hero, Atlanta Business Chronicle Healthcare Heroes award in 2005,and  “Up and Comers Award” in 2004, Who’s Who in Black Atlanta 2007, International Who’s Who of Professionals, the Alpha Kappa Alpha Pink Ice Gala Community Service Award and the Delta Sigma Theta Golden Torch Award. He is a member of the Omega Psi Phi and Sigma Pi Phi national fraternities.

Haley has been  a Woodruff Leadership Academy Fellow at Emory University and completed a Fellowship for  the National Association of Public Hospitals (NAPH) program.. He is a member of the American College of Emergency Physicians, the American College of Healthcare Executives and the American College of Physician Executives. He was also  a member of the Institute of Medicine Committee on Health and Insurance Status.

Haley is an active member of the Georgia Trauma Network Commission and the Boards of Leadership Atlanta, Camp Twin Lakes, the Grady Foundation and the National Public Health and Hospital Institute. In addition, he is a member of the National Advisory Boards for the Agency of Healthcare Reasearch and Quality (AHRQ) and the Griffith Leadership Center at the University of Michigan.



GMC Creates Office of Research, Led by Holly Richards

Thursday, June 27th, 2013

Gwinnett Medical Center (GMC) recently announced its newly created Office of Research, which will support sponsored research for internal departments at the hospitals in Duluth and Lawrenceville and external physician groups using GMC’s facilities when conducting research. Holly Richards was named as director of clinical research to support this program.

The Office of Research will coordinate research efforts by providing support and consultative services, in areas including regulatory and financial aspects of conducting research, as it relates to community physicians and staff. The program will provide administrative oversight of the research studies currently being conducted by the Center for Cancer Care, a service of GMC, as well as any additional studies conducted at the hospital. The office will also manage and enforce standard research procedures at GMC as it relates to logistics reviews, contract and budgeting negotiations, Medicare coverage analysis and billing compliance, among others.

Richards comes to GMC with more than 20 years of experience in clinical research operations and administration and specializes in oncology and cardiovascular services.  Most recently, she was with Genocea Biosciences, based in Cambridge, Mass., as Director of Clinical Operations and Quality Assurance. There, she oversaw all clinical operations in regards to research and development, served as head of operations related to quality assurance and authored clinical materials, among other responsibilities.  Prior to Genocea Biosciences, she served at large hospital in Kentucky as the executive director of the Center for Advanced Medicine.


Chiang Leads WellStar’s Allergy & Asthma Practice

Thursday, June 27th, 2013

WellStar Medical Group, Allergy & Asthma, led by Grace Chiang, M.D., has recently opened a new East Cobb office.

Dr. Chiang is board certified in adult and pediatric allergy and immunology. She specializes in allergy and asthma care for patients of all ages, including infants, children and adults.

Conditions commonly treated include asthma, allergic rhinitis (hayfever), sinusitis, atopic dermatitis (eczema), hives and/or angioedema (swelling), anaphylaxis, allergies to foods, drugs and insect stings, and immune deficiency. Diagnosis and treatment may include skin testing and allergy shots.


New Screening Program Aids in Early Detection of Lung Cancer

Thursday, June 27th, 2013

Piedmont Atlanta Hospital has launched a new lung cancer screening program to improve early detection of the disease, which is the second leading cause of death behind heart disease.

Patients who meet a certain criteria and are deemed “high risk” for lung cancer will be able to participate in the new program, which uses a low-dose CT (computed tomography) screening to detect the disease. Those who are at high risk include people older than 55 years of age who have smoked approximately one pack of cigarettes a day for more than 30 years; those who have smoked two packs a day for 15 years; and those who have smoked three packs a day for 10 years or more.

Also at risk are current or former smokers over 50 years of age with at least a 20-pack year history and at least one additional risk factor (radon exposure, lung disease history, family history of lung cancer, or occupational exposure to known cancer-causing chemicals). Pack years are defined by the number of packs per day multiplied by the number of years a person has smoked.

“The test only takes 30 minutes to complete and the new low-dose CT uses far less radiation,” said Saeid Khansarinia, M.D., Piedmont Atlanta. “This new program will help us catch lung cancer at an earlier stage so we have better chances of curing our patients and giving them a fighting chance at life.”

A national lung screening trial found that screening with the use of low-dose CT, which is used to find nodules in the lungs, reduces mortality from lung cancer by 20 percent. Since insurance does not typically cover these screenings, Piedmont Atlanta will offer the tests at a discounted rate of $99.

As with many diseases, early detection of lung cancer is key to successful treatment. Screenings such as the new low-dose CT can detect cancer before signs appear. Common symptoms of lung cancer include coughing that lasts, blood in lungs, excessive mucus, shortness of breath, wheezing, chest area pain, tiredness, pneumonia, hoarse voice, pain when swallowing, and high-pitched sound when breathing.

Known risk factors for lung cancer are tobacco smoking, contact with radon, contact with asbestos or other cancer-causing agents, family history of lung cancer, diagnoses of certain other cancers and/or lung disease and contact with second-hand smoke.


Medical Association of Atlanta Annual Dinner

Tuesday, June 25th, 2013

June 25, 2013 at the Capitol City Club, Atlanta. For more information visit MAA Annual Dinner.


Georgia Society of Ophthalmology Summer Meeting

Friday, June 14th, 2013

June 14-16, 2013, Sea Island, GA. For more information, visit Georgia Society of Ophthalmology


GAFP Summer CME Meeting

Thursday, June 13th, 2013

June 13-16, 2013, Ponte Vedra, FL. For more information, visit Georgia Association of Family Physicians


AMGMA Meeting

Thursday, June 13th, 2013

June 13, 2013. For more information, visit Atlanta Medical Group Management Association



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