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Archive for January, 2014

30th Annual Atlanta Breast Surgery Symposium

Friday, January 31st, 2014

January 31, 2014, Atlanta. For more information, visit Southeastern Society of Plastic and Reconstructive Surgeons

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7th Annual Oculoplastic Symposium

Thursday, January 30th, 2014

January 30, 2014, Atlanta. For more information, visit Southeastern Society of Plastic and Reconstructive Surgeons

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Physicians Day at the Capitol

Wednesday, January 29th, 2014

January 29, 2014, Atlanta. For more information, visit Medical Association of Georgia

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A New Shade of Obesity Research

Tuesday, January 28th, 2014

by Hyacinth Empinado, for Georgia Health News

Not all fat cells are created equal. White cells store globs of fat and make bellies jiggle. Brown cells burn fat and keep mice slim. In between is a type of fat called “beige,” which may be a key to fighting the bulge.

This prospect is so trendy that a beige-fat expert was featured in November during the nation’s largest meeting of obesity experts and bariatric surgeons.

And though “beiging” is not widely studied as yet, it has caught the attention of researchers at the University of Georgia. Both beige and brown fat cells burn energy and produce heat, Bruce Spiegelman, a professor of cell biology and medicine at Harvard Medical School, said in his keynote address at Obesity Week 2013 in Atlanta.

But they have different origins, with brown fat arising from muscle cell precursors, and beige fat cells emerging from cushy pools of white fat. What brown and beige fat cells share is a gene called uncoupling-protein 1 (UCP-1), which gives them the ability to generate heat, said Spiegelman, a professor of cell biology and medicine at Harvard Medical School.

Under normal conditions, beige cells barely express this gene and consume little energy. With the right stimulation, the expression of UCP-1 throttles up the cells, gobble energy and release it as heat.

The hand on the gear shift is a molecule called meteorin-like, which triggers a chain of events in the immune system that activates the beige fat cells in globs of white fat.

UGA nutrition researcher Clifton Baile and his research group are using phytochemicals to turn immature white fat cells into beige ones. Phytochemicals are naturally occurring chemicals found in plants.

“We want to see not only if we can eliminate [the white fat cells’] filling and development, but to move the cell development more to the beige,” said Baile, who leads UGA’s campus-wide Obesity Initiative.

If his lab’s current experiments using rodents are successful, and white fat cells can be redirected without harm to the animals, they hope eventually to try this with human volunteers.

Colette Miller, a Ph.D. student in Baile’s lab, thinks science is headed for the beige. Researchers from other institutions have been able to jack up heat-producing activity in brown fat cells, but the drugs that made this happen are too dangerous to ever be used as treatments for human obesity.

“I think the beiging is going to probably be a better story,” Miller said.

Phytochemicals are not only safer than those earlier drugs, but these natural plant chemicals also fight bone loss and reduce the symptoms of fatty liver disease. They even act in other ways to help reduce the number of white fat cells.
The Baile and Spiegelman labs, as well as others, are hoping to develop products that turn on the heat-producing, energy-burning action of fat.

With rates of obesity rising in the United States and much of the world, Spiegelman believes this is a problem that society must solve.

“We must provide multiple avenues of therapy – surgery, medicine and education,” Spiegelman said.

Hyacinth Empinado is a freelance science writer and a graduate student in the health and medical journalism program at the University of Georgia.

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Bringing Back Function and Quality of Life After Traumatic Brain Injury

Tuesday, January 28th, 2014

By Tania Barroso, M.D.

The rate of Traumatic Brain Injury (TBI) has increased tremendously over the past decade. This is mostly because of injuries sustained in sports and on the battlefield by our brave military personnel. It has been called “the silent epidemic,” since there has been very little knowledge and lack of screening protocols in the past, which led to frequent missed brain injuries and, hence, to lack of appropriate management. The good news is that this has directed us to an increase in awareness followed by improvements in the tracking, identification and treatment of brain injuries.

As a physiatrist working with veterans, I have been challenged by the complicated nature of these injuries in our military population. Their brain injuries are usually complex, compound and accompanied by numerous comorbidities such as PTSD and chronic pain. Fortunately, new breakthroughs and focused rehabilitation programs are now in place to meet the needs of patients with brain injury, not only for our veterans and service members, but also for the general community.

What is TBI?

TBI, also known as acquired brain injury, occurs when a sudden trauma disrupts the normal function of the brain. The effects of TBI can vary in duration and severity. Thankfully, the majority of brain injuries are of the mild range, but for many people with severe TBI, long-term rehabilitation is often necessary to maximize function and independence. Even with mild TBI, the consequences to a person’s life can be overwhelming.

TBI Symptoms and Sequelae

TBI can cause a host of physical, cognitive, social, emotional and behavioral effects, and its outcome can range from complete recovery to permanent disability or death. Symptoms vary according to the severity of the injury and the stage of recovery. Mild TBI symptoms may be difficult to identify because the patient may look normal and act coherent. Nonspecific symptoms, such as headaches and fatigue, can easily be ignored and overlooked. Typically, signs and symptoms manifest quickly after injury, but sometimes symptoms may be delayed by weeks and even months. Seizures, dizziness, vision problems, attention deficit and personality disorders can all result from mild TBI and last for many years. Severe TBIs can result in paresis, aphasias, spasticity and contractures. Emotional and behavioral symptoms may include depression, anxiety and personality changes.

Epidemiology

The Centers for Disease Control and Prevention (CDC) states that there are 1.7 million TBIs each year and that TBI is a contributing factor to a third (30.5 percent) of all injury-related deaths in the United States.(1) It is a leading cause of death and disability around the globe, and the impact on society and economy is huge.

It is important to understand that these numbers underestimate the true incidence of TBI because first, they do not include military-related TBIs, second, they do not include brain injuries diagnosed and treated in the outpatient settings, and third, they do not include mild brain injuries that were missed or where the patient did not seek medical care.

Military-related TBI

In the military, brain injury has become known as the “signature wound” and one of the invisible injuries of the wars in Iraq and Afghanistan. Since Sept. 11, 2001, more than 2.5 million service members have been deployed to Iraq and Afghanistan in Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn. More than 250,000 cases of TBI in the military have been reported between the years 2000 and 2012. The most common cause of military-related TBIs are blast explosions. Most of these injuries are classified in the mild spectrum, although the long-term consequences are anything but mild.

What is unique to military-related brain injury is the complexity of its relationship to PTSD, depression, drug abuse and suicidality. It is extremely difficult to determine whether their symptomatology is a result of PTSD or from a mild TBI because they frequently overlap. There are still knowledge gaps and uncertainty when it comes to the treatment of these co-occurring conditions.

Congress initiatives, such as the National Research Action Plan and the Defense and Veterans Brain Injury
Center, were created to develop more research in these areas and to improve access to mental healthcare for veterans, service members and their families. All service members are being evaluated for brain injury when they return from combat tours in order to diagnose TBI early and treat it more effectively.

Sports-related TBI

Sports-related TBI has also become a popular topic in the medical community and on social media over the last few years. Repetitive concussive impacts have been linked to long-term devastating consequences, such as dementia and chronic traumatic encephalopathy. An initial cognitive and physical rest period, followed by a gradual increase in physiologic and cognitive stress in asymptomatic athletes, is the hallmark of the management. Continued education to the general public is essential to properly identify concussed individuals and direct them to appropriate medical care.

Causes of TBI

In the civilian sector, the leading cause of sustaining a TBI is through falls.(1) This is followed by motor vehicle crashes, stuck by/against events and assaults. Blasts are a leading cause of TBI for active duty military personnel in war zones.(2)

Severity of TBI

The severity of a TBI injury may range from mild to severe. Although the severity level has prognostic value, it does not necessarily predict the likelihood of functional recovery. Tools to measures severity include the Glascow Coma Scale (GCS), duration of coma and the length of posttraumatic amnesia (PTA).

It is important to understand that mild TBI, unlike moderate or severe TBI, often cannot be corroborated with objective diagnostic tools, and MRI and CT scans may be completely normal. New and exciting research on the development of blood biomarkers and eye-tracking devices for diagnosing brain injury is getting closer. Hopefully, it will serve as a standard diagnostic tool in the future. Early diagnosis leads to better intervention, therefore better recovery and treatment outcomes.

Rehabilitation After TBI

There is no doubt that a brain injury can drastically change a person’s life. The majority of mild TBI patients recover within three months with minimal treatment. Serious brain injury survivors acquire a mix of lifelong impairments, but with hard work and the support of their loved ones, they can regain some abilities lost to their injuries.

Brain tissue healing begins as soon as the patient is stabilized. The brain can rewire and grow new neural pathways among its territories through plasticity, which is the process through which a healthy area of the brain assumes the functions of an injured area. However, these processes alone are not enough to enable a patient to resume his or her pre-injury potential. For the best outcome, a patient must participate in a specialized rehabilitation program.

To achieve maximum quality of life, a brain injury patient must learn ways to work around his or her new deficits. Brain rehabilitation aims to help patients relearn lost life skills and teach them compensatory strategies for long-term functional deficits. Some people may be able to return to their premorbid level of functioning, and some may need lifetime care. It is of utmost importance that the rehabilitation team incorporates efforts among family, employers and friends to improve community integration outcomes.

Rehabilitation can take place in various settings. Possible settings include inpatient rehabilitation hospitals, outpatient rehabilitation, home-based rehabilitation, comprehensive day program and independent living center. A rehabilitation program is determined based on the needs of the individual. Ideally, rehabilitation services should begin as soon as the survivor is medically stabilized, but patients benefit most from rehabilitation when they have reached a level of 3 or 4 on the Rancho Scale, which means they are starting to interact and become aware of their surroundings.

Services include physical therapy, physical medicine, occupational therapy, psychiatric care, psychological care, speech and language therapy and social support. Patients may need evaluations for bowel and bladder control, speech abilities, swallowing abilities, strength and coordination, ability to understand language, mental and behavioral state and social support needs.

As to cognitive rehabilitation, neuropsychological assessment through standardized tests that measure cognitive function are performed as early as possible and repeated throughout the rehabilitation course in order to monitor their progress. Areas assessed include attention and concentration, verbal memory, visual memory, executive function, language, motor function, neurobehavioral function and validity. These evaluations are useful in targeting areas for cognitive rehabilitation and identifying intervention strategies to optimize treatment outcomes. Cognitive skills can be relearned with a structured rehab plan of strategies and repetition.

Behavioral and emotional changes are very common in TBI. They are usually most distressing to caregivers, family and friends of the patient. Behavioral disorders can include apathy, aggression, irritability, impulsivity, poor social skills, substance abuse and several psychiatric diagnoses. Pharmacologic therapies can be extremely helpful in helping control these symptoms, but environmental controls also play an important role, especially in agitated patients.

Brain survivors may have a variety of physical problems, such as contractures, paresis and possibly other bodily injuries associated with the trauma that impairs their mobility. Physical therapists are key to help overcome these physical impairments.

Social interaction is also addressed in rehabilitation. When the patient is ready, the survivor is slowly reintroduced into the community and social skills are tested.

The Role of Pharmacology in TBI Management

There are a wide range of TBI neurologic and medical complications that are addressed by the physiatrist in the acute and post-acute stages. Particular attention must be paid to the use of medication that may adversely affect cognitive functioning.

Seizures can be seen in the first 24 hours (immediate), in the first two to seven days (early) and/or after seven days (late). The use of phenytoin has been shown to be effective during the first week after a TBI. If there is no seizure after one week, continued use is not warranted.

Balance disorders can be treated with medications, surgery, dietary modifications, vestibular balance rehabilitation therapy and visual therapies. Medications for dizziness should only be used on a short-term basis to minimize negative effects in rehabilitation therapies.

Post-traumatic headaches are seen in 30 percent to 50 percent of patients with mild TBI,(3) with tension-type headaches being more common than the migraine-type. Treatments for post-traumatic headaches are similar to that of primary headache.

Spasticity is a common problem among patients with brain injury. Spasticity is a velocity-dependent increase in tone. This means that the faster a patient attempts to move, the more resistance to that movement occurs. Physical therapy and early intervention is important to prevent development of contractures due to spasticity. Anti-spasticity medications include tizanidine, clonidine, dantrolene, diazepam and baclofen. Local injection therapy includes motor point blocks and Botox.

Arousal may fluctuate during the day in persons with TBI. Dopaminergic agents (amantadine and bromocriptine) are the most commonly used drugs to improve arousal and fatigue.

Attention issues are frequently treated with methylphenidate, which has been shown to improve attention, reaction times and processing speeds.

Agitation and aggression are problematic behaviors common in TBI and may be very stressful, especially for the caregivers. Environmental controls are essential for reducing the triggers for agitation. Benzodiazepines are avoided due to the potential negative effect on brain recovery. Anxiolytics, mood stabilizers, antipsychotics and antidepressants are preferred.

Memory is best addressed with the use of compensatory strategies and services. Cholinergic medications such as donepezil and rivastigmine improve arousal and attention, which indirectly help with memory because they improve the ability to learn.

TBI-related depression and emotional ability are treated with antidepressants. SSRIs are first-line because they are generally believed to be neutral with respect to cognitive functioning.

TBI occurs in 1.7 million Americans annually. TBI rehabilitation includes a variety of services that are individualized to the patient’s needs. Proper diagnosis and early intervention are vital to successful outcomes.

Management of TBI symptoms and complications requires an experienced professional in the appropriate setting. Environmental, psychosocial and pharmacologic interventions are useful in the rehabilitation of cognitive, emotional and behavioral issues after TBI.

References

1. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.

2. Department of Defense and Department of Veterans Affairs (2008). “Traumatic Brain Injury Task Force”. http://www.cdc.gov/nchs/data/icd9/ Sep08TBI.pdf.

3. Post-traumatic headache: neuropsychogical and psychological effects and treatment implications J Head Trauma, Rehabil 1999

4. www.Brainlinemilitary.org

5. Up-to-Date Advances in Rehabilitation: Review Issue Traumatic Brain Injury: A Review of Practice Management and Recent Advances.
J Physical Medicine and Rehabilitation Clinics of North America, 2007; 18: 681-710

6. www.traumaticbraininjury.com

7. Braddom, Randall. Physical Medicine & Rehabilitation. Philadelphia: Saunders Elsevier, 2007

8. Frontera, Walter. Essentials of Physical Medicine and Rehabilitation. Philadelphia: Saunders Elsevier, 2008

Tania Barroso, M.D. practices physical medicine and rehabilitation at the Veteran’s Medical Center in Atlanta. A native of Puerto Rico, she obtained her B.A. and M.D. with honors from the University of Puerto Rico in 2006. She completed her physical medicine and rehabilitation residency at Emory University from 2007 to 2010. She is a diplomate of the American board of PM&R and a member of the American academy of PM&R. She is currently an associate professor for the Emory University Residency Training Program.

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WellStar Welcomes Urology Associates

Tuesday, January 28th, 2014

Urology Associates has recently joined WellStar Medical Group (WMG). The practice will be known as WellStar Medical Group, Urology, and will remain in their current office locations in Marietta, Austell, Douglasville and Hiram.

WellStar Medical Group, Urology includes Drs. Chun, Dusseault, Emerson, Evans-Theiss, Kouzova, McCowan, Mygatt, Roper, Schmidt, Symbas, Townsend, Watson and their team. The group will continue to provide a full range of diagnostic tests and procedures including cystoscopy, semen analysis, TRUS/prostate biopsy, circumcision, lithotripsy, vasectomy and vasectomy reversal.

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Georgia PCPs to Focus on Genetic Risks for Cancer

Tuesday, January 28th, 2014

On Feb. 21, 2014, the Georgia Breast Cancer Genomic Health Consortium and Georgia CORE – the Center for Oncology Research and Education are offering a conference to improve the knowledge of primary care providers on cancer genomics and genetic risk assessment, particularly regarding hereditary breast and ovarian cancer (HBOC). Titled “The First Line of Defense: Application of Breast Cancer Genomics Standards in Primary Care,” the conference is the first of its kind in Georgia and is funded by the Center for Disease Control & Prevention through a cooperative agreement to the Georgia Department of Public Health. It will be held at Callaway Gardens in Pine Mountain, Ga.

Targeted to primary care physicians, physician assistants, nurse practitioners and nurses, the conference will share many facets of HBOC genomics, including the genetics behind the syndrome; the role of genetic screening, counseling and testing; the current state of coverage for these services by major health insurance companies in Georgia; and educational resources to share with patients and community members. Mark Ebell, MD, MS, an Associate Professor of Epidemiology and Biostatistics at the University of Georgia and United States Preventive Services Task Force (USPSTF) member, will provide the keynote address.

In December, USPSTF released a statement recommending primary care providers screen women for BRCA 1/2 mutations with one of several screening tools designed to identify a family history. The Breast Cancer Genetics Referral Screening Tool (B-RST) located at www.BreastCancerGeneScreen.org was cited as a tool to help providers reach this goal. The tool was developed and validated by Dr. Cecelia Bellcross, an associate professor at Emory University and member of Winship Cancer Institute and the Georgia Breast Cancer Genomic Consortium. Since 2012, the Consortium has integrated the tool in six Georgia public health clinics’ services in order to identify women at high-risk for HBOC.

“The genomics conference will highlight the use of B-RST in Georgia public health clinics, as well as ways to integrate genetic risk assessment into primary care practices across the state,” said Georgia CORE Vice-Chairman Roland Matthews, MD of the Morehouse School of Medicine, who serves as the Conference Chair. “With the recognition from the U.S. Preventive Services Task Force, we know there is relevance to increasing awareness about breast cancer genomics in Georgia among primary care providers.”

For more information about the conference, visit Georgia CORE.

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WellStar Kennestone Physician Performs Minimally-Invasive Fibroid Surgery

Tuesday, January 28th, 2014

A WellStar Kennestone Hospital physician is the first in Georgia to treat women with symptomatic fibroids using the Acessa™ Procedure.  This new minimally-invasive procedure enables a woman to obtain relief from fibroid symptoms while avoiding a hysterectomy and keeping her uterus intact.

The outpatient surgery was performed by Kevin Windom, M.D., of OB/GYN Associates of Marietta, at the WellStar Kennestone Outpatient Surgery Center.

This fibroid procedure is highly effective, less invasive than most surgical alternatives with faster recovery and symptom relief. Also the need for further fibroid treatment is low, as demonstrated by clinical studies in which 90 percent of patients three years after the procedure did not require further medical or surgical treatment.

Fibroids are benign, non-cancerous tumors in a woman’s uterus that, when symptomatic, can be very painful and cause heavy bleeding, pressure on the bladder or rectum, and abdominal discomfort and distention.

The Acessa™ Procedure is a laparoscopic surgical procedure.  Using a small scope and ultrasound guidance, the surgeon first locates the patient’s fibroids.  Then each fibroid is treated individually with radiofrequency energy to destroy it and leave the surrounding tissue unharmed.

Patients treated with the procedure typically experience a rapid recovery, returning home the same day and back to work or normal activities within three to four days.  Those that need pain medication after surgery typically use only over-the-counter pain relievers.  Most patients experience relief from fibroid symptoms, such as pelvic pain and pressure, shortly after undergoing the procedure with heavy bleeding noticeably improved in three to six months.

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Spectrum Neurosurgical Specialists Welcomes Bart MacDonald

Tuesday, January 28th, 2014

Spectrum Neurosurgical Specialists has announced the addition of Bart MacDonald, M.D., board certified neurosurgeon to the practice.  Dr. MacDonald offers many options to his patients, including Mazor spine robotic surgery.

A native of Georgia and graduate of Georgia Tech, Dr. MacDonald attended medical school at the Medical College of Georgia and completed his internship at the University of Florida. During his neurosurgical residency, Dr. MacDonald trained at Harvard’s Brigham & Women’s Hospital and Children’s Hospital of Boston. He then moved to Houston to start his residency, focusing on spine and brain trauma with an emphasis on complex spine. He then completed his residency at the University of Texas Medical Branch.  Afterward, he was appointed an assistant professor at the University of Texas Medical Branch as well as participating in private practice before deciding to return to Georgia.

Dr. MacDonald focuses on minimally invasive surgeries and conservative spine treatments.  This includes using microsurgical, minimally invasive, and percutaneous techniques to spinal surgery including stereotactic and robotic spine surgery.

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DeKalb Medical Physicians Group Welcomes Atlanta Podiatry Group

Tuesday, January 28th, 2014

The DeKalb Medical Physicians Group announces the addition of Atlanta Podiatry Group to its team of specialist physicians. The practice is located in Snellville and specializes in surgery, reconstruction, trauma and treatment of all diseases of the foot and ankle. Atlanta Podiatry Specialists brings over 25 years of experience to the team.

Dr. Thomas Cain graduated from Georgia Institute of Technology with a Bachelor of Science Degree and received his Doctor of Podiatric Medicine degree from Pennsylvania College of Podiatric Medicine. He is a Board Certified Podiatric Physician and Surgeon of the foot and ankle.

Dr. David Alder is a graduate of Barry University School of Podiatric Medicine in Miami. After completing his surgical residency in Tucker, Ga., he continued his career as Residency Director of podiatric medicine and surgery at DeKalb Medical and became a faculty member of The Podiatry Institute. He is board certified in foot surgery by ABPS, and is a Fellow of the American College of Foot and Ankle Surgeons.

The DeKalb Medical Physicians Group (DMPG) is comprised of 14 primary care physician practices and 10 specialty practices throughout the eastern metro-Atlanta area.

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