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UI Consult Deep Archive Home
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UI Consult Spring 2009Download PDF
HALO ablation therapy available for patients with Barrett's esophagus The HALO360 System, a balloon-based radiofrequency device designed to remove areas of dysplasia in the esophagus, is now used as the preferred treatment in the Clifton Center for Digestive Diseases at UI Hospitals and Clinics for patients with Barrett's esophagus. Barrett's esophagus is a condition caused by chronic acid reflux. Pathologically, it is a transformation of the squamous epithelium of the lower esophagus into an intestinal columnar epithelium (intestinal metaplasia). The intestinal metaplasia can appear without dysplasia or with low- or high-grade dysplasia. As a pre-cancerous condition, high-grade dysplasia has traditionally been treated with surgery. More recently, various endoscopic modalities have become available as less invasive alternatives. Of the latter, radiofrequency ablation using a HALO balloon catheter achieves a high rate of eradication, and has fewer side effects compared with photodynamic therapy. Radiofrequency ablation allows for a controlled superficial burn of the diseased mucosa that heals without strictures. HALO balloon therapy is performed by Henning Gerke, MD, director of the Diagnostic and Therapeutic Unit of the Center. For more information or to refer a patient, please call the nurse coordinator, Diane Madsen, RN, at 319-384-6582. Parents magazine gives high grades to UI Children's Hospital University of Iowa Children's Hospital, a comprehensive 190-bed pediatric hospital, has been ranked by Parents magazine among the top 25 children's hospitals in the U.S. and is the only hospital in Iowa to have received this recognition. In addition, Parents rated the pediatric emergency care available at UI Hospitals and Clinics fifth in the nation. From routine illnesses to complex medical and surgical conditions, patients who come to UI Children's Hospital receive the highest level of pediatric care. Parents created the ranking as a guide for parents who want to make informed decisions about their child's health care, especially when a serious illness is involved. The ranking is based on more than 100 children's hospitals surveyed across the country. The survey resulted in a data-driven comparison of children's hospitals based on responses to detailed questions in areas such as survival rates, experience in performing certain complex procedures, and depth of research program. To refer a pediatric patient to UI Children's Hospital, call UI Consult at 800-322-8442. Limb salvaging surgery for patients with peripheral vascular disease UI Heart and Vascular Center vascular surgeons with long experience in limb salvaging surgery offer surgical treatment of all lower limb-threatening conditions resulting from a peripheral vascular disease, such as gangrene, non-healing ulcers of various etiology, and arresting pain from arterial insufficiency. The number of patients with these conditions is growing and many people, including family physicians, are unaware that limb-salvaging opportunities have increased. Angiographic imaging techniques allow for a precise assessment of the adequacy of the patient's limb circulation and determine the best method for managing the patient's condition. The interventions for limb salvaging used at UI Hospitals and Clinics are catheter-based de-blocking of the narrowed artery, stenting, or bypass surgery. A five-year follow-up demonstrated 80-90% success with management that combines early imaging diagnostics with adequate surgical treatment. For more information or to refer a patient, call 319-356-2902. New pediatric VAD saves child with heart malformation In a first and unique attempt to save the life of a 5-year-old patient waiting for heart transplant, Erik Edens, MD, director of the Pediatric Heart Transplant program at UI Children's Hospital, obtained permission to use EXCOR® Pediatric, a ventricle assist device (VAD), as a bridge to transplant. The device was developed in Germany for use in children, toddlers, and even newborns. It consists of a variety of blood pumps (10-60 ml volume) and a wide range of tiny cannulas. It is not yet approved for use in the U.S., except in extraordinary circumstances. Edens made a strong case for urgent FDA approval and insurance provider coverage for his patient. The implanted device dramatically improved the cardiac output and the general condition of this small patient and marked the first time in Iowa a VAD was implanted in a patient younger than 11 years of age. It also was the first pediatric VAD in the state implanted in a patient born with a single ventricle. Observations on the procedure and follow-up data from this patient are being added to the national clinical trial of the EXCOR® Pediatric. For more information or to inquire about pediatric heart conditions, call Edens at 319-356-3537. Middle- and advanced-age women benefit from new robotic procedure UI Women's Health offers a new robotic surgery treatment to women with uterine and/or vaginal prolapse. Catherine Bradley, MD, director of the urogynecology division in the Department of Obstetrics and Gynecoloy, and colleague Ali Luck, MD, have successfully performed a number of robotic-assisted sacral colpopexy procedures (with or without hysterectomy) since introducing it at UI Hospitals and Clinics nine months ago. Uterine and vaginal prolapse occur in middle- or advanced-age women due to genetic causes, childbirth trauma, heavy lifting, or obesity. The condition is experienced as a bulge in the vaginal area, resulting from a descending uterus or vaginal wall. Advanced prolapse may also cause urination and defecation difficulties. While milder forms are common and need not be treated, the gold standard for treating advanced prolapse is sacral colpopexy, a surgical procedure that suspends the vagina to the pelvic surface of the sacrum using a mesh. This traditionally open-abdomen procedure can now be performed through several small incisions using robot assistance. Compared with traditional surgery, the robotic operation has a shorter hospital stay (overnight), quicker recovery, and faster return to work (two vs. six weeks). For more information or to refer a patient, call 319-356-2294 or go to www.uihealthcare.com/urogynecology. A-fib catheter treatment expanding Under its new director Alex Mazur, MD, the UI Heart and Vascular Center atrial fibrillation program is expanding its catheter ablation treatment as a more effective and safer alternative to anti-arrhythmic medication. Catheter ablation procedure is primarily indicated to patients who remain symptomatic on anti-arrhythmic medications and to a subset of patients with congestive heart failure. The success rate of catheter ablation is high: 70-80% in cases with paroxymal tachycardia and somewhat lower for chronic arrhythmia. At the UI Heart and Vascular Center, it is performed under general anesthesia or conscious sedation, depending on patient's choice. Lately, the catheter-ablation lab has doubled its capacity by expanding its anesthesia coverage. Surgeons and cardiologists jointly evaluate every patient to find the optimal individual approach to treatment. For more information or to refer a patient, call UI Consult at 800-322-8442. Cardiologists attempt to treat severe migraine cases A randomized, controlled, double blind clinical trial is being conducted at the UI Heart and Vascular Center to evaluate the effects of a patent foramen ovale (PFO) occluder in patients with severe migraine headache. The AMPLATZER PFO occluder will be compared to medical management over a 12-month period. In 15-20 percent of people, the fetal foramen ovale does not close after birth resulting in a PFO. Observational studies suggest that people with severe or frequent migraines are more likely to have a PFO than the general population and that headache symptoms might improve after a PFO closure. Migraine patients with headaches resistant to medication may be eligible for this trial of PFO closure whether or not they have a known PFO. The principal investigator is Phillip A. Horwitz, MD, associate professor with the cardiovascular diseases division of the Department of Internal Medicine. For evaluation, please refer patients who continue to have severe migraines despite medical treatment for evaluation by calling the trial coordinator Ronda Wilson, RN, at 319-353-6675. Those eligible will be randomized to the device group or placebo procedure group and followed for headache symptoms and safety endpoints. Clinical trial for women with bladder control problems Women with frequent urinary leakage and urgency to urinate are invited to participate in a research study conducted at the UI Women's Health Center to determine if fesoterodine (study medication) is more effective than placebo (inactive substance) in reducing the frequency of urge urinary incontinence. Eligible participants will include healthy women, age 18 and older, with urinary leakage that occurs every day on average. Participation involves a screening visit, followed by visits every one, two, or three months at UI Hospitals and Clinics over a one-year period. Participants will be randomly assigned to take fesoterodine or placebo for three months. After three months, participants may choose to take fesoterodine for an additional nine months as part of the study. The UI Department of Obstetrics and Gynecology is one of 13 participating centers; the local lead investigator is Catherine Bradley, MD, associate professor and director of urogynecology in the Department of Obstetrics and Gynecology. For more information, call 319-384-8028 or email regina-arthur@uiowa.edu. Coming in 2009…. Stay tuned for UI CareLink, a tool that allows referring providers electronic access to enter and retrieve secure patient information. University of Iowa Hospitals and Clinics is installing the EPIC clinical information system to meet your and your patients' needs. More information in upcoming issues of UI Consult. One call puts you in touch Information needed to refer a patient:
For the full list of upcoming UI Carver College of Medicine continuing medical education events, visit: www.medicine.uiowa.edu/cme/ or call the CME office, 319-335-8599. New Faculty Anesthesia
Family Medicine
Internal Medicine
Obstetrics and Gynecology
Ophthalmology
Pediatrics
Psychiatry
Radiation Oncology
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