|
|
|
|
UI Consult Home
|
UI Consult Winter 2009Download PDF
New center offers full range of aortic disease fixes A new Aortic Surgery Center at University of Iowa Hospitals and Clinics provides the full range of surgical treatment for patients with aortic disease as an integral part of UI Heart and Vascular Center. Domenico Calcaterra, MD, a cardiovascular surgeon trained at the University of Miami and Texas Heart Institute, Baylor College of Medicine in Houston, Texas, recently joined the UI Department of Cardiothoracic Surgery to build its aortic disease surgery program. Disorders of the aortic wall, such as aneurysms or dissections, are in most cases life-threatening and require urgent surgical intervention. Aortic repair can be performed either invasively, by opening the thoracic cavity, or non-invasively, by inserting an aortic stent via an endovascular procedure. Because of the complex anatomy and vascular connections of the aorta, stenting of its various segments— ascendant, arch, descendent, thoracic, and abdominal up to the aortic bifurcation— requires unusual skills by the surgeon and specially designed stents. Dr. Calcaterra brings two unique features to UI Hospitals and Clinics. First, he masters all types of surgical approaches to all kinds of aortic disorders. In addition to aneurysm and dissection repairs, he performs aortic valve replacement and valve-sparing aortic root replacement, a procedure replacing the aortic root while keeping the patient's own valve. Secondly, he coordinates and is the performing surgeon in the 24/7 emergency response to cases with aortic dissection across the state of Iowa. The emergency line is available to every provider in Iowa who has a patient with suspect or confirmed diagnosis of dissection. By calling UI Consult at 800-322-8442, patients with dissections will be emergently transported via the UI AirCare helicopter for an immediate, potentially life-saving treatment. Dr. Calcaterra has built a team of anesthesiologists, perfusionists, ICU caregivers, and imaging technicians specialized in the very complex art of surgical treatment of aortic disorders. World-renown neurosurgeon treats Chiari malformation Neurosurgeons at University of Iowa Hospitals and Clinics offer the most advanced treatment of syringomyelia (SM) and Chiari malformation (CM) in the country (with over 1,000 cases operated on since 1980). SM is a disorder caused by the formation of a cyst or cavity within the spinal cord. One type of SM is caused by the CM, where an anatomic abnormality of the cranio-cervical junction allows the lower part of the cerebellum to protrude into the cervical or neck portion of the spinal canal. CM can also be a manifestation of the Ehlers-Danlos Syndrome, a systemic collagen disorder. Neurosurgeon Arnold Menezes, MD, medical director of the American Syringomyelia Alliance Project (ASAP), a patient support organization, has more than 30 years of experience with the surgical treatment of the cranio-cervical junction, including CM. The prevalence of CM is 1 in every 2,000 Americans, and patients diagnosed with the disorder need immediate help by a highly experienced neurosurgeon. Because of the rarity of the condition and the anxiety associated with its prognosis, more often than not patients have a difficult time finding the right place to be treated. Dr. Menezes' record includes patients from across the nation and all over the world. Please call 319-356-2237 to refer a patient or find more information. The Women's Health Center at University of Iowa Hospitals and Clinics has installed LUMA, a cervical imaging system recently approved by the FDA, to help gynecologists detect cervical dysplasia with greater precision and fewer inconveniences for women. The standard of care for cervical cancer diagnosis follows these steps: if routine Pap smear is positive, the patient is referred for colposcopy; if the latter reveals abnormal areas, take biopsy; if biopsy confirms cancer or high-grade dysplasia, treat. Since colposcopy relies on the gynecologist's subjective evaluation, LUMA has been introduced to eliminate uncertainty that results from a false positive colposcopy. The pre-approval studies showed that the new imaging technique, using UV and broad-spectrum light, found 26 percent more cases of precancerous disease than colposcopy alone. Currently at UI Hospitals and Clinics, Colleen Kennedy, MD uses the machine in combination with standard colposcopy as part of a post-approval study to assess its effectiveness in early diagnosis of pre-cancerous states. Dr. Kennedy, a faculty physician with the Department of Obstetrics and Gynecology, can be reached at 319-356-2294 for more information or to refer a patient. For women who cannot afford the test, funds are available through a gift from John and Mary Pappajohn of Des Moines. Pregnant women, new mothers receive psychological help The Women's Wellness and Counseling Service, located on Level 3 in the Pomerantz Family Pavilion of UI Hospitals and Clinics, provides highly advanced diagnosis, counseling, and treatment for pregnant women and new mothers. Psychiatrists and psychologists offer their services in the Obstetrics and Gynecology Clinic, an environment that is easily accessible and allows for coordination of obstetrical care. Since it opened in 2007, the service has been an integral part of the UI Women's Health Center, the UI Health Care's location for comprehensive care of women. The service addresses the complete range of mental health needs associated with childbirth for women ages 18 and older, with special focus on depression during and after pregnancy. The clinic's team provides education, screening, counseling, and medication evaluation for patients, as well as evaluation of ongoing care and second opinions regarding treatment. The Service also provides pre-conception evaluations and prevention strategies for women at risk. All of the services are unique to the State of Iowa. Patients can schedule to be seen upon referral by an obstetrician or a primary care provider. For more information or to refer a patient, please visit their Web site www.uihealthcare.com/depts/womenswellness/index.html or call 319-356-2294. Emphysema patients evaluated for non-surgical care Researchers associated with the Iowa Institute for Biomedical Imaging, a multidisciplinary center at University of Iowa Health Care, have developed novel image acquisition techniques and software to evaluate lung capacity and determine how to treat emphysema patients. Emphysema—a subtype of chronic obstructive pulmonary disease—is a progressive and debilitating disorder resulting from an irreversible airflow obstruction that leads to significant lung hyperinflation. This causes dyspnea, an increasingly difficult and painful breathing. The current standard management for emphysema is medical therapy including pulmonary rehabilitation and oxygen use. The only therapy that increases life expectancy is oxygen. Recently, lung volume reduction surgery (LVRS) has been used to remove the most diseased portions of the lung and thus alleviate breathing difficulties. LVRS is associated with significant risk. Several U.S. companies are currently testing non-surgical devices to reduce lung volume by shutting off the dysfunctional part of the lung, usually a lobe. The Iowa Institute for Biomedical Imaging and a spin-off company, VIDA Diagnostics, have provided the imaging capacity and the evaluating software. The Institute is a participating center in this effort to substitute endobronchial methods of pulmonary lobe exclusion for LVRS. The Institute invites physicians to refer patients with emphysema to participate in clinical trials. Please call 319- 353-8862 or e-mail Kimberly Sprenger, study coordinator, at kimberly-sprenger@uiowa.edu The UI Heart and Vascular Center's Cardiomyopathy program at UI Hospitals and Clinics, directed by Frances Johnson, MD, has successfully implanted the HeartMate II into 11 patients with severe left heart failure since May 2008. HeartMate II is an implantable ventricle assist device that takes over the pumping function of the left ventricle (LVAD). It has been used experimentally since 2003 and received FDA approval in April 2008 as a life-saving bridge to cardiac transplant. In a U.S. trial of the device, one year after implantation, 77% of patients achieved one of the following outcomes: survival, receiving a transplant, or recovery of heart function. Its predecessor, the HeartMate XVE, a pulsatile LVAD, also increased patient survival and quality of life, but its large size, limited durability, and noisiness were quite inconvenient for the 24/7 use required. HeartMate II is a continuous-flow LVAD that is much smaller in size, quiet, with longer durability, and that causes fewer inconveniences to the patient with its smaller percutaneous lead. While it is approved for use as a bridge to transplantation (while patients are on a waiting list), FDA approval is also expected for its use as an alternative to a transplant. A federal registry of mechanical circulatory device outcomes (INTERMACS) shows that the best survival rates have been achieved in patients with recurrent advanced heart failure implanted before they become critically ill. Referral for a HeartMate implant should be considered in patients that have more than one of the following risk factors: inability to walk one block without shortness of breath; one or more HF-related hospital admissions in the past six months; diuretic dose > 1.5 mg/kg/d; serum sodium < 136 mmol/L; BUN > 40 mg/dL; intolerant or refractory to ACE inhibitors, angiotensin receptor blockers, or beta-blockers; hematocrit < 35%; and QRS > 140 msec refractory to CRT. For referral call (319) 356- 1616 and ask for the heart failure physician on call or e-mail uicardiomyopathy@uiowa.edu. Coming in 2009…. More information in upcoming issues of UI Consult. UI Consult is a centralized resource linking health care providers with members of UI Physicians and services at UI Hospitals and Clinics. Whether you are seeking a consultation, are providing a referral, need patient information, or want news about clinical trials or CME courses, a single call is all it takes to put you in touch with the right person. UI Consult is available 24 hours a day, 7 days a week. Simply call 800-322-8442. When referring a patient, you may also fill out an online referral form at www.uihealthcare.com/consult. Information needed to refer a patient:
Upcoming CME Activities The UI Physicians Web site can also be accessed at www.uihealthcare.com/depts/uiphysicians/index.html New Faculty Internal Medicine
Pediatrics
Radiation Oncology
|
||||
| Email this Page | We Welcome Your Comments |
Site Index A-Z Last modification date:
Fri Sep 25 14:29:34 2009
|
|||||
