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Gibney E.M.,Piedmont Hospital | Doshi M.D.,Wayne State University | Hartmann E.L.,Wake forest University | Parikh C.R.,Yale University | Garg A.X.,London Health Sciences Center
Clinical Journal of the American Society of Nephrology | Year: 2010

Background and objectives: Ensuring follow-up of living kidney donors (LKDs) is essential to long-term preventive care. We sought information on health insurance status of US LKDs, with particular attention to age, gender, and ethnicity. Design, setting, participants, & measurements: The United Network for Organ Sharing/Organ Procurement Transplantation Network database was queried for associations among age at donation, race, gender, and health insurance status. We studied all US LKDs between July 2004 and September 2006. Results: A total of 10,021 LKDs with known health insurance status were studied, 1765 (18%) of whom lacked health insurance at donation. There were 4852 donors without health insurance information. Younger kidney donors had higher rates of being uninsured (age 18 to 34: 26.2%; age 35 to 49: 15.2%; age 50 to 64: 11.2%; age >65: 3.8%; P < 0.0001), as did men (19.5 versus 16.3% for women; P < 0.0001), and ethnic minorities (white 13.4%, black 21%, Hispanic 35.6%, Asian 26.7%; P < 0.0001). Conclusions: This study confirms that younger patients, ethnic minorities, and men are less likely to have health insurance when donating a kidney, which could negatively affect adherence to long-term follow-up. Copyright © 2010 by the American Society of Nephrology.


Naugler W.E.,Oregon Health And Science University | Alsina A.E.,Tampa General Hospital | Frenette C.T.,Center for Organ and Cell Transplantation | Rossaro L.,University of California at Davis | Sellers M.T.,Piedmont Hospital
Clinical Gastroenterology and Hepatology | Year: 2015

Optimal care of the patient with hepatocellular carcinoma (HCC) necessitates the involvement of multiple providers. Because the patient with HCC often carries 2 conditions with competing mortality risks (cancer and underlying cirrhosis), no single provider is equipped to deal with all of these patients' needs adequately. Multidisciplinary teams (MDTs) have evolved to facilitate care coordination, reassessments of clinical course, and nimble changes in treatment plans required for this complex group of patients. Providers or sites that elect to manage patients with HCC thus are increasingly aware of the need to build their own MDT or communicate with an established one. The availability of new communication technologies, such as teleconferencing or teleconsultation, offers the possibility of MDT expansion into underserved or rural areas, as well as areas such as correctional facilities. Although the availability of resources for HCC patient care varies from site to site, construction of an MDT is possible in a wide spectrum of clinical practices, and this article suggests a blueprint for assembly of such collaboration. Research strategies are needed to explain how MDTs improve clinical outcomes so that MDTs themselves can be improved. © 2015 AGA Institute.


Namur J.,French National Center for Scientific Research | Citron S.J.,Piedmont Hospital | Sellers M.T.,Piedmont Hospital | Dupuis M.H.,Piedmont Hospital | And 3 more authors.
Journal of Hepatology | Year: 2011

Background & Aims: To follow the local tissue delivery of doxorubicin in HCC explants from patients embolized with drug-eluting beads and to compare it with histologic modifications. Methods: Six patients with HCC underwent chemoembolization with doxorubicin-eluting beads (caliber 100-300 μm, dose 75-150 mg) followed by liver transplantation at different time points (8 h to 36 days). On sections of the explanted liver, the tissue concentration of doxorubicin was determined radially around bead-occluded vessels with microspectrofluorimetry. The intra/peritumoral location of the beads and the modifications of the surrounding tissue were determined on an adjacent hematein-eosin-saffron-stained section and compared to drug measurements. Results: Doxorubicin was detected in the tissue surrounding the beads at all times of explantation. The drug impregnates an area of at least 1.2 mm in diameter around the occluded vessel. The tissue concentration of drug ranges from 5 μM at 8 h to 0.65 μM at 1 month. In patient transplanted at 8 h, no major tissue modification was observed and we found 42% of the beads occluding intratumoral vessels. Drug concentration was not different around intratumoral and peritumoral occluded vessels. After 9-14 days, necrosis was present around 37% of vessels and at 32-36 days, around 40% of vessels. Necrotic tissue was associated with a deeper penetration and a higher concentration of the drug than non necrotized areas, though statistically significant only at 32-36 days. Conclusions: Doxorubicin-eluting beads provide a sustained delivery of drug for a period of 1 month and local tissue concentrations above cytotoxic threshold in HCC-bearing livers. © 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.


Duralde X.A.,Piedmont Hospital
American journal of orthopedics (Belle Mead, N.J.) | Year: 2012

Humeral head resurfacing is indicated for the treatment of glenohumeral arthrosis in a variety of well-described situations, including humeral shaft abnormalities and obstructing hardware. This report of 2 cases emphasizes the benefit of this stemless device in situations in which dislocation of the humeral head and access to the humeral canal is not possible. In these 2 patients with developmental dysplasia and secondary glenohumeral arthrosis, humeral head resurfacing arthroplasty resulted in successful improvement of severe preoperative pain. In cases in which the humeral head cannot be dislocated due to severe dysplastic changes and joint line medialization, humeral resurfacing arthroplasty allows prosthetic placement through nontraditional exposures and results in high patient satisfaction and excellent pain relief.


Martin R.C.G.,University of Louisville | Kwon D.,Ford Motor Company | Chalikonda S.,Cleveland Clinic | Sellers M.,Piedmont Hospital | And 4 more authors.
Annals of Surgery | Year: 2015

Objectives: Ablative therapies have been increasingly utilized in the treatment of locally advanced pancreatic cancer (LAPC). Irreversible electroporation (IRE) is an energy delivery system, effective in ablating tumors by inducing irreversible membrane destruction of cells. We aimed to demonstrate efficacy of treatment with IRE as part of multimodal treatment of LAPC. Methods: From July 2010 to October 2014, patients with radiographic stage III LAPC were treated with IRE and monitored under a multicenter, prospective institutional review board-approved registry. Perioperative 90-day outcomes, local failure, and overall survival were recorded. Results: A total of 200 patients with LAPC underwent IRE alone (n = 150) or pancreatic resection plus IRE for margin enhancement (n = 50). All patients underwent induction chemotherapy, and 52% received chemoradiation therapy as well for a median of 6 months (range, 5-13 months) before IRE. IRE was successfully performed in all patients. Thirty-seven percent of patients sustained complications, with a median grade of 2 (range, 1-5). Median length of stay was 6 days (range, 4-36 days). With a median follow-up of 29 months, 6 patients (3%) have experienced local recurrence. Median overall survival was 24.9 months (range: 4.9-85 months). Conclusions: For patients with LAPC (stage III), the addition of IRE to conventional chemotherapy and radiation therapy results in substantially prolonged survival compared with historical controls. These results suggest that ablative control of the primary tumor may prolong survival. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Reinhart W.J.,Case Western Reserve University | Musch D.C.,University of Michigan | Jacobs D.S.,Boston Foundation for Sight | Lee W.B.,Piedmont Hospital | And 2 more authors.
Ophthalmology | Year: 2011

Objective To review the published literature on deep anterior lamellar keratoplasty (DALK) to compare DALK with penetrating keratoplasty (PK) for the outcomes of best spectacle-corrected visual acuity (BSCVA), refractive error, immune graft rejection, and graft survival. Methods Searches of the peer-reviewed literature were conducted in the PubMed and the Cochrane Library databases. The searches were limited to citations starting in 1997, and the most recent search was in May 2009. The searches yielded 1024 citations in English-language journals. The abstracts of these articles were reviewed, and 162 articles were selected for possible clinical relevance, of which 55 were determined to be relevant to the assessment objective. Results Eleven DALK/PK comparative studies (level II and level III evidence) were identified that compared the results of DALK and PK procedures directly; they included 481 DALK eyes and 501 PK eyes. Of those studies reporting vision and refractive data, there was no significant difference in BSCVA between the 2 groups in 9 of the studies. There was no significant difference in spheroequivalent refraction in 6 of the studies, nor was there a significant difference in postoperative astigmatism in 9 of the studies, although the range of astigmatism was often large for both groups. Endothelial cell density (ECD) stabilized within 6 months after surgery in DALK eyes. Endothelial cell density values were higher in the DALK groups in all studies at study completion, and, in general, the ECD differences between DALK and PK groups were significant at all time points at 6 months or longer after surgery for all of the studies reporting data. Conclusions On the basis of level II evidence in 1 study and level III evidence in 10 studies, DALK is equivalent to PK for the outcome measure of BSCVA, particularly if the surgical technique yields minimal residual host stromal thickness. There is no advantage to DALK for refractive error outcomes. Although improved graft survival in DALK has yet to be demonstrated, postoperative data indicate that DALK is superior to PK for preservation of ECD. Endothelial immune graft rejection cannot occur after DALK, which may simplify long-term management of DALK eyes compared with PK eyes. As an extraocular procedure, DALK has important theoretic safety advantages, and it is a good option for visual rehabilitation of corneal disease in patients whose endothelium is not compromised. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references. © 2011 American Academy of Ophthalmology.


Fondaparinux, a pentasaccharide which selectively binds to antithrombin III, has negligible to no cross-reactivity with heparin-induced thrombocytopenia (HIT) antibodies in in vitro studies. The lack of cross-reactivity suggests a potential role in the management of HIT, and indeed, there are several such case reports and small studies. These published data have used both the prophylactic and weight-based treatment doses. However, due to the small possibility of developing HIT with thromboembolic complications while receiving fondaparinux, it is suggested that the appropriate weight-based treatment dose be used. In all these reports, fondaparinux provided adequate anticoagulation, prevented further thromboembolic events, and platelet counts returned to normal. However, there have been a couple of case reports on possible HIT or HIT-like syndrome secondary to fondaparinux use. Conclusion: Fondaparinux is an attractive anticoagulant therapy in patients with HIT. There is still the need for larger randomized trials evaluating the true efficacy, appropriate dose, safe duration of treatment, and the true incidence of HIT associated with fondaparinux. © 2010 The Author(s).


Alvarez S.,Piedmont Hospital
Journal of Diagnostic Medical Sonography | Year: 2012

Natural breast augmentation, or fat transfer, involves taking fat cells from one area of the body and injecting them into another area, such as the breast. This can be done for cosmetic reasons after a lumpectomy or other surgical procedures that affect the shape of the breast. Breast augmentation is also being used electively by some women to enhance the appearance of their breasts. Defects such as asymmetry, sagging, or indentations have been improved with fat transfers. The changes of the breast tissue from the reaction to the new fat can also change the outcome of mammograms and sonograms. The interpreting radiologist might recommend a biopsy to exclude the possibility of missing a malignant lesion. These two case reports give sonographers an idea of what additional questions they may need to ask patients to clarify their history. © Society of Diagnostic Medical Sonography 2012.


News Article | October 28, 2016
Site: www.prweb.com

Christenbury Eye Center now offers a new implantable multifocal lens by Abbott Medical Laboratories, the TECNIS® Symfony Extended Range of Vision iOL. Multifocal lens implants have been available for years; however, the TECNIS Symfony implantable lens is an upgraded technology providing even greater benefits. This new lens’ multiple benefits include high-quality vision at all distances and astigmatism correction. Night vision and reading vision in dim illumination is also improved. The implant procedures at Christenbury Eye Center are performed by Dr. Jonathan Christenbury and Dr. Casey Mathys. In a 3-month study by the manufacturer, patients said they would choose the TECNIS Symfony implant procedure again. At Christenbury Eye Center, patients say in their testimonials, they are very pleased with this life-changing procedure. One patient, Niliva Felipe, says, “I spend a lot of time in front of computers…reading, studying and working on my Ph.D. Today, [after TECNIS] I cannot tell you enough that I have bionic eyes. I swear by them…. I feel like I’m 22 again and my vision is better than 20/20.” Patients normally choose a multifocal lens implant procedure to eliminate their reading glasses or bifocals. The TECNIS Symfony lens offers vision near and far and all distances in between. Cataract patients also choose a multifocal lens implant. The implant is performed at the same time as the cataract removal surgery. Post procedure they are not only cataract free, but they no longer require reading glasses or bifocals or the need for future cataract surgeries. “Why would anyone wear glasses at all?” says Dr. Jonathan Christenbury, Medical Director at Christenbury Eye Center. “Multifocal lens implant procedures are so advanced and the results so dramatic, especially with the Symfony lens. I can’t imagine why a patient might not choose this procedure.” Dr. Christenbury’s passion for this procedure results from personal experience. After he received a lens implant in both eyes, his vision continues to be a perfect 20/20 years later. He continues to stay on top of the latest technology in this vastly improving field to bring the best options to his patients. The TECNIS Symfony lens is now available at Christenbury Eye Center. If you would like to see if you qualify for a multifocal lens procedure, contact Christenbury Eye Center at (877) 702-2020 or visit the Christenbury Eye Center website to request a free consultation. Dr. Jonathan Christenbury established Christenbury Eye Center in 1987 and is known for his groundbreaking work in vision care. For two decades he has consistently been one of the first surgeons in the Carolinas to perform many pioneering vision care procedures including LASIK, Visian ICL and TECNIS. Dr. Christenbury performed the first LASIK procedure in the Carolinas in the early 1990s and since that time has performed more than 100,000 laser vision correction procedures. He performed the first WaveFront Customized IntraLASIK in the Carolinas in 2005. Today, Dr. Christenbury is the most experienced multifocal implant surgeon in the United States. Dr. Kenneth Mathys is a Board-Certified, fellowship-trained Cornea and Refractive surgeon. He earned his medical degree at Case Western Reserve University. He completed an ophthalmology residency at the University of North Carolina at Chapel Hill where he was honored with the position of Chief Resident. Upon completion of residency, Dr. Mathys continued his ophthalmic training as a Cornea and Refractive surgical fellow at Piedmont Hospital in Atlanta, GA. Dr. Mathys is a member of the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery.


News Article | October 31, 2016
Site: www.eurekalert.org

NEW YORK, NY (Oct. 31) -- A major international study has found that drug-eluting stents, a less-invasive alternative to bypass surgery, are as effective as surgery for many patients with a blockage in the left main coronary artery. Findings from the EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial were published this morning online in the New England Journal of Medicine and presented at the annual Transcatheter Cardiovascular Therapeutics conference in Washington, DC. The trial research team included interventional cardiologists and cardiac surgeons from 126 centers in 17 countries. Coronary artery bypass graft (CABG) surgery has long been considered the definitive treatment for patients with left main coronary artery disease (LMCAD), in which the artery that supplies oxygen-rich blood to most of the heart muscle is clogged with atherosclerotic plaque. About two-thirds of all LMCAD patients have mild to moderate disease in the remainder of the coronary arteries. "Our study has shown that many patients with left main coronary artery disease who prefer a minimally invasive approach can now rest assured that a stent is as effective as bypass surgery for at least 3 years, and is initially safer, with fewer complications from the procedure," said first author Gregg W. Stone, MD, professor of medicine at Columbia University Medical Center and director of cardiovascular research and education at the Center for Interventional Vascular Therapy at NewYork-Presbyterian/Columbia. Stents, which are placed into the diseased artery via a catheter that is inserted through a small opening in a blood vessel in the groin, arm, or neck, are a less-invasive treatment option for many people with coronary artery disease. However, coronary artery bypass surgery (CABG) has long been considered the definitive treatment for patients with LMCAD, which affects a large portion of the heart muscle. Previously, randomized clinical trials suggested that first-generation drug-eluting stents, which release antiproliferative medications to prevent the artery from becoming re-occluded after stent placement, might be appropriate for patients with LMCAD without extensive blockages in the remainder of the heart arteries. The trial results, however, were inconclusive. "Since that time, stents have gotten better, and so has cardiac bypass surgery," said Dr. Stone. "That required us to take a fresh look at the relative safety and effectiveness of the two approaches." In the current study, 1,905 patients with LMCAD and low or intermediate coronary artery disease complexity (as determined by the SYNTAX score, an angiographic tool for measuring disease severity) were randomized to receive a drug-eluting stent that releases the antiproliferative agent everolimus (XIENCE, made by Abbott Vascular of Santa Clara, CA) or bypass surgery. The patients were followed for at least two years, with a median follow-up of three years. "We found that approximately 15 percent of patients in both groups had a heart attack, stroke, or died within three years," said Dr. Stone, lead author of the paper. "In other words, stents were equally effective as bypass surgery." The researchers also analyzed what happened to the patients in the first 30 days after treatment, when serious complications are most likely to occur. Within that period, stent patients had a significantly lower incidence (4.9 percent) of death, stroke, heart attack, or revascularization than those who had bypass surgery (7.9 percent). In addition, fewer stent patients had major bleeding, infections, kidney failure, or severe abnormal heart rhythms compared to those treated with surgery. The researchers reported that bypass surgery should still be considered standard therapy for those with LMCAD and extensive blockages in the remainder of the heart arteries, although the study did not include patients with severe disease. "Our study establishes stents as an acceptable or preferred alternative for patients with LMCAD and low or moderate disease complexity in the other 3 coronary arteries--about two-thirds of all LMCAD patients," said Dr. Stone. "While bypass is still considered a more durable repair, patients and doctors may prefer a percutaneous treatment approach, which is associated with better upfront results, fewer complications, and quicker recovery." Coronary artery disease (CAD), the most common form of heart disease in the US, results from the buildup of atherosclerotic plaques in the arteries that supply oxygenated blood to the heart. CAD frequently leads to strokes or heart attacks, killing more than 370,000 people annually, according to the Centers for Disease Control and Prevention. The left main artery, the primary supply of blood to the heart, is affected in about 10 percent of people with CAD. The study is titled, "Comparison of Everolimus-Eluting Stents and Bypass Graft Surgery in Selected Patients with Left Main Coronary Artery Disease." The other contributors are: Joseph F. Sabik (Cleveland Clinic Foundation, Cleveland, OH); Patrick W. Serruys (International Centre for Circulatory Health, NHLI, Imperial College London, London, UK); Charles A. Simonton (Abbott Vascular, Santa Clara, CA); Philippe Généreux, Erick Schampaert, and Pierre Pagé (Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada); John Puskas and Roxana Mehran (Mount Sinai Hospital, New York, NY); Nicholas Lembo, David E. Kandzari, and W. Morris Brown, III (Piedmont Hospital, Atlanta, GA); Marie-Claude Morice (Générale de Santé, Hopital Privé Jacques Cartier, Massy, France); David Taggart and Adrian Banning (John Radcliffe Hospital, Oxford, UK); Béla Merkely and Ferenc Horkay (Semmelweis University, Budapest, Hungary); Piet W. Boonstra and Ad Johannes van Boven (Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands); Imre Ungi and Gabor Bogáts (University of Szeged, Szeged, Hungary); Samer Mansour and Nicolas Noiseux (Hôpital Hôtel-Dieu de Montréal, Montréal, Québec, Canada); Manel Sabaté and Jose Pomar (Hospital Clinic, Barcelona, Spain); Mark Hickey and Anthony Gershlick (University Hospitals of Leicester NHS Trust, Leicester, UK); Pawel Buszman and Andrzej Bochenek (Medical University of Silesia, Katowice, Poland and American Heart of Poland, Ustron, Poland); Ovidiu Dressler (Cardiovascular Research Center, New York, NY); Ioanna Kosmidou (NewYork-Presbyterian, New York, NY); Stuart J. Pocock (London School of Hygiene and Tropical Medicine, London, UK); and Arie Pieter Kappetein (Erasmus Medical Center, Rotterdam, The Netherlands). The study was sponsored and funded by Abbott Vascular, Santa Clara, CA. Additional authors' disclosures are included in the article. Columbia University Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. The campus that Columbia University Medical Center shares with its hospital partner, NewYork-Presbyterian, is now called the Columbia University Irving Medical Center. For more information, visit cumc.columbia.edu or columbiadoctors.org. NewYork-Presbyterian is one of the nation's most comprehensive healthcare delivery networks, focused on providing innovative and compassionate care to patients in the New York metropolitan area and throughout the globe. In collaboration with two renowned medical school partners, Weill Cornell Medicine and Columbia University College of Physicians & Surgeons, NewYork-Presbyterian is consistently recognized as a leader in medical education, groundbreaking research and clinical innovation. NewYork-Presbyterian has four major divisions: NewYork-Presbyterian Hospital is ranked #1 in the New York metropolitan area by U.S. News and World Report and repeatedly named to the magazine's Honor Roll of best hospitals in the nation; NewYork-Presbyterian Regional Hospital Network is comprised of leading hospitals in and around New York and delivers high-quality care to patients throughout the region; NewYork-Presbyterian Physician Services connects medical experts with patients in their communities; and NewYork-Presbyterian Community and Population Health features the hospital's ambulatory care network sites and operations, community care initiatives and healthcare quality programs, including NewYork Quality Care, established by NewYork-Presbyterian, Weill Cornell and Columbia. NewYork-Presbyterian is one of the largest healthcare providers in the U.S. Each year, nearly 29,000 NewYork-Presbyterian professionals deliver exceptional care to more than 2 million patients. For more information, visit http://www. and find us on Facebook, Twitter and YouTube.

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