New transplant surgery chief plans pancreas, islet transplants

Vaughn Whittaker, MD, and Rainer Gruessner, MD perform kidney transplants at Upstate University Hospital.

Vaughn Whittaker, MD, and Rainer Gruessner, MD perform kidney transplants at Upstate University Hospital.

Upstate’s new transplant surgery chief, Rainer Gruessner, MD, is accepting patients for pancreas transplants he expects to offer in the near future.

Already, Upstate University Hospital is known for kidney transplant expertise, and Gruessner says a good number of people whose kidneys have failed due to diabetes mellitus would also benefit from a new pancreas. The new pancreas would not only protect the newly transplanted kidney but also halt or reverse the secondary diabetic complications and rend the patient non-diabetic and insulin-free.

Some patients would have both organs transplanted at the same time. Others would likely undergo pancreas transplant alone to preserve their kidney function or after a previous kidney transplant to prevent failure of the transplanted kidney due to ongoing diabetes.

Diabetes is the most common cause of end stage kidney disease or renal failure. “Rather than waiting until the kidney fails,” Gruessner says, “you may want to be proactive and go for a pancreas transplant.” A functioning pancreas transplants remains the only treatment option that achieves insulin-independence long term.

He says surgeons in the United States perform about 1,000 pancreas transplants per year and only about 35 in all of New York State. He hopes to increase those numbers starting in 2016.

This year already 70 kidney transplants have been performed at Upstate, the highest number ever. At least two more were scheduled for December.

Hear an interview about kidney transplants with Rainer Gruessner, MD.

Gruessner came to Upstate in September from the University of Arizona, where he built a successful multivisceral transplant program, in which three or more abdominal organs are transplanted en bloc. He and his team also performed the first fully robotic removal of a native pancreas and simultaneous islet auto-transplant in a patient with chronic pancreatitis.

He expects to be able to offer islet transplants at Upstate in the future as well, for two distinct patient populations. The first group are patients with chronic pancreatitis and intractable pain who will undergo complete removal of the pancreas and a simultaneous islet transplant so that the patient does not require insulin. This islet “auto” transplant is covered by most insurance companies.

The second group are patients with brittle or labile insulin-dependent diabetes mellitus. Since the results of islet transplants trail those of pancreas transplants, these islet “allo”transplants are currently not covered by most insurance companies.

Gruessner’s medical degree is from the Johannes-Gutenberg-University in Mainz, Germany. He obtained the habilitation, the equivalent of a doctorate, from the Philipps-University in Marburg, Germany. He completed his general surgery training at the same institutions and then a fellowship in transplantation surgery at the University of Minnesota from 1987 to 1989.

He made many significant contributions to the field of transplantation during his early academic career at the University of Minnesota, including a preemptive liver transplant to an infant with a rare metabolic disorder called oxalosis and creation of a standardized technique for intestinal transplantation from a living donor.

Gruessner was part of the teams that performed the world’s first split pancreas transplants and the world’s first pancreas allotransplant after complete removal of a patient’s native pancreas.

In Arizona, he was chairman of the department of surgery from 2007 to 2014. He has edited three textbooks, written more than 80 textbook chapters and more than 300 medical journal articles.

coverofppdGruessner is accepting new adult and pediatric patients for all types of abdominal transplants – kidney, pancreas, islet, liver and intestine. Eventually, he wants to add liver and intestine to the transplants performed at Upstate. He is also accepting patients with chronic pancreatitis for evaluation of total pancreatectomy and islet auto-transplantation.

Reach him through transplant services at 315-464-5413.

This story appears in the January issue of Physicians Practice.

Hear an interview about kidney transplants with Rainer Gruessner.

 

 

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Upstate researchers seek participants for mental health study

65492861_thumbnailResearchers from Upstate are seeking families to take part in a study of the genetic bases of some childhood behavioral and psychiatric disorders, such as attention deficit hyperactivity disorder.

About the project: Most of the common disorders of this type are at least partially heritable, meaning they have a genetic basis, according to Stephen Glatt, PhD, a professor of psychiatry and behavioral sciences and physiology at Upstate. Variants in DNA that predispose people to ADHD, for instance, also predispose them to autism spectrum disorders and mood disorders.

“We’re starting from the presumption that these disorders all have something in common genetically,” said Glatt, who together with colleague Stephen Faraone, PhD, received a $3 million grant from the National Institute of Mental Health to explore which segments of DNA are shared between family members with various mental health disorders.

Bruce Brumfield of Camillus agreed to take part in the study “really just to try to understand the challenges that I and my wife are having with our 12-year-old.” The family spent almost three hours answering questionnaires, completing computer-based tasks and giving blood samples as part of the project. They were pleased to be part of something that could help reshape the way mental health is considered.

“The prevailing diagnostic system for mental disorders is not founded in a really valid science. It’s observational, in a sense. There are no biological markers. And the groupings of children under diagnostic categories doesn’t have a sound basis in biology, even though we know these are biological brain disorders,” Glatt explained. “Our premise is to start with the biology and potentially to redefine psychiatric disorders from a biology-first basis.”

Who would take part: Biological parents with a child with a mental health disorder between the ages of 6 and 12 years, plus siblings; and, families with a child in the same age range who is typically developing.

What is required: Blood samples, questionnaires and computer tasks that will last from two to three hours. Participants receive $50 each.

Why take part: Help scientists zero in on a core set of genes that may put humans at risk for a variety of brain disorders, including ADHD.

How to enroll: Contact research assistant Pat Forken at 315-464-5619.

fall2015coverThis article appears in the fall 2015 issue of Upstate Health magazine.

Posted in community, environment, genetics, mental health, psychiatry, research, volunteers | Leave a comment

Penile cancer risk may be increased in obese men

A man would generally notice a small lesion that developed on his penis and would seek medical care before the lesion developed into advanced penile cancer. If that man is severely overweight, his penis may not be visible, enveloped in fat pads.

“Buried penis represents a difficulty in early detection of suspicious lesions — but may also provide an environment susceptible to poor hygiene and subsequent chronic inflammation,” Timothy Byler, MD, writes in the September issue of Case Reports in Urology. He’s lead author of a paper with input from colleagues at Upstate Medical University, including Dmitriy Nikolavsky, MD, Srinivas Vourganti, MD, and Jared Manwaring.

They write about two cases of men in their 40s and 50s who may represent an enlarging demographic at risk. “Although HPV was found on one of the surgical specimens, these men represent young, nonsmokers who were circumcised as neonates and therefore should be at low risk for penile cancer,” Byler writes.

Both men had body mass indexes in the 50s. Each sought medical care for discharge from the area where his penis was contained. In both cases, doctors could not visualize the area without causing pain, so each man had to be examined under anesthesia. Biopsies revealed cancer. Both men chose to have their penises removed for treatment. One subsequently died from unrelated lung failure. The other was prescribed chemotherapy afterward.

Traditional risk factors for penile carcinoma include advanced age, lack of circumcision, smoking, HPV or HIV infection.

The urologists say they believe buried phallus may mimic lack of circumcision, because maintaining hygiene in the area is difficult, and the space provides an area for chronic inflammation and low grade infections. “This represents a new group of patients that must be carefully examined and counseled regarding penile carcinoma,” they write.

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Upstate’s music man: His ‘prescriptions’ target stress

Mitchell Karmel, MD, in an operating room in the radiology suite with a sampling of the thousands of albums he owns. (PHOTO BY ROBERT MESCAVAGE)

Mitchell Karmel, MD, in an operating room in the radiology suite with a sampling of the thousands of albums he owns. (PHOTO BY ROBERT MESCAVAGE)

BY AMBER SMITH

Patients answer many questions on the paperwork they complete prior to an interventional radiology appointment at Upstate.

But when they arrive for a biopsy, catheter installation or other procedure, if their doctor is Mitchell Karmel, MD, patients face one additional question: To what music would you like to listen?

Classic rock is a popular answer. Many patients prefer something mellow, like Van Morrison’s “Astral Weeks” album.

Once, a woman with breast cancer requested AC/DC. “That’s not the most relaxing music,” Karmel pointed out.

“It’s relaxing to me,” the woman said. And Karmel played “Hell’s Bells.”

In his decades of experience, Karmel said only one patient has requested silence instead of music. Most patients defer to his preference, which changes from day to day. Some try to stump him.

“What I’d really love to hear is ‘Boris the Spider,’ ” one patient said. Karmel thumbed to the song released by The Who in 1966.

Another said, “I’m sure you don’t have ‘Several Species of Small Furry Animals…’ ” and didn’t finish the song title before Karmel was pulling up “Ummagumma,” Pink Floyd’s double album from 1969 that featured “Several Species of Small Furry Animals Gathered Together in a Cave and Grooving With a Pict.”

When a patient requested Iron Butterfly’s “In-a-Gadda-Da-Vida,” Karmel needed clarification of the heavy-metal classic. “The five-minute version or the 17-minute version?”

Karmel’s iPod contains more than 9,400 songs. His iMac holds 24,500 more. He prides himself on full libraries of all genres, saying he needs to have all of his music at his fingertips “because you never know what you will want to listen to.”

Young technologists and nurses are impressed that his music collection contains modern rap and R&B music.

Karmel advocates music during radiologic procedures, not just because it creates a pleasing work environment. “Music has healing qualities, there’s no doubt about it,” he said. He points to studies showing music can reduce postoperative pain and anxiety, reduce the amount of pain medicine and increase patient satisfaction.

At Upstate, Karmel is director of interventional radiology. His medical degree is from the University of Buffalo School of Medicine. He completed an internship at Memorial Sloan-Kettering Cancer Center in New York, a residency through Cornell University and then a fellowship at Harvard Medical School in Boston.

Carmel has always liked music. It was in first or second grade that he and his classmates were assessed and funneled, if they made the cut, into”‘ band class. He remembers the first day of band, when the teacher looked him over. ” ‘You have long fingers. You’re playing clarinet.’ ”

He played clarinet, even though he thought the drums would have been more fun.

His real love of music blossomed during summer camp at the age of 14, when he was among the big kids who got to attend a concert at Tanglewood. Performing were B.B. King, Jefferson Airplane and The Who. Karmel was hooked.

Today he appreciates and listens to all sorts of music, from philharmonic orchestras to rap. His favorite remains “the inspirational and melodious” Pink Floyd.

More than once, Karmel has had patients ask for the name of the album that played during their procedure. He pulls out a sheet of paper. He writes a mock prescription, for stress, to be taken as needed: Pink Floyd’s “The Division Bell.”

Research ‘notes’

Using music during patient care has been the subject of many a medical study by researchers around the world. Here’s a look at five studies:

Music during mammography?

Music therapy has the potential to decrease the amount of anxiety. However, it did not decrease the amount of pain participants experienced during mammograms that screen for breast cancer.

Researchers from: Robert Wood Johnson University Hospital in New Brunswick, NJ, and the University of Virginia Medical Center in Charlottesville.

Published in: Clinical Journal of Oncology Nursing, June 2014.

Music during prostate biopsy?

Listening to music during a transurethral ultrasound-guided prostate biopsy significantly reduced patients’ feelings of pain, discomfort and dissatisfaction. Men who listened to music during the procedure had lower heart rates and blood pressures afterward than men who did not.

Researchers from: Chungbuk National University in Korea.

Published in: Urologia Internationalis, December 2014.

Music for children during MRI?

Listening to music, watching a clown show or interacting with a dog all demonstrated a beneficial effect in reducing negative emotions in children facing magnetic resonance imaging. Also, the number of children requiring sedation during their scans dropped significantly.

Researchers from: Meyer Children’s Hospital and the University of Florence, Italy.

Published in: Pediatric Reports, March 2015.

Music during colonography?

Patients who listened to music and/or inhaled the scent of essential oils while they underwent a computerized tomographic colonography reported little improvement in pain or discomfort. However, they requested music and/or oils for subsequent imaging scans.

Researchers from: Kameda Medical Center in Japan.

Published in: European Journal of Radiology, December 2014.

Music after surgery?

An analysis of 4,261 studies shows that music after surgical procedures reduces postoperative pain, anxiety and the use of pain medicine and increases patient satisfaction. While the patients’ length of stay is not affected, the authors wrote, “music is a noninvasive, safe and inexpensive intervention that can be delivered easily and successfully in a hospital setting.”

Researchers from: Queen Mary University in London.

Published in: The Lancet, August 2015.

fall2015coverThis article appears in the fall 2015 issue of Upstate Health magazine.

Posted in community, entertainment, hospital, radiology, research, surgery, urology | Leave a comment

3 things to do before getting pregnant

 

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Family planning expert Renee Mestad, MD, gives this advice to women before they begin trying to conceive:

  1. Stop smoking. Smoking interferes with ovulation, the ability of the egg to move through the fallopian tube, and it affects implantation. It also increases the risk of miscarriage and preterm delivery.
  2. Start taking prenatal vitamins. The folic acid helps prevent birth defects that develop in the first four to six weeks, before most women realize they are pregnant.
  3. Talk to your medical provider. Some common medications, such as nonsteroidal anti-inflammatories, decongestants and antihistamines, can affect fertility.

Hear Mestad, division chief of obstetrics and gynecology at Upstate, give a radio interview about contraceptive choices. This article appears in the fall 2015 issue of Upstate Health magazine.
 

Posted in community, health care, Health Link on Air, maternity, nutrition, pharmacy, public health, women's health | Leave a comment

Learning how the brain develops

 

fall science is art

This image of different types of neurons — from the work of two Upstate researchers — was featured on the cover of the Journal of Neuroscience.

The cellular and molecular processes of cerebral cortex development are under study in the Upstate laboratory of Eric Olson, PhD, an associate professor of neuroscience and physiology. The cerebral cortex is the brain’s outer layer.

Olson and Ryan O’Dell, PhD, had this image from their work selected for the cover of the Journal of Neuroscience. The microscopic structures in purple, red and yellow are different types of neurons. O’Dell recently received his PhD and is completing his medical degree through Upstate’s MD/PhD program.

This article appears on the back cover of the fall 2015 issue of Upstate Health magazine.

Eric Olson, PhD (left), and Ryan O’Dell, PhD, with the Journal of Neuroscience cover featuring their work. (PHOTO BY WILLIAM MUELLER)

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Why does the cold weather make my nose run?

1314379_HiResHaidy Marzouck, MD, an otolaryngologist at Upstate who specializes in sino-nasal allergies, said the answer to why a person’s nose runs in cold weather has two components.

Haidy Marzouk, MD

Haidy Marzouk, MD

“It’s part of your nose’s job to condition the air as it travels to your lungs.

“Part of this conditioning process is to moisturize the air.  Often, in cold weather, the air is dry as well.  As a result, the nose reflexively begins to increase fluid production for this conditioning process.

“When fluid production increases, the nose begins to run.

“Secondly, during exhalation in cold weather, the moisture in the air being exhaled into a colder environment condenses from gas to liquid, usually collecting at the tip of one’s nose — creating an increase in nasal discharge.”

fall2015coverThis article appears in the fall 2015 issue of Upstate Health magazine.

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Concussion experts assess head injury assessment tools

Kenneth Slack, a student athlete on the Le Moyne College soccer team, is part of a control group for a study of concussion at Upstate Medical University. (PHOTOS BY CHUCK WAINWRIGHT)

Kenneth Slack, a student athlete on the Le Moyne College soccer team, is part of a control group for a study at Upstate Medical University of the tools that assess brain function in concussion cases. Here, he is undergoing an electroencephalograph test to check his brain wave patterns. (PHOTOS BY CHUCK WAINWRIGHT)

Collegiate athletes in the communities near Upstate Medical University are helping researchers improve the identification and assessment of head injuries in sports.

Students playing sports at Cazenovia, Le Moyne and Onondaga Community colleges and other schools may participate in a study that assesses the concussion assessment tools currently in use. Upstate is one of about 10 sites partnering with BrainScope, a private medical neurotechnology company that is developing a new generation of portable, hand-held devices for objectively assessing brain function.

The sports with higher concussion risk include football and soccer, but principal investigator Christopher Neville, PhD, said athletes from non-contact sports such as swimming and track will likely make up a comparison group.

When an athlete suffers a possible concussion, study coordinator Joshua Baracks, an athletic trainer, arranges for a sophisticated magnetic resonance imaging scan within 72 hours of injury. The athlete also undergoes balance and neurocognitive testing, plus an electroencephalogram.

For the study, that athlete is matched with someone of the same age, gender and sport – likely a teammate – who has not been injured and who undergoes the same type of testing. The series of tests is designed to determine the best tool for identifying and assessing concussions.

Slack, center, stands on a straight line with his eyes closed to test his physical functions, watched by athletic trainer Joshua Baracks (left) and project director Christopher Neville, PhD. Before that, test subjects are asked to recite a series of words and count backwards, and afterward, an EEG is used to track and record brain patterns.

Slack, center, stands on a straight line with his eyes closed to test his physical functions, watched by athletic trainer Joshua Baracks (left) and project director Christopher Neville, PhD. Before that, test subjects are asked to recite a series of words and count backwards, and afterward, an EEG is used to track and record brain patterns.

Sports concussion laws

The vast majority of concussions are relatively benign. “It’s really when we don’t manage the concussion properly, or we don’t recognize a person has had a concussion, that we increase the risk for more problems,” said Brian Rieger, PhD, director of the Upstate Concussion Center.

That’s what prompted laws like New York’s, which mandates concussion education for players and coaches and requires that players be removed from play or practice if a concussion is suspected. Medical evaluation is required, and an athlete must receive medical clearance before returning to play.

New York’s concussion laws apply to injuries suffered in school sports or other school-based activities.

hloa-art2Hear Rieger’s radio interview about the diagnosis and management of concussions. This article appears in the fall 2015 issue of Upstate Health magazine.

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A big-screen cameo and real-life remembrances for an Upstate surgeon

A still from the independent film "The Lennon Report," about the death of former Beatle John Lennon.

A still from the independent film “The Lennon Report,” about the death of former Beatle John Lennon. (FRANCISCO PRODUCTIONS)

In an indie movie appearing at film festivals, actor Evan Jonigkeit plays the role of David Halleran, MD, a young medical resident at midtown Manhattan’s Roosevelt Hospital on the night of Dec. 8, 1980, when police brought in a victim of four gunshots.

David Halleran, MD

David Halleran, MD

While Halleran and others worked to save the man’s life, someone looked through his wallet for identification. The driver’s license read: John Lennon.

Halleran is now a colorectal surgeon at Upstate and former president of the Onondaga County Medical Society. The movie, called “The Lennon Report,” was filmed last year in New York City, and Halleran has a cameo.

hloa-art2fall2015coverHear an interview with Halleran about that night. This article appears in the fall 2015 issue of Upstate Health magazine.

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An audience with the pope reverberates at Upstate

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Pope Francis during his recent visit to the United States.

Jake Braithwaite, 26, and Brendan Coffey, 30, are chaplain interns at Upstate University Hospital, Braithwaite in neurology and Coffey in cardiology.

The two men have taken vows of chastity, poverty and obedience in the multiyear process of becoming Jesuits. They were among 17 Jesuit novices in Syracuse who were invited to the Mass led by Pope Francis at the Basilica of the National Shrine of the Immaculate Conception in Washington, D.C.

Coffey said the joy was palpable in the basilica as the Pope arrived. He stood on a pew to get a good look. He could not hear the Pope, but he saw him make the sign of the cross.

As chaplain interns at Upstate, Coffey and Braithwaite minister to patients who request a spiritual presence.

Braithwaite explained how the Pope’s compassion is an inspiration, recalling news coverage of him washing the feet of prisoners, and blessing people with deformities. “His instincts are the instincts I hope to replicate when I see patients here at Upstate.”

fall2015coverThis article appears in the fall 2015 issue of Upstate Health magazine.

Posted in cardiac, community, hospital, mental health, neurology, spiritual care | Leave a comment