February 2011 issue | pdf

Progressnotes
February 2011
Changing What’s Possible in Health Care
_ Gamma Knife Center Changing Outcomes for Patients
_ MUSC Epilepsy Center Adds Pediatric Specialists
_ Most Comprehensive Prostate Cancer Care in S.C.
_ Frank P. Tourville Sr. Arrhythmia Center Opens
_ MUSC Approved as a Lung Transplant Center
Istvan Takacs, M.D., explains the
procedure to a patient.
MUSC Gamma Knife Center Changing Outcomes
for CNS Patients
By Istvan Takacs, M.D., Gamma Knife Center Co-Medical Director
Since opening in 2010, the MUSC Gamma Knife Center has treated more than 130 central nervous
system (CNS) patients with the latest technology of the Leksell Perfexion Gamma Knife, considered the
gold standard for noninvasive surgical management for benign and malignant brain tumors, vascular
malformations and other abnormalities of the head and neck areas, including:
• Malignant brain tumors
• Malignant tumors of cranial nerves
• Malignant pituitary/pineal tumors
• Metastases to brain/meninges
• Non-malignant brain tumors:
brain/nerves/meninges
• Pituitary adenomas/craniopharyngeal tumors
• Neoplasms of uncertain behavior
• Cerebral/spinal meningioma
• Glial tumors
• Glomus neoplasm
• Trigeminal neuralgia
• Essential tremor
With the Gamma Knife, tumors that might be difficult or impossible to manage with other types
of surgery often can be treated safely and quickly. Open-skull incisions are unnecessary and the submillimeter (0.15mm) accuracy of the Gamma Knife means minimum dose exposure to surrounding
healthy tissue – even when treating tumors that are deep-seated or close to sensitive parts of the brain
like the spinal cord or auditory cortexes. With the Gamma Knife, there are fewer surgery-related
complications: Patients don’t have the infection risk of regular surgery or the destructive track lesion
common with other radiological treatments. An additional benefit is that the Gamma Knife is performed
as an outpatient procedure, with no side effects like bleeding, nausea or vomiting. It can be especially
effective for patients who are not suitable for standard surgical techniques due to illness or advanced age.
One of two hospitals in South Carolina with a Gamma Knife, MUSC is the only hospital with
the infrastructure of an NCI-designated cancer center and the advantages an academic medical
center can offer, including extensive clinical expertise treating a wide range of CNS patients.
Of course any tool is just part of treatment. The real advantage for patients is our team approach to
their care.
Our program exemplifies the best in interdisciplinary cooperation, working closely with neurosurgeons,
radiation oncologists, neurologists, otolaryngologists, interventional radiologists, physicists and
engineers. Each week, a tumor board devoted to neuroplasms of the CNS meets to discuss which patients
need surgery, who needs surgery with a follow-up by the Gamma Knife and who should have the Gamma
Knife as a first option. Treatment recommendations are decided from there. In addition, the Gamma
Knife team meets regularly to evaluate patients’ progress, comparing the latest scans to previous scans in
order to monitor improvement.
As we evaluate our first year, we have excellent results for arresting tumor growth and are confident we
will see significant tumor shrinkage based on extensive world-wide outcomes data available for Gamma
Knife procedures – we know that if we achieve A, B will come. In addition we’ve had excellent results
treating movement disorders and trigeminal neuralgia with the Gamma Knife, with significant reductions
in tremors and facial pain seen just a few weeks after treatment.
Referring a patient is as simple as making a phone call to MEDULINE or filling out our online referral
form on the Physician Portal (http://physicianportal.muschealth.com/). Our team will work with your
office and the patient to schedule a time for an initial consultation, as well as manage any necessary
insurance approvals required for the procedure. Referring physicians will receive a complete report on the
results of the procedure as well as any follow-up appointments and diagnostic tests performed.
Why Gamma Knife?
There are several radiation delivery systems that operate on stereotactic principles, for example LINAC
and CyberKnife. Both of these are essentially linear accelerators that deliver x-rays from a mobile source
that orbits on a track or is mounted on a robotic arm. In contrast, the Gamma Knife operates with sliding
collimator windows over an array of 192 cobalt sources.
Open systems that navigate around the patient like LINAC and CyberKnife have more degrees of
freedom and can be used to treat any body part – making them attractive options for most hospitals. But
those extra degrees of freedom cause more wear and tear on the machine, leading to wobble and quality
assurance issues that make them a poor choice for treating CNS patients. The Gamma Knife has fewer
degrees of freedom and can only accommodate the head and upper neck, but can accommodate the sharp
margins required in the brain. It requires a large CNS population and a strong clinical experience in place,
both of which MUSC can offer as an academic medical center.
Istvan Takacs, M.D., Gamma Knife Center Co-Medical Director
How to Refer
For consultation or referral, call MEDULINE at 1.800.922.5250 or 843.792.2200.
Additional Resources More information on MUSC’s Gamma Knife Center is available at:
http://www.muschealth.com/gammaknife
Medical School: Lund University, Lund, Sweden, 1986
Residency: University of Linkoping, Karolinska Hospital, Sweden
Fellowship: University of Toronto, University of Arizona
Special Interests: Stereotactic and functional neurosurgery, Gamma Knife surgery,
movement disorders, Parkinson’s disease, essential tremor, epilepsy,
neurosurgical pain management
J. Marcus Wharton, M.D., (left) and
Michael R. Gold, M.D., (right)
T h e F r a n k P . T o u r v i l l e S r . A r r h y t h m i a C e n t e r a t M U S C Offers
C o m p r e h e n s i v e C l i n i c a l , R e s e a r c h a n d E d u c a t i o n P r o g r am
Cardiac arrhythmia is one of the top reasons for hospital admissions across South Carolina and the
United States, but current numbers are only the tip of the iceberg. Because arrhythmia risk increases
dramatically with age and obesity, it is becoming an increasingly pervasive problem as Baby Boomers
continue to reach senior status and gain weight.
The most common form of sustained arrhythmia – atrial fibrillation – already has been diagnosed in
2.2 million Americans and that number is increasing at a rate of about 750,000 new cases per year. A
study published in July 2006 predicted that if current trends continue, 15 million Americans will have
atrial fibrillation by 2050.
Long recognized nationally and internationally for its clinical expertise in treating atrial fibrillation
and other arrhythmias, the MUSC Heart & Vascular Center has established the Frank P. Tourville Sr.
Arrhythmia Center at MUSC. In addition to an expansion of its clinical staff, the center will provide
cutting-edge research and education.
“Our vision for the Arrhythmia Center is to address this challenge through a two-fold approach,” said
J. Marcus Wharton, M.D., the new center’s director and Director of Clinical Cardiac Electrophysiology
(EP). “We want to reduce the number of arrhythmia cases as well as enhance our ability to treat those
cases successfully. And, ultimately, we want to find a cure for atrial fibrillation.”
How to Refer
For consultation or referral, call MEDULINE at 1.800.922.5250 or 843.792.2200.
While Wharton and Michael R. Gold, M.D., Director of the Division of Adult Cardiology, have
earned international reputations for clinical care and research, both physicians said greater resources
were required to meet the needs of South Carolina and a steadily growing patient base at MUSC.
“Despite the growing numbers of atrial fibrillation patients, there now are only 10 or so major
arrhythmia centers in the United States, and perhaps 15 worldwide,” Dr. Wharton said. Despite the fact
that we have some of the nation’s leading authorities in the treatment of arrhythmias here at the Medical
University, South Carolina did not have a major center.”
In addition to Dr. Wharton and Dr. Gold, the EP team includes: Robert B. Leman, M.D., director
of Adult Electrophysiology and Arrhythmia Control; J. Lacy Sturdivant, M.D.; and Frank A. Cuoco Jr.,
M.D. The physicians specialize in complex ablations for atrial fibrillation and ventricular tachycardia, as
well as device implants and other complex treatments, such as hemodynamically supported ventricular
tachycardia ablations that combine an advanced interventional cardiology device called Tandem Heart,
which greatly enhances patients’ chances of surviving the procedure. The team currently is conducting
27 clinical trials and plans a significant expansion over the next several years.
Funded with a generous grant from Frank P. Tourville Sr. and his company, Zeus Industrial Products,
Inc., of Orangeburg, the Arrhythmia Center will permit MUSC to expand its medical staff and facilities
in the state-of-the-art Ashley River Tower hospital, its EP fellowship program and both clinical and basic
science research. The grant also funds the Frank P. Tourville Sr. Chair for Dr. Wharton.
“We plan to recruit a top researcher who is a really good basic scientist,” Dr. Wharton said. “We
want to do more than just treat atrial fibrillation. We need to look more closely at it, design drugs, new
technologies, and ultimately find a cure. We now have the capability to do these things here at MUSC.”
MUSC already is widely recognized as a leader in arrhythmia, consistently ranked among the top five
U.S. heart centers. Patients from all over the United States and Europe come for treatment from Dr.
Wharton, an internationally recognized leader in performing atrial fibrillation ablations. Wharton has
developed enhancements for the procedure and trained hundreds of other EP specialists.
Located in one of the most technologically advanced heart hospitals in the United States, the
Arrhythmia Center has state-of-the-art EP labs that provide electro-anatomic mapping systems, intracardiac echocardiograph, invasive hemodynamic monitoring and support, and TandemHeart and
cardiopulmonary bypass for complex ablation procedures. Intra-operative ablations are performed in
the cardiac operating rooms, where physicians are pioneering robotic and minimally invasive approaches
to non-pharmacological management of arrhythmias.
In addition to promoting the new center to physicians throughout South Carolina, Dr. Wharton is
planning to form the S.C. Electrophysiology (EP) Research Cooperative. He has begun meeting with EP
specialists across the state and hopes to conduct an annual symposium.
Additional Resources For more information, see our website at www.muschealth.com/heart/services/electro.htm
Jonathan Edwards, M.D.
MUSC Epilepsy Center Adds Pediatric Specialists,
Increases Access
By Jonathan Edwards, M.D., Director, MUSC Epilepsy Center
Population-based estimates by the quality standards subcommittee of the American Academy of
Neurology and the practice committee of the Child Neurology Society suggest that every year 25,000 to
40,000 children in the United States experience a first unprovoked seizure.
Recognizing the severity of the problem – South Carolina has a particularly underserved child
neurology population – the MUSC Epilepsy Center recently has expanded to include eight epilepsy
specialists and a broad range of treatment options. As the only Level 4 epilepsy center in South
Carolina, MUSC offers extensive expertise and comprehensive care in the medical, surgical, social and
psychological management of epilepsy.
Plus, MUSC Children’s Hospital, the premier children’s hospital in South Carolina, offers patients
and their families all of the benefits of an academic medical center in a family-centered environment
where all children are made to feel safe and comfortable.
We offer multidisciplinary diagnostic and planning services, and a full spectrum of leading-edge
medical and surgical therapies for patients from infancy to young adulthood. Our goal is to develop
a partnership with referring physicians so that each child receives optimal long-term care. Specialty
Rebecca K. Lehman, M.D.
services such as speech language pathology and neuropsychology are available, as well as extensive
diagnostic services including inpatient and outpatient video EEG monitoring.
MUSC encourages referrals from across the region to collaborate on diagnoses or treatment options;
for example, when new symptoms appear that cause physicians to question their original diagnosis.
Many patients are referred because they are not responding to typical therapies and their physicians are
seeking additional treatment options or believe patients may be good candidates for epilepsy surgery. In
all cases, we work closely with referring physicians to provide patients the best care possible and, as our
program continues to expand, we can evaluate patients faster than ever. Generally an epilepsy patient
can be seen by one of our specialists in less than two weeks.
Two of our new colleagues work exclusively with children. Dr. Samir Karia is a board-certified pediatric
epileptologist and Dr. Rebecca K. Lehman is a fellowship-trained pediatric neurologist specializing in
pediatric movement disorders. This is a great asset to our team since many patients initially diagnosed
with epilepsy actually have movement disorders. There are only a few pediatric neurologists in South
Carolina, much less fellowship-trained neurologists, so to add two physicians of this caliber is a huge
step forward for South Carolina.
As an academic medical center, MUSC can offer the most advanced options for the treatment of
epilepsy, including using diet in combination with medication, which the best evidence available
indicates is more effective than medication alone for patients with refractory epilepsy. These diets can
be prescribed by the referring physician, but they’re challenging to manage due to how rigidly they are
calculated and the resources required, including clinicians and dieticians with advanced training and
experience in the implementation of these diets. We currently have one of the best diet programs in the
country. In addition to the ketogenic diet, MUSC has other options for patients including a modified
Atkins diet and a low-glycemic diet. Our team includes registered dieticians, nurse practitioners and
physician assistants who are thoroughly trained in the diets and can offer options to determine what
works best for a patient.
MUSC can offer you and your patients extensive expertise and comprehensive care in the medical,
surgical, social and psychological management of epilepsy. We look forward to working with you.
Additional Resources For more information, including background on our team, services and treatment options, visit
http://www.musckids.com/epilepsy
When to Refer
_ If seizures have not been brought under control after three months of care by a primary care
provider (family physician, pediatrician), further neurologic intervention by a neurologist is
appropriate.
_ If a patient’s seizures have not been brought under control by a neurologist after 12 months,
he or she should be referred to a specialized epilepsy center with an epileptologist.
Samir Karia, MBBS
Medical School: University of Rochester School of Medicine and Dentristy
Medical School: Dr. P.D. Medical College, Amravati, India
Residency: University of Rochester School of Medicine and Dentristy
Residency: Children’s Hospital of Michigan in Child Neurology
Fellowship: University of Rochester in Electroencephalography
Brooklyn Hospital Center in Pediatrics
University of Rochester in Movement Disorders
Fellowship: University of Michigan Hospitals and Health Centers
Board Certified:Neurology-Special Qualifications, Child Neurology
Special Interests: Pediatric epilepsy
Special Interests: General pediatric neurology, movement disorders, tremors
ablation, brachytherapy or a combination of treatments. These specialists collaborate with patients in
one location, ensuring coordination of care, increased convenience and the ability to identify those
patients who may benefit from being part of a clinical trial.
As an NCI-designated cancer center, we offer the most advanced research and clinical trials in the
war on cancer. MUSC Hollings Cancer Center is one of the nation’s leading cancer research centers
developing new cancer treatments and more effective approaches to cancer prevention and diagnosis.
It has long been a misconception that patients have to leave South Carolina to get world-class
treatment and access to NCI clinical trials. But MUSC’s expertise and cutting-edge research continue to
attract some of the world’s most talented physicians and researchers to South Carolina. So if you have a
patient who thinks he has to go to New York or Baltimore to get the best care, tell him that’s simply not
true. The MUSC Hollings Cancer Center has world-class faculty, expertise and technology. We’re here
and we’re available.
Additional Resources
Learn more about MUSC’s prostate cancer program at www.muschealth.com/prostate
Thomas E. Keane, MBBCh, FRCSI, FACS,
Chair, Department of Urology
MUSC Offers the Most Comprehensive Prostate Cancer
Care in South Carolina
MUSC Hollings Cancer Center Clinical Trials
1. CTO 101488, Sponsor: Millennium (C21004)
Prednisone With Placebo Plus Prednisone in Patients With Chemotherapy-Naive Metastatic
By Thomas E. Keane, MBBCh, FRCSI, FACS, Chair, Department of Urology
How many times has a patient with prostate issues asked about minimally invasive robotic surgery after
researching his options on the Internet and assumed “if I have a robot everything’s going to be wonderful?”
Robotic surgery is an excellent option for many patients, but where can physicians send patients with GI
problems, previous surgeries or transplants or who are simply too obese for robotic surgery?
The MUSC Department of Urology, in conjunction with the Hollings Cancer Center, has the
most comprehensive treatment program for prostate cancer in South Carolina, including every
available surgical option – the daVinci Surgical System, laparoscopic, perineal and open retropubic
prostatectomies. MUSC Hollings Cancer Center is the only NCI-designated cancer center in the state,
which allows patients access to the latest research and treatment breakthroughs.
Once a prostate cancer patient is referred to MUSC, a multidisciplinary team will evaluate his case
using state-of-the-art radiologic and cancer imaging – including a 128-slice CT scanner, 3 Tesla MRI
and PET Imaging – and discuss all available treatment options. A weekly genitourinary tumor board
of urologists, pathologists, radiologists, radiotherapists and medical oncologists makes decisions on
patient care through a team approach, which is essential for patients with locally advanced disease or
microscopically advanced disease. Together, MUSC cancer experts design a custom course of treatment
for each patient, whether it’s active surveillance, minimally invasive surgery, cryotherapy, radio-frequency
A Phase 3, Randomized, Double-Blind, Multicenter Trial Comparing Orteronel (TAK-700) plus
Castration-Resistant Prostate Cancer
2. CTO 101372, Sponsor: Bristol Myers Squibb (CA184043)
A Randomized, Double-Blind, Phase 3 Trial Comparing Ipilimumab vs. Placebo Following
Radiotherapy in Subjects with Castration Resistant Prostate Cancer that Have Received Prior
Treatment with Docetaxel
3. CTO 101217, Sponsor: RTOG (0534)
A Phase III Trial of Short Term Androgen Deprivation with Pelvic Lymph Node or Prostate Bed Only
Radiotherapy (SPPORT) in Prostate Cancer Patients with a Rising PSA after Radical Prostatectomy
Additional information on clinical trials is available at physicianportal.muschealth.com/clinicaltrials
Thomas E. Keane, MBBCh, FRCSI, FACS, Chair, Department of Urology
When to Refer
Symptoms of prostate cancer may include:
_ Weak or interrupted flow of urine,
urinating often (especially at night)
_ Difficulty urinating or holding back urine,
inability to urinate
_ Pain or burning when urinating
_ Blood in the urine or semen
_ Nagging pain in the back, hips or pelvis
_ Painful ejaculation
Medical School: University College Dublin
Residency: St. Vincent’s Hospital, Dublin
North Tees General Hospital, Cleveland, UK
Duke University Medical Center
Fellowship: Royal College of Surgeons, Ireland
Board Certified:
Urology
Special Interests: Urology, urologic cancers
The Medical University of South Carolina Welcomes
New Physicians to the MUSC Medical Center
Corey M. Hatfield, D.O.
Medical School: Pikeville College School of Osteopathic Medicine
Residency: Medical University of South Carolina
Special Interests: Rheumatology & Immunology
Jennifer J. Jaroscak, M.D.
Timothy P.M. Whelan, M.D., examines a
lung transplant patient.
MUSC Approved as a Lung Transplant Center
By Timothy P.M. Whelan, M.D., Medical Director, Lung Transplant Program, and William M.
Yarbrough, M.D., Surgical Director, Lung Transplant Program
The United Network for Organ Sharing (UNOS) has approved the Medical University of South
Carolina (MUSC) as a Lung Transplant Center. With this certification, MUSC has begun evaluating
patients with advanced lung disease who may be eligible for transplant.
As medical and surgical directors for the program, we were recruited to launch the MUSC Lung
Transplant Program from successful lung programs at the University of Minnesota and Stanford
University. Our team also includes cardiothoracic surgeons Chadrick E. Denlinger, M.D., and John S.
Ikonomidis, M.D., Ph.D., chief of cardiothoracic surgery. Additionally, MUSC’s Division of Pulmonary,
Critical Care, Allergy and Sleep Medicine is integrally involved in the care of patients with advanced
lung disease.
MUSC is committed to providing full services to your advanced lung disease patients. This includes
assessment by nationally recognized clinicians, cutting-edge clinical research trials, and transplantation
services. As part of our commitment, we will be sure to provide timely responses to your requests for
patient evaluation and fully communicate our findings about your patients with you.
South Carolina has a proven track record in successful organ donation and procurement. The citizens
of South Carolina have consistently donated more than 60 lungs per year over the last five years. Previously, these organs were sent out of state, but our program will ensure that those patients listed at
MUSC get first consideration for these lungs. This clearly is advantageous to patients who have reached
the end of medical therapies and need a lung transplant.
We look forward to working with you to provide the best possible care for your patients with advanced
lung disease. Please visit our website at http://www.muschealth.com/transplant/lung-transplant.
For consultation or referral, call MEDULINE at 1.800.922.5250 or 843.792.2200.
Medical School: Ohio State University College of Medicine
Residency: Children’s Hospital, Columbus, Ohio
Fellowship: University Hospitals of Cleveland
Duke University Medical Center
Special Interests: Pediatric Hematology/Oncology
George R. Simon, M.D., FACP, FCCP
Medical School: Christian Medical College, Punjab, India
Residency: Christian Medical College, Punjab, India
St. Joseph’s Hospital, University of Colorado
Fellowship: University of Colorado Health Services
Board Certification: Internal Medicine, Medical Oncology
Special Interests: Hematology/Oncology
William B. Wince, M.D.
Medical School:
Indiana University School of Medicine
Residency:
Emory University
Fellowship:
Vanderbilt University, Duke University
Board Certification: Cardiovascular Disease, Nuclear Medicine
Special Interests:
Cardiovascular MRI, Nuclear medicine
Nuclear Cardiology, Cardiovascular CT
Etta D. Pisano, M.D.
Vice President for Medical
Affairs and Dean, College
of Medicine
Executive Editor
Patrick J. Cawley, M.D.
Executive Medical Director,
Medical Center
Editor
Patrick McHugh
Managing Editor
mchughp@musc.edu
843.792.7877
Brennan Wesley
Art Director
Photographer
MEDICAL UNIVERSITY OF SOUTH CAROLINA
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CME conference schedule
The following conferences are sponsored by the Medical University of South Carolina. All conferences will be held in Charleston unless
otherwise noted. Visit cme.musc.edu for a complete list of CME conferences.
March 4 - 6, 2011 Updates in General Internal Medicine for Primary Care Doubletree Guest Suites Hotel March 5, 2011 6th Annual Chronic Kidney Disease Conference Charleston SC March 11 - 12, 2011 DHEC Winter Diabetes Symposium Myrtle Beach SC March 13 - 16, 2011 17th Charleston Symposium: Multi-modality Imaging Francis Marion Hotel March 25 - 26, 2011 10th Pediatric Neuroscience Update Kiawah Island Resort
March 28 - 30, 2011 42nd Annual Ob/Gyn Spring Symposium Francis Marion Hotel
April 29 - May 1, 2011 South Carolina Rheumatism Society Annual Meeting Renaissance Hotel
June 1 - 4, 2011 Cardiology for the Primary Physician: Evidence-based Management Doubletree Guest Suites Hotel
CLINICAL TRIALS
For a complete listing of MUSC clinical trials, visit physicianportal.muschealth.com/clinicaltrials
For information about clinical trials at MUSC Hollings Cancer Center, call MEDULINE at 1.800.922.5250
or 843.792.2200, e-mail novittm@musc.edu or visit www.hollingscancercenter.org