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Archive for 2008

December 2008-Bone marrow transplant program celebrates 25 years

Twenty-five years — 4,000 transplants.

 

UNMC and its hospital partner, The Nebraska Medical Center, are celebrating a significant milestone this year.

 

The bone marrow and stem cell transplant program at the medical center, known for its innovation and success in stem cell transplantation, is celebrating its 25-year anniversary.

 

The program was founded in 1983 by James Armitage, M.D., Shapiro Professor of Medicine at UNMC and hematologist/oncologist at The Nebraska Medical Center, who is world renowned for his clinical research in lymphoma and bone marrow and stem cell transplantation.

 

“Jim and his team always wanted the transplant program to be the best in the world and it has become the best,” UNMC Chancellor Harold M. Maurer, M.D., said Wednesday at a ceremony commemorating the program’s 25th anniversary. “(The program is made up of a) marvelous team of people that cannot be duplicated very easily anywhere else.”

 

Drawing patients from around the world, the program is ranked as one of the busiest adult lymphoma and pediatric programs in the country. The program averages 150 transplants a year and has performed more than 4,000 transplants since its founding.

 

There are many reasons why people come from around the world to receive care from the medical center’s transplant program.

 

Since its founding 25 years ago, physicians and researchers in the program have been pioneers in the field and have been recognized internationally for a number of ground-breaking advancements.

 

These advancements have helped improve success rates and have made bone marrow and stem cell transplants a more viable and promising option for a growing number of patients. This includes those with malignancies that include primarily lymphomas, leukemias, multiple myeloma as well as some blood disorders.

 

The first of these revolutionary achievements was the study and introduction of autogolous transplantation by Dr. Armitage and his colleagues, which served as the starting point and foundation for the program’s success.

 

“At the time, bone marrow transplants were still a very new thing,” Dr. Armitage said. “Allogeneic transplants, in which stem cells are harvested from a donor, were increasingly being done, but they were quite dangerous and risky. We wanted to find a way to help people who had otherwise incurable lymphoma. So we developed a hypothesis and began testing autogolous transplants as another option for these people.”

 

Autogolous transplants involve using the patient’s own stem cells, which reduces the complexity of the procedure and eliminates rejection issues such as graft versus host disease. This condition, which Dr. Armitage said occurs in more than half of all allogeneic transplants, happens when the new immune cells recognize that they are not in the right body and attack the other cells of the body.

 

Today, autogolous transplants are the preferred form of transplantation for more than 75 percent of lymphoma patients, he said.

 

Another milestone in the field of bone marrow and stem cell transplantation was the development of stem cell transplantation, which was introduced in 1984 by Anne Kessinger, M.D., professor of oncology/hematology at UNMC and a hematologist/oncologist at The Nebraska Medical Center.

 

The use of peripheral blood-derived stem cells, as opposed to bone marrow-derived stem cells, has become the standard of care for transplantation. This has helped improve outcomes for autogolous transplant patients, contributed to much quicker recovery times and decreased infection rates.

 

Peripheral blood-derived stem cell transplant is similar to bone marrow transplant except the cells are collected from those circulating in the blood rather than bone marrow. Bone marrow is the spongy tissue found inside the bones. It produces the body’s blood cells and cells of the immune system. The blood cells of the bone marrow, white blood cells, red blood cells, platelets and others, all come from one type of cell called the stem cell.

 

The process for removing stem cells is much easier, quicker and more comfortable for the patient, said Julie Vose, M.D., chief of hematology/oncology at UNMC. For instance, bone marrow removal required general anesthesia and was performed by using numerous needles to inject the patient until enough marrow had been withdrawn.

 

In comparison, stem cells are removed during a two- to three-hour procedure in which a catheter is placed into the chest and inserted into a large blood vessel. The blood is circulated through a special machine that separates out the stem cells from the rest of the blood. The stem cells are then frozen and stored until they are ready to be re-infused back into the patient.

“Research is critical. As leaders in research, we are able to offer our patients new and promising therapies before anyone else. You can either watch others do it or you can be the ones doing it, and we are definitely leaders in this area.”
– James Armitage, M.D.

 

Physicians and researchers at UNMC and The Nebraska Medical Center also have been extensively involved in the study and use of colony stimulating factors, also called growth factors. Growth factors are drugs that are used to stimulate the growth of cells before the collection of stem cells and are used during and after transplant.

“By being able to stimulate and increase the growth of stem cells after transplant, today we are seeing decreased infections, lower death rates, fewer transfusions and reduced recovery time in the hospital,” Dr. Vose said.

 

Other important treatment advancements that have had a significant impact in improving the outcomes for patients, Dr. Vose said, include improvements in supportive care techniques, anti-rejection medications and the ability to prevent and treat complications, especially infections.

 

“Twenty years ago, 30 to 40 percent of adult patients died from complications of an autogolous transplant,” she said. “Today, that number is down to 1 to 2 percent.”

 

In addition, adult transplant candidates used to be limited to those younger than 60 years of age. Today, transplants are performed on individuals as old as 75 years old. Survival rates average 50 to 60 percent, depending on the type of malignancy, compared to approximately 20 to 40 percent 10 years ago.

 

“Research is critical,” Dr. Armitage said. “As leaders in research, we are able to offer our patients new and promising therapies before anyone else. You can either watch others do it or you can be the ones doing it, and we are definitely leaders in this area.”

 

Pediatric transplants are another component of the bone marrow and stem cell transplant program. Started in 1987 by Peter Coccia, M.D., vice chairman of the department of pediatrics at UNMC and chief of pediatric hematology/oncology at The Nebraska Medical Center, the program has performed more than 335 transplants. Transplants in the pediatric population are normally reserved for patients with more aggressive disease and are far less common than adult transplants.

 

The majority of pediatric transplants are performed on patients with acute lymphoblastic leukemia. More than 80 percent of these patients will be cured with conventional chemotherapy, said Al Grovas, M.D., hematologist/oncologist at UNMC and The Nebraska Medical Center and clinical director for the pediatric bone marrow and stem cell transplant program, leaving about 20 percent of patients who will need a stem cell transplant.

 

“The knowledge curve has risen steadily since the first pediatric transplant in 1987,” Dr. Grovas said. “And with that, improved success rates have followed suit.

 

“The Nebraska Medical Center program is unique in that it shares the same transplant unit as the adult program. This provides us the advantage of sharing all of the same resources and the expertise of our experienced nursing staff and other health care professionals.”

 

-Dr. Armitage with Nancy Wurtele of Nebraska City, who was the second person to receive a transplant through the bone marrow and stem cell transplant program.

 

The program also is part of the National Institutes of Health/National Cancer Institute Bone Marrow Transplant Clinical Trials Network. This is a consortium of 16 transplant centers across the country that collaborate on clinical trials in order to derive data from a larger population of patients and to allow for greater sharing of information between centers.

 

Through this network, doctors can study and refine their techniques to diagnose, treat and follow patients to provide them with optimal care.

 

The medical center’s program is the only one of its kind in the region, said Theresa Franco, executive director of the cancer program.

 

“We have experienced physicians focused around specific diseases, an investigational mentality and pioneering treatments,” she said. “We have built this program on total commitment, total expertise and total engagement of our patients and families.”

 

Dr. Armitage said his ultimate hope is that the bone marrow and stem cell transplant program will some day go out of business.

 

“Because that would mean that we had learned enough about treating these cancers that patients would no longer need transplants,” he said.

 

And you can be sure that Dr. Armitage and researchers at UNMC and The Nebraska Medical Center will have played a major role in that scenario should it some day come to fruition.

The Nebraska Medical Center named one of America’s Best Hospitals

The Nebraska Medical Center has been named one of America’s best hospitals in U.S. News & World Report’s 2008 publication of America’s Best Hospitals. For the first time, the medical center is ranked for two services, Cancer and Neurology & Neurosurgery. The July 21st edition of US News hits news stands Monday, July 14, but is available online on July 11 at www.usnews.com/besthospitals
In the list of America’s Best Hospitals for cancer care, The Nebraska Medical Center ranked 39th. On the list of best hospitals for Neurology & Neurosurgery, the medical center is 41st.

 

“Our cancer and neurology rankings in U.S. News & World Report provide national recognition of specialized expertise, quality, technology and reputation from our peers around the country,” said Glenn Fosdick, president and CEO of The Nebraska Medical Center. “We’re proud of this accomplishment and our talented team at The Nebraska Medical Center, who provide the highest level of care to our community.”

 

“Our patients get the best of both worlds – the clinical expertise of our academic and private practice physicians and the work being done by the researchers at the University of Nebraska Medical Center,” said Fosdick.

 

Out of 5,453 hospitals across the country considered, only the top 170 medical centers were selected for the 2008 America’s Best Hospital’s report. The report focused on 16 areas of specialty from cancer to urology.

 

“The cancer ranking is a reflection of the comprehensive quality of our care and the most cutting edge cancer treatments available at our medical center,” said Theresa Franco, executive director of the Cancer Care service line at The Nebraska Medical Center. “We are the only National Cancer Institute designated cancer center in the five-state region from North Dakota down to Texas. It is a true team effort of all our clinical staff that combines oncology & hematology headed by Dr. Julie Vose, radiation oncology headed by Dr. Charles Enke, and surgical oncology directed by Dr. James Edney, coupled with the strength of the UNMC Eppley Cancer Center and its status as a leading national cancer center.”
“This cancer ranking confirms our commitment to cancer patients and we are humbled by the recognition,” added Franco. “However, this recognition does not mean we will stop striving to be better in the care delivered everyday. We take the journey to excellence very seriously.”

 

“The neurology & neurosurgery ranking is a reflection of the clinical expertise, state-of-the-art technology and research available at our medical center,” said Deb Istas, executive director of the Neurological Sciences service line at The Nebraska Medical Center.

 

“Our epilepsy center has been recognized by The National Association of Epilepsy Centers as a level four regional center for the treatment of epilepsy – the highest designation possible and our stroke program is the first program in the state to receive certification from The Joint Commission, a nationally and internationally recognized leader in health care quality evaluation. Our neurosurgeons provide state-of-the-art care to patients throughout Nebraska and the surrounding region offering highly specialized treatment of the spine and the spinal cord, brain tumors, cerebrovascular disease and disorders of peripheral nervous system.”

 

This neurology recognition is the result of a team effort that combines the expertise of both academic and private practice neurologists and neurosurgeons. Leading this team is Dr. Pierre Fayad, Chairman Department of Neurological Sciences, and Dr. Ken Follett, Chief of Neurosurgery along with their private practice partners.

 

The 16 ranked specialties ranked by U.S.News & World Report are cancer; gastroenterology; ear, nose, and throat; endocrinology; geriatric care; gynecology; heart and heart surgery; kidney disease; neurology and neurosurgery; ophthalmology; orthopedics; psychiatry; rehabilitation; respiratory disorders; rheumatology; and urology.

 

“The America’s Best Hospitals rankings provide readers with trusted material during some of life’s most concerning times – hospitalization,” said Brian Kelly, editor of U.S.News & World Report. “Our rankings highlight the internal culture of excellence embraced by caregivers in the great hospitals throughout the U.S.”
“Talent and money alone don’t put hospitals in the rankings,” agreed Best Hospitals editor Avery Comarow. “The truly best hospitals are never satisfied,” he said. “Of course they have high medical standards. But the emphasis is not only on doing well, but always doing better–squeezing another few percentage points out of the infection rate, improving the quality of life of elderly patients besides helping more of them survive.”

 

Methodology
The rankings in 12 of the 16 specialties weigh three elements equally: reputation, death rate, and a set of care-related factors such as nursing and patient services. In these 12 specialties, hospitals have to pass through several gates to be ranked and considered a Best Hospital:

  • The first gate determines whether a hospital is eligible to be ranked at all by requiring that any of three conditions be met–to be a teaching hospital, to be affiliated with a teaching hospital, or to have at least six important medical technologies from a defined list of 13.
  • The second gate determines whether a hospital is eligible to be ranked in a particular specialty. To be eligible, the hospital had to either have at least a specified volume in certain procedures and conditions over three years, or had to have been nominated in our yearly specialist survey.
    The third gate is whether a hospital does well enough to be ranked, based on its reputation, death rate, and factors like nurse staffing and technology.
    In the four other specialties–ophthalmology, psychiatry, rehabilitation, and rheumatology–ranking is based solely on reputation, derived from the three most recent physician surveys.

 

About The Nebraska Medical Center: With a reputation for excellence, innovation and extraordinary patient care, The Nebraska Medical Center has earned J.D. Power and Associates’ Hospital of Distinction award for inpatient services for three consecutive years. It is a US News & World Report 2008 “Best Hospital” for Cancer, Neurology and Neurosurgery. It also received the 2007 Consumer Choice Award, a mark of patient satisfaction as selected by healthcare consumers and has achieved Magnet recognition status for nursing excellence, Thomson 100 Top Hospitals Performance Improvement Leader recognition, as well as the Award of Progress from the state of Nebraska’s Edgerton Quality Awards Program. As the teaching hospital for the University of Nebraska Medical Center, this 624 licensed bed academic medical center has an international reputation for providing solid organ and bone marrow transplantation services and is well known nationally and regionally for its oncology, neurology and cardiology programs. The Nebraska Medical Center can be found online at www.nebraskamed.com

 

 

About the U.S. News Media Group: The U.S. News Media Group is a multi-platform digital publisher of news and analysis which includes U.S.News & World Report magazine, www.usnews.com and www.rankingsandreviews.com. Focusing on Health, Money & Business, Education and Public Service/Opinion, the U.S. News Media Group has earned a reputation as the leading provider of service news and information that improves the quality of life of its readers. The U.S. News Media Group’s signature franchises include its News You Can Use® brand of journalism and its “America’s Best” series of consumer guides that include rankings of colleges, graduate schools, hospitals, health plans and more.

July 2008-Story contributed by The Nebraska Medical Center

Story contributed by The Nebraska Medical Center
 
Complex and rare cancers comprise approximately 15 percent of new cancer cases each year, making it difficult for patients to locate or research facilities with oncologists or surgical teams that are experienced in treating these specific malignancies.
Blue Cross and Blue Shield of Nebraska has named UNMC’s hospital partner, The Nebraska Medical Center, as a Blue Distinction Center for Complex and Rare Cancers.

 

Only 88 other medical centers in the United States have earned the same distinction.

 

Blue Distinction Centers for Complex and Rare Cancers were developed in strategic collaboration with the National Comprehensive Cancer Network (NCCN) with input from a panel of leading clinicians and professional organizations.
The NCCN is an elite group of 21 cancer centers across the United States, of which The Nebraska Medical Center is the only one in the region.

 

Peter Coccia, M.D., a pediatric oncologist at UNMC and The Nebraska Medical Center and member of the board of directors of NCCN, said, “We are very pleased to receive the Blue Distinction designation. As a founding member of the NCCN and as a National Cancer Institute Designated Cancer Center, it re-enforces our reputation as a nationally recognized referral site for rare and complex cancers. This designation and our recent award of being named one of the top 50 cancer care hospitals in the U.S. truly set this medical center apart.”

 

“Blue Distinction reflects the commitment of the entire organization to provide extraordinary care,” said Glenn Fosdick, president and CEO of The Nebraska Medical Center. “We care for some of the most seriously ill patients in the region. Our clinicians have worked diligently to make this one of the elite centers in the United States for these rare and complex cancers.”

 

“We want to recognize and reward those network providers who are setting new standards of excellence in the quality of health care,” said Dr. Bill Minier, chief medical officer at Blue Cross and Blue Shield of Nebraska. “Cancer touches the lives of so many Nebraskans. We are thrilled at the level of outstanding specialty care available to our members right here in our state.”

 

Blue Distinction Centers for Complex and Rare Cancers are facilities within participating Blue Cross and Blue Shield network service areas that offer comprehensive inpatient cancer care programs for adults, delivered by multidisciplinary teams with subspecialty training and distinguished clinical expertise in treating the following complex and rare subtypes of cancer:

 

Bone cancer;
Brain cancer;
Esophageal cancer;
Gastric cancer;
Head and neck cancers;
Liver cancer;
Pancreatic cancer;
Rectal cancer;
Soft tissue sarcomas;
Thyroid cancer; and
Acute leukemia.
The Blue Distinction Centers for Complex and Rare Cancers designation is focused primarily on multidisciplinary treatment planning and complex, major surgical treatments.

 

Among other selection criteria, The Nebraska Medical Center met the following thresholds necessary to be named as a Blue Distinction Center for Complex and Rare Cancers:

Has multidisciplinary team input, including sub-specialty trained teams for complex and rare cancers and demonstrated depth of expertise across cancer disciplines in medicine, surgery, radiation oncology, pathology and radiology;
Demonstrates ongoing quality management and improvement programs for cancer care;

Demonstrates an ongoing commitment to using clinical data registries and providing access to appropriate clinical research for complex and rare cancers.
Demonstrates sufficient volume of experience in treating rare and complex cancers.
Blue Distinction is a designation awarded by Blue Cross and Blue Shield of Nebraska to medical facilities that have demonstrated expertise in delivering quality health care. The designation is based on rigorous, evidence-based selection criteria established in collaboration with leading clinicians, medical societies and professional organizations.

The Nebraska Medical Center recognizes that the majority of patients’ multidisciplinary treatment may be best accomplished by integrating the expertise available in a Blue Distinction Center with locally available treatment resources, especially for outpatient chemotherapy and radiotherapy, based on individual circumstances and patient preference. Optimal support of a patient’s comprehensive cancer care needs may be achieved by coordination of care between the patient and their family, local physicians, The Nebraska Medical Center and Blue Cross and Blue Shield of Nebraska.

Doctors to be donor, recipient in transplant

BY MICHAEL O’CONNOR
WORLD-HERALD STAFF WRITER

As a family physician, Dr. Joann Schaefer sometimes delivered bad news. Six weeks ago, she was the recipient.

 

Dr. Joann Schaefer will receive a transplant of half of Dr. Gary Gorby’s liver Monday at the Nebraska Medical Center. Schaefer, the State of Nebraska’s chief medical officer, was told she would need a liver transplant. Soon.

 

She has a life-threatening liver disease, her doctor says, and is scheduled to undergo a transplant Monday at the Nebraska Medical Center. Dr. Gary Gorby, a friend, is donating half of his liver.

 

Schaefer, who was appointed chief medical officer in 2005, said she hopes her case will raise awareness about organ donation. April is National Donate Life Month, which is aimed at encouraging people to become organ and tissue donors.

 

Nationally, more than 98,000 people await organ transplants. The count in Nebraska is 459 and in Iowa 472.

 

Schaefer was diagnosed with liver disease 12 years ago. At the time, doctors told her she would need a transplant eventually, probably within five to seven years.

 

The 40-year-old Schaefer, who is married to Phil Haines and has two daughters, said healthy eating and exercise helped her hold off on the transplant longer than doctors had anticipated.

 

Schaefer said she was in the best shape of her life when she was first diagnosed. She was training for a marathon, running up to seven miles a day and farther on weekends.

 

But a test for a life insurance policy indicated that her liver enzymes were high.

 

“I looked at the pattern and said, ‘Oh, my gosh,'” she said. “I knew there was a problem.”

 

More tests were needed to determine the severity of the problem. Before those tests were completed, Schaefer recalled that her grandmother had died from liver disease at age 52. She also knew it can be hereditary.

 

“A light went on,” she said.

 

Dr. Michael Sorrell, Schaefer’s liver specialist at the medical center, said a problem with her immune system likely caused the disease. The system has been attacking her liver, causing cirrhosis or scarring. Her condition was possibly inherited, he said.

Although alcohol abuse and infectious hepatitis can cause liver disease, that is not the case with Schaefer, Sorrell said.

 

The scarring led to internal bleeding. Some internal bleeding persists, though Schaefer’s most serious problems were fixed with surgery four years ago.

 

Other symptoms, including weight loss, extreme fatigue and constant nausea, have become worse over the past few months.

 

Schaefer, a former high school tennis player, struggles to walk up steps. Favorite foods like homemade burritos don’t sound appetizing anymore.

 

Testing in February showed she couldn’t wait much longer for a transplant.
With a successful transplant, Schaefer can lead a normal life, Sorrell said.
If she had to wait for a liver from a deceased donor, it would be at least two years before the transplant, he said. Schaefer, he said, was fortunate to find a live donor.
Nine family members and friends volunteered. Gorby, her friend, turned out to be a good match.

 

They’ve known each other for more than a decade and live in the same west Omaha neighborhood. Gorby, chief of infectious diseases at Creighton University School of Medicine, said he got to know Schaefer best through his work with the state on public health issues.

 

Gorby will miss four to eight weeks of work after doctors remove the right half of his liver. The remaining half will regenerate and grow back to full size, he said.

 

His doctors have told him that once he recovers, he will be able to lead a normal life and his liver should work fine.

 

Gorby said he considers it a privilege, not a sacrifice, to donate to Schaefer.
“You don’t get the opportunity to save the life of a friend very often,” he said.

February 2008 Special Report-UNMC researchers: Estrogen derivative may initiate certain cancers

by Vicky Cerino, UNMC public affairs
 
UNMC researchers are part of a team that studied simple urine samples and found that certain estrogen derivatives can react with DNA to cause damage that may initiate breast, prostate and other cancers.

 

These findings — which are published in the Dec. 20 issue of the International Journal of Cancer — could result in better assessment of cancer risk and prevention, the researchers said. The team published similar findings in the journal The Prostate in 2006.

 

“We have a novel approach to cancer. We know the initiating step,” said Ercole Cavalieri, D.Sc., a professor at the UNMC Eppley Cancer Center. “We think prevention of cancer can be solved by eliminating this initiating step.”

 

The team’s findings were confirmed in a second, larger study and presented at a recent gathering of international scientists and physicians in San Antonio.

 

The study involves researchers at UNMC, Mayo Clinic and the Italian National Cancer Institute. The majority of the study was funded by a U.S. Army Breast Cancer Research Program Center of Excellence Award.

 

Estrogens can initiate cancer when natural mechanisms of protection do not work properly in the body, allowing estrogen metabolites to react with DNA.

 

“If these protections are insufficient, due to genetic, lifestyle or environmental influences, we think cancer can result,” Dr. Cavalieri said. “Now that we have the basic knowledge about this unifying mechanism of cancer initiation, we have a greater sense of urgency to assess people at risk and, at the same time, begin studies of prevention by using specific natural compounds.”

 

The screening test developed by the researchers analyzes estrogen metabolite profiles in humans and can simultaneously associate the profile with one’s risk of getting breast cancer. It involves testing a one-ounce sample of urine using a sophisticated method called tandem mass spectrometry, which analyzes about 40 estrogen-related compounds, including estrogen-DNA adducts formed by a chemical reaction of estrogen metabolites and DNA.

 

“We know the initiating step. We think prevention of cancer can be solved by eliminating this initiating step.”
Ercole Cavalieri, D.Sc.

 
Researchers analyzed estrogen-DNA adducts from 46 women with normal risk for breast cancer, 12 women at high risk of developing breast cancer, and 17 women diagnosed with breast cancer.

 

They found women at high risk of breast cancer and the women with breast cancer had significantly higher levels of the estrogen-DNA adducts in their urine samples, while the women with normal risk for breast cancer had low levels of the DNA adducts in their urine.

 

Nilesh Gaikwad, Ph.D., a UNMC researcher who developed the methodology for the screening tool, said the simple, non-invasive test could easily be applied in the clinical setting.

 

“We have found the first step that starts a cell down the road to becoming a cancer cell,” said UNMC research collaborator Eleanor Rogan, Ph.D. “By preventing this first step from happening, we think we can stop the development of breast or prostate cancer. The combination of an early detection test for cancer risk with administration of preventing agents should enable us to significantly reduce the number of women and men that develop breast or prostate cancer.”

 

The results are exciting because they show women at high risk of breast cancer can be identified by the level of adducts in a urine sample, researchers said.

 

“Similarly, initial studies in men have shown that healthy men have relatively low levels of estrogen-DNA adducts in their urine samples, but men with prostate cancer have much higher levels of the estrogen-DNA adducts in their samples,” Dr. Cavalieri said.

 

Researchers can use these estrogen-DNA adducts as a measure of cancer risk, he said.

 

“In addition,” Dr. Cavalieri said, “we have begun to establish how effective natural compounds may be at preventing cancer by determining their ability to reduce the levels of these adducts in urine.”

 

Dr. Cavalieri also said accumulating evidence suggests that specific metabolites of estrogens, if abundantly formed, can become cancer-initiating agents by reacting with DNA and generating mutations leading to cancer.

 

DNA is composed of four bases called adenine, guanine, cytosine and thymine.

 

He said estrogen metabolites react predominantly with the first two DNA bases, adenine and guanine, to form estrogen-DNA adducts.

 

The resulting damage generated by the reaction can give rise to mutations that eventually initiate cancer. The important estrogen-DNA adducts spontaneously fall out of the DNA, leaving behind gaps that generate the cancer-initiating mutations.
The estrogen-DNA adducts eventually make their way out of cells and are excreted in urine.

 

“This finding identifies a new biomarker in the urine, which appears to correlate with a women’s risk of developing breast cancer,” said Kenneth Cowan, M.D., Ph.D., director of the UNMC Eppley Cancer Center. “While these studies need to be confirmed in a prospective study in a larger group of patients, this could become an important screening assay for women and could lead to new therapies to prevent breast cancer.”

 

Dr. Cavalieri said one of the major obstacles in cancer research is related to the concept that cancer is a problem of 200 diseases — a viewpoint that has impeded researchers from looking at the origin of cancers because the search would be prohibitively complex.

 

While the expression of various cancers coincides with the concept of 200 diseases, some scientists consider there to be a common origin for many prevalent types of cancer. There is widespread agreement in the scientific community that cancer is triggered by genetic mutations in critical genes, he said.

 

“The article is the best example of translational research. They have generated a unified concept of carcinogenesis and obtained a practical marker detectable in the urine of breast cancer patients,” said Jose Russo, M.D., senior member, at the Fox Chase Cancer Center in Philadelphia. “This article provides the adequate setting to explore this concept further by laying the basis to prepare a set of prospective clinical trials testing the preventive effects of the agents or mixtures of agents that can intercept the initiation event in breast or other cancers.”

 

The work represents a paradigm shift in detection of cancer risk in humans and provides the earliest possible rational marker for prevention strategies and regimens, said David Longfellow, Ph.D., president and chief executive officer of the Toxicology Forum — an international, nonprofit organization devoted to conducting open dialogues about problems in toxicology.

 

“This work conveys a very exciting message — that breast and prostate cancer risk can be identified years before the development of a tumor and suggests that natural preventive agents may be effectively used to prevent the initiation step in cancer,” Dr. Longfellow said. “Although this is a single manuscript, it is based on an extensive body of work in animal models and humans that consistently supports these findings and is complemented by collaboration with many international cancer scientists.”

February 2008-UNMC physicians on Best Doctors list

by Elizabeth Kumru and Ann Lawlor, UNMC Public Affairs

A total of 280 UNMC physicians, including 150 full and part-time faculty, have been recognized on this year’s list of the Best Doctors in America.

 

The Best Doctors in America 2007-2008 database contains the names and professional profiles of approximately 35,000 physicians in the United States in more than 40 specialties, or the top 3 percent to 5 percent of specialists in the country.

 

“Our UNMC faculty are truly outstanding clinicians. The Best Doctors recognition once again reaffirms that our patient care and teaching facility is world-class,” said UNMC Chancellor Harold M. Maurer, M.D.

 

UNMC College of Medicine Dean John Gollan, M.D., Ph.D., agreed.

 

“Quality patient care is a top priority,” he said. “As an academic health sciences center, our faculty stay abreast of the latest medical advances and are involved in discovering new therapies. Our patients receive exceptional care and our students train with, and learn from, the best.”

 

“Our UNMC faculty are truly outstanding clinicians. The Best Doctors recognition once again reaffirms that our patient care and teaching facility is world-class.”

UNMC Chancellor Harold M. Maurer, M.D.

 

The UNMC physicians practice at UNMC’s hospital partner, The Nebraska Medical Center.

 

Physicians are selected on the basis of the question: “If you or a loved one needed a doctor in your specialty, to whom would you refer them?” A peer-review survey by thousands of doctors determines the doctors included in the database. Only those doctors who earn the consensus support of their peers are included and only physicians in the Best Doctors database are allowed to receive the survey, nominate others and vote.

 

Two renowned physicians affiliated with Harvard Medical School founded Best Doctors in 1989. Today, it is among the leading resources for more than 10 million people in 30 countries who are seeking expert medical resources and guidance to treat illnesses and injuries of all kinds.

 

Among the UNMC physicians featured in the Best Doctors in America 2007-2008 database:

 

Full and part-time faculty

 

Hurlbert, Barbara – Anesthesiology
Tinker, John – Anesthesiology

 

Caudill, Christopher – Cardiovascular Disease
Easley, Arthur – Cardiovascular Disease
Niebauer, Mark – Cardiovascular Disease
Porter, Thomas – Cardiovascular Disease
Windle, John – Cardiovascular Disease

 

Hayes, Kristie – Dermatology

 

Muelleman, Robert – Emergency Medicine

 

DeSouza, Cyrus – Endocrinology & Metabolism
Goldner, Whitney – Endocrinology & Metabolism
Lane, James – Endocrinology & Metabolism
Larsen, Jennifer – Endocrinology & Metabolism
Mack-Shipman, Lynn – Endocrinology & Metabolism
Neumeister, Amy -Endocrinology & Metabolism

 

Fruehling, Richard – Family Medicine
Halm, Daniel – Family Medicine
Harrison, Jeffrey – Family Medicine
Mathews, Monty – Family Medicine
Mostek, Debra – Family Medicine
Nasir, Laeth – Family Medicine
Paulman, Paul – Family Medicine
Paulman, Audrey – Family Medicine
Sitorius, Michael – Family Medicine
Smith, John – Family Medicine
Wheatley, Douglas – Family Medicine

 

Gollan, John – Gastroenterology
Mailliard, Mark – Gastroenterology
McCashland, Timothy – Gastroenterology
Mukherjee, Sandeep – Gastroenterology
Schafer, Daniel – Gastroenterology
Sorrell, Michael – Gastroenterology
Zetterman, Rowen – Gastroenterology

 

Eberle, Catherine – Geriatric Medicine
Keller, Brenda – Geriatric Medicine
Lyons, William – Geriatric Medicine
Malloy, Timothy – Geriatric Medicine
Potter, Jane – Geriatric Medicine

 

Vandenberg, Edward – Geriatric Medicine/Family Medicine

 

Nystrom, Nils – Hand Surgery

 

Kalil, Andre – Infectious Disease
Preheim, Laurel – Infectious Disease
Rupp, Mark – Infectious Disease

 

Bessmer, Joel – Internal Med (general)
Neumeister, J. Scott – Internal Med (general)
O’Dell, David – Internal Med (general)
Shehan, Joseph – Internal Med (general)
Tape, Thomas – Internal Med (general)
Wigton, Robert – Internal Med (general)

 

Buehler, Bruce – Medical Genetics
Schaefer, G. Bradley, Medical Genetics

 

Armitage, James – Medical Oncology and Hematology
Bierman, Philip – Medical Oncology and Hematology
Cowan, Kenneth – Medical Oncology and Hematology
Haire, William – Medical Oncology and Hematology
Hauke, Ralph – Medical Oncology and Hematology
Kessinger, Margaret Anne – Medical Oncology and Hematology
Reed, Elizabeth – Medical Oncology and Hematology
Vose, Julie – Medical Oncology and Hematology

 

Follett, Kenneth – Neurological Surgery
Hellbusch, Leslie – Neurological Surgery
Lennarson, Peter – Neurological Surgery
Long, Douglas – Neurological Surgery

 

Fayad, Pierre – Neurology

 

Larsen, Paul – Neurology, Child

 

Berg, Teresa – OB/GYN
Martin, Thomas – OB/GYN
Smith, Carl – OB/GYN

 

Camras, Carl – Ophthalmology
Gigantelli, James – Ophthalmology

 

Esposito, Paul – Orthopaedic Surgery
Fehringer, Edward – Orthopaedic Surgery
Garvin, Kevin – Orthopaedic Surgery
Ginsburg, Glen -Orthopaedic Surgery
Hasley, Brian – Orthopaedic Surgery
Mormino, Matthew – Orthopaedic Surgery
Scherl, Susan – Orthopaedic Surgery

 

Leopold, Donald – Otolaryngology
Lydiatt, Daniel – Otolaryngology
Lydiatt, William – Otolaryngology

 

Bridge, Julia – Pathology
Chan, Wing C. (John) – Pathology
Cohen, Samuel – Pathology
Greiner, Timothy – Pathology
Hans, Christine – Pathology
Hinrichs, Steven – Pathology
Johansson, Sonny – Pathology
Lele, Subodh – Pathology
Markin, Rodney – Pathology
McComb, Rodney – Pathology
Pirruccello, Samuel – Pathology
Weisenburger, Dennis – Pathology
Wisecarver, James – Pathology

 

Antonson, Dean – Pediatric Specialist
Coccia, Peter – Pediatric Specialist
Colombo, John – Pediatric Specialist
Corley, Kevin – Pediatric Specialist
Danford, David – Pediatric Specialist
Erickson, Christopher – Pediatric Specialist
Gordon, Bruce – Pediatric Specialist
Gumbiner, Carl – Pediatric Specialist
Kugler, John – Pediatric Specialist
Rizzo, William – Pediatric Specialist
Romero, Jose – Pediatric Specialist
Sammut, Paul – Pediatric Specialist
Warkentin, Phyllis – Pediatric Specialist/Pathology

 

Finken, David – Pediatrics (general)
Lacroix, Amy – Pediatrics (general)
Lutz, Richard – Pediatrics (general)
Pitner, Sheryl – Pediatrics (general)
Seivert, Patricia – Pediatrics (general)
Snyder, Sheilah – Pediatrics (general)
Stoolman, Sharon – Pediatrics (general)
Walburn, John – Pediatrics (general)

 

Bandla, Hari – Pediatrics/Family Medicine

 

Johnson, Perry – Plastic Surgery

 

Boust, Susan – Psychiatry
Burke, William – Psychiatry
Fleisher, Mark – Psychiatry
Greiner, Carl – Psychiatry
Kratochvil, Christopher – Psychiatry
Roccaforte, William – Psychiatry
Stull, Todd – Psychiatry
Wengel, Steven – Psychiatry

 

Rennard, Stephen – Pulmonary & Critical Care Medicine
Romberger, Debra – Pulmonary & Critical Care Medicine
Sisson, Joseph – Pulmonary & Critical Care Medicine
Smith, Stephen – Pulmonary & Critical Care Medicine
Von Essen, Susanna – Pulmonary & Critical Care Medicine

 

Enke, Charles – Radiation Oncology
Zhen, Weining (Ken) – Radiation Oncology

 

Anderson, Joseph -Radiology
Apker, Kimberly – Radiology
Gurney, Jud – Radiology
Imray, Thomas – Radiology
Moore, Timothy – Radiology
Walker, Craig – Radiology

 

Klassen, Lynell – Rheumatology
Mikuls, Ted – Rheumatology
O’Dell, James – Rheumatology

 

Barkoukis, Teri – Sleep Medicine

 

Baxter, B. Timothy – Surgery
Langnas, Alan – Surgery
Lynch, Thomas – Surgery
Shaw, Jr., Byers – Surgery
Sudan, Debra – Surgery

 

Smith, Russell – Surgery/Otolaryngology

 

Edney, James – Surgical Oncology

 

Duncan, Kim – Thoracic Surgery
Lackner, Rudy – Thoracic Surgery
Quader, Mohammed – Thoracic Surgery

 

UNMC volunteer faculty

 

Hopp, Russell – Allergy and Immunology
Kettelhut, Brett – Allergy and Immunology
Nilsson, Thomas – Allergy and Immunology
Tracy, James – Allergy and Immunology

 

Hutton, Kent – Anesthesiology
Kugler, Jane – Anesthesiology

 

Gard, Joseph – Cardiovascular Disease

 

Spry, Leslie – Clinical Pharmacology, Nephrology

 

Blatchford, Garnet – Colon and Rectal Surgery
Pitsch, Jr., Richard – Colon and Rectal Surgery

 

Basler, Rodney – Dermatology
Braddock, Suzanne – Dermatology
Huerter, Christopher J. – Dermatology
Sutton, Margaret – Dermatology

 

Wahl, Timothy – Endocrinology & Metabolism

 

Fitzgibbons, William – Family Medicine
Haeberle, John – Family Medicine
Hoelting, David – Family Medicine
Knerl, Jeffrey – Family Medicine
McCoy, Michael – Family Medicine
Settje, Gary – Family Medicine
Zink, Dorothy – Family Medicine

 

Dyke, David – Gastroenterology
Schafer II, Edwin – Gastroenterology

 

Scholer, Susan – Geriatric Medicine

 

Michels, Dale – Geriatric Medicine, Family Medicine

 

Cochran, Robert – Hand Surgery

 

Bittner, Marvin – Infectious Disease
Gorby, Gary – Infectious Disease

 

Bailey, Steven – Internal Med (general)
Bohart, Andrew – Internal Med (general)
Cannella, John – Internal Med (general)
Hoesing, John – Internal Med (general)
Holmes, T.J. – Internal Med (general)
Hranac, Richard – Internal Med (general)
Olson, David – Internal Med (general)
Osterholm, Richard – Internal Med (general)
Policky, David – Internal Med (general)
Shiffermiller, William – Internal Med (general)
Stivrins, Timothy – Internal Med (general)

 

Schmidt, Michael – Medical Genetics/Pediatrics (general)

 

Block, Margaret – Medical Oncology and Hematology
Commers, James – Medical Oncology and Hematology
Copur, M. Sitki – Medical Oncology and Hematology
Hutchins, Mark – Medical Oncology and Hematology
Moravec, Jr., Daniel – Medical Oncology and Hematology
Silberstein, Peter – Medical Oncology and Hematology
Verdirame, Joseph- Medical Oncology and Hematology

 

Gelber, Benjamin – Neurological Surgery
Greene, George – Neurological Surgery
Pierson, Eric – Neurological Surgery

 

Bertoni, John – Neurology
Birkmann, Lewiston – Neurology
Bobenhouse, James – Neurology
Frankel, Harris – Neurology
Pattee, Gary – Neurology

 

Bassett, Craig – OB/GYN
Buckley, Krynn – OB/GYN
Gibbens, Donald – OB/GYN
Knolla, Michelle – OB/GYN
Legino, Lonny – OB/GYN
Schulte, Raymond – OB/GYN
Westcott, Susan – OB/GYN

 

Halsted, Michael – Ophthalmology
Sutton, Gregory – Ophthalmology
Troia, Robert – Ophthalmology
Troia, Sebastian – Ophthalmology
Whitted, Peter – Ophthalmology

 

Brown, David – Orthopaedic Surgery
Burt, Charles – Orthopaedic Surgery
Canedy, James – Orthopaedic Surgery
Fitzgibbons, Timothy – Orthopaedic Surgery
Goebel, Mark – Orthopaedic Surgery
Hutton, Kirk – Orthopaedic Surgery
McMullen, Scott – Orthopaedic Surgery

 

Emanuel, Jane – Otolaryngology
Goble, Richard – Otolaryngology
Goebel, Debora – Otolaryngology
Lusk, Rodney – Otolaryngology
Nabity, Thomas – Otolaryngology
Nissen, Alan – Otolaryngology
Quinlan, Trent – Otolaryngology

 

Mysore, Mohan – Pediatric Specialist
Reynolds, George – Pediatric Specialist
Vanderhoof, Jon – Pediatric Specialist

 

Wilson, Mark – Pediatric Specialist/Allergy & Immunology

 

Bleicher, Stacie – Pediatrics (general)
Brabec, Bradford – Pediatrics (general)
Brown, Larry – Pediatrics (general)
Domet , Mark – Pediatrics (general)
Ebers, Douglas – Pediatrics (general)
Gasseling, Philip – Pediatrics (general)
Germer, Michael – Pediatrics (general)
Harrison, Francis – Pediatrics (general)
Higgins, Karen – Pediatrics (general)
Kaufman, David – Pediatrics (general)
Kinberg, Jo Ann – Pediatrics (general)
Koch, Robert – Pediatrics (general)
Krenzer, Kari – Pediatrics (general)
Kronberg, Kent – Pediatrics (general)
Lerner , Gary – Pediatrics (general)
Mikuls, Mary Jane – Pediatrics (general)
Moore, John – Pediatrics (general)
Nelson, Paul – Pediatrics (general)
Nielsen, Laura – Pediatrics (general)
Severson, Gregory – Pediatrics (general)
Shaffer, Kenton – Pediatrics (general)
Stephenson, Betsy – Pediatrics (general)
Straley, Joseph – Pediatrics (general)
Swisher, William – Pediatrics (general)
Willman, Brent – Pediatrics (general)
Woodford, Robert – Pediatrics (general)

 

Edney, John – Plastic Surgery
Heieck, John – Plastic Surgery
Stice, R. Coleen – Plastic Surgery

 

Bhatia, Shashi – Psychiatry
Chu, Chung-Chou – Psychiatry
Malin, Paula Jo – Psychiatry
Marcil, William – Psychiatry
Wilson, Daniel – Psychiatry

 

Floreani, Anthony – Pulmonary & Critical Care Medicine

 

Nelson, Nick – Radiology

 

Palmer, William – Rheumatology

 

Cole, Timothy – Surgery
Kingston, Timothy – Surgery
Raynor, Stephen – Surgery
Voigt, David – Surgery
Waltke, Eugene – Surgery

 

Thorson, Alan – Surgical Oncology/Colon & Rectal Surgery

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