Archive for the ‘Articles’ Category

ORs Set Record for Cases Performed

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The week of Nov. 16, Perioperative Services set a record for the most cases performed in a day.

There’s never a dull moment in our operating room suites. Last month, Perioperative Services set not one, but two records in the same week. On Nov. 16, 94 cases were performed, beating the old record of 92. But it doesn’t stop there. Just three days later, the record was broken again as the perioperative team bettered the old mark as 100 cases were performed.

As you may recall from an article back in August, Perioperative Services performed 18,038 cases in FY2015, which broke the previous record of 16,182 in FY2014.

It takes a great deal of teamwork and comradery from the OR staff and surgeons. To accomplish these amazing feats, more than 400 colleagues from 11 different cost centers must work together, often resulting in long days that stretch into the evening.

Congratulations to all colleagues who made this feat a reality!

A New Lease on Life for the New Year

1-6-free-hip-and-knee-Brenda-BosticBrenda Bostic and Curtis Hartman, MD, right before Bostic’s procedure.

While many of us take for granted our daily mobility, millions of Americans are living with excruciating hip and knee pain that cripples them, their lifestyles and their ability to work or provide for themselves or their families. There are physical and psychological tolls. Most of all, they just want their lives back.

The solution is often hip and knee replacement surgery. But what happens to those individuals who desperately need new joints to minimize pain and regain mobility and can’t have access to them due to lack of insurance coverage, financial or other constraints?

Through Operation Walk USA 2015, two Nebraska Medicine patients received free joint replacements from orthopaedic surgeon, Curtis Hartman, MD. In mid-December, 59-year-old Brenda Bostic of Bellevue, Neb., and 63-year-old Randy Robins of Blair, Neb., underwent surgery at the med center. Bostic worked in receiving at Walmart most of her adult life, and was very aware of the arthritis and pain in her knee. For 20 years, she tried to minimize the discomfort with cortisone shots, frequent doctor visits and other procedures. But, in October, she thought her knee was going numb. She was rushed to the emergency department and was told she needed knee replacement surgery. When Bostic mentioned to the med center physicians that she didn’t have insurance, they recommended Operation Walk USA. She applied and was accepted.

“I was absolutely ecstatic,” says Bostic. “I want to be able to jump up and down and run along the field to support my grandchildren at their sporting events. Being a grandmother is the joy of my life.”

1-6-free-hip-and-knee-Randy_Robins_IMG_0905-690x460Randy Robins smiles with second year orthopaedic surgery resident Tyler Larson, MD, and orthopedic surgeon Curtis Hartman, MD.

Bostic, who is also legally blind, underwent a total left knee replacement on Dec. 15, under the care of Dr. Hartman. That same day, Dr. Hartman performed a left hip replacement on Robins, who enjoyed a long career at Union Pacific Railroad. Over the years, Robins has met life’s challenges head on. Twelve years ago, his youngest daughter was diagnosed with cancer. Five years ago, he came down with a rare form of cancer himself. Then, came Robins’ left hip. He’d been feeling discomfort for years, but after his recovery from cancer, the pain was excruciating.“I’m a pretty tough guy. Always have been,” says Robins. “But, the pain was so bad that I couldn’t walk.”

Given the physical nature of his work, Robins was forced to retire early. He had little insurance and was still paying off his cancer bills. His eldest daughter had read about Operation Walk USA and applied on his behalf without him knowing it.

“I’m very emotional about it,” says Robins. “I’ve been an unselfish man all my life and told my case worker that I don’t want to take an opportunity away from somebody else. I consider myself a fortunate man just to be here. I want to live again. I want to work again.”

Operation Walk USA provides all aspects of treatment – surgery, hospitalization, and pre-and post-operative care ─ at no cost to participating patients who may not qualify for government health coverage, have insurance or afford surgery on their own. Operation Walk USA takes place annually in early December to allow for greater hospital, surgeon and medical staff participation – and as a holiday gift to the patients it treats.

Team Performs First Lung Transplant

Stress-surgery-photo1-690x412Serious Medicine

Back in November, we announced that Nebraska Medicine has re-implemented its Lung Transplant Program after a 17-year hiatus.

Transplant team members recently performed the first lung transplant on a patient in need of this life-saving procedure. This marks the first time the procedure has been performed here since the relaunch of the program.

Our patient has requested privacy during recovery, so this is all we are able to share at this time. Learn more about our lung transplant program in this video.

Lung Transplant Program Begins at Nebraska Medicine

One of a Few Institutions Nationwide Offering All Solid Organ Transplants

Nebraska Medicine is home to one of the most reputable and well-known organ transplant programs in the country. In the decades since the first transplant in 1970, its nationally and internationally renowned specialists have performed thousands of heart, liver, kidney, pancreas and intestinal transplants. After years of planning and preparation, the organization is launching a comprehensive Lung Transplant Program. The addition makes Nebraska Medicine one of a few institutions nationwide to offer all solid organ transplants under one roof.

“We are thrilled to offer this lifesaving treatment,” says Heather Strah, MD, medical director of lung transplantation. “The addition of lung transplantation takes Nebraska Medicine’s already elite solid organ transplant program and elevates it to the highest level in the country.”

Nebraska Medicine first offered a lung transplant program in 1995, which remained in operation until 1998. The program now looks to once again shape the field of patient care, offering a multidisciplinary team of surgeons, physicians, respiratory therapists, psychologists, social workers, dietitians, nurses and others. Professionals will provide patients support from pre-evaluation to long-term follow-up care.

“A transplant program requires a large team of people pulling in the same direction,” says lung transplant surgical director Aleem Siddique, MD. “This program is the product of a great deal of hard work. It will allow us to provide world-class care to the people of Nebraska and surrounding states.”

Patients will no longer need to travel hundreds of miles for treatments of end-stage lung disease. Nebraska Medicine’s program will also assume the care of appropriate patients who received lung transplants at other institutions.

“Patients who have been transplanted far from Omaha often have a tremendous burden on them,” says Dr. Strah. “The time and financial resources required to receive follow-up care can be astonishing. With our new program, patients will have expert care close to home while ensuring superior care coordination with their transplant center. In addition, patients who were too ill to travel and receive a transplant may now be candidates locally.”

Nebraska Medicine’s Lung Transplant Program will offer single lung, double lung and heart-lung transplants. Although the transplant process is very unpredictable, clinicians hope to evaluate 20-30 patients and transplant 10 patients in the first year. Some diseases that may require a lung transplant include cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pulmonary hypertension and many other chronic lung diseases.

“Patients who survive their first year after transplant are typically expected to survive seven or eight years,” says Dr. Strah. “But, there are lots of patients I follow who were transplanted 10, 15, 20 years ago and are still enjoying relatively good health. That’s what we want for everyone. We want nothing more than to provide the best treatment possible for those who walk through our doors.”

Along with extraordinary patient care, the program will provide lung education, research and innovation. Clinicians will also work to promote the importance of organ donation.

“Nationally, it’s estimated that 18 people die every day while waiting for organ transplants,” says Dr. Siddique. “A single donor may save up to eight lives. For the donor or their family, it’s an opportunity for altruism that may be deeply rewarding.”

To register as an organ donor, visit www.donatelifenebraska.com. To learn more about the Lung Transplant Program at Nebraska Medicine, visit NebraskaMed.com/Transplant.

 

Experimental treatment regimen effective against HIV

University of Rochester public relations

Gend0421UNMC’s Howard Gendelman, M.D.

Protease inhibitors are a class of antiviral drugs that are commonly used to treat HIV, the virus that causes AIDS. Scientists at UNMC designed a new delivery system for these drugs that, when coupled with a drug developed at the University of Rochester School of Medicine and Dentistry, rid immune cells of HIV and kept the virus in check for long periods.

The results appear in the journal Nanomedicine: Nanotechnology, Biology and Medicine. While current HIV treatments involve pills that are taken daily, the new regimens’ long-lasting effects suggest that HIV treatment could be administered perhaps once or twice per year.

Howard Gendelman, M.D., professor and chair of the UNMC Department of Pharmacology and Experimental Neuroscience, designed the investigational drug delivery system, a so-called “nanoformulated” protease inhibitor.

The process

The nanoformulation process takes a drug and makes it into a crystal, like an ice cube does to water. Next, the crystal drug is placed into a fat and protein coat, similar to what is done in making a coated ice cream bar. The coating protects the drug from being degraded by the liver and removed by the kidney.

When tested together with URMC-099, a new drug discovered in the laboratory of UR scientist Harris (“Handy”) Gelbard, M.D., Ph.D., the nanoformulated protease inhibitor completely eliminated measurable quantities of HIV. URMC-099 boosted the concentration of the nanoformulated drug in immune cells and slowed the rate at which it was eliminated, thereby prolonging its therapeutic effect.

“The chemical marriage between URMC-099 and antiretroviral drug nanoformulations could increase drug longevity, improve patient compliance, and reduce general toxicities,” said Dr. Gendelman, lead study author, who has collaborated with Dr. Gelbard for 24 years. “We are excited about pursing this research for the treatment and eradication of HIV infections.”

The two therapies were tested together in laboratory experiments using human immune cells and in mice that were engineered to have a human immune system. Drs. Gendelman and Gelbard believe that the nanoformulation technology helps keep the protease inhibitor in white blood cells longer and that URMC-099 extends its lifespan even more.

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Harris Gelbard, M.D., Ph.D.

Dr. Gelbard, director of UR’s Center for Neural Development and Disease, developed URMC-099 to treat HIV-associated neurocognitive disorders or HAND, the memory loss and overall mental fog that affects half of all patients living with HIV.

He tested it with several protease inhibitors, including the nanoformulated version developed by Dr. Gendelman, as any patient prescribed URMC-099 would also be taking antiretroviral therapy. The goal was to determine whether the drugs could be safely administered together. Much to the surprise of Drs. Gelbard and Gendelman, URMC-099 increased the effectiveness of the nanoformulated drug.

“Our ultimate hope is that we’re able to create a therapy that could be given much less frequently than the daily therapy that is required today,” Dr. Gelbard said.

UNMC researcher: Top arthritis drug underused

by Tom O’Connor, UNMC public relations

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James O’Dell, M.D.

A UNMC rheumatologist revealed study results at a major national conference earlier this month which showed that physicians are underutilizing methotrexate, the leading drug for rheumatoid arthritis (RA), or not keeping patients on the drug long enough before switching them to more expensive biologic drug options.

James O’Dell, M.D., Bruce Professor of Internal Medicine and chief of the UNMC divisions of rheumatology and immunology, delivered the message at the annual meeting of the American College of Rheumatology and the Association of Rheumatology Health Professionals in San Francisco.

Study results

To better understand how methotrexate is utilized for RA treatment in the United States, Dr. O’Dell’s research team performed an exhaustive review of anonymous claims data on 274 million patients, representing 92 percent of all prescription drugs written in the U.S. The claims data was produced by Symphony Health Solutions.

From this data, researchers were able to follow the treatment course of 35,640 RA patients between 2009 and 2014. The key findings were:

  • 15,599 (43.8 percent) continued treatment with oral methotrexate.
  • 17,528 (49.2 percent) added or switched to a biologic treatment.
  • A biologic was added at a median of 170 days and 41.5 percent of patients added a biologic agent within 90 days of the initiation of oral methotrexate.
  • Only about 7 percent of patients followed were switched from oral to subcutaneous administration of methotrexate.

“There are some major concerns here,” Dr. O’Dell said. “It shows that we’re not doing all we should with methotrexate, our No. 1 therapy for rheumatoid arthritis.”
Methotrexate is the anchor drug for a class of drugs known as disease-modifying anti-rheumatic drugs (DMARDs). The DMARDS are much less expensive than the other class of drugs used to treat RA called biologics. Previous studies have shown that the DMARDs produce the same clinical benefits in the majority of RA patients as the biological treatment.

If oral methotrexate is not producing the desired results, Dr. O’Dell said the next step should be to try patients on subcutaneous methotrexate at a higher dose.

“What we found in patients who made a treatment change was that 87 percent added a biologic instead of trying subcutaneous methotrexate,” he said. “Patients switched to biologics too quickly – 41 percent switched in three months or less.”

Dr. O’Dell said switching to subcutaneous methotrexate can prevent the need for – or significantly extend the time to – a biologic.

The study found that 72 percent of patients who switched from oral to subcutaneous methotrexate stayed on this treatment for 5 years. The other 28 percent eventually needed a biologic, at a median of 289 days on subcutaneous methotrexate.

“The bottom line,” Dr. O’Dell said, “is that more appropriate optimization of methotrexate could lead to better control of RA and produce significant cost savings. Oral methotrexate is underdosed in clinical practice, and subcutaneous methotrexate is underutilized.”

Dr. O’Dell hopes to submit his research findings to a leading scientific journal in the near future.

From refugee to M.D.: Dr. Nguyen and his family come to America

Posted by Kalani Simpson
immigrant-stories-013z-1024x707During UNMC International Week, Dr. Nguyen told the story of his family’s immigration to the U.S.
Dr. Quan Dong Nguyen’s first step toward becoming an American began when his father went in to report to the new communist government and disappeared for the next 42 months.

During the early 1970s, despite the Vietnam War, Dr. Nguyen’s family lived a relatively normal life in South Vietnam. But after the fall of Saigon on April 30, 1975, when Dr. Nguyen was 8 years old, things changed. The North Vietnamese communist army invited those who were working with the government of the Republic of South Vietnam, like Dr. Nguyen’s father, a physician, and his uncle, who was a provincial chief of police, to come and “meet the new government to learn about the new policies.”

They didn’t see his father again for three and a half years.

When the family finally reunited, they decided they needed to escape. They were among the millions who fled Vietnam during the decade following the fall of South Vietnam.

Dr. Nguyen, professor and McGaw Memorial Endowed Chair in Ophthalmology, and inaugural director of the Stanley M. Truhlsen Eye Institute, told his story as part of UNMC’s International Week.

To make their escape, the Nguyen family – Dr. Nguyen, his parents and his three brothers – piled into a fishing boat, filled mostly with the elder Dr. Nguyen’s patients, many of whom were Chinese. The Nguyens attempted to pass themselves off as Chinese, too.

They picked the stormiest time of year to make the journey. A time when even the murderous pirates they were hoping to avoid would rather stay on dry land. Only about two of every 10 boats making these types of escapes made it, Dr. Nguyen said.

“The ocean,” he said, “usually wins.”

He was seasick, and afraid. That first night, two of the boat’s four engines broke down. The next night, another engine, gone. They were all but drifting on the open sea.

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Dr. Nguyen’s father, Dong So Nguyen, at Pulau Bidong, a refugee camp in Malaysia, in 1979. The elder Dr. Nguyen was president of the camp, his son said. He later resumed his medical practice in Virginia.
People died on that boat. Dr. Nguyen was just a kid: “You just have to let it go in your mind,” he said. The bodies were released into the ocean so that the journey could continue.

At last, they saw land – an island in Malaysia. He can still remember the relief.

It was an uninhabited island. They didn’t know what would happen next. All they knew was, where they were now was better than where they had just been.

After three days, Malaysian police found them. They went to another Malaysian island, Pulau Bidong, which has been set up as a refugee camp, to live among thousands and thousands of fellow Vietnamese refugees. “The life was rough,” Dr. Nguyen said. “But for the first time, people felt like they had freedom again.”

At the refugee camp, emissaries from other countries came to see if they could take in some of the refugees. Germany, Dr. Nguyen said, would take engineers. Australia wanted farmers. Denmark welcomed orphans and kids who had left family behind.

Dr. Nguyen’s parents spoke French. Their educations were French. France would surely take them.

But, no. They wanted to go to the place which would be least likely, in all the world, to turn Communist.

“We didn’t want to escape a second time,” Dr. Nguyen said.

They applied to come to America.

When young Dr. Nguyen settled in the U.S., in northern Virginia, in 1980, he was going into the eighth grade. Though his father was a physician and his mother was an attorney, they were starting over, from scratch, with nothing. They were on food stamps and welfare for the first year, and that was difficult – but they were grateful for the kindness that they received.

“You always remember,” he said, “the first (secondhand) table that people gave to you.”

At school … how to put this politely? “Young teenagers are very nice,” Dr. Nguyen said, “but they also can be quite unfriendly.”

Looking back, the adult Dr. Nguyen forgives those kids. They were just young children, and their new classmate may as well have been from outer space.

But at the time, he thought to himself: how could he be on even ground with them? How could he be the kid in class who wasn’t behind everyone else? In learning a foreign language! And in that, he excelled.

(To this day, if he lectures in South America, for example, he’ll do some of it in Spanish as a sign of cultural respect.)

He went to Phillips Exeter Academy, Yale, Penn, Harvard and Johns Hopkins. He became a doctor.

Now he lives in Omaha, Neb.

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Nguyen and Do in front of the Truhlsen Eye Institute at UNMC.
He married another Vietnamese American, Dr. Diana Do, the daughter of his father’s medical school classmate. Dr. Do is also a professor of ophthalmology and visual sciences at the Truhlsen Eye Institute. Their three children are Vietnamese Americans. Dr. Nguyen and Dr. Do are teaching their children both Vietnamese and American cultures.

He will tell anyone who will listen that despite “many different things in this country that, yes, can make one feel angry,” we should also know this is the greatest country on earth, with many generous, philanthropic citizens and numerous opportunities.

So, after all of these years, does he consider himself truly, fully American?

Well, maybe not quite 100 percent: “I still do not understand all of the jokes yet,” he said (showing that of course he does).

But as a member of the audience said emphatically, “No, Dr. Nguyen, you are an American.”

Most of us are Americans through sheer luck, an accident of birth.

Dr. Nguyen earned his (red and white) stripes the hard way.

Langnas family also shared stories

Frieda Langnas, mother of Alan Langnas, D.O., professor and chief of transplantation, and Dr. Langnas’ sister, Susan Feber, also spoke via teleconference at the presentation. They told the story of how Frieda and her husband separately, as children, emigrated to the U.S. as their families were refugees who escaped the Nazis before and during World War II.

You Can Take Steps to Stop Congestive Heart Failure

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Hareeprasd Vongooru

Most of us are guilty of it. We’re not feeling well, but we can’t put our finger on it, so we put off going to the doctor. But when it comes to congestive heart failure, seeking treatment early on can have a big impact. Early and appropriate treatment may be able to stop the progression of congestive heart failure and improve your quality and length of life.

The key to managing congestive heart failure is intervening before you have reached progressive stages and require advanced therapies. Too often, we are finding patients are not receiving optimal medical therapy for heart failure beyond diuretics. Today, we have advanced diagnostic equipment that allows us to more effectively diagnose and monitor you so we can treat the underlying problem or administer advanced medications that allow us to manage your condition more effectively to prevent the need for a heart transplant or  left ventricular assist device (LVAD).

Dr. Vongooru is one of four board certified heart failure specialists at Nebraska Medicine. Brian Lowes, MD, Eugenia Raichlin, MD, and Ronal Zolty, MD, PhD, are the other heart failure certified specialists at Nebraska Medicine.

When should you see a heart failure specialist?

Dr. Vongooru recommends that you be referred to a heart failure specialist when you meet one or more of the following criteria:
•You have been classified with Class 3 or 4 heart failure and have limited exertional capacity.
•You have required two or more hospitalizations for your condition in the last six months.
•You require high doses of diuretics or have difficulty tolerating optimization of heart failure targeted medical therapy.
•You are have low blood pressure.
•You are having liver or kidney complications.

One of the largest areas of growth for the heart failure program has been the use of the LVAD. Traditionally, heart transplantation has been the gold standard of care for treating severe, end-stage heart failure. However, when transplantation is not a viable option due to advanced age, other concurrent medical conditions, or the increasing shortage of hearts suitable for transplantation, the LVAD has become a long-term option for many people with end-stage heart failure.

In a small, but growing number of people, use of the LVAD device has allowed them to recover from end-stage heart failure and forgo the need for a heart transplant.

The bottom line, no person is too sick or too healthy to be seen by our advanced heart failure cardiology team. There is a growing number of therapies available to help you no matter what stage of congestive heart failure you are in. We may be able to either slow the progression of the disease by optimizing the your medications or provide other interventions to extend your life.

Nebraska Medicine has the largest heart failure program in the state and the only United Network for Organ Sharing (UNOS) certified heart transplant center. Nebraska Medicine has also received certification for advanced heart failure and LVAD and is one of the top 10 programs in the country. The program performed 38 heart transplants in 2014 and 61 LVADs.

 

The Truth About Lung Cancer

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Alissa Marr, MD

There are many myths surrounding lung cancer, one of the deadliest of all cancers. While the death rate still remains very high for lung cancer, we are making tremendous strides in diagnosing and understanding the underlying genetic changes in the different types of lung cancer that are helping us provide new therapies that we hope will ultimately improve survival rates. Oncologist and lung cancer specialist Alissa Marr, MD, sheds some light on lung cancer.

Lung cancer is the number one cause of cancer-related deaths in both men and women.

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Each year in the United States, more people die from lung cancer than from colon, breast and prostate cancers combined. Of the approximately 228,000 cases that are diagnosed each year, almost 70 percent result in death.

You will know when you have lung cancer.
False

A lack of symptoms often allows lung cancer to go undetected until it reaches advanced stages. Symptoms such as chronic cough, coughing up blood, shortness of breath, chest pain and unexplained weight loss -may be some of the symptoms that result from lung cancer.

Anyone can get lung cancer.
True
While smokers have a 10 to 30-fold increased risk of developing lung cancer, 15 percent or more of cases occur in people who have never smoked. Approximately 23,000 deaths occur annually among non-smokers in the U.S. Smoking cigars and pipes and exposure to second-hand smoke also increase one’s risk. Other non-smoking causes include radon and possibly exposure to diesel fumes, lead, arsenic, grain dust, farming chemicals or home cleaning products.

You may have radon in your home and not know it.
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Radon is a colorless, odorless gas that’s a decay product found in soil and rocks and can get trapped in houses and buildings. It is estimated that one in 15 homes in the U.S. will have high radon levels. In Nebraska, that number is even higher. Approximately one out of every two radon tests conducted in the state have elevated levels of radon. You can get your house tested for radon with an in-home kit or by a certified service provider.  Winter is a good time to do testing as you get the best results when a closed home is maintained for 12 hours prior to and during the test.

Once you have been a smoker, you cannot reduce your risk for lung cancer.
False
It is never too late to quit. Smokers can gain an estimated six to 10 years of life by quitting smoking and will see a reduction in cancer risk within five years of kicking the habit and an estimated 80 to 90 percent risk reduction in 15 years.

There is no way to screen for lung cancer.
False
A low-dose CAT scan is offered at Nebraska Medicine. Screening CT scans can hopefully detect lung cancer at an early stage, when cure rates are much higher. The screening test is recommended for high-risk groups that includes individuals who are at least 55 years old; have a 30-pack history (equivalent to smoking one pack each day for 30 years or three packs each day for 10 years) and are either currently smoking or have quit within the past 15 years. Please discuss with your primary medical provider if you think you may qualify for this screening test.

Clinical trials may be the best treatment option.
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Clinical trials are carefully monitored research studies that may give you access to potentially life-saving treatment. Nebraska Medicine participates in many clinical trials for lung cancer. Talk with your doctor about whether a clinical trial is the right treatment decision for you.

To learn more or to schedule an appointment with a physician, call (800) 922-0000.

Stroke Center Receives Fifth Consecutive Recertification

For the fifth consecutive time, Nebraska Medicine’s Stroke Center has been recertified by the Joint Commission as a Primary Stroke Center. The program has been certified by the Joint Commission since 2005 and was the first nationally certified stroke center in the state.

“This certification signifies that the services we provide have the critical elements to achieve long-term success in improving outcomes,” says Matt Pospisil, executive director of Neurology and Orthopaedic Services. “Nebraska Medicine’s Stroke Center has more neurovascular provider expertise than any other health system in the region including two vascular neurologists, a neuro hospitalist, stroke APRN, a neuro intensivist and is the only facility in the area with two fellowship-trained endovascular specialists.”

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