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Archive for September, 2018

Orthopaedics study will impact artificial knee design

Hani Haider, Ph.D.

A study by a team of researchers in the UNMC Department of Orthopaedic Surgery has challenged a doctrine surrounding knee replacement design.With science and medicine helping people live longer, people now often outlast the life of their joint cartilage.

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Dr. Haider receives the Adult Reconstructive Knee Poster Prize at the American Academy of Orthopaedic Surgeons Annual Meeting in March.

“Technologists and surgeons have designed artificial knees which can alleviate pain and permit almost normal motion for daily living activities. In fact, good knee replacement designs can now last the lifetime of a patient,” said Hani Haider, Ph.D., professor and principal investigator of the study.

“In the evolution of knee replacements since the 1970s, designers focused on stress reduction in the bearings to reduce wear, which should be avoided for many reasons,” Dr. Haider said. “They did so by increasing contact area of the bearings to spread the load, which was vital for the older generation of bearing materials and early designs of the artificial joint.”

The team’s study — “For Lower Wear of Total Knee Replacements, Is Higher or Lower Contact Area Better?” — was awarded the best poster prize in the category of Adult Reconstructive Knee at the recent American Academy of Orthopaedic Surgeons Annual Meeting in New Orleans March 6-10. Ten first-place posters were awarded from 7,000 entries.

Using test data from UNMC’s Biomechanics and Advanced Surgical Technologies Laboratory, Dr. Haider and colleagues found that increasing contact area to reduce stress with contemporary joint materials is like a law of diminishing returns. When taken too far, larger total knee replacement sizes and contact area can actually increase wear with modern designs and materials. This was confirmed by eight separate studies in Nebraska contracted with UNMC by multiple companies from the orthopaedic industry.

“Working closely with multiple companies from industries worldwide makes our results meaningful, relevant and makes them translate to tangible benefits,” Dr. Haider said. “In this case, our results were described to shine a new beacon for artificial knee designers everywhere.”

Bone and joint health problems are the leading cause of disability in the U.S., accounting for more than half of all chronic conditions in people over the age of 50, according to the American Academy of Orthopaedic Surgeons. The organization projects that the demand for knee replacements will increase by 674 percent between the years 2012-2030.

“This is yet another tremendous achievement by our faculty, and we wish to thank all who have supported this research resulting in further international recognition,” said Kevin Garvin, M.D, professor and chair of the Department of Orthopaedic Surgery and Rehabilitation.

Robotic Thyroid Surgery Now Offered at Nebraska Medicine

 

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After being diagnosed with thyroid cancer, 24-year-old Katie O’Callaghan of Hastings, Nebraska, underwent a robotic thyroidectomy at Nebraska Medicine. The incision was made behind her earlobe. 

Katie O’Callaghan was working the checkout line at her parents’ grocery store in Hastings, Nebraska, when a customer noticed a lump on O’Callaghan’s neck. The 24 year old, who was four months pregnant with her first child, brought it up at her next OBGYN appointment. A biopsy later revealed she had thyroid cancer.

“I couldn’t believe it,” says O’Callaghan. “Being pregnant with my first child was intimidating enough, let alone discovering I had cancer.”

Wanting a second opinion, O’Callaghan was referred to Estelle Chang, MD, a former Otolaryngology Head and Neck surgeon at Nebraska Medicine, who completed a six-month Advanced Robotic Head and Neck Endocrine Surgery Fellowship at Severance Hospital of the Yonsei University Health System in Seoul, South Korea. During her fellowship, Dr. Chang studied the latest, minimally invasive, thyroid and parathyroid surgery techniques.

“Traditionally, thyroidectomy has been performed using a 4 to 8 cm incision in the front of the neck, which can leave a visible scar,” explains Dr. Chang. “Robotic thyroidectomy is a minimally invasive surgical technique that is used to remove all or part of a thyroid gland without leaving a visible scar. This is the future and we should be at the forefront.”

At Nebraska Medicine, three robotic thyroidectomy approaches are offered for patients:

  • Underarm

  • Facelift (behind the earlobe)

    • If the patient wants a complete facelift at the end of the procedure, that’s a possibility

  • Through the mouth

“We can tailor to the patient, depending on the size of the tumor and the patient’s physical characteristics,” explains Dr. Chang. “This type of surgery is a great option for Caucasians who tan easily, African Americans and Asians. They all tend to have a difficult time with scarring.”

 

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Estelle Chang, MD

Not wanting a scar on her neck, O’Callaghan opted for Dr. Chang to perform the facelift approach. For the safety of the baby, surgery was put on hold until after O’Callaghan gave birth to her son. On May 22, O’Callaghan became the first patient to undergo a robotic thyroidectomy at Nebraska Medicine. Dr. Chang made the incision behind O’Callaghan’s earlobe and surgery took approximately three hours. O’Callaghan was kept overnight for observation and released the next day.

“I knew I was in good hands at Nebraska Medicine,” says O’Callaghan. “Currently, I have no cancer in my body and I feel great. By looking at me, you’d never know I had thyroid surgery. I’m really happy with the outcome.”

Thyroid nodules are very common and occur in approximately 30 percent of all people in the United States. By the age of 60, more than half of women will have a thyroid nodule. The vast majority of the nodules are benign, with about 5-10 percent being cancerous. Symptoms of thyroid cancer can involve swollen lymph nodes in the neck, difficulty swallowing or breathing – but most patients don’t experience any symptoms.

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Abbey Fingeret, MD

“While thyroid cancer can be seen in people of any background, age or gender, most cases occur in women, people less than 55 years old, and those with Caucasian or Asian backgrounds,” says Nebraska Medicine surgical oncologist Abbey Fingeret, MD. “Fortunately, in most cases, it can be completely cured with surgery.”

Dr. Fingeret is currently the only Endocrine Surgery Fellowship trained surgeon in the state of Nebraska. She completed her fellowship at Harvard University and Massachusetts General Hospital, performing more than 500 thyroid operations. Dr. Fingeret also finished a three-month Advanced Robotic Endocrine Surgery Fellowship in South Korea. This summer, she looks to perform her first robotic thyroidectomy at Nebraska Medicine.

 

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Not wanting a scar on her neck, O’Callaghan opted for the facelift approach. “By looking at me, you’d never know I had thyroid surgery. I’m really happy with the outcome.”

“I truly believe in the mission of Nebraska Medicine,” says Dr. Fingeret. “We are here to offer state-of-the-art care, where the patient always comes first. It’s my honor and privilege to be part of this exceptional team of ancillary staff, clinicians and researchers.”

“Nebraska Medicine treats all aspects of thyroid ailments and endocrine-related disorders,” adds Harris Frankel, MD, chief medical officer at Nebraska Medicine. “We have a large and experienced multidisciplinary team, which includes physicians from ENT, Endocrinology, General Surgery and Cancer Services. When you walk in the door, you can be seen by an endocrinologist and thyroid surgeon on the same day.”

Nebraska Medicine is one of a few academic medical centers in the country offering robotic thyroidectomies. Patients with multiple medical problems who shouldn’t be under anesthesia for extended periods of time are not ideal candidates. Robotic surgery can also be used to remove other benign masses of the neck, such as lipomas and thyroglossal duct cysts.

To schedule an appointment with a specialist at Nebraska Medicine, call +1-402-559-3090 or OIHS@nebraskamed.com.

Unique Treatment Crafted for Multiple Myeloma Patient

Muhamed Baljevic, MD, is seen with patient Vincenzo Neri. Dr. Baljevic and his team were able to respect his religious beliefs and perform a bloodless stem cell transplant.

For the first time at Nebraska Medicine, a bloodless stem cell transplant has been performed on a Jehovah’s Witness.

“I’m surprised, excited, relieved and thankful they respected my beliefs and I congratulate them for helping me through this difficult time.”

Vincenzo Neri was diagnosed with ultra-high risk multiple myeloma and needed an autologous stem cell transplant to survive. Autologous transplantation is a process where the patient’s own stem cells are collected and reinfused. During the transplant process, most patients depend on red blood cells and platelets to protect themselves against infection, bleeding and organ failure. Jehovah’s Witnesses don’t believe in accepting any blood products, so Neri’s case was more difficult in many ways.

“He can’t get any of the red blood cells or platelets – normally, every patient depends on these products during the transplant process because red blood cells can go very low and platelets can go very low,” says Muhamed Baljevic, MD, multiple myeloma specialist. “However, we cannot depend on these blood products in this patient’s case because he’s a Jehovah’s Witness and his religious beliefs don’t allow him to accept any blood products.”

Through sign language interpreters, Dr. Baljevic explained in detail how Neri’s transplantation would work.

“We modified almost every single step in the transplantation process for him and his needs,” says Dr. Baljevic. “We had these plans in place where we used particular medicines, to try to prevent him from bleeding, where we stimulated his own bone marrow with stimulating medicine and building blocks for red blood cells as much as we could – such that we avoided all together the need for any blood products.”

Neri’s recovery went extremely well and he was discharged one week earlier than expected. Only a few health systems across the country perform stem cell transplants on Jehovah’s Witnesses. Nebraska Medicine is now one of them.

“In looking back when I was first diagnosed with cancer, I went down quickly, but now I feel freedom – the sick body is gone – I feel healthy again, active to do anything – makes me feel built up and excited,” says Neri. “Everyone here respected my religion and I’m impressed that everyone was respectful of my faith.”

“We hope other patients, who share same believes, other Jehovah’s Witnesses, or patients who cannot get blood products, know that we are very committed to provide top quality care, multidisciplinary care and care that can meet the biggest challenges of modern medicine – and this is certainly one of them,” says Dr. Baljevic.

Watch more of this amazing story in this video below.

 

To schedule an appointment with a specialist at Nebraska Medicine, call +1-402-559-3090 or OIHS@nebraskamed.com.

WATCHMAN Device Offers Breakthrough Treatment for Atrial Fibrillation Patients

After suffering five strokes in a matter of months, Tom Keeling and his wife Sandy began to wonder if life would ever be normal again.

The 65-year-old Keeling suffered from a type of irregular heartbeat called atrial fibrillation. Atrial fibrillation can lead to the formation of dangerous clots that increase your risk for stroke. Keeling’s condition was doubly serious because doctors were also having difficulty regulating his blood thinners, which are critical to helping reduce clot formation.

Keeling recently became one of the first handful of people at Nebraska Medical Center to receive an implant device called the WATCHMAN™, an alternative to long-term blood thinners for people with atrial fibrillation. Since having the device implanted several months ago, Keeling’s strokes have come to a screeching halt.

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Tom Keeling and his wife, Sandy, celebrate after a successful surgery reduced Tom’s stroke risk.

The Nebraska Medical Center is the first hospital in Omaha to offer patients the WATCHMAN implant. The device reduces the risk of stroke by closing off an area of the heart called the left atrial appendage. This helps keeps harmful blood clots from forming here, entering the bloodstream and potentially causing a stroke. Over time, patients should also be able to stop taking blood thinners.

“This new device provides doctors with a breakthrough stroke risk reduction option for patients,” said Andrew Goldsweig, MD, interventional cardiologist at Nebraska Medicine. “Blood thinners are one of the biggest challenges for managing people with atrial fibrillation. Although patients need blood thinners to help prevent clot formation, blood thinners can cause bleeding as well as other adverse reactions or interactions with other medications. Forty-five days after the WATCHMAN is implanted, patients should be able to stop taking blood thinners while receiving stroke protection from the device that is equivalent to a full-dose thinner.”

Atrial fibrillation is the most common type of arrhythmia. It increases with age and occurs in as many as one in 10 people over 80. As the disease progresses, it can significantly increase your risk for stroke and congestive heart failure. In fact, people with atrial fibrillation are five times more likely to have a stroke than the general population.

To implant the device, the doctor inserts a small needle in the upper leg, followed by a narrow tube, similar to a standard stent procedure. The doctor then guides the device into the left atrial appendage of the heart. Patients commonly stay in the hospital overnight and leave the next day.

Nebraska Medicine has a specialized clinic established to evaluate if WATCHMAN is the right course of treatment.

“This gives us another tool to elevate our already high level of cardiac care,” says Jessica Delaney, MD, Nebraska Medicine cardiac electrophysiologist.

“We are both looking forward to getting back to a life of normalcy again,” says Sandy. “We’re still young. I thought we still had a lot of time to do things in our lives.” Since Tom’s surgery, Sandy says planning a cruise is back on the bucket list. “We are so grateful for all of the care we’ve received at Nebraska Medicine. Everyone was so nice and put us at ease. The care was wonderful.”

This article was first featured in Advancing Health, a quarterly magazine from Nebraska Medicine with information about innovative treatment options, prevention tips and making better choices for a long healthy life. Sign up below to join our mailing list and receive the next edition of Advancing Health straight to your mailbox.

To schedule an appointment with a specialist at Nebraska Medicine, call +1-402-559-3090 or OIHS@nebraskamed.com.

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