The Changing Face of Interventional Medicine - The University Of ...

innovationsMedical Advancements at The University of Kansas HospitalVolume 3, Issue 2Inside3 Cardiology:Extending Qualityof Life6 Neurosurgery:Advances OfferSafe Alternatives9 Rehabilitation:New Options forPain ManagementThe ChangingFace ofInterventionalMedicine11 Nephrology:Preventing Loss ofVascular AccessKUMedInnovationsSummer2013_X.indd 16/13/13 10:09 AM

Medical Advancements atThe University of Kansas Hospital3Minimally Invasive CardiovascularProcedures: New Options ExtendQuality of LifePeter Tadros, MDMedical Director, Heart Valve CenterTrip Zorn, MDSurgical Director, Heart Valve CenterInterventional cardiology,electrophysiology andcardiothoracic surgeryoffer new alternatives forpatients who otherwise face diminishedquality of life.These innovations rely on fresh waysto use established technologies and anunprecedented level of cooperationamong medical and surgical disciplines.At The University of Kansas Hospital’sCenter for Advanced Heart Care, weoffer interventional procedures andaccess to clinical trials, including• Bioabsorbable cardiac stenting• Minimally invasive valve repair andreplacement• New treatment options forhypertrophic cardiomyopathy• Surgical treatment of atrialfibrillation• Other new applications ofinterventional cardiologytechniquesNew generation ofabsorbable stentsOne of the first truly new advancementsin the treatment of coronary arterydisease in years is the new bioabsorbablestent. Like a traditional stent, it aids inrestoring blood flow to the heart. Buta traditional metallic stent can affectvasomotion. In addition, traditionalmetallic stents increase risk of stentthrombosis and restenosis.By contrast, the bioabsorbable stentprovides excellent scaffolding and drugdelivery for six months and then beginsto be absorbed. The stent is completelyabsorbed in two years. Early studiesshow that vasomotion returns to normalafter absorption, as well. Eventually, thenew stent may lower the risk of stentthrombosis and reduce the need forprolonged dual antiplatelet drugs.The Absorb Bioresorbable VascularScaffold stent is nearly ready forrandomized clinical trials, andThe University of Kansas Hospitalis the only hospital in the regionto participate.Catheter-based valve repair andreplacement therapyAbout 60,000 valve replacements areperformed in the United States everyyear. And as many as 400,000 peoplewith valve disease go without treatmentdue to their surgical risks. Transcathetervalve replacement therapy offers anew option, especially for those whohave high surgical risk for morbidityto mortality. The University of KansasHospital is one of the only hospitalsin the nation, and the only one in theregion, to offer all three transcatheteroptions, two for aortic and one forpulmonic valve replacement, currentlyavailable.Aortic valve replacementThe Center for Advanced Heart Careis one of only a few offering transaorticvalve replacement or implantationSURTAVI trialEarlier CoreValve® trials involved patients who were at high risk for surgery,mostly due to age. It simply assessed the safety and efficacy of the procedure.The University of Kansas Hospital is participating in the CoreValve SURTAVI trial,designed to evaluate the safety and efficacy of CoreValve in the treatment ofsymptomatic severe aortic stenosis in subjects who are at intermediate risk foraortic valve surgery. It is a randomized trial comparing TAVI with surgery.KUMedInnovationsSummer2013_X.indd 36/13/13 10:09 AM

Medical Advancements atThe University of Kansas Hospitaltechniques have shown promise, theyare often lengthy, require retreatmentand include complications. Surgery– primarily the maze procedure – hasgreat potential, but many physiciansare reluctant to take this step when thecondition is medically manageable.Hybrid ablation and structuralcorrection are two new approachesthat show great promise.Structural: Amplatzer cardiacplug and LARIAT® deviceMore than 90 percent of clots thatcause strokes in patients with nonvalvular atrial fibrillation arise inthe left atrial appendage, or LAA, aubiquitous embryologic remnant.Blood thinners are the mainstayof therapy for stroke prophylaxis.However, a significant portion ofpatients who might benefit from bloodthinners have contraindications dueto systemic bleeding, frequent fallsand other potential problems. Somepatients without contraindications mayexperience stroke despite the use ofblood thinners. Patients need treatmentstrategies that can potentially eliminatethe LAA from systemic circulation. TheAmplatzer Cardiac Plug, or ACP, andthe LARIAT are devices used to occludethe LAA.The University of Kansas Hospital isone of 70 sites participating in a clinicaltrial for stroke prevention with the ACP,and the only location in the region.This is a two-to-one randomized trial ofthe ACP vs. anticoagulation studyingoverall success, safety and efficacy. Itinvolves inserting a catheter through thefemoral vein, performing a transseptalpuncture and placing the device withinthe LAA. This seals off the LAA toblood flow and prevents clot formation.Scar tissue then forms to permanentlyseal off the LAA where most AF-relatedembolic strokes originate.The LARIAT suture delivery deviceis a catheter-based system that uses asnare to close off the LAA. It has beenshown to safely and reliably suture theLAA shut using combined endocardialand epicardial access. Like the ACP, theLARIAT involves inserting a catheterthrough the femoral vein, performinga transseptal puncture and placinga wire with a magnetic tip into theLAA. A catheter is also placed into thepericardium and another magnet-tippedwire is then placed through the catheteron the outside of the heart. The magnetsfind each other. A lasso or LARIAT isthen placed over the wire ensnaringthe LAA. An embedded suture then iscinched down over the LAA, closingit off.In both of these procedures, the aim isto prevent strokes, and eliminate theneed for long-term anticoagulant drugsin patients with atrial fibrillation.Hybrid ablationFor patients with persistent orlongstanding AF, ablation therapydoesn’t yield similar results as itdoes in those with paroxysmal AF.A new hybrid technique, combininga percutaneous electrophysiologicalapproach with a mini-maze procedureholds great potential for bringing thebest of all these treatments together.With this approach, the surgeonperforms anatomically guided epicardialablation using continuous lines andcreates a left atrial box lesion throughminimally invasive right chest access.The electrophysiologist employselectrically guided mapping to performendocardial ablation, to identify gaps inthe epicardial ablation lesion sets and toabate triggers and re-entry arrhythmias.The benefits of hybrid ablation include• Shorter time for each procedure• Complete lesion set: epicardial +endocardial• Epicardial occlusion of LAA, if desired• Fewer complications• Improved outcomesThis approach is currently under studyfor a clinical trial later this year.To consult with a physician at theCenter for Advanced Heart Care,call 913-588-5862 or toll free877-588-5862. Find moreinformation at kumed.com/heart.Dr. Tadros is director of interventional services and Lynn H. Kindred, MD, Cardiovascular Catheterization Laboratories atThe University of Kansas Hospital’s Center for Advanced Heart Care, a member of the Cardiovascular Research Institute andassistant professor at the University of Kansas Medical Center.5Dr. Zorn is the surgical director of The University of Kansas Hospital’s Center for Advanced Heart Care Valve Center. Recentresearch includes “Role of hybrid endovascular suite in improving outcomes of surgical ligation of coronary artery fistula.” Steffen,Kelly; Zorn III, George Trip; Tadros, Peter; Gupta, Kamal. The Journal of Invasive Cardiology 2012, 24(1), E10-12.KUMedInnovationsSummer2013_X.indd 56/13/13 10:09 AM

Interventional Neurosurgery:Advances Offer Safe AlternativesPaul Camarata, MD, Chair, NeurosurgeryKoji Ebersole, MD, Director, Endovascular NeurosurgeryDouglas Girod, MD, OtolaryngologyinnovationsRecent advancesin technology andprocedures forusing catheterbasedand other interventional methods inneurosurgery are providing faster, safer, moreeffective treatments. We now have moreoptions for treating certain aneurysms, strokesand other head and neck issues that may havebeen untreatable in the past. The best news,however, is that we have only just begun.The most common interventionalaneurysm repair attempts to “pack” theaneurysm, causing thrombosis that willreduce the pressure and inhibit rupture.The primary method is coiling: platinumwires delivered via catheter to fill theaneurysm as tightly as possible, leadingto clot formation and occlusion.This much less invasive technique workedbest initially on spherical aneurysms withsmall necks. Over time, we found betterways to fit the coils more tightly into oddlyshaped aneurysms and to more effectivelybridge the neck. We also have seen thedevelopment of balloons that inflatetemporarily in the vessel, giving us moretime to make the coils fit complex shapes.And new coiling materials and liquids areable to increase the density of the packing.Still, the recurrence rate with coiling canaverage around 15 percent.Each innovation in materials, proceduresand skill development holds the promiseof even broader application, giving us hopefor continuing to dramatically increasethe survivability of these potentiallydevastating events. This is a review of someof the latest developments in:• Treatment of cerebral aneurysms• Mechanical thrombectomy• Other interventions in neurosurgeryand otolaryngologyEmbolization device virtually erasesevidence of aneurysmAbout 1 or 2 percent of the U.S.population likely has a cerebral aneurysm.That equates roughly to the entirepopulation of the state of Kansas orMissouri. Yet only a very small percentage– about 30,000 of these aneurysms – willrupture each year. Smaller aneurysms areoften better left alone; depending on thepatient’s risk characteristics, they are notlikely to rupture. But larger, more complexaneurysms often warrant treatment.Open surgical treatment of aneurysm,most recently using surgical clips, has beenavailable for more than 60 years and hasproven very successful, with low recurrencerates. But interventional procedures havesurpassed open surgery by two or threeto one over the past 25 years, due to theirattractive minimally invasive nature.The new Pipeline embolization devicerelies on a completely different thoughtprocess. Instead of packing the aneurysmand allowing the blood flow to continuestressing that spot with each pulsation,the Pipeline relies on diverting blood flowaway from the weakened vessel wall.Unlike the usual stent, which is designed tobe as light as possible, the Pipeline is like adense hose, consisting of 48 braided wiresmade of 75 percent cobalt chromium and25 percent platinum tungsten. It is placedinside the vessel from which the aneurysmarises, providing supportive scaffoldingacross the aneurysm neck and keepingthe blood flow in a favored vector down6KUMedInnovationsSummer2013_X.indd 66/13/13 10:09 AM

innovationsIt is important to understand that theindications for clot retrieval are evolving. Inthe past, we sought this option only withinthe first three hours of stroke occurrence.But, in certain circumstances, that timewindow may be extended to six hours andeven beyond. Mechanical clot retrieval isthought to be most beneficial when thecore ischemic zone – where damage ispermanent – is small, and the ischemicpenumbra – where the tissue is stillpotentially viable – is relatively large. Thesepatients may benefit from reperfusionthrough clot retrieval beyond the previousabsolute time marks.The bottom line, as with cerebralaneurysms, is to offer stroke patients thegreatest number of options for treatment.As one of the first five healthcare facilitiesin the nation – and the only one inthe region – to be named an AdvancedComprehensive Stroke Center,The University of Kansas Hospital canoffer the greatest number and quality oftreatment possibilities.Technology and experienceexpand use of other interventionaltechniques• New treatment for pseudotumorcerebriBroadened understanding ofpathophysiology, coupled withLeading-edge research, extraordinary careThe University of Kansas Medical Center is one of 25 sites selected in 2011to participate in the Network for Excellence in Neuroscience Clinical Trials, orNeuroNEXT. This federally funded group of research institutions works tospeed the development of new treatments forneurological disorders.The University of Kansas Hospital and the Universityof Kansas Medical Center reinforce one another withstrong clinical initiatives and well-funded, leading-edgeresearch. It’s an extraordinary level of care that hasreceived national attention. The hospital’s neurology andneurosurgery care ranked No. 22 in U.S. News & WorldReport’s 2012-13 Best Hospitals list.advances in neuroendovasculartechnology, has increased treatmentoptions for patients with this difficultdiagnosis. A subset of patients developpseudotumor as a consequence ofstenosis in the intracranial venoussinus system. A growing body ofevidence suggests that intracranialstenting in the region of stenosis canresult in normalization of venous sinuspressures. The subsequent clinicalimprovement in these select cases canbe very satisfactory for both patientsand clinicians alike.• Managing vascular lesionsGrowing expertise and improvedtechnology also are expandingour ability to embolize head andneck lesions via endovascular andpercutaneous routes. Innovationsin interventional sclerotherapyoffer additional options for benignlesions such as hemangiomas andlymphangiomas. The application ofthese adjuvant techniques improvessurgical safety, decreases blood lossand operating times, and renders rarethe necessity to prescribe gross totalresection for benign vascular headand neck lesions.To consult with a specialist at theCenter for Advanced Brain andNeurological Care, call 913-588-5862or toll free 877-588-5862.Find more information atkumed.com/neurosciences.Dr. Camarata serves as chair of neurosurgery at The University of Kansas Hospital and associate professor at the University of KansasSchool of Medicine. Recent research includes, “Collateral damage: heat transfer as a possible mechanism of optic nerve injury duringneurosurgical intervention.” Shaw, My Le; Kelley, Brian; Camarata, Paul; Sokol, Jason A. Ophthalmic Plastic and Reconstructive Surgery2012-09, 28(5), 328-30.Dr. Ebersole is director of endovascular neurosurgery at The University of Kansas Hospital and assistant professor at the University ofKansas School of Medicine. Recent research includes, “‘Successful’ coiling of a giant ophthalmic aneurysm resulting in blindness: casereport and critical review.” Ashour, R.; Johnson, J.; Ebersole, K.; Aziz-Sultan, MA., Neurosurgical Review, May 2013.Dr. Girod is executive vice chancellor of the University of Kansas Medical Center, interim executive dean of the University of KansasSchool of Medicine, professor of otolaryngology/head and neck surgery and is an associate member of cancer biology at The Universityof Kansas Cancer Center. Recent research includes, “Functional swallowing outcomes following transoral robotic surgery vs primarychemoradiotherapy in patients with advanced-stage oropharynx and supraglottis cancers.” More, Y.I.; Tsue, T.T.; Girod, D.A.; Harbison, J;Sykes, K.; Williams, C; Shnayder, Y. JAMA Otolaryngol Head Neck Surgery, 2013 Jan. 139(1):43-8.The University of Kansas Hospital’s interventional neurosciences team also includes Ernest Madarang, MD, neuroradiologist, Alan Reeves,MD, neuroradiologist, and Michael Abraham, MD, neurointensivist. These specialists, and all members of our multidisciplinary team,work together to ensure the best possible outcomes for aneurysm and stroke patients.8KUMedInnovationsSummer2013_X.indd 86/13/13 10:09 AM

Medical Advancements atThe University of Kansas HospitalInterventional Rehabilitation Medicine:The New Face of Pain ManagementRaj Mitra, MD, Chair, Rehabilitation Medicine9An accurate diagnosis, efficiencyand continuity of care – that’s whatinterventional pain managementbrings to the field of physicalmedicine and rehabilitation.Traditionally, physical medicineand rehabilitation enter into patientcare following a surgical procedure.Interventional rehabilitation medicinespecialists at The University of KansasHospital are evolving our approachto rehabilitation to benefit patientsacross the spectrum of disease. Indoing so, we have developed the largestinterventional rehabilitation programin the region. As we continue to growthis subspecialty, we are positionedto serve as a resource for the medicalcommunity and patients throughout theregion, especially those with complexhealth issues.Across the spectrum of diseaseInterventional rehabilitation medicineis helping a diverse patient population,from recreational athletes with sportsinjuries to cancer patients sufferingwith swallowing and chewing difficulty.Regardless of the health concern, theapproach is the same. By focusing oncollaboration, accurate diagnosis andreasonable, conservative care, we offertreatment that helps patients findrelief or improved function throughminimally invasive options. It is anin-depth approach taking into accountphysical exams, imaging and labstudies. and multiple viewpoints fromspecialists to determine treatment.We use this approach not merely forthe sake of using an intervention, butalways to serve the patient and, whereappropriate, to break the cycle ofrecurring pain and future treatments.Interventions may include:• Medication management• Customized physical therapy fromtherapists specializing in spine care• Pain management injections• Interventions using fluoroscopy• Alternative medicines andtherapies, such as acupuncture,aquatic therapy, alternative painmanagement and transcutaneouselectrical nerve stimulation, orTENS.For example, adhesive capsulitis maybe treated surgically which includesrecuperation and rehabilitation.Alternatively, an interventional shoulderprotocol provides an effective option.A suprascapular nerve block is followedby an injection of an intra-articularsteroid and an injection of an anestheticagent with brisement normal salinevolume dilation. The shoulder is thenmanipulated to break adhesions.Patients quickly experience improvedshoulder abduction and flexion and asignificant improvement of motion.Comprehensive careThe Marc A. Asher, MD,Comprehensive Spine Center providesa range of patient care and facilitiesunequaled in the region and rarely seenacross the nation. Here, specialists fromorthopedics, neurosurgery, physicalmedicine and rehabilitation, speech andphysical therapy and anesthesia worktogether under one roof providing acomprehensive perspective on spinalcare. The University of Kansas Hospitalhas the only fellowship for spine andpain interventions in the region.From joint injections to cyst aspirationsto epidural injections to radiofrequencyneurotomy, interventional rehabilitationspecialists rely upon a range of toolsto disrupt pain signals, improvemovement, and help patients avoid therisks of both surgery and medications.In our women’s health program,interventionalists from rehabilitation,radiology, neurology, orthopedics andanesthesia work together to restoreInterventional case studyA female patient presented atThe University of Kansas Hospitalsuffering chronic pelvic pain. Afteran MRI, the interventional teamdiscovered the veins in the pelviswere dilated and diagnosed pelviccongestive syndrome. Working withradiology, the team embolized theseveins and, for the first time in 12years, the patient is pain free, can sitand participate in physical therapythat was previously too painful.KUMedInnovationsSummer2013_X.indd 96/13/13 10:09 AM

innovationsThe Case for CollaborationPhilip Johnson, MD, Chair, RadiologyWhile interventional radiology often benefits patients with shorter recovery times, better outcomes andminimized risk, “less invasive” doesn’t always equate to “less risk.” Overlap of treatment options exists for manymedical conditions. Hence a collaborative and multidisciplinary approach is essential to determine the besttreatment for an individual patient, be it interventional, surgical or medical.With 25 radiologists, five body-interventionalists and four neuro-interventionalists, The University of KansasHospital has the leading IR department in the region with the largest volumes. Through this experience anda commitment to continual research, training and multidisciplinary collaboration, we provide the full gamut of treatment forpatients, including the newest treatments, often before anyone else in the region.Technological advances are best for the patient when they travel on the heels of collaborative care. That’s the advantage thatwe have at The University of Kansas Hospital.function and manage pain for pregnantwomen and those with chronic pelvic,spine, hip or shoulder pain including sportsinjuries. Surgery-free pain managementinvolves similar interventional innovationsand collaboration.• A local nerve block at the ganglionimpar can relieve coccyx, pelvic orperineal pain.• Nerve blocks can resolve chronic,neuropathic perineal pain fromvisceral or sympathetic pain syndrome.• Coccygeal injections provide anothertherapeutic approach for managingcoccydynia.Cancer rehabilitationThe cancer rehabilitation program isthe only one of its kind in the region.We assist oncology patients who haveany type of cancer, at any stage of theirdisease, by working to restore functionusing the advanced technology, includinginterventions. The emphasis is onevaluating and treating neuromuscular,musculoskeletal and functionalcomplications that may result from cancerand cancer treatments, including acuteand chronic pain, fatigue, muscle spasms,neuropathy, myopathy, radiation fibrosis,dystonia and spasticity among others.A cancer rehabilitation and pain specialistmay help reduce swelling in a patientwith lymphedema, for example, byemploying a custom therapy program thatincludes medications, steroid or anestheticinjections, and radiofrequency nervelesioning.Our treatment is always multimodal toprovide comprehensive treatment and mayincorporate a combination of physical,occupational, and/or lymphedema therapy,assistive devices, orthotics, prosthetics,medications, patient education and, whenneeded, joint and soft tissue injections.Collaborating for better patient careAs an academic medical center,The University of Kansas Hospital takes amultidisciplinary approach to every aspectof patient care. We begin with an accuratediagnosis and follow with a collaborative,evidence-based approach to treatment.The role that interventional rehabilitationmedicine may play in a patient’s treatmentand care is routinely considered as part ofthis process. Interventional rehabilitationmedicine is a logical evolution along thecontinuum of care.To consult with one of ourrehabilitation or radiologyspecialists, call 913-588-5862 ortoll free 877-588-5862. Find moreinformation on rehabilitationmedicine and interventionalradiology at kumed.com.Dr. Mitra is a professor and serves as chair of rehabilitation medicine at the University of Kansas School of Medicine. Recent researchincludes, “Adjuvant analgesics in cancer pain: a review.” Mitra Raj; Jones Stephanie. The American Journal of Hospice & Palliative Care 2012,29(1), 70-79.The University of Kansas Hospital’s interventional rehabilitation program is attracting leading physiatrists from across the nation. S. KamalFetouh, MD, heads our cancer pain management and rehabilitation program. Dr. Fetouh previously served at Memorial Sloan-KetteringCancer Center. Tiffany Williams, MD, medical director of the Marc A. Asher, MD, Comprehensive Spine Center, recently joined us fromJohns Hopkins University. Dr. Williams will be involved in clinical research examining minimally invasive lumbar decompression.10KUMedInnovationsSummer2013_X.indd 106/13/13 10:09 AM

Medical Advancements atThe University of Kansas HospitalEffects of Interventional Medicinein NephrologyAlan Yu, MDDirector, Kidney InstituteMore than 871,000 people in theUnited States are being treated forend-stage renal disease, accordingto the National Institute ofDiabetes and Digestive and KidneyDiseases. Of those patients, more than365,000 receive renal replacement throughhemodialysis.For these patients, vascular access isboth a lifeline and an Achilles heel.While arteriovenous fistulas andgrafts are vital for dialysis, they aresusceptible to stenosis, thrombosis andinfection. When these complicationsoccur, prompt treatment is critical to apatient’s survival.Hospital admissions for vascular accessinfection rose steadily nationwide until2005. Since that peak, admissions havefallen 24 percent. A portion of thisdecline may be attributed to the rise ofinterventional medicine in nephrology.Interventional proceduresInterventional procedures can quicklyclear arteriovenous fistulas forhemodialysis without open surgery andprovide better patient outcomes. Suchprocedures include catheter placement,fistulograms, percutaneous balloonangioplasties, thrombectomies, venousmapping and kidney biopsies.At The University of Kansas Hospital,our nephrologists work alongsideinterventional radiologists, providingthem with key knowledge about dialysis,the potential complications of vascularaccess, and the effects of complicationson patients’ treatments and qualityof life. Using minimally invasiveprocedures and this multidisciplinaryapproach, we can quickly treat clots orfailures of arteriovenous fistulas andgrafts, renal artery stenosis, and many,ifif not all, vascular access complications.Improved care leads to loweroverall costsFor patients, the power of interventionalnephrology is realized in the reductionof emergency treatments andhospitalizations. Studies have showninterventional nephrology programsdecrease the number of hospitalizationsand missed dialysis treatments.However, beyond interventionalnephrology’s positive effect on patientcare, there is an undeniable financialimpact.In 2010, Medicare expendituressurpassed $30 billion with totalend-stage renal disease, or ESRD,expenditures amounting to $47.5billion. A significant proportion ofthese costs were due to complications ofvascular access, emergency dialysis andhospitalizations of patients with ESRD.World-class kidney careFor the past four years, The Universityof Kansas Hospital’s nephrologyprogram has ranked among the nation’sbest in U.S. News & World Report’s BestHospitals. Nephrology ranked No. 15among the nation’s top 50 for 2012-13. We offer superb clinical fellowshiptraining, a widely respected clinicalprogram and a strong tradition intranslational medicine that integratesscientific research with clinical trials.To consult with one of ournephrologists, call 913-588-5862or toll free 877-588-5862. Findmore information at kumed.com.Dr. Yu is director of the division of nephrology and hypertension, and professor of medicine at the University of Kansas School ofMedicine. He is also director of the Kidney Institute at the University of Kansas Medical Center. Dr. Yu is also co-editor ofBrenner and Rector’s The Kidney, the internationally best-selling nephrology reference text.11KUMedInnovationsSummer2013_X.indd 116/13/13 10:09 AM

innovationsClinical trial aimed at advanced gastricor gastroesophageal junction cancerPeter J. Van Veldhuizen, MDPrincipal InvestigatorA Phase II Study of MK-2206(NSC-749607) as Second LineTherapy for Advanced Gastric orGastroesophageal Junction CancerThis phase II clinical trial studies howwell MK-2206 works in treating patientswith advanced gastric or gastroesophagealjunction cancer. MK-2206 may stop thegrowth of tumor cells by blocking some ofthe enzymes needed for cell growth.Eligibility criteria• 18 years or older with histologicallyor cytologically confirmedadenocarcinoma of the stomach orgastroesophageal junction• Disease that has progressed after firstlineregimen or is recurrent within thepast six months after adjuvant therapy• Measurable disease by CT scans orMRI within the past 28 days• No known brain metastases• Zubrod performance status 0-1• ANC ≥ 1,500/mm3• Platelet count ≥ 100,000/mm3• Hemoglobin ≥ 9 g/dl• Bilirubin normal• AST and ALT ≤ 2.5 times upper limitof normal (ULN) (≤ 5.0 times ULNfor patients with liver metastases).• Serum creatinine ≤ ULN or creatinineclearance > 50 mL/min• INF ≤ 1.2 (unless taking therapeuticWarfarin)• Fasting blood sugar ≤ 150 mg/dL• Hemoglobin A1C < 7%For a complete list of criteria, visitclinicaltrials.gov and use identifierNCT01260701 HSC12615. As youevaluate your patients in daily practice,consider referring those who may becandidates for this study. Enrollment iscurrently under way.For more information or to consultwith one of our oncologists, call913-588-5862 or 877-588-5862 tollfree. Or visit kucancercenter.org/consult.To learn more about our cancer clinicaltrials, visit kucancercenter.org/clinicaltrials.Nationally recognized excellence12KUMedInnovationsSummer2013_X.indd 126/13/13 10:09 AM

Medical Advancements atThe University of Kansas HospitalPROGRESS NOTESNEWS AND RESOURCES FROMTHE UNIVERSITY OF KANSAS HOSPITALNEW LEADER FOR MEDICAL CENTERDouglas A. Girod, MD,has been appointedexecutive vicechancellor for theUniversity of KansasMedical Center.Dr. Girod, a surgeon, previouslyserved as chair of the Departmentof Otolaryngology-Head and NeckSurgery since 2002.Dr. Girod has been deeply involvedin strategic planning, qualityimprovement and other crucialinitiatives at The University ofKansas Hospital. His leadership wasinstrumental in the otolaryngologyprogram’s rankings among thenation’s best by U.S. News & WorldReport over the past four years.Dr. Girod earned his medical degreefrom the University of Californiaat San Francisco and completedhis residency and an NIH researchfellowship at the University ofWashington in Seattle. Prior tojoining the University of KansasMedical Center faculty in 1994, heserved as vice chairman and researchdirector in the Department ofOtolaryngology at the Naval MedicalCenter in Oakland, Calif.He has given nearly 50 invitedpresentations to national andinternational organizations, coeditedthe textbook Oral CavityReconstruction, written 11 bookchapters and published 57 articles inscholarly journals.LIVER TRANSPLANTMILESTONE REACHEDEarlier this year, The University ofKansas Hospital became first in thestate and the Kansas City metro areato perform 1,000 liver transplants.Timothy Schmitt, MD, and JamesonForster, MD, performed the historicmilestone surgery. Forster also performedthe hospital’s first transplantin 1990. The hospital’s liver transplantprogram is now among the top 25programs by volume nationally.Patient outcomes, as measured byone-year survival, have remainedgreater than the national averageover the same period, even with 250percent growth in the program overthe last five years.GROUNDBREAKINGFOR REHABILITATIONFACILITYConstruction is under way forThe University of Kansas Hospital’snew state-of-the-art inpatient acuterehabilitation care facility. Opening inspring 2014, the new facility will offer29 patient rooms and a wide rangeof amenities to help patients preparefor self-care at home. The buildingis located near the main hospital atRainbow Boulevard, just south of39th Avenue.COMPLEX SURGERY DESTINATION CENTERAt The University of Kansas Hospital, we specialize in managing the most complex surgical cases. Our state-of-the-artsurgical suites allow us to work in tandem with a variety of specialists to perform the most advanced procedures withoutmoving the patient. Our centers of excellence offer a multidisciplinary approach to the evaluation and treatment ofmultiple conditions, including heart disease, cancer, trauma, neurosurgery, burns and wounds, and organ transplant.Here, highly experienced surgeons devote their practices to complicated procedures for such uncommon conditions aspancreatic cancer, advanced melanoma, esophageal and gastric cancer, endocrine surgery and more. Whenever possible,surgeons use leading-edge technologies, such as the robotic daVinci® Surgical System, to perform less invasive surgicalprocedures. Our hospital is one of the few in the region with established experience in robotic surgery for gastrointestinalprocedures.Our survival rates are among the top third of academic medical centers nationwide. To consult with one of our surgeons,call 913-588-5862 or toll free 877-588-5862. For more information, please visit kumed.com/consult.13KUMedInnovationsSummer2013_X.indd 136/13/13 10:09 AM

NEW PHYSICIANSThese dedicated physicians have recently joined the medical staff at The University of Kansas Hospital.David W. Anderson, MDOrthopedicsMedical School: CreightonUniversityInternship: University of KansasMedical CenterFellowship: MassachusettsGeneral HospitalDonald Beahm, MDOtolaryngologyMedical School: University ofKansasInternship: Louisiana StateUniversity Health ScienceCenter-New OrleansResidency: Louisiana StateUniversity Health ScienceCenter-New OrleansFellowship: Thomas JeffersonUniversity-PhiladelphiaCertification: American Board ofOtolaryngologyPeter DiPasco, MDSurgical OncologyMedical School: University ofMissouri-Kansas CityResidency: University of KansasMedical CenterFellowships: WashingtonUniversity-St. Louis andUniversity of Miami-Miller Schoolof MedicineCertification: American Board ofSurgerySherin Fetouh, MDRehabilitation MedicineMedical School: St. GeorgesUniversity-GrenadaResidency: Thomas JeffersonUniversity HospitalFellowship: Memorial SloanKettering Cancer CenterCertification: American Boardof Physical Medicine andRehabilitationWilliam Freund Jr., MDGeneral SurgeryMedical School: University ofKansasInternship: University of KansasMedical CenterResidencies: University ofKansas Medical Center and VidantMedical Center-East CarolinaUniversityFellowship: St. Luke’s Hospital-Kansas CityCertification: American Boardof SurgeryJulie Holding, MDPlastic & Reconstructive SurgeryMedical School: University ofTexas Medical Branch-GalvestonResidency: University of TexasMedical Branch-GalvestonFellowship: University ofWashingtonColleen Hupp, DOVascular SurgeryMedical School: Kansas CityUniversity of Medicine andBiosciencesResidency: University of KansasMedical CenterFellowship: University ofMissouri-ColumbiaMichael Rippee, MDNeurologyMedical School: University ofMissouri-Kansas CityInternship: University of KansasMedical CenterResidency: University of KansasMedical CenterFellowship: University of KansasMedical CenterSPINE CENTER ADDS NEW LOCATIONThe University of Kansas Hospital’s Marc A. Asher, MD, Comprehensive Spine Center has opened a location in southern Johnson Countyat our Indian Creek Campus. Fellowship-trained physicians provide care in six specialties, offering patients a full complement of spineevaluation and treatment services under one roof. The program serves patients with back, joint or neck pain; sports, work-related or othermusculoskeletal inquiries; and spinal deformities or infections.14KUMedInnovationsSummer2013_X.indd 146/13/13 10:09 AM

3901 Rainbow Blvd.Kansas City, KS 66160CME PROGRAMS at The University of Kansas HospitalThroughout the year, we provide the latest medicalinformation on a variety of topics to physicians andother healthcare professionals.Our CME-accredited programs focus on essentialareas of patient care, including the prevention,diagnosis and treatment for specific conditions.Specialty areas include• Cancer• Cardiology and cardiovascular surgery• Neonatal intensive care• Neuroscience• Orthopedics and sports medicine• Pediatrics• Solid organ transplant• SurgeryFor more information, contact physicianrelations at 913-945-5241.Our programs are offered toprofessionals who directly care foror treat patients within each CMEevent’s specific area of focus.Our events are planned andimplemented in accordance withthe Essential Areas and Policiesof the Accreditation Council forContinuing Medical Educationthrough the joint sponsorshipof the University of KansasMedical Center Office ofContinuing Education andProfessional Development and ourhospital. For more information,visit continuinged.ku.edu/kumc.KUMedInnovationsSummer2013_X.indd 156/13/13 10:09 AM