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ExploreHealth with Sentara
Medical Breakthroughs: ExploreHealth with Sentara highlights the latest in medical breakthroughs available at Sentara.
 New Surgical Disc Replacement Procedure Helps Neck Pain PRESTIGE® Cervical Disc
Pancreas Transplant Can Cure Type 1 Diabetes: First Pancreas Transplant Performed at Sentara Norfolk General Hospital
Transnasal Endoscopic Surgery for Skull-based Tumors
Cardiovascular MRI - Unprecedented Images of the Heart
Minimally Invasive Surgical Option For Women With Pelvic Prolapse
NeuroThera™ : Laser Takes Aim at Improving Outcomes for Stroke Patients
Radiofrequency Ablation: Using Wave of Heat Energy to Destroy Lung Tumors
Bravo™ pH Monitoring System: A More Patient-Friendly Test For Heartburn
Robotic Major Thoracic Surgeries
Breast-Specific Gamma Imaging: When A mammogram is inconclusive
Southside Breakthrough: Zimmer® Gender Solutions™ Knee
Dignity Preserving Surgery for Bowel Control
December 2007
New Surgical Disc Replacement Procedure Helps Neck Pain PRESTIGE® Cervical Disc
Sentara Norfolk General Hospital is the region's first facility to implant a new artificial disc, PRESTIGE® Cervical Disc, recently approved by the Food and Drug Administration for treating degenerative cervical disc disease.
Until now, the most common form of surgery for the estimated 200,000 Americans who sought surgical treatment for cervical degenerative disc disease is cervical spine fusion. Fusion involves removing a troubled disc and bolting the vertebrae together with steel plates to restrict motion. The PRESTIGE® disc offers a major neurosurgical breakthrough that may lead to better outcomes for the rest of the spine and can vastly improve the lives of people who suffer with cervical disc problems.
The surgically implanted, stainless steel PRESTIGE® disc is intended to relieve neck pain and stiffness, and the occasional weakness or numbness in the arms, due to a pinched nerve. This can be caused by a herniated disc between cervical vertebrae or a bone spur on a vertebrae, both of which can push on the nerve root.
Natural Motion Design
The PRESTIGE® disc mimics the natural motion of the neck through a "ball-and-trough" design that allows for a variable center of rotation. It is inserted through a 1½-inch incision in the front of the neck.
Clinical Trial Outcomes
In a two-year clinical trial ending in August 2004, patients receiving the PRESTIGE® disc experienced statistically significant outcomes 24 months after surgery in an index that measures how much a patient's neck pain affects the ability to manage everyday activities*. Patients also returned to work an average of 26 percent faster than those receiving spinal fusion. The trial involved 541 patients enrolled at 32 sites across the country.
If you are experiencing neck pain symptoms, talk to your physician or call 1-800-SENTARA for more information.
*Medtronic, manufacturer of the PRESTIGE® Cervical Disc.
Source: www.prestigedisc.com/pages/media_room.html
November 2007
Pancreas Transplant Can Cure Type 1 Diabetes
First Pancreas Transplant Performed at Sentara Norfolk General Hospital
With its first pancreas transplant, Sentara Norfolk General Hospital is now offering patients with Type 1 diabetes and end-stage renal disease a life-changing surgery that can be done in conjunction with a kidney transplant.
An estimated 20.8 million children and adults in the United States have diabetes. Nearly one-third don't even know it.* For those with Type 1 diabetes, usually diagnosed in children and young adults, a pancreas transplant, in conjunction with a kidney transplant, can cure their diabetes.
In Type 1 diabetes, the pancreas stops producing insulin, a hormone necessary to convert food into energy. This can lead to kidney (renal) failure and the need for a kidney transplant. A kidney transplant frees a patient from dialysis but does not solve the root problem of Type 1 diabetes. A pancreas transplant can.
The process for a pancreas transplant is similar to that of a kidney transplant. When a patient is matched with a deceased donor kidney, ideally, the pancreas would be transplanted at the same time. If the kidney is from a living donor, the kidney transplant may be done first. After several months of recovery, the person could be placed on the pancreas transplant list. A successful pancreas transplant would spare the donor kidneys from the negative effects of diabetes.
It's a lengthy, detailed procedure, where the entire multidisciplinary team of experts such as nephrologists, vascular and transplant surgeons and specialized staff work together to prepare the organs and the patient for a successful transplant.
Patients usually require seven to 10 days of hospital care. Immunosuppressive medications are given and patients are monitored closely to assure that the organs are being accepted and functioning well.
For more information, call 1-800-SENTARA or visit www.sentara.com/transplant.
*Source: American Diabetes Association, www.diabetes.org/about-diabetes.jsp
October 2007
Transnasal Endoscopic Surgery for Skull-based Tumors
Innovative Surgery Removes tumors Using A Natural Passageway: The Nose
A Team of cutting-edge surgeons at Sentara Norfolk General Hospital is performing an innovative surgical technique that uses the nose as a "natural orifice" (opening in the body) to remove skull-based tumors; without a large surgical skin incision.
For many years, minimally invasive surgical techniques have been reducing the size of the surgical incision, offering patients less pain and shorter recovery times. Specially trained surgeons across the country, including right here in Hampton Roads are beginning to remove various types of tumors or cancer from the body using natural orifices or openings in the body--without large skin incisions.
Removing Tumors Through the Nose
It's a breakthrough procedure called Transnasal Endoscopic skull base surgery (or neuro-endoscopic procedure) for removing tumors. Simplified, it refers to surgery that removed pituitary and other skull-based tumors through the nose--without the large surgical incisions required to remove the tumor through the face or skull.
An otolaryngologist, an expert on the anatomy of the ears, nose and throat, pairs up with a neurosurgeon, an expert on the brain's anatomy, to remove tumors through the natural path the nasal passages offer to the brain. With an Endoscopic image, meticulous Endoscopic maneuvers with precisely angled instruments, and a radiographic image-guidance system, surgeons don't even make any incisions until they are deep inside the nasal cavity.
The advantages for patients are clear: no, or minimal, visible scarring, less pain and a quicker recovery.
Surgeons caution that this method is not for every patient. There are circumstances when the position or size of the tumor would not allow this Endoscopic method to be used. In that incidence, traditional surgery would be implemented.
For more information, talk to your physician or call 1-800-SENTARA.
September 2007
Cardiovascular MRI is a powerful, non-invasive tool in evaluating:
The size and thickness of the heart chambers,
Any damage from a heart attack or heart disease, and
The pumping efficiency of the heart.
Cardiovascular MRI - Unprecedented Images of the Heart
The Advanced Imaging Center - Sentara Heart Hospital® has added an unprecedented imaging capability to its heart program that is not available within 100 miles.
It's a MRI dedicated for the evaluation of cardiac tumors, valve problems, and wall damage following a heart attack. This technology coupled with the 64-slice cardiac CT provides a comprehensive assessment of the heart without an invasive procedure.
Magnetic Resonance Imaging, MRI, is used to help physicians diagnose, and rule out, a vast number of diseases. It uses radio wave energy and a strong magnetic field rather than x-rays to take clear and detailed pictures. This new technology, Cardiovascular MRI, creates detailed images of the heart and blood vessels inside the body to assess heart function, anomalies and weaknesses of the heart valves, and viability of the heart muscle itself.
During the MRI, a contrast material may be given to the patient to make the blood vessels more visible.
Hundreds of specific questions about heart conditions can be answered using this new advanced imaging tool, along with the 64-slice CT scanner. By combining the strengths of both tools, doctors have a complete picture of their patients' heart health that can lead to more precise care.
The magnetic field of the MRI makes this testing not available for all patients, especially those with pacemakers. For more information, talk to your physician or call 1-800-SENTARA.
August 2007
EBUS: Endobronchial Ultrasound
A Minimally Invasive Tool For Diagnosing Lung Cancer
A technological breakthrough is helping patients with lung and lymph node tumors to be more accurately diagnosed so treatment can begin sooner. With a new, minimally invasive endobronchial ultrasound procedure at Sentara Norfolk General Hospital, known as EBUS, doctors are able to diagnose patients with lunch cancers before any surgery begins.
Often a diagnosis of cancer cannot be confirmed without invasive diagnostic surgery. A new technology breakthrough called endobronchial ultrasound (EBUS) is offering patients a less invasive alternative for evaluating the airways and diagnosing lung and lymph node tumors.
Outpatient, No Incisions Required EBUS involves no incisions. Patients receive only conscious sedation for this outpatient procedure, making it a good choice for patients at high risk for invasive diagnostic surgery. This minimally invasive diagnostic tool is useful for patients with possible cancers in their lymph nodes. Previously, patients with concerning lymph nodes would most often have to undergo surgery to get a correct diagnosis.
The physician uses a bronchoscope equipped with an ultrasound device that is threaded through the patient's nose or mouth into the airways of the lungs. Doctors are able to see "real-time" ultrasound images that guide them to where to take the biopsy that tests for cancer as well as other diseases.
Lung cancer kills more Americans than breast, colon and prostate cancer combined. With new technology such as EBUS, physicians are able to continue to make strides toward diagnosing and treating lung cancers as quickly as possible.
For more information, talk to your physician or call 1-800-SENTARA.
Minimally Invasive Surgical Option For Women With Pelvic Prolapse
Women with pelvic prolapse have an alternative to hysterectomy with this minimally invasive procedure. A mesh sling is positioned in the pelvis to cradle and support pelvic organs in their natural position to eliminate the symptoms of pelvic prolapse. This procedure is available at Sentara Hospitals.
About 50% of women who have had children will suffer from pelvic prolapse, a condition where the body no longer holds internal organs such as the uterus, bladder or small intestines in their proper place. This results in pain and intense pressure that can cause otherwise healthy women to limit their active lifestyles.
For many women with pelvic prolapse, a hysterectomy has been the main surgical option. Now, a specially designed mesh, made of synthetic material, offers patients a longer-lasting solution for pelvic floor repairs. The mesh becomes part of the pelvic tissues to cradle and support the internal organs as they body once did.
The minimally invasive procedure used to insert the mesh involves three or fewer small incisions and takes just over an hour to complete. Most patients are mobile the next day. After this surgery, patients are able to walk, job and enjoy other activities that may have been too uncomfortable before.
Talk to your physician if you have symptoms of pelvic prolapse. For more information or a physician referral, call 1-800-SENTARA.
Symptoms of Pelvic Prolapse:
• Uncomfortable pressure in the abdomen and vagina
• Painful intercourse
• Frequent urination
• Back pain
• Problems with bowel movements
This technique offers a longer-lasting solution for pelvic floor repairs with little hospitalization, improved recovery time and eliminating the need for a hysterectomy.
NeuroThera™
Laser Takes Aim at Improving Outcomes for Stroke Patients
Neurologists at Sentara Virginia Beach General Hospital are participating in a multicenter clinical trial evaluating the safety and effectiveness of NeuroThera™ - a noninvasive, infrared laser device being evaluated for use in the treatment of ischemic stroke.
The American Stroke Association estimates that each year about 700,000 people suffer a new or recurrent stroke in the United States. Ischemic stroke or a "brain attack" occurs when a vessel supplying blood to the brain becomes blocked by a clot or buildup of plaque. Brain cells that are unable to get enough blood and oxygen die. This results in serious long-term disability, or for more than 150,000 people a year, death.
Treatment Keeps Brain Cells Alive
The approved drug therapy for stroke, tPA, must be administered to the patient within three hours after the onset of stroke symptoms. Most stroke patients don't get to the hospital that quickly. NeuroThera™, the therapy being used and evaluated in a nation-wide clinical trial, can be administered up to 24 hours after the onset of stroke symptoms.
The NeuroThera™ technology works by transmitting specific infrared wavelengths through the skull. Patients wear a specially designed skullcap with pre-identified areas for the neurologist to place the infrared beams. The technology is believed to work by stimulating metabolic reactions, preventing brain cells from dying.
PhotoThera, the company that developed NeuroThera™, has completed an initial, randomized human trial called the NEST-1 study. Based upon those positive results, the FDA agreed to proceed with NEST-2, the current clinical trial. NEST-2 is a randomized, double-blinded study at 50 medical centers across the country, including Sentara Virginia Beach General Hospital.
Get Help FAST
Getting to the hospital quickly can save lives and prevent the disabling effects of stroke. For more information, call 1-800-SENTARA or visit www.sentara.com/neuro.
Risk Factors For Stroke Include:
• Family history of stroke or heart disease
• Age, gender, medical history and race
• High blood pressure, undesirable levels of cholesterol and diabetes
• Cigarette smoking, excessive alcohol consumption, drug abuse
• Obesity, physical inactivity
• Use of birth control pills
NeuroThera™ is designed to treat stroke in patients who have suffered an acute stroke within the past 24 hours.
Radiofrequency Ablation
Using Wave of Heat Energy to Destroy Lung Tumors
Surgeons and interventional radiologists at Sentara Heart Hospital® recently performed the region's first radiofrequency ablation procedure that uses waves of heat energy to destroy cancerous tissue. The procedure is a promising alternative to the surgical removal of lung tumors.
Standard treatments for lung and esophageal cancer often include surgery combined with chemotherapy. But for patients who are medically fragile or at high risk for surgical complications, minimally invasive radiofrequency ablation (RFA) offers the latest medical breakthrough alternative.
Thoracic surgeons and interventional radiologists team up for this RFA procedure. Radiologists use computed tomography (CT) scanning to guide the surgeon's placement of a small needle electrode inserted through the skin, directly into the tumor tissue. An alternating electrical current set to the frequency of radio waves is passed through the electrode causing the tissues around the electrode to heat up, killing nearby cancer cells, but sparing surrounding healthy tissue.
RFA may also be used for patients with multiple tumors. This reduces the tumor burden so that the remaining tumor cells may be eliminated by chemotherapy or radiation therapy.
While surgical removal of a cancerous growth does have a better success rate that RFA, the radiofrequency ablation procedure is a good option for patients who are medically frail and not good candidates for surgery. It takes much less time for patients to recover from radiofrequency ablation that from traditional surgery.
State-of-the-art procedures such as RFA are just one part of the services performed at Sentara Heart Hospital's® thoracic surgery program.
Bravo™ pH Monitoring System: A More Patient-Friendly Test For Heartburn
Sentara physicians and hospitals are now offering a more comfortable way to evaluate heartburn symptoms. With the world's first catheter-free Bravo™ pH Monitoring System, a small pH capsule is attached to the interior wall of the esophagus to transmit information to an external pager-sized recorder. This allows patients to continue with their daily activities and avoid the discomfort and inconvenience of monitoring through a nasal catheter.
Heartburn. Acid indigestion. Reflux.
These are common names for a condition where the valve between the stomach and the esophagus randomly allows stomach acid to flow back up into the esophagus. As this acid touches the esophagus, it creates a burning sensation in your chest, or a bitter taste in your throat or mouth.
An estimated 10-20% of Americans have frequent heartburn. Occasional heartburn is normal, but when it is more frequent and severe, it may be a symptom of gastroesophageal reflux disease or GERD.
By monitoring the pH levels of the esophagus, your physician can determine the cause of your symptoms and the best treatment. The Bravo™ pH Monitoring System is the first catheter-free pH monitoring system, offering a more gentle way to capture the information essential to diagnosing heartburn symptoms. (Traditional pH monitoring requires a tube inserted through the nose which often creates discomfort and embarrassment.)
It takes only minutes for a gastroenterology specialist to place a miniature pH capsule on the inside wall of the esophagus. It's so small that you can eat normally and go about your daily living while the capsule tracks the activity in your esophagus. This information is transmitted to a pager-sized receiver work on your belt.
The Bravo testing can last either 24 or 48 hours. Once the test is complete, the recorded data is downloaded and interpreted by your gastroenterologist. The pH capsule simply falls off the esophageal wall, passes through the digestive track and is eliminated.
The Bravo™ pH Monitoring System now available at Sentara Hospitals may not be appropriate for all patients, including those with pacemakers or other conditions. For more information, talk to your physician or call 1-800-SENTARA.
If you experience heartburn 2 or more times a week, or have been taking antacids for more than 2 weeks, it's time to see a doctor.
Robotic Major Thoracic Surgeries
da Vinci™ robot used in innovative, minimally invasive thoracic procedures for lung cancers and other types of cancers and other types of complex chest surgeries.
Surgeons at Sentara Heart Hospital® recently performed the state's first robotic major thoracic procedures. Using the da Vinci™ surgical robot, lung cancer tumors and other masses in the chest area can be removed with these innovative new procedures designed to minimize trauma to patients.
Lung cancer is the leading cause of cancer deaths in the United States for both men and women. According to the American Cancer Society, more people die of lung cancer than of colon, breast, cervix and prostate cancer combined.
Most patients with lung cancer that are treated surgically have a lobectomy, the removal of one of the lungs' five lobes. The da Vinci™ surgical robot now allows surgeons to apply minimally invasive techniques that offer patients many advantages.
Smaller Incisions, Quicker Recovery
The goal of thoracic surgery is to completely and cleanly remove tumors found in the chest cavity. Using traditional surgical methods, opening the chest cavity (thoracotomy) for thoracic surgery requires a seven- or eight-inch incision and the removal of a rib. Using the da Vinci robotic procedures, surgeons can accomplish better quality surgery using incisions only one to two inches long. This reduces the trauma to the chest wall and patients can recover more quickly.
Surgeons at Sentara Heart Hospital's® thoracic surgery program expect to use the robotic procedures primarily for lung cancer and other types of complex thoracic surgeries that require more specialized care.
With robotic-assisted surgery, surgeons can perform procedures using three small incisions versus one long surgical incision. The results are a welcome improvement in patient recovery time.
Sentara Heart Hospital® is one of the only two programs in the state that tracks its quality thoracic outcomes against data from the Society of Thoracic Surgeons. For the past two years, the mortality rate for lobectomy has been zero compared with the national 2 percent mortality rate.
Breast-Specific Gamma Imaging: When A mammogram is inconclusive
A new technique called Breast-Specific Gamma Imaging (BSGI) is assisting doctors in evaluating areas of concern when a mammogram is inconclusive. By imaging metabolic activity of lesions in the breast, physicians have an additional tool for diagnosing—or ruling out— early stage breast cancer. This technology is currently available at Sentara CarePlex Hospital.
An x-ray mammogram remains the primary screening tool for early detection of breast cancer. But when the complexity of the breast tissue or other diagnostic challenges make the mammogram results uncertain, additional testing such as Breast Ultrasound, Breast MRI or Stereotactic Breast Biopsy may be needed. Breast-Specific Gamma Imaging is one of the newest technologies available to women in our area.
Where mammography measures differences in tissue density, BSGI works on a cellular level, offering non-invasive advanced imaging of the metabolic activity of breast lesions. It can differentiate cancerous tissue from other structures like scar tissue, calcium or non-cancerous tissue.
The equipment for this imaging, the Dilon 6800 Gamma camera, was developed locally by Jefferson Laboratory and is built by Dilon Technologies in Newport News, Va.
BSGI can detect early stage cancers— even in dense tissue, and provide multiple angle views. Breast compression is not required so it can be used for patients with implants.
When mammography cannot answer all the questions, BSGI is especially valuable for patients who have:
- Dense breast tissue
- Suspicious areas on a mammogram
- Lumps that can be felt but not seen with mammography or ultrasound
- Post-surgical or post-therapeutic mass
- Implants and breast augmentation
- Been taking Hormone Replacement Therapy.
This high-resolution camera creates pictures so doctors can see breast cancers as small as as 3 millimeters.This type of testing may also help your doctor clarify whether a biopsy is necessary.
If you are a woman, fight breast cancer by receiving your regular screening mammogram and doing your monthly breast self-exam. For more information, talk to your physician, call 1-800-SENTARA get more information online.
Southside Breakthrough: Zimmer® Gender Solutions™ Knee
A Knee Replacement Designed Just For Women
Sentara orthopedic surgeons are involved in a clinical trial using the Zimmer® Gender Solutions™ Knee, a knee replacement specially designed to fit the anatomy of the female knee. The goal is to have a better fitting knee to reduce post-surgical pain.
It just goes without saying, men and women are different. But did you know that even our knees are different? This is new research that could make a difference to women considering knee replacement surgery.
The Zimmer® Gender Solutions™ Knee for women features a more contoured and proportioned shape to offer a better fit and more natural movement.
After comparing CT scans of female and male knee anatomy, it appears that modifying the size and shape of the existing knee replacement components may result in a better fit for women*.
To that end, the Zimmer® Gender Solutions ™ Knee, is the first knee replacement specially designed for women. Jordan-Young Institute is currently the only group in the country performing a comparative study between the gender knee and the standard total knee. During surgery, each patient is fitted with two different components to ensure the patient receives the implant that best fits their anatomy.
Why Shape Matters
Designed to be more like the front bone of a woman’s knee, the Zimmer® Gender Solutions™ Knee is thinner than traditional knee replacements. Incorrect sizing in a knee replacement component may result in stiffness and pain**. Being more narrow and shaped more like the female knee improves the fit. Additionally, a more natural motion can be achieved with the adjustments made in the degree of the angle between the hip and knee, which differs between men and women.
Up to 25%*** of people continue to experience some degree of pain after knee replacement. The goal of a more anatomically correct knee replacement is to achieve a better fit and reduce the percentage of patients with continued pain, which may be due to overhang of the prostheses, following knee replacement.
Are you a candidate?
The gender specific knee may not be the perfect choice for every woman. If your knee pain is severe enough to keep you from doing the things you enjoy, talk with your doctor or call 1-800-SENTARA for more information.
Reference Sources:
* Maitrise Orthopedique (English Translation Version).
2006 Nov
** J Orthop Surg. 10(2): 194-202, 2002
*** J Bone Joint Surg Am. 2006 Jun: 88(6): 1201-7
Dignity Preserving Surgery for Bowel Control
Sentara surgeons are offering innovative surgeries at Sentara CarePlex Hospital that restore a person's control over bowel functions, and restore the ability to once again enjoy the simple pleasures of life.
It’s often too embarrassing to talk about, but for over 5.5 million Americans*, the lack of bowel control can be devastating. The fear of an “accident” can keep them from living a full life. Loss of bowel control, also called bowel or fecal incontinence, affects people of all ages, from children to adults, and is more common in women than men.
Bowel incontinence may be the result of vaginal childbirth, neurological disorders, fecal impaction or other unknown causes.
Colon cancer is the second most common type of cancer. When cancer is located low in the colon or in the rectum, it can jeopardize the ability of the sphincter muscles to control intestinal functions.
When bowel control is not restored with medication, behavioral changes or other therapies,surgery may be indicated.
Saving Muscle Control
The key to fecal incontinence surgery is a thorough evaluation by a board-certified colon rectal surgeon including a history and physical exam and as indicated, physiologic testing. These specialized tests at Sentara CarePlex Hospital include anorectal manometry, anorectal ultrasound and defecography. New advanced surgical techniques can often preserve the sphincter muscles and bowel control, and avoid a permanent colostomy (where waste is re-routed to a surgical opening in the abdominal wall). The laparoscopic surgical procedures used during the
surgery aid patients with a faster recovery.
If you are having trouble with bowel control, make the decision to talk candidly with your physician about new treatments that will not only help with bowel control but give you back your dignity and lifestyle.
For more information, call 1-800-SENTARA.
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