Hand transplantation is a complex surgery involving attachment of a hand and arm from a donor to a recipient. The procedure involves the reattachment of skin, bone, muscles, nerves, tendons and blood vessels. People in good health who have lost both hands due to trauma may be candidates for hand transplantation in this program. Mayo’s Hand Transplant Program will initially treat patients with bilateral injuries or amputations. 

“Mayo Clinic has extensive experience and national recognition with transplantation and hand surgery,” says Steven L. Moran, M.D., Mayo Clinic plastic surgeon and the program’s co-director. “This, coupled with one of the strongest rehabilitation programs in the country, is one of the many reasons Mayo has embarked on this endeavor to help people who have suffered the traumatic loss of their hands.”

As with all transplants, there is an extensive evaluation process for potential hand transplant patients, which involves physical assessments, blood tests, X-rays, a psychiatric consultation and other tests as needed. Patients will be treated with standard immunosuppression and will be offered the option of participating in clinical research.

“Our hand transplant program highlights the integrative approach that is inherent in the Mayo Clinic Model of Care, bringing together specialists representing a number of areas,” says Hatem Amer, M.D., Mayo Clinic transplant nephrologist and the other co-director. “Our team of caregivers are from Hand and Micro Surgery, Transplant Medicine, Rehabilitation, Immunology, Psychiatry, Neurology, Transplant Infectious Disease and Nursing, to name a few.”

Below are edited youtube videos with Dr. Moran and Dr. Amer that you can embed with your stories.

Dr. Levy’s commentary finds that given that no two patients and no two ACL injuries are identical, it is extremely difficult to recommend a single treatment strategy for all patients with ACL injuries. The study by Frobell et al. confirms that  some patients who are not elite-level athletes can function with an ACL-deficient knee. However, it is  difficult to predict which patients will have symptoms of instability that require surgery, and longer-term data are needed to truly understand the benefits and consequences of each of the two strategies  described in this study. Ultimately, the decision about whether to reconstruct an ACL-deficient knee, and the timing of surgery when reconstruction is indicated, should be individually tailored to address the unique characteristics of each injured knee and to meet the specific needs of each patient.

To read the rest of Dr. Levy’s commentary, please see the lastest issue of NEJM:

http://content.nejm.org/cgi/content/full/363/4/386

Below is a link to an edited youtube video with Dr. Levy.

Researchers analyzed outcomes of 362 patients with only one kidney who underwent surgery between 1990 and 2008 at Mayo Clinic and Cleveland Clinic for renal cortical tumors. Using a technique called warm ischemia, surgeons kept the patient’s kidneys body temperature during the partial nephrectomy. Ischemia involves cutting off the blood supply to the kidney with clamps in order to control bleeding and to keep blood from obscuring the surgeon’s view of the kidney. Ischemia can cause tissue damage from a lack of oxygen and nutrients.

Researchers found that each additional minute of warm ischemia is associated with a five-to-six-percent increase in the odds of developing acute renal failure or reduced kidney functioning and is associated with a six percent increased risk of new onset Stage IV chronic kidney disease during long-term follow-up.

“This is the largest evaluation of warm ischemia time in patients with a single kidney who are undergoing a partial nephrectomy,” says R. Houston Thompson, M.D., a urologist at Mayo Clinic and study primary investigator. “These results suggest that every minute counts when the renal arteries and veins are clamped. When planning for the surgery, surgeons should make efforts to minimize ischemia time, especially in situations where a person only has one kidney,” says Dr. Thompson.

Below is a link to an edited youtube video with Dr. Thompson that you can embed with your stories.

David Ahlquist, M.D., a gastroenterologist with Mayo Clinic and the senior investigator, said that sensitive stool DNA test methods developed at Mayo Clinic can detect common forerunners of colorectal cancer. “Detection of precursor lesions during screening is essential if cancer prevention is the goal,” Dr. Ahlquist says.

Compared to widely used fecal blood tests, stool DNA testing has higher detection rates for curable stage colorectal cancer and for common precancerous polyps (called adenomas).

Detection of Colorectal Precancerous Lesions in Inflammatory Bowel Disease

The first study, presented on May 3 at Digestive Disease Week, involves identifying both cancer and a precancerous lesion, called dysplasia, in people who suffer from IBD. In a blinded study with 10 cases and 10 controls done in conjunction with Mount Sinai Medical Center and the University of Chicago, researchers found that stool DNA testing was positive in nine out of 10 cases (five of five with cancer, and four of five with dysplasia).

“This study shows that cancer and pre-cancer in IBD can be detected noninvasively,” says Dr. Ahlquist. “The 90 percent detection rate by stool DNA testing is remarkable. It’s important for people with IBD because they are at much higher risk for colorectal cancer than the general population. Given the limitations of colonoscopies in detecting these lesions, stool DNA testing could play a complementary role to improve the effectiveness of cancer surveillance.”

Detection of Serrated Colorectal Polyps

The second study, presented on May 4, involves detecting serrated colorectal polyps. Unlike common adenomas, which usually protrude from the colon lining and are easy to see, serrated polyps are typically flat and the same color as the colon lining. Dr. Ahlquist says serrated polyps have been ignored or excluded from most screening studies to date because it wasn’t clear they were associated with cancer. “Now they are regarded as the forerunner in roughly 30 percent of colon cancers,” says Dr. Ahlquist. “Most of these are located on the right side of the colon, where screening has had less impact historically.”

“Detection of these important types of precancer by stool DNA testing offers promise in our efforts to more effectively and affordably prevent colorectal cancer ,” says Dr. Ahlquist. “However, findings from  both pilot studies need to be corroborated in larger studies.”

Below is a link to an edited youtube video with Dr. Ahlquist discussing the IBD study.

SERRATED POLYP STUDY

Below is a link to an edited youtube video with Dr. Ahlquist discussing the serrated polyp study.

Data from 3,846 colonoscopies performed at Mayo Clinic during 2008 were examined in the study. After excluding factors known to influence polyp detection, such as poor bowel preparation and involvement of fellows in training in the procedures, researchers compared polyp detection rates by daily shifts.

“Some people develop colon cancer even after having colonoscopies,” says Gregory Munson, M.D., M.P.H., a gastroenterology fellow at Mayo Clinic and study co-author. “Polyp miss rates are partially to blame, so we want to discover how to make the quality of the colonoscopy exam better.”

Mayo Clinic schedules outpatient colonoscopies during three 3 hour shifts each weekday (a morning shift, 7:30 to 10:30 a.m.; a midday shift, 10:30 a.m. to 1:30 p.m.; and an afternoon shift, 1:30 to 4:30 p.m.). Researchers found the morning shift polyp detection rate was 39.1 percent, midday was 44.6 percent and afternoon was 38.9 percent. The average time a colon was examined during scope withdrawal remained constant throughout the day at just over eight minutes, with only a five-second variation between the shifts with the longest and shortest average times, Dr. Munson says.

“Our endoscopists usually work only one three-hour shift per day rather than a half or full day of endoscopy,” says Dawn Francis, M.D., M.H.S., a gastroenterologist at Mayo Clinic and lead researcher. “With shorter shifts throughout the day, we don’t see the drop in polyp detection rate later in the day that has previously been reported. Other health care facilities might also want to consider a model that breaks up the day into three-hour shifts.”

Below is a link to an edited youtube video with Dr. Munson.

“These study results are strong enough to change clinical practice,” says William Sandborn, M.D., gastroenterologist and vice chair of the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester. “They have certainly changed mine.”

The researchers in the international, multicenter SONIC study recruited 508 patients with Crohn’s disease who were naive to immunomodulator drugs. Of these patients who were randomized to treatment,169 got infliximab monotherapy, 170 azathioprine monotherapy, and 169 infliximab plus azathioprine combination therapy. Patients underwent colonoscopies at a pre-study examination and again at week 26. Patients still in the trial at week 30 were given the option of continuing in a blinded extension trial for another 20 weeks.

Researchers found that 57 percent of patients who received combination therapy with infliximab and azathioprine achieved steroid-free remission after 26 weeks. This is compared to 44 percent of patients who achieved remission with infliximab monotherapy and 30 percent with azathioprine alone. Both the infliximab combination therapy and infliximab monotherapy groups were showed better response than the azathioprine group. These results were similar through week 50.

“Results of this study will provide doctors and their patients with more information on how to use these drugs most appropriately to most effectively treat Crohn’s disease,” says Dr. Sandborn. “For the first time, we have longer-term outcome data on the advantages of combination therapy that will help guide our treatment of patients with Crohn’s disease.”

Below is a link to an edited youtube video with Dr. Sandborn.

Mayo Clinic and the Minnesota Twins announced today they will work together to help improve the health of people across Twins Territory. The relationship will begin April 2 and 3 when Mayo Clinic presents the Exhibition Series as the Twins play their first games in Target Field against the St. Louis Cardinals (April 2 at 5:10 p.m. and April 3 at 1:10 p.m.).

The two organizations are teaming up to provide on-site health screenings and educational events before Twins’ home games, pregame interviews with Mayo Clinic physicians on health topics, and other collaborative efforts throughout the year.

“The Twins are proud to build a relationship with Mayo Clinic to encourage people throughout Twins Territory to maintain and enhance their health,” says Dave St. Peter, Twins president. “We are excited to work together with another Minnesota organization with such a strong tradition of excellence, teamwork and success.”

The content of the health screenings, educational events, in-stadium signage and print advertisements will center primarily around three areas: heart, neurosciences and orthopedics. The emphases will be on both maintaining and enhancing health as well as showcasing Mayo Clinic as the place to go when expert care is needed.

“Mayo Clinic is excited to work with the Minnesota Twins,” says John Noseworthy, M.D., president and CEO of Mayo Clinic. “By teaming up with the Twins, we share ways for fans to improve their own health and remind fans throughout the region that Mayo Clinic is close to home so that if you or a family member is faced with a serious health condition, we can help you find the answers you need.”

To learn more about the Mayo Clinic-Twins relationship and the dates of the offered health screenings, visit http://www.mayoclinic.org/mntwins/.

Data from the Centers for Disease Control and Prevention’s National Hospital Discharge Survey were compared for 1990-1994 and 2002-2006 for patients having total knee replacements (also known as total knee arthroplasty). About 800,000 procedures were performed in 1990-1994, and 2.1 million in 2002-2006.

Researchers found the average age of total knee replacement patients decreased by two years (from 70 years to 68 years) between the two time periods and that the percentage of minorities increased by 1.4 percent (from 8 percent to 9.4 percent).

The study also found that Medicare is paying less for total knee replacements, and the length of hospital stays decreased. The Medicare payment for the procedures dropped from 72 percent to 61 percent. Hospital stays went from 8.4 days to 3.9 days. This coincides with an increase in the number of patients going to short- or long-term care facilities after surgery.

“This information will be useful for planning for the future,” says Michele D’Apuzzo, M.D., the Mayo Clinic orthopedic surgery resident who led the study. “Total knee replacements aren’t going away any time soon. We’re going to be seeing younger patients undergoing this procedure. Younger patients have a higher chance of getting revisions, and physicians and medical facilities need to prepare for that.”

 Below is a link to an edited youtube video with Dr. D’Apruzzo. 

“These are some of the strongest findings yet between vitamin D and cancer outcome,” says the study’s lead investigator, Matthew Drake, M.D., Ph.D., an endocrinologist at Mayo  Clinic in Rochester, Minn. “While these findings are very provocative, they are preliminary and need to be validated in other studies. However, they raise the issue of whether vitamin D supplementation might aid in treatment for this malignancy, and thus should stimulate much more research.”

The researchers’ study of 374 newly diagnosed diffuse large B-cell lymphoma patients found that 50 percent had deficient vitamin D levels based on the commonly used clinical value of total serum 25(OH)D less than 25 ng/mL. Patients with deficient vitamin D levels had a 1.5-fold greater risk of disease progression and a twofold greater risk of dying, compared to patients with optimal vitamin D levels after accounting for other patient factors associated with worse outcomes.

The study was conducted by a team of researchers from Mayo Clinic and the University of Iowa. These researchers participate in the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence (SPORE), which is funded by the National Cancer Institute. The 374 patients were enrolled in an epidemiologic study designed to identify predictors of outcomes in lymphoma. Since this was not a clinical trial, patient management and treatments were not assigned, but rather followed standard of care for clinical practice.

The findings support the growing association between vitamin D and cancer risk and outcomes, and suggest that vitamin D supplements might help even those patients already diagnosed with some forms of cancer, says Dr. Drake. “The exact roles that vitamin D might play in the initiation or progression of cancer is unknown, but we do know that the vitamin plays a role in regulation of cell growth and death, among other processes important in limiting cancer,” he says.

Below is a link to an edited youtube video featuring Dr Witzig and Dr. Drake.

Of the 616 men, 58 (9.4 percent) developed prostate cancer. Men who were diagnosed with prostate cancer had a faster rise in PSA (6 percent/year) compared to men who were not diagnosed with cancer (3.3 percent/year). However, the increase in prostate size was similar between these two groups (median change of 2.2 percent/year).

PSA is a substance produced in the prostate gland. Normally, a small amount of PSA enters the bloodstream. A higher amount of PSA or an abrupt rise in PSA levels can indicate a problem, possibly cancer.

“The question we’re trying to answer is, if we see a man with a rising PSA level, could this change in PSA be explained by a proportional increase in prostate size?” says Dr. Breau. “Our data indicate that men with or without prostate cancer have similar rates of prostate growth. If a man’s PSA is quickly rising, he likely deserves a prostate biopsy to determine if he has prostate cancer. Assessment of change in prostate size should not influence the decision to biopsy.”

Below is a link to an edited youtube video with Dr. Breau discussing this research.