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A concussion is more than just a headache

 

Ken Mautner, MD

To ensure better management of sports concussions, physicians at Emory Sports Medicine Center have incorporated Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) into their program for high school athletes.

 

Concussions occur in about 10 percent of all athletes in contact sports.

They are caused by sudden and violent rocking of the brain inside the skull from a traumatic blow to the head or upper body.

Symptoms vary in length of time and may include amnesia, disorientation, confusion, fogginess, headache, blurred vision, nausea, fatigue and sometimes loss of consciousness.

Ken Mautner, MD, sports medicine physician and assistant professor in the Department of Orthopaedics at Emory University School of Medicine, says that most athletes recover completely from concussions as long as they are not returned back to play too soon.

Repeated concussions are cumulative and may cause critical damage to the brain.  Studies have indicated a possible association with frequent or untreated concussions and development of dementia, depression and, most recently, ALS (Lou Gehrig’s Disease).  Going back to the sport too soon, before the brain recovers, leaves athletes vulnerable to repeat concussions.

Athletes in the ImPACT program take a 20-minuted baseline test on a computer that measures brain processing such as speed, memory, and visual motor skills.

Each individual’s data are stored in a computer file. In the event of injury, the athlete will take the ImPACT test in the days following concussion.  Post-concussion data are then compared to baseline data to help determine the severity and effects of the injury.

Mautner says that data from ImPACT combined with a thorough history and physical exam is the best way to prevent athletes from getting “back in the game” too soon.

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First of its kind neurosurgery boot camp held at Emory

Emory’s Department of Neurosurgery recently hosted a two-day boot camp for first-year neurosurgery residents. The unique event was part of a new national course launched by the Society of Neurological Surgeons (SNS) in Atlanta and five other cities including Boston, Portland and Chicago.

The course focused on fundamental skills, patient safety, professionalism and communications. Day one was structured in a traditional lecture format, while day two placed participants in simulated operating room environments and neurosurgical procedures.

A first-year neurosurgery resident participates in the nation's first series of neurosurgery boot camps.

“This boot camp concept is the first of its kind in medicine providing interns with a strong foundation to learn basic concepts and procedures and helping to ultimately reduce the number of errors among training residents,” says Costas Hadjipanayis, MD, PhD, assistant professor of neurosurgery at Emory School of Medicine and chief of neurosurgery service at Emory University Hospital Midtown.

More than 90 percent of all incoming neurosurgery residents in the United States participated in the training at one of the sites. Emory neurosurgical faculty, fellows, and residents led intensive and interactive exercises oriented to fundamental bedside procedural and operative skills.

The exercises were designed to allow residents to familiarize themselves with the basics in an educational and risk-free environment. Skills relevant to all first-year residents were covered, such as line placement and suturing, as well as specific neurosurgical skills like drilling and performing a craniotomy.

According to Hadjipanayis, one of the Emory organizers and course directors, the group of 37 interns participating in the Atlanta training was the largest number nationwide. They were from universities across the region ranging from Virginia to Puerto Rico.

“This was definitely a great start to a course we will cultivate and enhance from year to year,” says Hadjipanayis. “Our goal is for continuous evaluation and improvement.”

Click here to view a CNN news story filmed at the Emory boot camp by CNN medical correspondent and Emory neurosurgeon, Sanjay Gupta, MD.

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New technology enables precision in jaw reconstruction

Steven Roser, MD

When people have misaligned jaws where the upper and lower teeth don’t match, the functional impact ranges from articulation and speech problems to problems with eating.

When jaw reconstruction is required, the outcome must be precise. The way people eat and bite is a very sensitive mechanism, and teeth have to meet in a certain way in order to bite and chew correctly.

Planning the surgery is the key.

A new system being used by Emory oral and maxillofacial surgeons helps them reach a level of preoperative planning that they had not been able to achieve before.

The system takes data from the patient obtained through CT scan (Computed Tomography) and optical scanning, and puts it into a software program that has been developed to allow the surgery to be performed virtually on the computer. This preoperative planning assists in the construction of an accurate intra-operative guide.

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Little eyes – big research

Having a newborn and managing all that comes with caring for that new little one is a big job. Add to that frequent trips to the ophthalmologist following a cataract surgery—yes, cataract surgery on a baby—and you might have highly stressed parents. But the parents of little James and slightly older M.J. seem unfazed by all the medical appointments and additional duties that go along with caring for their young sons.

M.J. Burkett and James Weeks became patients in the IATS trial, which has treated 114 babies across the United States.

Both the boys, like 300 babies each year in the United States, were born with a cataract in one eye. In an infant, if the affected eye isn’t surgically addressed within the first few months of life, that eye will not develop properly and vision can be permanently lost. These boys and their parents and 112 other young patients and their families have participated in the Infant Aphakia Treatment Study (IATS), a nationwide, multi-center clinical trial based at the Emory Eye Center. The 10-year study will evaluate whether replacing that lost lens with a contact lens or an intraocular lens (IOL) is preferable.

Adults typically get an IOL implant following cataract surgery. In the past, standard treatment was a contact lens for these babies. IATS randomized children into two groups: those who received IOL implants and those who received contact lenses. Those with IOLs also received glasses for residual vision correction. And both groups had daily patching of the unaffected eye to make sure that the newly corrected eye could become strong.

A team of professionals from Emory and beyond came together to provide the many layers of data necessary for the study. They included experts from the Rollins School of Public Health and the Department of Epidemiology and Data Coordinating Center in the Department of Biostatistics and Bioinformatics, as well as a visual acuity tester from the University of Alabama, Birmingham, who traveled to all sites to check these children.

For more information about IATS, read the feature article “One Big Question: Ten Diligent Years” in Emory Eye magazine’s summer 2010 issue.

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Survivors of intimate partner violence find safety, hope and purpose

Nadine Kaslow, PhD

Nadine Kaslow, PhD, Emory psychologist and professor in the Department of Psychiatry and Behavioral Sciences at Emory, has learned a lot about Intimate Partner Violence (IPV) over the last two decades. In the 1990’s, Kaslow began the development of a program that was eventually named the “Nia Project.”

Nia is a counseling program for abused and suicidal African American women, funded by grants from the Centers for Disease Control and Prevention (CDC) and the National Institute of Mental Health. The name comes from the Kwanzaa term that means “purpose.”

Nia serves countless numbers of abused (click site for information on domestic abuse) and suicidal women who come through Atlanta’s Grady Memorial Hospital’s emergency department each year. The women come in with black eyes, broken bones, and broken spirits, often inflicted by the people who are supposed to love them the most: their husbands, boyfriends and partners.

According to the CDC, Intimate Partner violence resulted in more than 1,500 deaths in the United States in 2005.  Statistics from the Commission on Domestic Violence show that African American females experienced intimate partner violence at a rate 35 percent higher than that of white females, and about 22 times the rate of women of other races. The number one killer of African American women ages 15 to 34 is homicide at the hands of a current or former intimate partner.

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Study: Prescription and OTC drugs leading culprits of kids’ poisonings

A study published online Aug. 4, 2010, by the journal Pediatrics found that prescription and over-the-counter drugs are the leading cause of accidental poisonings among American children.

Each year, more than 71,000 U.S. children ages 18 and younger are seen in emergency rooms for unintentional overdoses of prescription and over-the-counter drugs, according to the study authors.

More than two-thirds of emergency department visits are due to poisoning from prescription and over-the-counter medications — that’s more than double the rate of childhood poisonings caused by household cleaning products, plants and the like, the researchers noted.

Robert Geller, MD, Emory professor of pediatrics and medical director of the Georgia Poison Control Center

“The number of children seen in the emergency room due to overdoses that are unintentional or medication errors is remarkable,” says Robert Geller, MD, professor of pediatrics in the Emory University School of Medicine and medical director of the Georgia Poison Center, who was not a part of the study.

The study team used 2004 and 2005 data from the National Electronic Injury Surveillance System to estimate the number of emergency department visits resulting from unintentional medication overdoses for children aged 18 and younger. The stafford nursery keeps kids safe and away from the danger.

The most common medications accidentally taken by children are acetaminophen, opioids or benzodiazepines, cough and cold medicines, nonsteroidal anti-inflammatory drugs (NSAIDs) and antidepressants, researchers found.

Geller says the study highlights the growing need to improve packaging to cut the number of cases of unintended ingestion.

“If you could make it harder for a kid who came upon a package to get the contents of the package, it would make it more likely they would never need to go to the emergency room,” Geller noted.

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Heart disease pioneer named ‘Georgia Woman of the Year’

Many people know that heart disease is currently the number one killer of women in the United States. But a little more than a half a century ago it was widely believed that cardiovascular disease only affected men. Renowned cardiologist, Nanette K. Wenger, MD, challenged this theory and thanks to her pioneering efforts over the last 50 years women today know better.

2010 Georgia Woman of the Year, Nanette K. Wenger, MD

Wenger, a professor of medicine in the division of cardiology at Emory University School of Medicine and former chief of cardiology at Grady Memorial Hospital, is being honored as the 2010 Georgia Woman of the Year for her lifetime commitment to reducing women’s disability and death from cardiovascular disease.

She joins the ranks of other distinguished Georgia women including First Lady Rosalynn Carter who was named the first Georgia Woman of the Year in 1996 by the Georgia Commission on Women. In addition to this prestigious accolade, Wenger has accumulated dozens of awards throughout her celebrated career including the Lifetime Achievement Award from the American College of Cardiology in 2009. She is a sought after lecturer for issues related to heart disease in women, heart disease in the elderly, cardiac rehabilitation, coronary prevention and contemporary cardiac care.

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Ventricular Assist Therapy Helping More Heart Failure Patients

After a long battle with congestive heart failure, former Vice President Dick Cheney this month was implanted with a left ventricular assist device (LVAD) in order to help improve the pumping function of his ailing heart.  Cheney, who has had numerous documented heart problems and hospitalizations, undoubtedly opted to have the small internal heart pump installed in order to help him live a better quality of life, and potentially reduce his hospital visits in the near future.

An LVAD is a battery-operated, mechanical pump that aids the left ventricle in pumping blood into the aorta.  Most commonly, an LVAD is installed to help patients survive the wait until a fully-functioning heart is available for transplant. However, in some cases the LVAD is used as a form of destination therapy (in place of a transplant) for patients who are not candidates for heart transplant. In 2006, surgeons at Emory University Hospital implanted Georgia’s first ventricular assist device (VAD) as destination therapy.

“When offering LVAD destination therapy, our goal is to safely integrate patients back to their respective communities and normal mode of living,” according to David Vega, MD, surgical director of the Emory Heart Transplant Program.

“Ventricular assist devices offer new hope and a much greater quality of life for individuals who are not transplant candidates, patients who do not want a transplant or those who may be transplant eligible in the future.”

According to the United Network for Organ Sharing (UNOS) there are more than 3,100 Americans – 34 in Georgia – who are currently awaiting a heart transplant. Regardless of the number of donor hearts available, many patients are not candidates for a heart transplant for a variety of reasons including cancer, personal and religious beliefs, blood clotting problems, and other debilitating health conditions.

“There are approximately five million Americans who suffer from congestive heart failure, with another half million diagnosed each year. Many of these people are limited by the severity of their heart failure, yet are not able to be transplanted for one of many reasons,” adds Dr. Vega. “These devices may be a viable option for many patients, allowing them to resume a much more normal lifestyle and improved quality of living.”

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Emory University Hospital celebrates 3000th bone marrow transplant


An Emory University Hospital patient recently prepared to celebrate a “birthday” with family, friends and caregivers  – but this was no typical birthday according to any calendar or tradition.

Instead, cheerful songs and celebratory clapping echoed through the halls of the Bone Marrow Transplant Unit at Emory University Hospital, as always when a potentially life-saving bone marrow transplant is about to occur. And the tradition did not stop on May 20, as the unit physicians, nursing staff, patients and hospital administrators gathered to celebrate the 3000th transplant.

Encouraged by Emory’s success, Edmund Waller, MD, PhD, director of Emory’s Bone Marrow and Stem Cell Transplant Center says, “While 3,000 is a nice round number, it’s the middle of a growing and successful program. After 3,000 procedures, I know we all look forward to the future of this program.”

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Pituitary tumors removed using a 3-D endoscope

Although the size of a pea, the pituitary gland, located deep within the skull at the base of the brain, is indispensible.

Known as the master gland, it directs other glands to produce hormones that affect metabolism, blood pressure, sexuality, reproduction, and development and growth, as well as other bodily functions.

Nelson Oyesiku, MD, PhD, on right

So when something goes wrong with the pituitary, such as the development of a tumor, the consequences can be serious, even life threatening. Relatively common, pituitary tumors initially can be difficult to diagnose and, once found, difficult to remove because they are surrounded by so many nerves, such as those that supply the eye with movement and vision and blood vessels that supply the brain with blood.

Emory’s Pituitary Center is one of a handful of medical centers across the country using the latest 3-D endoscope for removal of pituitary tumors, a delicate and precise procedure. Having the new 3-D endoscope is a tremendous aid for a surgeon when operating on a small organ at the base of the brain, says Emory neurosurgeon Nelson Oyesiku, MD, PhD.

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