UPMC Physician Resources

Archives for Neurosurgery

Save the Date: Stroke Update 2014

PITTSBURGH, July 7, 2014 – Stroke Update 2014 will be held at the Wyndham Grand Pittsburgh Downtown in Pittsburgh, Pa., on Friday, September 5, 2014.

This conference will cover the identification, management, and treatment of stroke in young adults, intracerebral hemorrhage, subarachnoid hemorrhage, and intracerebral swelling. Clinical applications for telemedicine and the benefits of telestroke also will be discussed.

Who Should Attend
This conference is designed for neurologists, neurosurgeons, interventionalists, emergency medicine physicians, family practitioners, internists, nurses, nurse practitioners, pre-hospital personnel, and hospital administrators.

Location
Wyndham Grand Pittsburgh Downtown
600 Commonwealth Place
Pittsburgh, PA, 15222

Course Directors
Tudor G. Jovin, MD
Associate Professor of Neurology and Neurosurgery
Director, UPMC Stroke Institute
Department of Neurology

Lori M. Massaro, MDN, CRNP
Clinical Supervisor
UPMC Stroke Institute
Department of Neurology

Ashutosh P. Jadhav, MD, PhD
Assistant Professor of Neurology
UPMC Stroke Institute
Department of Neurology

To view the full course brochure, or to register online, please visit the Upcoming Events page at the Center for Continuing Education in the Health Sciences and click the ‘Stroke Update 2014′ link.

Continuing Education Credit
The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of Pittsburgh School of Medicine designates this live activity for a maximum of 6.5 AMA PRA Category 1 Credits™. Each physician should claim only credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded 0.6 continuing education units (CEUs) which are equal to 6.5 contact hours.

Nursing: The University of Pittsburgh Medical Center (UPMC) is an approved provider of continuing nursing education by PA State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. This program is awarded 6.5 contact hours. Participants must attend the entire day and complete an evaluation form to be awarded a certificate and 6.5 contact hours.

Pitt Study Shows for First Time How Huntington’s Disease Protein Could Cause Death of Neurons

PITTSBURGH, May 18, 2014 – Scientists at the University of Pittsburgh School of Medicine have identified for the first time a key molecular mechanism by which the abnormal protein found in Huntington’s disease can cause brain cell death. The results of these studies, published today in Nature Neuroscience, could one day lead to ways to prevent the progressive neurological deterioration that characterizes the condition.

Huntington’s disease patients inherit from a parent a gene that contains too many repeats of a certain DNA sequence, which results in the production of an abnormal form of a protein called huntingtin (HTT), explained senior investigator Robert Friedlander, M.D., UPMC Professor of Neurosurgery and Neurobiology and chair, Department of Neurological Surgery, Pitt School of Medicine. But until now, studies have not suggested how HTT could cause disease.

“This study connects the dots for the first time and shows how huntingtin can cause problems for the mitochondria that lead to the death of neurons,” Dr. Friedlander said. “If we can disrupt the pathway, we may be able to identify new treatments for this devastating disease.”

Examination of brain tissue samples from both mice and human patients affected by Huntington’s disease showed that mutant HTT collects in the mitochondria, which are the energy suppliers of the cell. Using several biochemical approaches in follow-up mouse studies, the research team identified the mitochondrial proteins that bind to mutant HTT, noting its particular affinity for TIM23, a protein complex that transports other proteins from the rest of the cell into the mitochondria.

Further investigation revealed that mutant HTT inhibited TIM23’s ability to transport proteins across the mitochondrial membrane, slowing metabolic activity and ultimately triggering cell-suicide pathways. The team also found that mutant HTT-induced mitochondrial dysfunction occurred more often near the synapses, or junctions, of neurons, likely impairing the neuron’s ability to communicate or signal its neighbors.

To verify the findings, the researchers showed that producing more TIM23 could overcome the protein transport deficiency and prevent cell death.

“We learned also that these events occur very early in the disease process, not as the result of some other mutant HTT-induced changes,” Dr. Friedlander said. “This means that if we can find ways to intervene at this point, we may be able to prevent neurological damage.”

The team’s next steps include identifying exact binding sites and agents that can influence the interactions of HTT and TIM23.

Co-authors of the paper include other scientists from the University of Pittsburgh School of Medicine and Washington University School of Medicine.

The project was funded by National Institutes of Health grants NS039324, NS077748 and AG033724; the Brain & Behavior Research Foundation; the DSF Charitable Foundation; and the Huntington’s Disease Society of America.

Second Annual Update on the Multidisciplinary Management of Pituitary Tumors

PITTSBURGH, Feb. 27, 2014 – The Second Annual Update on the Multidisciplinary Management of Pituitary Tumors will be held at UPMC Shadyside in Pittsburgh, Pa., on Friday, April 4, 2014.

This conference will cover the most recent advances in the diagnosis and treatment of pituitary tumors, including functioning and nonfunctioning tumors, hypopituitarism, and pituitary adenomas. The role of and advances in surgical and medical therapies for pituitary tumors, and perioperative management of pituitary tumors will also be discussed.

Who Should Attend
This conference is designed for physicians, physicians’ assistants, nurses, and other health care professionals practicing in the areas of Endocrinology and Metabolism, Family Medicine, General Internal Medicine, and Neurosurgery.

Location
UPMC Shadyside, West Wing Auditorium – First Floor, 5230 Centre Avenue, Pittsburgh, PA, 15232

Course Directors
Paul A. Gardner, MD
Associate Professor of Medicine
University of Pittsburgh School of Medicine
Co-Director, Center for Cranial Base Surgery, UPMC

Sue M. Challinor, MD
Associate Professor of Medicine
Division of Endocrinology and Metabolism
University of Pittsburgh School of Medicine

For more information, or to register online, please visit the Center for Continuing Education in the Health Sciences page.

Continuing Medical Education
The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of Pittsburgh School of Medicine designates this live activity for a maximum of 6.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded 0.6 continuing education units (CEUs) which are equal to 6.2 contact hours.

UPMC Physicians Offer Lectures Throughout the Region

UPMC has assembled a group of physician leaders from UPMC Passavant who will be available to make informal, informational presentations to small groups as well as larger audiences in western Pennsylvania, northern West Virginia, and eastern Ohio. These physicians represent a wide range of specialties and will discuss topics related to their specific clinical interests.

Physician presenters can discuss topics such as brain surgery, cardiac surgery, cardiology, colon and rectal surgery, orthopaedics, plastic and reconstructive surgery, spine surgery, surgical oncology, and vascular surgery.

The featured speakers include:

For more information about this new lecture series and specific topics, or to schedule a presentation, in western Pennsylvania, northern West Virginia, or eastern Ohio email OPRoutreach@upmc.edu.

Chief of Pediatric Neurosurgery Named Chairman of Scholarly Journal

Ian F. Pollack, MD, chief of the Division of Pediatric Neurosurgery at Children’s Hospital of Pittsburgh of UPMC, was recently named chairman of the editorial board of the Journal of Neurosurgery: Pediatrics. Dr. Pollack has served on the editorial board since 2003.

The Journal of Neurosurgery publications are scholarly journals of the American Association of Neurosurgeons. The Journal of Neurosurgery: Pediatrics was originally a quarterly supplemental, but has been published monthly since 2005.

Dr. Pollack is the Walter Dandy Professor of Neurological Surgery at the University of Pittsburgh School of Medicine and co-director of the Brain Tumor Center of the University of Pittsburgh Cancer Institute. His primary research interests focus on identifying and evaluating innovative strategies for treating malignant brain tumors, improving the treatment of children with brain tumors, and optimizing the management of childhood craniofacial disorders.

Children’s Hospital of Pittsburgh of UPMC & Pitt Public Health Researchers Receive NIH Grant to Study Pediatric Traumatic Brain Injuries

PITTSBURGH, July 25, 2013 Children’s Hospital of Pittsburgh of UPMC and University of Pittsburgh Graduate School of Public Health researchers have been selected by the National Institutes of Health (NIH) to lead a $16.5 million international study to evaluate treatments for pediatric traumatic brain injuries (TBI).
This effort is being led by Michael J. Bell, M.D., director, Pediatric Neurocritical Care and Neurotrauma at Children’s Hospital and Stephen Wisniewski, Ph.D., senior associate dean and co-director of the Epidemiology Data Center at Pitt Public Health. Dr. Bell will coordinate patient enrollment and clinical activities within the project and Dr. Wisniewski will coordinate data collection and the statistical analysis for this project.
The five-year study aims to provide compelling evidence to change clinical practices and provide recommendations for guidelines that could immediately improve outcomes for injured children.
The researchers plan to enroll 1,000 children up to 18 years old from over 36 locations in the United States and abroad to compare the effectiveness of immediate treatments of the injury, including strategies to lower intracranial pressure, strategies to treat secondary injuries and the delivery of nutrients in a study that is called the Approaches and Decisions for Acute Pediatric TBI (ADAPT) Trial.
“Incremental improvement in outcomes of traumatic brain injury could make enormous differences for the health of children, but such advances have remained elusive,” said Dr. Bell, also associate professor, Critical Care Medicine and Neurological Surgery at the University of Pittsburgh School of Medicine. “No mitigating treatments have been translated into clinical practice, so we hope this study helps us gain a better understanding of contemporary therapies.”
“Traumatic brain injury is the leading cause of death in children in the U.S. with the CDC estimating more than 7,000 children dying each year from TBI,” said Dr. Wisniewski, also professor of Epidemiology at Pitt Public Health. “Given the incidence of the condition and the outcomes from previously reported clinical studies, we estimate that up to 1.3 million life-years are at risk each year from severe TBI. Any benefits that can be gained by improving clinical practice can have enormous consequences for children right now, and for clinical trials in the future.”
The study, which is expected to more than double existing evidence-based treatment recommendations for traumatic brain injuries in children, will provide volumes of data for improved TBI research protocols that would limit variability in treatments. Such variability has led to the failure of previous randomized controlled trials. The study also will evaluate the effectiveness of six therapies encompassing three specific aims – intracranial hypertension therapies, secondary insult prevention, and metabolism.
Children with severe traumatic brain injuries where an intracranial pressure monitor is placed will be enrolled in the study. The children will receive the standard of care offered by their hospital in the United States and Europe and extensive data on their cases will be collected over the week following the injury. Outcomes will be tested at 6 months and 1 year after injury for all children.
Dr. Wisniewski plans to use statistical methods to evaluate the impact of treatments on outcomes up to one year after the injury. This will allow the researchers to determine what approach works best.
“Completion of this study will provide compelling evidence to change clinical practices, provide evidence for new recommendations for future guidelines and lead to improved research protocols that would limit inconsistencies in traumatic brain injury treatments – helping children immediately through better clinical practices and ultimately through more effective investigation,” Dr. Bell said.
“Beyond the large impact that these recommendations will have on the field of pediatric traumatic brain injury, we expect our study to lead to the development of feasible randomized controlled trials,” Dr. Wisniewski said. “Such trials are the best way to provide assurances that a recommended treatment truly has the greatest odds of healing an injured child.”
“This novel study, which includes many dedicated international physicians and scientists, has the potential to accelerate our knowledge of how to treat children who sustain severe traumatic brain injuries,” said Ramona Hicks, Ph.D., a program director at the NIH National Institute of Neurological Disorders and Stroke (NINDS), which is providing the grant support for the study. “NINDS looks forward to rapid results that will inform clinical practice within the next few years.”
Other key investigators on the project include an international group of TBI experts: Patrick M. Kochanek, M.D. and Sue Beers, Ph.D., University of Pittsburgh; P. David Adelson, M.D., Barrow’s Neurological Institute Phoenix Children’s Hospital; Jamie Hutchison, M.D., The Hospital for Sick Children in Toronto; Robert Tasker, M.D., Boston Children’s Hospital; and Monica Vavilala, M.D., University of Washington. Statisticians and epidemiologists include Tony Fabio, Ph.D., M.P.H. and Sheryl Kelsey, Ph.D., Pitt Public Health; and Joel Greenhouse, Ph.D., M.P.H., Carnegie Mellon University.  Collaborators from the NIH include Deborah Hirtz, M.D., and Ramona Hicks, Ph.D.

UPMC Again Earns Top-10 Spot on U.S. News & World Report Honor Roll of America’s Best Hospitals

PITTSBURGH, July 16, 2013UPMC clinches the 10th place in U.S. News & World Report’s annual Honor Roll of America’s Best Hospitals for the second year in a row – again making it the highest-ranked medical center in Pennsylvania.
 
“This prestigious recognition speaks to the skill and commitment of UPMC physicians, nurses and staff as they continue to provide exceptional care to our community. UPMC is dedicated to making a difference in the lives of our patients, and we are honored when our excellence in health care is recognized,” said Elizabeth Concordia, executive vice president of UPMC and president of the Hospital and Community Services Division. “We are proud that patients continue to choose us to deliver world-class care right here in western Pennsylvania.”
 
Nationally, UPMC is ranked for excellence in 15 of the 16 specialty areas, and is among the top 10 hospitals in eight specialties: Ear, Nose & Throat; Gastroenterology; Geriatrics; Gynecology; Neurology and Neurosurgery; Psychiatry; Pulmonology and Rheumatology.
 
Last month, U.S. News named its 2013 Honor Roll of America’s Best Children’s Hospitals, on which Children’s Hospital of Pittsburgh of UPMC ranked 10th. This year marks UPMC’s 14th appearance on the Honor Roll.
 
“UPMC’s national ranking highlights our unique combination of superb medical care, a leading health insurance plan and close ties to one of the nation’s best medical schools at the University of Pittsburgh,” added Steven Shapiro, M.D., executive vice president and chief medical and scientific officer, UPMC.  “We are proud to be a leader on the U.S. News Honor Roll — but, most importantly, to be leading the way in developing new and better ways of taking care of patients.”

Brain Abnormalities Found in Concussion Patients Similar to those in Alzheimer’s Patients, Pitt Study Finds

PITTSBURGH, June 18, 2013 – The distribution of white matter brain abnormalities in some patients after mild traumatic brain injury (mTBI) closely resembles that found in early Alzheimer’s, according to a new study published in this month’s Radiology by University of Pittsburgh School of Medicine investigators.
White matter in the brain is made up of long, finger-like fibers projecting from nerve cells and is covered by a whitish fatty material. While gray matter, the part of our brain without the fatty covering, holds our knowledge, white matter is what connects different regions of gray matter, allowing different parts of the brain to communicate with one another.
The study suggests that the initial traumatic event that causes mTBI, or concussion, acts as a trigger for a sequence of degenerative changes in the brain, which result in patient symptoms and are very similar to the degenerative changes seen in early Alzheimer’s. Saeed Fakhran, M.D., assistant professor of radiology at Pitt, and his research team wanted to see if there was a relationship between white matter injury patterns and severity of post-concussion symptoms in mTBI patients with normal findings on conventional magnetic resonance imaging (MRI) exams. The researchers studied data from imaging exams performed on 64 mTBI patients and 15 control patients utilizing an advanced MRI technique called diffusion tensor imaging (DTI), which identifies microscopic changes in the brain’s white matter.
“In the past, we believed that patients with mTBI have symptoms because of abnormalities secondary to the initial injury,” said Dr. Fakhran. “Our preliminary findings suggest that the initial event causing the concussion is like lighting a fuse, acting as a trigger for a sequence of degenerative changes resulting in patient symptoms that could potentially be prevented.”
According to Dr. Fakhran, sleep-wake disturbances (SWD) are among the most debilitating post-concussive symptoms, affecting patients’ quality of life and productivity and magnifying post-concussion memory and social dysfunction. Such disturbances are among the earliest symptoms in Alzheimer’s patients, and also are seen in many mTBI patients. In addition, many mTBI patients have difficulty filtering out white noise and concentrating on important sounds, making it difficult for them to understand the world around them. Hearing problems are an independent risk factor for developing Alzheimer’s disease, and the same type of problem in mTBI patients has predicted which patients with memory problems will eventually develop Alzheimer’s disease.
“For this study, we looked back, analyzing images of injuries. In further research, we hope to recruit patients immediately after their injury and watch brain changes as they occur over time. The first step in developing a treatment for any disease is understanding what causes it, and if we can prove a link, or even a common pathway, between mTBI and Alzheimer’s it could potentially lead to effective treatment strategies for both diseases,” said Dr. Fakhran.

Pitt Researchers Find No Increase in Brain Cancer Related to Working at Connecticut Jet Engine Manufacturing Plant

PITTSBURGH, May 24, 2013 – Researchers at the University of Pittsburgh Graduate School of Public Health have concluded a 12-year, multi-part study into a perceived increase in brain cancer at the Pratt & Whitney jet engine manufacturing plant in North Haven, Conn., and have found no statistically significant elevations in the overall cancer rates among the workforce.
The results of the study, available online, will be published in the June edition of the Journal of Occupational and Environmental Medicine.
In May 2000, the Connecticut Department of Public Health (CTDPH) began an investigation of a reported increase in brain cancer at the North Haven facility and identified several cases of glioblastoma (GB), the most common form of brain cancer. A preliminary comparative cancer incidence analysis was inconclusive, and the CTDPH recommended Pratt & Whitney hire an independent research group to conduct a comprehensive study.
In July 2002, Gary Marsh, Ph.D., director of the Center for Occupational Biostatistics and Epidemiology, Pitt Public Health, and Nurtan Esmen, Ph.D., Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago (UIC), began work on a large, multi-part investigation to determine whether mortality from or the incidence of central nervous system (CNS) neoplasms, or tumors, including GB, were elevated among workers at the North Haven plant or seven other Pratt & Whitney facilities serving as comparison sites, and whether those rates were associated with specific workplace exposures.
“Pitt Public Health and UIC researchers analyzed the records of almost a quarter million subjects over a 53-year period, making it one of the largest and most comprehensive cohort studies in an occupational setting,” said Dr. Marsh. “It also is the first large-scale study of workers in the jet engine manufacturing industry.”
Pitt epidemiologists and biostaticians studied the employment records and death certificates of more than 223,000 Pratt & Whitney workers employed during a period stretching from 1952 to 2001. Researchers identified 723 workers diagnosed with CNS neoplasms during 1976 to 2004. Those tumors were malignant, benign or unspecified, and included 277 GB cases. Researchers interviewed workers or available family members to gain more detailed information on behavioral and personal lifestyle factors. Low participation rates precluded analysis of this data, but the Pittsburgh case-control study provided the basis for a more refined assessment of workplace exposures.
The UIC exposure assessment considered 11 chemical or physical agents on the basis of known or suspected carcinogenic potential that could affect the central nervous system or other organs. UIC generated quantitative exposure estimates for soluble and mineral oil metalworking fluids, nickel, cobalt, chromium, solvents and a combustion aerosol generated during high-speed and high-temperature grinding that was unique to the North Haven plant. Researchers assigned qualitative exposures for ionizing radiation, electromagnetic fields, polychlorinated biphenyls and lead-cadmium. Exposure to one or more of 20 jet engine part families and 16 process categories created for the study also was assigned.
The UIC quantitative estimates showed workers had decreasing exposures to these chemicals over the course of the study period; in addition, the quantitative exposure levels were similar to or lower than those in published data from other industries.
At the conclusion of the study, researchers found no statistically significant increase in overall CNS neoplasm rates among the Pratt & Whitney workforce as compared with the corresponding rates in the general populations of the U.S. and Connecticut. Comparisons among the five Pratt & Whitney plant groups revealed a slightly higher incidence of CNS neoplasms and GB among workers at the North Haven plant; however, further evaluation found no association with estimated workplace exposures.
“If not due to chance alone, the slightly elevated GB rates at the North Haven plant may reflect external occupational factors that we did not measure, or other factors unique to North Haven or the baseline plant used in the internal comparisons,” said Dr. Marsh.
During an overall evaluation of mortality rates from all causes of death, Pittsburgh and UIC researchers noted elevated chronic obstructive pulmonary disease (COPD)-related mortality rates in two of five plant groups studied, but found no association with the occupational factors examined in the study. Researchers could not rule out exposures workers received outside of the workplace, or other risk factors, such as smoking, as reasons for the observed COPD excesses.
Additional co-authors of this study include Ada O. Youk, Ph.D., Jeanine Buchanich, Ph.D., and Sarah Downing, B.S., Department of Biostatistics, Pitt Public Health; Kathleen J. Kennedy, M.S., and Roger P. Hancock, M.C.E., UIC Division of Environmental and Occupational Health Sciences; Steven E. Lacey, Ph.D., Department of Public Health, Indiana School of Medicine, Indianapolis; Jennifer S. Pierce, Ph.D., ChemRisk, LLC, Chicago; Mary Lou Fleissner, Dr.P.H., formerly with the CTDPH Division of Environmental Epidemiology and Occupational Health, Hartford.
The University of Pittsburgh and the University of Illinois at Chicago received funding from Pratt & Whitney for this research, but the design, conduct, analysis and conclusions are those of the authors.

Child Neurodevelopmental and Mental Health Disabilities on the Rise, Children’s Hospital of Pittsburgh of UPMC Study Finds

PITTSBURGH, May 5, 2013 – More children have disabilities now than a decade ago, and the greatest increase is among children of higher-income families, according to a Children’s Hospital of Pittsburgh of UPMC study presented today at the Pediatric Academic Societies(PAS) annual meeting in Washington, DC.

Results of the study, led by Amy Houtrow, M.D., Ph.D., M.P.H., chief, Division of Pediatric Rehabilitation Medicine at Children’s Hospital, also showed that while disabilities due to neurodevelopmental and mental health problems have increased sharply, disabilities related to physical health conditions have decreased. This trend was most noteworthy among children under 6 years of age whose rate of neurodevelopmental disabilities nearly doubled during the study, from 19 cases to 36 cases per 1,000 children.

“A century of health care improvements and social changes have altered the face of childhood chronic disease and disability,” said Dr. Houtrow, who also is an associate professor of physical medicine and rehabilitation and of pediatrics at the University of Pittsburgh School of Medicine. “Nearly six  million kids were considered disabled in 2009 and 2010—almost one million more than in 2001 and 2002.”

Dr. Houtrow said that while previous studies have found an increase in the  prevalence of childhood disability, she and the research team wanted to look more closely at the specific conditions and socio-demographic factors associated with disabilities.

The researchers studied data from the National Health Interview Survey conducted by the U.S. Centers for Disease Control and Prevention from 2001 to 2002 and from 2009 to 2010. Participants included  more than 102,000 parents of children up to age 17.

The research team assembled a composite of disability indicators to identify disabled children and their associated underlying chronic conditions. Conditions were categorized into three groups: physical, neurodevelopmental/mental health, and other.

The overall rate of disability for children under age 18 increased 16.3 percent between the 2001 to 2002 study period and the 2009 to 2010 study period.

Children living in poverty represented the largest numbers of overall children with disability in both time periods but not the highest growth rates. The largest increase in growth rates of disabilities was seen among children living in households with incomes at or above 300 percent of the federal poverty level—about $66,000 a year for a family of four in 2010.

“We are worried that children living in lower income families may be having problems accessing diagnostic and treatment services,” Dr. Houtrow said.

Since the study could not pinpoint why the disability rate is increasing, more research is needed, the author concluded.

Co-investigators were: Kandyce Larson, Ph.D., American Academy of Pediatrics; Paul Newacheck, Dr.P.H., Professor of Pediatrics and Health Policy, University of California San Francisco; Neal Halfon M.D., M.P.H., Professor of Pediatrics, Health Policy and Management, UCLA.

For more information on Dr. Houtrow and the Division of Pediatric Rehabilitation Medicine, visit http://www.chp.edu/rehab.

 

 

 

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