Using the recently acquired da Vinci^® S Surgical System, Dr.  Henry Pham and Dr.  John Boon, urologists on staff at Methodist Sugar Land Hospital, can remove the tumor affecting the kidney and leave the healthy tissue. Patients can then often avoid the increased risk of organ failure that results from having a single healthy kidney.

Dr. Pham and Dr. Boon performed the first robotic nephrectomy in Fort Bend County on patient Michael Gann, leaving him with a barely visible scar and a quicker recovery time.

In the largest study to date, researchers at the Washington University School of Medicine in St. Louis concluded that da Vinci nephrectomy is a safe and effective approach to kidney cancer treatment.

“This robotic-assisted, minimally invasive approach may not only provide patients with excellent short-term cancer control, but for select patients, it may help them keep their kidney and avoid increased risk for life-long dialysis,” said Dr. Pham.

Study co-authors reviewed data from 183 patients who underwent da Vinci nephrectomy at four centers between 2006 and 2008. Of the tumors removed, 69% were malignant and 2.7% of these showed positive surgical margins - meaning there was cancer at the edge of the specimen - a sign that the cancer may not have been taken out completely.

“A da Vinci nephrectomy is comparable to both the open and laparoscopic approaches in terms of cancer control, but with minimal recovery time,” said Dr. Pham.

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Nurse practitioner Art Encarnacion is filing regular reports.

Friday, March 5 - Last night in Haiti … what an experience for us all!  It is with deep sorrow that we have to leave tomorrow because these people need long-term help and rehab, I hope and pray that more medical teams that follow us will transition and continue the solid work that Dr. Lawrence Nguyen has set in place!

But with that said we all long to be home and hug our spouses and children.  I am honored to be have been given this opportunity to help the people of Haiti and share our Methodist I CARE values!  God bless Haiti.  Art out!

Thursday, March 4 -Today has been a much slower day which is a good thing because all the nurses are doing their own wound care in their respective tents.  One of the ladies had to go to surgery because when Celita (Paladio) and I went in to change her dressing, flies were all over her sheets and the odor was tremendous.

Her wound was massively infected and pus was pooling in the middle of the wound bed.  One of the orthopedic surgeons from our team rushed her to the operating room for wound debridement.  I was told by one of the physicians that approximately 90 percent of all the wounds (they are seeing) are infected and they are trying to put all the patients on long-term antibiotics.

This evening, the pediatric ward was given a surprise party by all of us on the nursing and medical staff.  It was quite an experience!

On a personal note, I lost it and had to leave and compose myself.  I just hope and pray that all these wonderful, beautiful children can recover physically and emotionally.  Art out!

Wednesday, March 3 -Kudos to my Methodist colleagues Sarah Alexandre and Chris Windham.  They are physical therapy techs in the United States but here in Haiti they are the cream of the crop!  Also, for nursing representation, mega-kudos to Celita Paladio of Dunn 7 West, who is the only nurse for a tent of 40 female patients, doing what a nurse practitioner does in the United States.

More mega kudos to Rachid El Karrazi, Dunn Operating Room Technician, who is proving his expertise in running a well-organized OR.  I am so proud to be associated with them and they are making The Methodist Hospital proud by spreading the I CARE values here in Haiti!

Dr. Lawrence Nguyen continues to demonstrate his God-given leadership skills and run this relief operation here at Sacre Coeur hospital.  Art out!

Tuesday, March 2 -Today’s weather felt like Houston in the middle of August - super hot and humid! I was sweating non-stop all day and had to keep hydrated.  I learned two Haitian words today: “sho” which means hot, and “swey” which means sweat.

I flew solo today and treated about 15 patients with some foul-smelling wounds.  My heart about broke today because I had to change a dressing on a two-month-old who was found under her dead parents.  She is the little jewel of the pediatric ward!  Busy day, so this will be a short one.  Goodnight.  Art out.

Monday, March 1 - What a day!  Went on wound rounds with a plastic surgeon from (Washington) D.C.  Lots of infections in the wounds, especially with all the flies, no circulating air, bed pans full of feces, urine under the cots … needless to say, a lot of infection.

The cots are inches apart, so it’s only a matter of time for communicable diseases to erupt.  Tomorrow my fellow nurse practitioner wound care specialist leaves, and I’m flying solo.

I want everyone at Methodist to know how proud they should be of Dr. Lawrence Nguyen, medical director of inpatient rehab on West Pavilion 9-10.  He has taken the role of physician leader of all medical personnel (60 total).  Before we got here, there was no organization whatsoever and Dr. Nguyen most definitely righted the ship.  More to come on that later.

Time to get some rest!  Art out.

Read more about this mission to Haiti

Encarnacion, a nurse practitioner in physical medicine and rehabilitation, is part of a Houston-based team traveling to Haiti to give medical care to people injured in the Jan. 12 earthquake.  He will be joined by six other Methodist employees and physicians as Orthopaedic Team No. 9, scheduled to fly to Haiti on Feb. 26 and return to Houston March 7.

“We really don’t know exactly what to expect when we get there,” says Encarnacion.  “The only thing I do know is that this will be a life-changing experience.”

The team includes Dr. Lawrence Nguyen, medical director for Physical Medicine and Rehabilitation at Methodist, and a handful of nurses and physical medicine-rehab technicians.  The group was organized by Drs. Rex Marco and Jerry Sucher, orthopedic surgeons affiliated with the University of Texas-Houston.

“We are the second wave of medical relief,” explains Encarnacion, who has worked at Methodist for nearly four years.  “Many of the surgeries have been done … but there are many people with amputated or disabled limbs, or prostheses, and we hope to use our rehabilitation skills to help them get back into normal life.”

But in the devastated country, “normal life” is a highly relative term.  Doctors and medical workers are doing the best they can to care for more than 300,000 injured people, many of whom have nothing more than the clothes they are wearing.

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The Methodist Hospital in Houston is a top 10 enrolling site for the CREST study (Carotid Revascularization Endarterectomy vs. Stenting Trials), funded by the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health.

CREST, a randomized clinical study, compared carotid endarterectomy, a common operation to treat a narrowing of the carotid artery, with the study procedure, carotid artery stenting. During stenting, a catheter is used to deliver a stent into the carotid artery, where the stent can expand and widen the blocked area and capture any dislodged plaque. In the trial of 2,502 participants, results showed that people at risk for stroke can benefit equally from either medical procedure, designed to prevent future strokes.

Dr. Michael DeBakey performed the first carotid endarterectomy in 1953 at The Methodist Hospital.

“More than 55 years later, Dr. DeBakey’s legacy continues. He helped us set the standard for how we treat this population of patients, and now we have another viable treatment option,” said Dr. David Chiu, CREST principal investigator at Methodist and medical director of the Eddy Scurlock Stroke Center at the Methodist Neurological Institute.

YouTube: Dr. David Chiu describes national stroke prevention study

One of the largest randomized stroke prevention trials ever, CREST took place at 117 centers in the United States and Canada over a nine-year period. The overall safety and efficacy of the two procedures was largely the same with equal benefits for both men and for women, and for patients with or without a previous stroke.

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In the United States, the human bacterial pathogen group A streptococcus causes an estimated 30 million cases of strep throat annually, and also causes rheumatic fever that damages the heart.

“This study has discovered previously unknown ways that a common bacterial pathogen communicates with its host during an infection episode. The result is a new, much higher level of understanding of how infection causes disease,” said Dr. James Musser, senior scientist on the study and co-director of The Methodist Hospital Research Institute. “These discoveries have already provided a wealth of information for future research into new treatments and vaccines, not only for strep throat, but also for other types of life threatening group A strep infections as well.”

“Our results are significant because despite the prevalence of strep throat, currently relatively little is known about what happens on a molecular level regarding interaction between group A streptococcus and the host during a throat infection, said Dr. Patrick Shea, scientist at TMHRI who is the first author of the study. “Advances in genome-wide analyses occurring in the last decade have facilitated the study of global gene changes that occur during microbial infection, giving us important new clues on how better to fight and prevent infections,” he said.

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“Targeting cancer stem cells, rather than cancer cells, is a completely new strategy for treating cancer,” said Dr. Stephen Wong, director of the Center for Bioengineering and Informatics at The Methodist Hospital Research Institute and principal investigator for the grant study. “By attacking the cancer stem cell, we hope to eliminate cancer’s ability to grow, recur or metastasize.”

The NIH grant will enable Wong’s team to model breast cancer stem cells - or see what they look like and how they act - using advanced genetic, imaging and computational modeling techniques. Wong said once the cells are modeled in the lab and in real environments, the team will be able to predict the behavior of cancer stem cells, enabling them to test drugs that might kill the cells or prevent the cells from duplicating and metastasizing.
Cancer stem cells, also called tumor initiating cells, have the ability to resist drugs, become cancer cells, and split into a cancer cell and another stem cell. Traditional cancer treatments use chemotherapy to kill cancer cells, but are not optimized to kill the stem cell.

“Targeting the cancer stem cell is the new horizon for cancer research,” Wong said. “We have put together a very strong team of top experts in the field. We’re able to combine that talent with the technology at our disposal at Methodist, Baylor, and UT. This is a formidable combination that has potential to achieve real breakthroughs in cancer research. It’s great to now have the backing of the NIH to help us move ahead.”

Wong’s team will build a modeling platform for investigation of breast cancer, with special emphasis on the role of tumor-initiating cells (TIC), or cancer stem cells. This platform will consist of two closely related components: biological experiments and mathematical computational modeling.

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“It is imperative to accurately diagnose patients who come to the emergency department with chest pain,” said Dr. John Mahmarian, cardiologist at the Methodist DeBakey Heart & Vascular Center and principal investigator of the study. “Unfortunately, diagnosing chest pain is often expensive and time-consuming. This new data could save millions of health care dollars and countless hours spent waiting on unnecessary tests.”

Mahmarian’s research, which was published online in the Annals of Emergency Medicine, shows that patients with a coronary artery calcium score of zero can be safely sent home without further cardiac testing.

Coronary artery calcium scoring (CACS) is a simple and readily available test for identifying coronary artery disease. CACS is done with a computed topography (CT) scanner. A CT scan uses x-rays to make a detailed image of the heart, showing calcium build up in the coronary arteries. The images can be read almost immediately after the scan. A CACS of zero correlates with an excellent short-term outcome and predicts a normal SPECT, which is a more advanced imaging test that is usually done following a CACS test.

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The most important thing I tell my female patients is to stay to as physically fit as possible. Every woman should work exercise into her lifestyle. Find something you enjoy doing, and do it regularly and often.

In addition to exercising, follow the Mediterranean diet, which is high in fish and fresh vegetables, and low in processed carbohydrates.

Get your cholesterol checked, especially if there is a family history of heart disease or stroke. At age 20 women are seeing their OB/gynecologists who perform blood pressure checks, fasting lipid panels and fasting sugars. Even young women should pay attention to these numbers and be on alert if any are out of range. If these numbers are abnormal, they indicate that you are at risk for developing heart problems in the future. They are early warning signals, which if corrected and treated can help prevent the development of heart disease. Often these numbers can be corrected with lifestyle changes including improving your diet, exercising and losing weight. If these measures fail, they can be easily corrected with medication.

I like to do an initial, thorough heart check at age 40 if a woman has risk factors or a family history of heart disease, or at age 50 if there’s no family history or risk factors. I don’t recommend heart scans until age 55.

Women should also be aware of stroke. Stroke prevention is very similar to heart disease prevention. Blood thinners and cholesterol drugs called statins have been shown to help prevent heart attacks and the need for bypass and angioplasty. These same drugs are also proven to reduce the incidence of stroke.

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“I’ve seen a number of injuries, some fatal, occur on Super Bowl Sunday because people often pay more attention to the game than to their health and safety,” said Dr. Jeff Kalina, associate medical director of emergency medicine at The Methodist Hospital in Houston. “The ER is usually busy after the game and we expect it to be no different this Sunday.”

Super Sunday usually brings on a rise in drunken driving accidents and stomach ailments because of the mixture of alcohol and junk food. People who drink too much and fail to get up and go to the bathroom can also develop a problem called urinary retention, a condition where the bladder gets so full that the muscles are not strong enough to generate a stream.

“During most sporting events people will get up and use the restroom during the commercials and not have any problem,” Kalina said. “However, most of the time the commercials are the best part of the Super Bowl, so we have seen people who have to come in and have a catheter put in to relieve themselves.”

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Kaufman has spent more than 60 years as a researcher and clinician.  A native of Brooklyn, New York, Kaufman received his medical degree in 1948 from the University of Maryland.  He completed residencies and postdoctoral fellowship at The Methodist Hospital and Beth Israel Hospital in New York City.  He served as the chairman of the department of obstetrics and gynecology at Baylor College of Medicine from 1973-1992 and chief of OB/GYN at Texas Children’s Hospital and St. Luke’s Episcopal Hospital until 1992.

Kaufman is an active member of numerous organizations and peer review boards and has held offices in many of them.  He has been president of the Houston Gynecological and Obstetrical Society, the Central Association of Obstetricians and Gynecologists, the International Society for the Study of Vulvar Disease and the Texas Association of Obstetricians and Gynecologists.  He is also the author of more than 270 published articles and numerous book chapters.

“Dr. Kaufman is an amazing clinician and researcher and an exemplary model of compassionate care and dedication to humankind. We congratulate him on such a well-deserved honor,” said Ron Girotto, president and CEO of The Methodist Hospital System.

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