Nearly 4 million concussions occur in amateur and professional athletics every year in the U.S. As many as half are not recognized. Children, youth and female athletes are particularly susceptible to concussions. The residual effects of repeated concussions put athletes at risk for long-term neurological consequences and even death.
David W. Dodick, M.D., of the Department of Neurology at Mayo Clinic in Arizona discusses Mayo’s comprehensive sports concussion program and the need for proper evaluations.
The Mayo Clinic sports concussion program team includes physicians and other experts from neurology, neuroradiology, neurosurgery, neuropsycholology, headache medicine, sports medicine, physical medicine and rehabilitation, emergency medicine, internal medicine, vestibular medicine, physical therapy, and occupational therapy. The multidisciplinary team, through its coordinated and comprehensive approach, evaluates and treats athletes with concussion from youth sports to the professional ranks.
Daniel S. Elliott, M.D., of the Department of Urology, discusses urinary incontinence as it occurs in men as a result of surgery and radiation for prostate cancer or surgery for urinary blockages. He comments on the profound impact that this condition can have on quality of life, and explains the advantages and disadvantages of different treatment options (including surgical) which may be appropriate.
Dr. Elliot discusses a range of treatments, including minimally invasive slings, artificial sphincters and surgesis wraps, and stresses the importance of patient counseling.
Daniel S. Elliott, M.D., of the Department of Urology, discusses urinary incontinence as it occurs in women. He explains the advantages and disadvantages of different treatment options, including minimally invasive collagen and bulking agents, outpatient procedures such as transobturator slings and suprapubic slings, and surgical procedures that may require autologous and cadaveric slings.
Dr. Elliott comments on the importance of evaluation to eliminate misdiagnosis and the profound impact that this condition can have on quality of life. He also stresses the need for patient counseling.
Although the genetic contribution to bipolar disorder has been unequivocally demonstrated, few specific genetic risk factors have been confirmed. The factors identified explain only a small proportion of the genetic contribution to bipolar disorder. Mark A. Frye, MD, chair of the Department of Psychiatry and Psychology, discusses the Mayo Clinic Center for Individualized Medicine’s Biobank for Bipolar Disorder, a resource for the bipolar research community working to confirm those risk factors and discover additional contributors to bipolar disorder susceptibility and response to treatment.
The biobank project is a multisite endeavor. Mayo Clinic in Rochester, Minnesota, serves as the primary location, but researchers from the University of Minnesota, Lindner Center of Hope in Cincinnati, Ohio, Mayo Clinic’s Arizona and Florida campuses, and Mayo Health System sites are contributing to the effort and will continue to collaborate following completion of infrastructure development in 2012. The large-scale biobank will collect biological samples and clinical data from 2,000 individuals between the ages of 18 and 65 years. Nearly 500 adults are currently enrolled.
Biobank to include children
Funding for an individualized medicine biobank for pediatric bipolar disorder was approved in May 2010. Christopher A. Wall, M.D. of the Department of Pediatric and Adolescent Medicine discusses several linked studies.
A study of children at risk for bipolar disease will include participants whose parents are included in the adult study. Additional participants will be recruited for the Pediatric Bipolar Biobank study, which focuses on children in whom bipolar disorder has already developed. Researchers will begin recruitment after the study protocol is approved.
Stephen A. Boorjian, M.D., of the Department of Urology discusses a study of the outcomes after treatment for patients with high-risk prostate cancer. Patients with the most aggressive forms of prostate cancer who had radical prostatectomy procedures had a 10-year cancer-specific survival rate of 92 percent and an overall survival rate of 77 percent. The cancer-specific survival rate for patients who had radiation therapy alone was 88 percent and the overall survival rate was 52 percent.
ABSTRACT Background
We compared the long-term survival of patients with high-risk prostate cancer following radical prostatectomy (RRP) and external beam radiation therapy (EBRT) with and without adjuvant androgen deprivation treatment (ADT).
Methods
We identified 1,238 patients who underwent RRP and 609 patients treated with EBRT (344 with EBRT + ADT and 265 with EBRT alone) between 1988-2004 who had a pretreatment prostate-specific antigen level (PSA) ≥ 20 ng/mL, biopsy Gleason score 8-10, or clinical stage ≥ T3. Median follow-up was 10.2, 6.0, and 7.2 years after RRP, EBRT + ADT, and EBRT alone, respectively. The impact of treatment modality on systemic progression, cancer-specific, and overall survival was evaluated using multivariable Cox proportional hazard regression analysis and a competing risk-regression model.
Results
Ten-year cancer-specific survival was 92%, 92%, and 88% following RRP, EBRT + ADT, and EBRT alone (p=0.06). After adjustment for case mix, no significant differences in the risks of systemic progression (hazard ratio, 0.78; 95% CI, 0.51 to 1.18; p=0.23) or prostate cancer death (hazard ratio 1.14; 95% CI, 0.68 to 1.91; p=0.61) were seen between patients treated with EBRT + ADT and patients who underwent RRP. The risk of all-cause mortality was, however, greater after EBRT + ADT than RRP (hazard ratio, 1.60; 95% CI, 1.25 to 2.05; p=0.0002).
Conclusions
RRP and EBRT + ADT provide similar long-term cancer control for patients with high-risk disease. Continued investigation into the differing impact of treatments on quality-of-life and non-cancer mortality are necessary to determine the optimal management approach for these patients.
Keith H. Baratz, M.D. of the Department of Ophthalmology discusses a genomewide association study that indicates a genetic variation in TCF4 contributes to the development of Fuchs corneal dystrophy (FCD).
ABSTRACT Background
Fuchs corneal dystrophy is a leading cause of corneal transplantation. It affects 5% of persons in the United States who are over the age of 40 years.
Clinically visible deposits called guttae develop under the corneal endothelium in patients with FCD. A loss of endothelial cells and deposition of an abnormal extracellular matrix are observed microscopically. In advanced disease, the cornea swells and becomes cloudy because the remaining endothelial cells are not sufficient to keep the cornea dehydrated and clear.
Although rare genetic variation that contributes to both early-onset and typical late-onset forms of FCD has been identified, to our knowledge, no common variants have been reported.
Methods
We performed a genomewide association study and replicated the most significant observations in a second, independent group of subjects.
Results
Alleles in the transcription factor 4 gene (TCF4), encoding a member of the E-protein family (E2-2), were associated with typical FCD (P = 2.3×10−26). The association increased the odds of having FCD by a factor of 30 for persons with two copies of the disease variants (homozygotes) and discriminated between case subjects and control subjects with about 76% accuracy. At least two regions of the TCF4 locus were associated independently with FCD. Alleles in the gene encoding protein tyrosine phosphatase receptor type G (PTPRG) were associated with FCD (P = 4.0×10−7), but the association did not reach genomewide significance.
Conclusions
Genetic variation in TCF4 contributes to the development of FCD.
This study was funded by the National Eye Institute and others.
Authors Keith H. Baratz, M.D., Nirubol Tosakulwong, B.S., Euijung Ryu, Ph.D., William L. Brown, O.D., Kari Branham, M.S., Wei Chen, Ph.D., Khoa D. Tran, Ph.D., Katharina E. Schmid-Kubista, M.D., John R. Heckenlively, M.D., Anand Swaroop, Ph.D., Goncalo Abecasis, Ph.D., Kent R. Bailey, Ph.D., and Albert O. Edwards, M.D., Ph.D.
More than half of behavioral medicine consultations at Mayo Clinic now occur in team-based or integrated practice settings. James R. Rundell, M.D. of the Department of Psychiatry and Psychology discusses studies that suggest the team model produces considerably better outcomes and patient satisfaction than a single-care provider approach to treatment of patients with depression.
P James B. Dyck, M.D. of the Department of Neurology discusses a study of patients who received psychiatric evaluation and attended nutritional clinics before having bariatric surgery at Mayo Clinic. The study was published in the June 2010 issue of Muscle & Nerve.
ABSTRACT Background
Previously we showed that peripheral neuropathy occurs after bariatric surgery and was associated with malnutrition (mainly sensory polyneuropathy). This study asks whether a multidisciplinary approach to bariatric surgery lowers risk for developing peripheral neuropathy.
Methods
We performed a retrospective cohort study of all patients with bariatric surgery at Mayo Clinic between 1985 and 2002. Patients underwent intensive nutritional management before and after surgery. Potential risk factors were analyzed using life-table methods (Cox regression).
Results
Univariate analysis showed the following risk factors:
• Increased serum glycosylated hemoglobin and triglycerides
• Prolonged hospitalization
• Postoperative gastrointestinal symptoms
• Nausea and vomiting
Peripheral neuropathy occurred less frequently (7% vs. 13%, P < 0.01) and specifically the sensory polyneuropathy subtype (1% vs. 7%, P < 0.0001) than in our prior cohort.
Conclusions
A systematic, multidisciplinary approach of intensive nutritional management before and after surgery with frequent follow-up greatly decreased development of peripheral neuropathy (especially sensory polyneuropathy) in patients receiving bariatric surgery.
Amy E. Krambeck, M.D. of the Mayo Clinic Department of Urology discusses advances in radiology that have led to improvements in care for patients with urinary tract stones.
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One of the most promising imaging techniques is dual-energy CT, which enables more accurate characterization of stone disease than other imaging techniques and helps direct therapy at the time of the initial imaging evaluation.
Improvements in percutaneous therapy have led to less-invasive and less-costly treatments for nephrolithiasis. This article describes some of these new approaches to diagnosing and caring for patients with renal stone disease.
William Pavlicek, Ph.D., radiologist and chair of the Section on Diagnostic Physics at Mayo Clinic in Arizona, discusses a new radiation tracking system that provides a comprehensive view of a patient’s total radiation doses over time.
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The DICOM tracking system, developed at Mayo in cooperation with Arizona State University, can track all the information contained in patients’ imaging studies and compile it into an accessible format, replacing time-consuming manual tracking processes.
The DICOM index tracker centralizes digital images information from tests such as mammography, CT scans, nuclear medicine and cardiac catheterization. The information can be sorted to assess the radiation dose and the number of procedures. Alerts built into the system ensure dosages are within limit guidelines set by the American College of Radiologists and other advisory bodies.
More than 1.5 million imaging tests are conducted at Mayo Clinic each year. The DICOM Tracker is used at Mayo’s three campuses in Arizona, Florida and Minnesota.
