Grand Rounds December


Simpler New Procedure to Correct Stress Incontinence at St. Cloud Regional

An innovative new minimally-invasive, outpatient procedure, performed by Board-Certified Gynecologist Peter J. Casella, MD, Medical Director of Gynecological Services at St. Cloud Regional Medical Center, provides a ribbon of support for the urethra, placing it back in its normal anatomical position and preventing urine from leaking.
 
Dr. Casella was the first physician in Central Florida and the second in the state to perform the Solyx® Sling procedure, and has successfully performed nearly 100 with 100 percent success. The outpatient procedure is performed quickly ñ often in less than 10 minutes ñ  and requires only one tiny incision. Routine physical activity is restricted for only a short period of time, although strenuous activity may be restricted for several weeks.
 
Stress urinary incontinence (SUI) often occurs as a result of hypermobility, which may be caused by childbirth, previous pelvic surgery or hormonal changes, explains Casella who continues that itís different than ëurge incontinenceí ñ that ìgotta goî feeling.
 
Hypermobility occurs when the normal pelvic floor muscles can no longer provide the necessary support to the urethra and bladder neck. As a result, the bladder neck is free to drop when any downward pressure is applied and thus, involuntary leakage occurs.
 
Another condition which causes SUI is call intrinsic sphincter deficiency, which refers to a weakening of the urethral sphincter muscles. As a result, the sphincter does not function normally regardless of the position of the bladder neck or urethra. Either way, daily activities are often interrupted and a womanís quality of life may be seriously diminished.
 
While conservative treatment is the first step in the treatment of SUI, for those women who do not benefit from measures such as pelvic floor exercises or medication, this revolutionary procedure may provide complete relief from the worry leakage causes.
 
Many surgical options have been developed for the correction of SUI due to hypermobility and/or ISD, says Casella but he didnít consider using the procedure until he knew that the quality of the outcomes approached or exceeded the quality of outcomes in more invasive procedures. Whether using the Solyx Sling or another method, the decision is always based on the needs of that specific woman and what will be the best method. Peter Casella, MD is both a Diplomate and Fellow of the American College of Obstetrics and Gynecology, and is also the Medical Director of Medical Solutions for Women in St. Cloud.
 

Florida Hospital Cancer Institute Oncologist Presents Research at Prestigious Medical Conference

Dr. Raul Castillo, an oncologist and hematologist at Florida Hospital Cancer Institute (FHCI), co-authored a research abstract on a breast cancer clinical trial and presented the findings at the annual American Society of Clinical Oncology (ASCO) meeting.
 
Dr. Castillo collaborated with a team of oncology specialists including Dr. Denise Yardley, senior investigator of the Sarah Cannon Research Institute (SCRI), which is one of the largest clinical research programs in the nation conducting community-based clinical trials in oncology, cardiology and gastroenterology.  He also worked with respected physicians from Tennessee, Georgia and California.
 
The team's research investigated how a specific regimen of medications administered preoperatively can reduce evidence of breast cancer after the tumor is removed.  This treatment of chemotherapeutic medications is designed to help women battling locally advanced breast cancer.  The results of the trial were also published in the supplement of the -Journal of Clinical Oncology distributed at the ASCO conference.
 

Physician Associates Welcomes New OB/GYNs

Physician Associates is pleased to announce that obstetricians and gynecologists Pamela C. Cates-Smith, M.D., and Dorothy J. Odom, M.D., recently joined the practice. Dr. Cates-Smith serves patients in the South Orlando office, and Dr. Odom serves patients in the Longwood office. In addition, obstetrician and gynecologist Norman Lamberty, M.D., is now serving patients in the Longwood office as well.  All three provide a full range of womenís healthcare from well-women exams and prenatal care to diagnosis and treatment of health concerns such as menopause, urinary incontinence and infertility among many others. 
 
Dr. Cates-Smith recently completed her residency at Winnie Palmer Hospital, part of Orlando Regional Healthcare, where she served as Chief Resident.  She earned her medical degree from Indiana University School of Medicine in Indianapolis.  A member of the American College of Obstetricians and Gynecologists, the American Medical Association, the Florida Medical Association and the Orange County Medical Society, Dr. Cates-Smith has special interests in high-risk obstetrics and adolescent health.
 
Dr. Odom also recently completed her residency at Winnie Palmer Hospital where she served as Chief Resident and received the top residency award.  She earned her medical degree from the University of Mississippi School of Medicine and worked as a nurse for 16 years, primarily in labor and delivery, prior to attending medical school.  Dr. Odom serves as an active member of the American College of Obstetrics and Gynecology, the American Medical Association and the Orange County Medical Society.  She has special interests in adolescent health, and ovarian cancer research and awareness. She also volunteers with the Victim Services Center in Orlando.
 
A part of Physician Associates for four years, Dr. Lamberty has served patients in the South Orlando office and recently began seeing patients in Longwood, the community he also calls home.  Board-certified and bilingual, he served his residency with Orlando Regional Healthcare and earned his medical degree from Georgetown University School of Medicine in Washington, D.C.  A member of the American College of Obstetrics and Gynecology, he has extensive training and experience in performing minimally invasive da Vinci Robotic Surgery.
 

The Wound Healing And Hyperbaric Center Helps Cancer Survivors With Leading Edge Treatment For Radiation Injuries To The Jawbone

St. Cloud — You would think that after surviving cancer, having a tooth extracted would be as easy as a walk in the park. Yet people who undergo radiation therapy of the head or neck are more likely to be at risk for osteoradionecrosis (ORN), delayed bone damage caused by radiation, which is most commonly found in the mouth. 
 
The extraction of teeth in a previously radiated jaw accounts for nearly nine out of 10 cases of trauma induced mandibular radionecrosis. Dr. Robert Bartlett, senior medical advisor for National Healing Corporation whose Wound Healing Centers explained that itís counterintuitive when cancer survivors gauge success in the passage of time, yet there is greater risk of ORN five years after radiation versus one year later since the degenerative process is progressing beneath the surface without any outward sign.
 
The Wound Healing & Hyperbaric Center at St. Cloud Regional, a National Healing Corporation Wound Healing Center, uses hyperbaric oxygen therapy (HBOT) to treat ORN.  Patients relax on a bed incased in a large see-through plastic shell as they are surrounded by 100 percent oxygen at higher-than-normal atmospheric pressure.  The therapy enables oxygen molecules to pass through the plasma to the tissue more easily and speed healing. 
 
Microorganisms begin to impact the surface of irradiated bone in the mouth explained Bartlett who also said it makes ORN a matter of wound healing rather than infection and the problematic wounds do not require the same type of topical management.
 
Complications from ORN can result in intractable pain, difficulty opening the mouth, bone fractures, nutritional deficiencies caused by difficulty eating, chronic wounds and the loss of large areas of soft bone and tissue.
 
Specialists at The Wound Healing & Hyperbaric Center at St. Cloud Regional recommend the following for preventing, identifying and treating ORN:
 
ORN is often not visible and may be diagnosed by x-ray, CT scans, MRI or biopsy.  The doctor may ask for your radiation therapy records to determine exact location and dose of radiation you received.
 
Patients considering radiation therapy of the head or neck should consider a pre-radiation dental consultation to optimize oral health.
 
ORN risk factors include inadequate healing time between undergoing oral surgery and starting radiation therapy, extractions within irradiated bone, alcohol and tobacco use and nutritional factors.
 
Quit smoking.  Radiation is successfully used to treat many types of head and neck cancer caused by tobacco use and the jawbone is the most common site of ORN because the bone receives poor blood flow due to its density and also because teeth are present.
 
The most common symptom of ORN is bone pain. Hyperbaric oxygen therapy can help in pain management if the pain is due to ORN and not recurring cancer or other causes.
 
Patients who are currently receiving chemotherapy must have a thorough review by a hyperbaric physician before being treated for injuries since some drugs may have adverse affects.
 

Florida Hospital DeLand Director Receives Certification

DELAND — Florida Hospital DeLand Imaging Director, Wes Harden, is now a Certified Radiology Administrator (CRA).
 
The CRA is the only professional credential tailored specifically for radiology administrators.  The program is designed to elevate professional standards, enhance individual performance and recognize administrators who demonstrate knowledge essential to the practice of radiology management.
 
Having CRA certification recognizes that an individual is not simply high performing but excels in these areas.  Certification is an independent verification of the professional's skill set.
 

St. Cloud Regional Welcomes Rebecca Brewer as New CEO

ST. CLOUD, — Rebecca Brewer has joined the leadership team at St. Cloud Regional Medical Center in the role of Chief Executive Officer.  Rebecca comes to St. Cloud from Heart of Florida Regional Medical Center in Haines City, a sister facility owned by Health Management Associates, Inc. (HMA). She was the Chief Operating Officer at Heart of Florida since January 2008, and during that time, she assisted three HMA hospitals as interim CEO. 
 
Prior to joining HMA in 2008, Rebecca spent 26 years with Health Corporation of America (HCA, Inc.).
 
Rebecca is Board Certified in Healthcare Management and a Fellow in the American College of Healthcare Executives. She received her Master of Science in Nursing from the University of South Carolina and her Bachelor of Science in Nursing from Clemson University.
 

Florida Hospital Celebration Health Welcomes Dr. Arnold Advincula

CELEBRATION — Dr. Arnold Advincula, FACOG, FACS, an expert in gynecological robotic surgery, was recently appointed to medical director of the gynecologic robotic surgery program at Florida Hospital Celebration Health.  An advocate for womenís health, Dr. Advincula provides women with more options for their treatment and strives to offer patients the latest in medical technology. 
 
A graduate from the Temple University School of Medicine, Dr. Advincula completed both a residency in obstetrics and gynecology (OB/GYN) and a fellowship in minimally invasive surgery at the University of North Carolina at Chapel Hill.  In 1999, he joined the faculty at the University of Michigan in the OB/GYN department where he eventually rose to the rank of clinical professor and director of an internationally recognized minimally invasive surgery program.  In 2001, Dr. Advincula began his work with robotics and the da Vinci® surgical system.  This cutting edge technology allows surgeons to transfer their skills into an enhanced laparoscopic environment that employs highly precise instruments and magnified vision. 
 
Supplying experience in his field, Dr. Advincula will also join other world-renowned robotic surgeons as co-medical director of Florida Hospitalís Global Robotics Institute (GRI).  The GRI is a world class, multi-specialty surgical program comprised of leading urologic, gynecologic, colorectal and cardiac physicians dedicated to providing superior patient outcomes through the use of robot-assisted laparoscopic technology.
 
Dr. Advincula will also serve as a clinical professor for minimally invasive gynecological surgery, a member of the UCF College of Medicine global medical faculty, co-medical director of the minimally invasive advanced gynecologic surgery fellowship and a member of the Nicholson Center for Surgical Advancement, a branch of the GRI that serves as the premier center for hands-on surgical instruction.
 

Hematologist/Oncologist Joins Florida Hospital DeLand

DELAND — Atis Barzdins, MD has joined the medical staff of Florida Hospital DeLand and Advanced Hematology and Oncology Centers.  
 
Previously, Dr. Barzdins was practicing hematology-oncology in a busy community based practice in Ocala and The Villages.
 
Dr. Barzdins brings to the DeLand community his broad knowledge and hands-on practical experience in hematology and oncology.
 
He is board-certified in internal medicine, medical oncology and hematology.
 
Dr. Barzdins comes from Eastern Europe. He received his Medical Degree from the Medical Academy of Latvia, where he also completed his medical residency during which he passed the United States Medical Licensing Exams before coming to the United States. After his Internal Medicine residency at NYU Downtown Hospital, he continued his training in New York City where he completed his hematology-oncology fellowship at St. Luke's Roosevelt Hospital Center. After his fellowship, he started practicing in Durango, Colo
 
Dr. Barzdins research activities include a publication of analysis of a novel chemotherapy regimen in treatment of refractory pancreatic cancer, as well as patient accrual for cooperative group trials.
 

Pediatric Orthopaedic Surgeon is Chosen for "Top Doctor" Two Years in a Row

Dr. Tamara Topoleski, of Orlando Orthopaedic Center in Orlando, FL, has once again been selected as Top Doctor by Consumers' Checkbook for 2009-2010.  The independent non-profit Consumers' Checkbook surveyed roughly 340,000 physicians.  The physicians were asked to choose one or two specialists, in each of 35 different specialty fields, he or she would consider most desirable for care of a loved one.  This list of doctors contains the names of physicians who were mentioned multiple times by other physicians in their communities.
 
Tamara A. Topoleski, M.D., is board certified in Orthopaedic Surgery.  She received her medical degree and served her internship and residency at New York Medical College, Valhalla, N.Y. Upon completion of her residency, Dr. Topoleski became a Pediatric Orthopaedic Fellow at Shriners Hospital for Children in Tampa, Florida.  She received specialized training in all aspects of children's orthopaedics, including pediatric spinal surgery.
 
Dr. Topoleski is one of 16 board-certified physicians at Orlando Orthopaedic Center.  They have five offices in central Florida including Downtown Orlando, Sand Lake, Oviedo, Longwood and Winter Park. 
 

Florida Hospital Neurosurgeon and Team Win Award for Groundbreaking Research on Brain Tumors & Stem Cells

NEW ORLEANS — Recently, Florida Hospital neurosurgeon, Dr. Melvin Field, presented the results of his team's recent research studying stem cells in malignant brain tumors at the Congress of Neurological Surgeons' annual meeting in New Orleans, La. The research won the Congress of Neurological Surgeonsí BrainLAB Neurosurgery Award, an accolade presented to a neurosurgeon practicing in a non-academic setting with the best research related to central nervous system tumors. Receiving this honor was especially notable this year because there were a record number of abstract submissions to the Congress for Neurological Surgeons. The research was also awarded one of the "Top Ten" abstracts of the meeting.
 
This study was a collaborative effort between Florida Hospital and University of Central Florida (UCF). An entire team was involved in the research, including Dr. Sergey Bushnev, Dr. Nicholas Avgeropoulos, Dr. Angel Alvarez and Dr. Kiminobu Sugaya. The teamís finding is the first of its kind, and is groundbreaking in the field of stem cell research because it could enable physicians to treat brain tumor patients more effectively, potentially resulting in better outcomes for this uniformly fatal tumor.
 

Florida Hospital East Orlando Opens New Surgery Center

Florida Hospital East Orlando opened its first outpatient surgery center to patients in Nov. The center is part of a new medical office building that is three stories and has nearly 60,000 square feet of space.  The surgery center features four state-of-the-art surgical suites that accommodate a variety of procedures from orthopedics to urology and more. The surgery center has easy access to parking and doesnít require all the detailed check in procedures that are required in a hospital.  Designers of the center also kept the patientís family in mind, creating a Zen-like waiting room that provides a calming environment for families to wait in during procedures.  There is also additional space on the upper floors of the building for physiciansí offices. 
 
This is the first outpatient surgery facility at Florida Hospital East Orlando and because of its proximity to the hospital it provides an extra level of safety for patients.  The surgery center is just yards away from the emergency room, as well as trained hospital staff who can handle any number of complications should they occur. 
 
General surgeon Dr. Kenley David said that east Orlando has never had an outpatient surgery center of this caliber and that it will be a means to bring new medical services to the east Orlando community. 
 
The new surgical suites will also allow for overflow so renovations and expansion of the existing operating rooms at Florida Hospital East Orlando can be made.  The center is located at 258 South Chickasaw Trail.   
 

Infant Safety A Priority At Health Central

OCOEE — Infants born at Health Central will be protected by a state of the art baby security system, thanks to a $100,000 donation from the Health Central Foundation Board.  Health Centralís new Cuddles Infant Protection System is designed to protect infants and patients in the pediatric unit and keep them secure.
 
The nurse-friendly system, which was recently installed at Health Central, uses a patented Soft Bracelet system with radio frequency identification technology to help protect against infant abductions. If the infant is taken from the area or the bracelet is removed or tampered with in any way; a department-wide alarm will sound resulting in a department lockdown. The alarm is monitored 24 hours a day from several areas. The Cuddles System also allows staff to admit and discharge their tiny patients and their moms in just moments.
 
"The Maternal Child Department greatly appreciates the generous donation from the Health Central Foundation for our Cuddles security system to help keep our babies and pediatric patients safe," said Debby Brown, Director of the Maternal Child Department at Health Central.
 

Seminole State nursing Students Continue To Surpass State Average On Exams

SANFORD — Graduates of the Nursing Program at Seminole State College of Florida continue to exceed state averages on their licensure exams, according to results released in October by the Florida Board of Nursing.
 
This summer, 94 percent of Seminole State Registered Nursing graduates passed the National Council Licensure Examination (NCLEX), exceeding the state average of 91 percent.
 
Among Practical Nursing graduates, Seminole State's rate of 94 percent also exceeded the state average of 82 percent.
 
Nursing Director Cheryl Cicotti said the pass rates continue to demonstrate the high quality of the faculty, curriculum and students.
 
Seminole State research shows that 35 percent of PN graduates return within two years for the collegeís RN track.
 
NCLEX is the state-required exam that determines whether graduates are prepared for entry-level nursing practice.

Seminole State College of Florida is addressing the critical nursing shortage in Central Florida by expanding its nursing programs at the Altamonte Springs Campus, which features 16 state-of-the-art health-care labs and high-tech patient simulators.


 

Florida Hospital's Health Village Expands with Topping Off of Medical Office Building

Florida Hospital Orlando "topped out" a seven-story, 156,000-square-foot medical office building on Nov. 13. The new facility will be a part of the area being developed around the hospital known as Health Village. Florida Hospital Diabetes Institute, Florida Hospital Transplant Center, Florida Hospital Digestive Health Center and physician offices will occupy the new medical office building. The $47 million building is scheduled to open in fall of 2010.
 
"Topping out a medical office building means we are ready for the next stage," said Des Cummings, executive vice president of Florida Hospital. "The medical office building will be the new home for leading physicians who choose to practice medicine at Florida Hospital. The building represents another step towards the construction of Health Village around the Florida Hospital Orlando campus."
 
During the celebration, Florida Hospital staff had an opportunity to sign a steel beam, which will be used in the framework of the building. The traditional tree was also placed on top of the structure. The new medical office building is located on the corner of N. Orange Ave. and Rollins St.