Physician Update — Florida

New Criteria Expand Options for Heart Failure Transplant Patients

Many heart failure patients who would not have been considered previously for a heart transplant are becoming candidates, thanks to improved surgical techniques, better immunosuppressive drugs and understanding how to use them, and, most importantly, using hearts from older donors who have been carefully screened.

Specifically, Mayo Clinic heart failure and transplantation specialists:

• Will look at potential candidates in their early 70s who are otherwise in good health with the understanding that they'll be extensively screened.
• Are performing combined organ transplantation (e.g., heart-kidney, heart-liver) so the presence of a second diseased organ system is not an absolute contraindication.
• Have become much better at taking care of diabetic patients. Thus, well-controlled comorbidities like diabetes are not always absolute contraindications

Mayo specialists' experience with mechanical support has enabled Mayo to use devices to "bridge" patients to transplantation. This includes the "bridge-to-bridge" scenario, where a patient at another facility, unable to be weaned from cardiopulmonary bypass or in severe cardiogenic shock, is transferred to Mayo. The patient is either left on the heart-lung machine or placed on a temporary device (e.g., biomedicus pump) prior to transfer. After an abbreviated evaluation is performed, a more intermediate device may be implanted with the understanding that a full transplant workup must be completed before listing for transplant. Left ventricular assist devices can also be used as "destination therapy" for those patients with end-stage cardiomyopathy who are good surgical candidates but not suitable for transplantation.

Heart failure patients also benefit from Mayo's outpatient Heart Failure Clinic, which is designed to reduce readmissions and improve patients' quality of life by emphasizing medication compliance, daily weights and a low-sodium diet. When diuretics do not suffice for patients, our specialists can perform aquapheresis, an advanced form of ultrafiltration used to remove excess fluid and relieve symptoms of end-stage heart failure.

For more information about patient criteria or Mayo's services, call 904-953-7278.

Innovative New Technology For Treatment Of Chronic Heartburn Being Studied

Mayo Clinic's campus in Jacksonville, Fla., is among 15 centers worldwide studying the safety and effectiveness of an innovative, surgically implanted, investigational device for treating gastroesophageal reflux disease (GERD).

GERD is a progressive disease that results from a weak or defective lower esophageal sphincter. About 20 million Americans suffer daily from GERD. The disease often requires lifelong medical therapy.

"Medical therapy is effective in controlling and suppressing acid production in the stomach but does not address the source of the reflux, which is a malfunctioning esophageal sphincter," says C. Daniel Smith, M.D., a Mayo Clinic surgeon investigating the new treatment. "This new device is designed to restore the function of the esophageal sphincter and prevent reflux."

If the device proves effective, Dr. Smith says, "It could make a significant difference in the treatment options we can offer patients."

The device is a ring of magnetic beads that is placed laparoscopically using small incisions during a procedure that takes less than an hour. The magnetic ring helps keep the sphincter closed, but the magnets release and allow the valve to open under the pressure of food or drink in the esophagus. The system was evaluated in a feasibility study, which validated its ability to significantly reduce the incidence of reflux and restore acid exposure to normal levels for most patients in the study. The current clinical study will evaluate the safety and effectiveness of the system.

For more information about the clinical trial, contact study coordinator Barbara Berg at 904-953-2854 or visit www.refluxstudy.com.

Mayo Clinic Researchers Discover and Manipulate Molecular Interplay That Moves Cancer Cells

In the March 29 online issue of Nature Cell Biology, Mayo researchers say that a molecule known as protein kinase D1 (PKD1) is key to the ability of a tumor cell to "remodel" its structure, enabling it to migrate and invade. The researchers found that if PKD1 is active, tumor cells cannot move. They say this finding explains why PKD1 is silenced in some invasive cancers. Read article.

Mayo Clinic Researchers Find Agents that Speed Up Destruction of Proteins Linked to Alzheimer's Disease

Taking a new approach to the treatment and prevention of Alzheimer's disease, a research team led by investigators at the Mayo Clinic campus in Florida has shown that druglike compounds can speed up destruction of the amyloid beta (A-beta) proteins that form plaque in the brains of patients with the disorder. Read article.

New Staff

Janice Clarke, M.D., Cardiovascular Diseases

Continuing Medical Education

Clinical Reviews and Primary Care Update – 2009
June 8-11, 2009
Location: Amelia Island Plantation, Amelia Island, Fla.
Contact: 1-800-462-9633 (toll free); cme-jax@mayo.edu
Course Web site

Advanced Imaging and Ablation Workshops
June 27 and Oct. 3, 2009
Location: Amelia Island Plantation, Amelia Island, Fla.
Contact: 1-800-462-9633 (toll free); cme-jax@mayo.edu
Course Web site

Mayo Clinic's 19th Annual Hematology/Oncology Reviews
July 30-Aug. 1, 2009
Location: The Ritz Carlton Amelia Island, Amelia Island, Fla.
Contact: 1-800-462-9633 (toll free); cme-jax@mayo.edu
Course Web site

Pulmonary Hypertension Update 2009
Aug. 29, 2009
Location: Kinne Auditorium, Mayo Clinic Jacksonville
Contact: 1-800-462-9633 (toll free); cme-jax@mayo.edu

More CME courses at Mayo Clinic in Florida

March 2009

Sleep Disorders Center Adds New Specialist

Pablo Castillo, M.D., is the newest addition to the Sleep Disorders Center team. A board-certified internist and neurologist, Dr. Castillo has completed subspecialty fellowships in cerebrovascular disease, neurophysiology and sleep medicine and holds a certification in the subspecialty of Sleep Medicine granted by the American Board of Internal Medicine. Some of his specialty areas include:

• Parasomnias (abnormal nocturnal behaviors)
• Nocturnal seizures
• Sleep in neurologic conditions
• Sleep disorders following stroke

If you have challenging patients with complex sleep
disorders that you would like to refer to Dr. Castillo,
call 904-953-2282.

National Transplant Data Shows Mayo Clinic in Florida has Highest Survival Rates for Liver in the Southeast

The most recent Scientific Registry of Transplant Recipients liver transplant data shows that the Mayo Clinic Transplant Center in Florida has again achieved one of the highest liver patient and graft survival rates in the nation, and the highest rates in the Southeast. For the third year in a row, the center has had statistically better-than-expected outcomes at all three intervals: 1 month, 1 year and 3 years.

Mayo Clinic Researchers Suspect a Novel Gene is Causing Restless Legs Syndrome in a Family

In 2005, a woman who had trouble sleeping asked Siong-Chi Lin, M.D., for help. Dr. Lin, a sleep disorders specialist at Mayo Clinic in Florida, diagnosed restless legs syndrome. Restless legs syndrome may be caused by a number of clinical factors, such as iron deficiency, but it has a strong genetic component as well. "In most people, it is likely due to a number of different causes, but genes are very likely the most important factor in affected families," says Dr. Lin.

Mayo Clinic Researchers Discover Drug Prevents Colon Cancer in Mice

Researchers at the Mayo Clinic in Florida have found that a drug now being tested to treat a range of human cancers significantly inhibited colon cancer development in mice. Because the agent appears to have minimal side effects, it may represent an effective chemopreventive treatment in people at high risk for colon cancer.

Experimental Therapy Turns on Tumor Suppressor Gene in Cancer Cells

Researchers at Mayo Clinic in Florida have found that the experimental drug they are testing to treat a deadly form of thyroid cancer turns on a powerful tumor suppressor capable of halting cell growth. Few other cancer drugs have this property, they say. In the Feb. 15 issue of Cancer Research, they report that RS5444, being tested in a Phase 1/2 clinical trial to treat anaplastic thyroid cancer, might be useful for treating other cancers.

New Staff

Thomas Spackman, M.D., Anesthesiology
Felicia Snead, M.D., Radiation Oncology

Education

New CME Education Series
April 4-Nov. 14, 2009
These half-day courses are designed for primary care physicians, physician assistants and nurses. The courses will provide a multispecialty approach to caring for the patient with breast (April 4) and prostate cancer (Aug. 29), offer the latest medical and surgical options for the obese patient (May 23), and provide the most recent information in preventive medicine (Nov. 14). Attendees will have the option to tour the new Mayo Clinic hospital on the Mayo Clinic campus.
Location: Mayo Clinic, Jacksonville, Fla.
Contact: 1-800-462-9633 (toll free); cme-jax@mayo.edu
Brochure

19th Annual Advances and Controversies in Clinical Nutrition
April 17-19, 2009
Location: Amelia Island Plantation, Amelia Island, Fla.
Contact: 1-800-462-9633 (toll free); cme-jax@mayo.edu
Course Web site

Clinical Reviews and Primary Care Review – 2009
June 8-11, 2009
Location: Amelia Island Plantation
Contact: 1-800-462-9633 (toll free); cme-jax@mayo.edu
Course Web site

Advanced Imaging and Ablation Workshops
June 27 and Oct. 3, 2009
Location: Amelia Island Plantation
Contact: 1-800-462-9633 (toll free); cme-jax@mayo.edu
Course Web site

Mayo Clinic's 19th Annual Hematology/Oncology Reviews
July 30-Aug. 1, 2009
Location: The Ritz Carlton Amelia Island, Amelia Island, Fla.
Contact: 1-800-462-9633 (toll free); cme-jax@mayo.edu
Course Web site

More CME courses at Mayo Clinic in Florida

In the News

Mayo Clinic Trustees Honor New Named Professors
Mayo Clinic Gene Hunter Featured in PBS Special on Parkinson's Disease

January 2009

New CEO

Oncologist William Rupp, M.D., was named CEO of Mayo Clinic's campus in Florida.

New IMRIS Neuro System Allows Surgeons to Use Real-Time Imaging

Mayo Clinic has installed an IMRIS Neuro diagnostic imaging system for brain surgery. The advanced system allows surgeons to use real-time imaging as they operate, which helps them see if the brain has shifted and determine if the entire tumor has been removed. A unique ceiling-mounted track moves the MRI system to the patient rather than the patient having to be moved to the system. The IMRI suite will be available early this year.

Mayo Clinic Receives Reaccreditation as a Certified Stroke Center

Mayo Clinic was awarded the Gold Seal of Approval for stroke care and reaccredited as a Primary Stroke Center by The Joint Commission following an on-site review in December.

Joint Commission certification means the program complies with the national standards in the implementation of established clinical practice guidelines, performance measurements and continuous improvement programs for the care of stroke patients.

The center, which was relocated to Mayo Clinic's new hospital on its San Pablo Road campus in April 2008 from St. Luke's Hospital, was first certified as a Primary Stroke Center in December 2004. Mayo Clinic is also certified as a Comprehensive Stroke Center by the Florida Agency for Health Care Administration. Only five other stroke centers in the state of Florida have received this designation.

Mayo Researchers Identify Dangerous 'Two-Faced' Protein Crucial to Breast Cancer Spread and Growth

Two critical properties of cancer cells are their ability to divide without restraint and to spread away from the primary tumor to establish new tumor sites. Now, researchers from the Mayo Clinic campus in Florida have found a protein they say acts as a deadly master switch, freeing cancer cells from a tumor and ramping up new growth.

New Staff

Carolyn Landolfo, M.D., Cardiovascular Diseases
Kevin Landolfo, M.D., Cardiothoracic Surgery
Juan-Carlos Martinez, M.D., Dermatology
Mary Wechter, M.D., Gynecology
Pablo Castillo, M.D., Pulmonary Medicine
Ron Landmann, M.D., Colon & Rectal Surgery
David Corda, M.D., Anesthesiology
Olga Petrucelli, M.D., Community Internal Medicine
Gretchen Johns, M.D., Laboratory Medicine and Pathology
Patricia Mergo, M.D., Radiology

Clinical Trials

Abdominal Bloating, Discomfort, Fullness
Mayo Clinic is looking for individuals who have:

• Chronic abdominal discomfort
• Bloating
• Early or excessive fullness following meals

The Clinical Studies Unit is investigating the effects of two medicines on symptoms after meals and on the movement of food through the stomach. The nine-month trial (three months on medication, six months of follow-up) involves questionnaires, laboratory tests, a nutrient drink test and a gastric emptying study. A sample of blood for DNA will be drawn and stored for future testing. Visits will range from two to six hours. Compensation is offered. Please call Verna Skinner at 904-953-0703 or send an email to mcjdyspepsia@mayo.edu.

Continuing Medical Education

For more information and to register.

Management Of Adjuvant And Metastatic Breast Cancer Based On New Data From Clinical Trials And The San Antonio Breast Cancer Symposium
Feb. 14, 2009
Location: Hyatt Regency Riverfront, Jacksonville, Fla.
Contact: 1-800-462-9633 (toll free) or cme-jax@mayo.edu.

Electromyography and Electroencephalography in Clinical Practice
March 8-14, 2009
Location: Amelia Island Plantation, Amelia Island, Fla.
Contact: 1-800-462-9633 (toll free) or cme-jax@mayo.edu.

19th Annual Advances and Controversies in Clinical Nutrition
April 17-19, 2009
Location: Amelia Island Plantation, Amelia Island, Fla.
Contact: 1-800-462-9633 (toll free) or cme-jax@mayo.edu.

Clinical Reviews and Primary Care Review — 2009
June 8-11, 2009
Location: Amelia Island, Fla.
Contact: 1-800-462-9633 (toll free) or cme-jax@mayo.edu.

Mayo Clinic's 19th Annual Hematology/Oncology Reviews
July 27-31, 2009
Location: The Ritz Carlton Amelia Island, Amelia Island, Fla.
Contact: 1-800-462-9633 (toll free) or cme-jax@mayo.edu.

November 2008

Palliative Medicine Outpatient Clinic Opens

In September, the Department of Family Medicine opened a new palliative medicine outpatient clinic. The primary goal of the clinic is to help patients achieve the highest quality of life possible, given their medical situation. The clinic is staffed by Robert Shannon, M.D., and Reetu Grewal, M.D., and offers services that include:

• Clarifying treatment goals
• Promoting the best quality of life for patients regardless of prognosis
• Managing difficult symptoms such as pain, nausea, anxiety, fatigue, depression, shortness of breath, constipation, anorexia, and spiritual distress
• Offering assistance to patients and families who are contemplating hospice
• Helping with advance directives and end-of-life care

ALTTO: Adjuvant Lapatinib and/or Trastuzumab Treatment Optimisation Study

A randomised, multi-centre, open-label, phase III study of adjuvant lapatinib, trastuzumab, their sequence and their combination in patients with HER2/ErbB2 positive primary breast cancer.

Siblings with a History of Stroke

The purpose of this research study is to try and identify the genes that increase the risk of developing a stroke.

Genotype 1, Chronic Hepatitis C study

Mayo Clinic is enrolling patients for a study indicated for individuals diagnosed with Genotype 1, Chronic Hepatitis C. The study is being conducted to learn more about the safety and effect of telaprevir in combination with peginterferon alfa-2a (PEG-IFN) and ribavir (RBV) in participants with hepatitis C who have never been treated for the virus. The study is designed to look at the relative benefits of 24 or 48 weeks of total treatment in people who responded quickly to a telaprevir-based treatment.

The study seeks volunteers between ages 18 and 70 with a confirmed and documented diagnosis. Participation in the study will be either 24 or 48 weeks in duration. All study-related procedures are provided at no charge to the patient.

To refer a patient, please contact Iris Orengo, clinical research coordinator, at 904-956-3214.

Education

Managing Ophthalmic Challenges: A Case-Based, Interactive Approach
Dec. 5-7, 2008
This course will cover current concepts in ophthalmology for the practicing ophthalmologist. It will discuss diagnosis and treatment of a broad range of conditions from each ophthalmic subspecialty. The format will consist of case presentation, drawing on audience participation by using the audience response system.
Location: The Breakers, Palm Beach, Fla.
Contact: 1-800-462-9633 (toll free)

Other Mayo CME courses in Florida

New on Staff

Oracio Asbun, M.D., General Surgery
Anthony Adelson, M.D., Radiology
Prasanna Vibhute, M.D., Radiology
Gunjan Gandhi, M.D., Endocrinology

September 2008

Glaucoma procedure aims to prevent further eye damage

Trabectome, a minimally invasive treatment for glaucoma, is now available at Mayo Clinic. It takes about 20 minutes and is designed to decrease pressure within the eye and stabilize the vision.

Clinical Trials

Gene Analysis for the Understanding of Barrett's Esophagus and Esophagus Cancer
This study will analyze blood and tissue to identify genes that may be involved in the development of esophagus cancer and Barrett's esophagus.

ALTTO: Adjuvant Lapatinib and/or Trastuzumab Treatment Optimisation Study
For patients who have early stage HER2 positive breast cancer that has been surgically removed.

Siblings with a History of Stroke Sought for Study
The purpose of this research study is to try and identify the genes that increase the risk of developing a stroke.

New Staff

Elliot Dimberg, M.D., Neurology
Gunjan Gandhi, M.D., Endocrinology
Liuyan (Jennifer) Jiang, M.D., Laboratory Medicine and Pathology
Douglas Riegert-Johnson, M.D., Gastroenterology and Hepatology

Education

For more information about the courses below and to register, go to http://www.mayo.edu/cme/jax-courses.html

Parkinson's Disease and Movement Disorders
Sept. 11-13, 2008
Location: The Homestead, Hot Springs, Va.
Contact: 1-800-462-9633 (toll free)

Practical Clinical Neurology Review
Oct. 29-Nov. 1, 2008
Location: Walt Disney World Swan & Dolphin, Orlando, Fla.
Contact: 1-800-462-9633 (toll free)

2008 State of the Art Multidisciplinary Care of Breast Disease
Nov. 13-15, 2008
Location: Sawgrass Golf Resort and Spa – Marriott, Ponte Vedra Beach, Fla.
Contact: 1-800-462-9633 (toll free)

Managing Ophthalmic Challenges: A Case-Based, Interactive Approach
Dec. 5-7, 2008
Location: The Breakers, Palm Beach, Fla.
Contact: 1-800-462-9633 (toll free)