Read about “A Segregation Analysis of Barrett’s Esophagus and Associated Adenocarcinomas”

Familial aggregation of esophageal adenocarcinomas, esophagogastric junction adenocarcinomas, and their precursor Barrett’s esophagus (BE) has been termed familial BE (FBE). Numerous studies documenting increased familial risk for these diseases raise the hypothesis that there may be an inherited susceptibility to the development of BE and its associated cancers. I

n this study, using segregation analysis for a binary trait as implemented in S.A.G.E. 6.0.1, we analyzed data on 881 singly ascertained pedigrees to determine whether FBE is caused by a common environmental or genetic agent and, if genetic, to identify the mode of inheritance of FBE. The inheritance models were compared by likelihood ratio tests and Akaike’s A Information Criterion. Results indicated that random environmental and/or multifactorial components were insufficient to fully explain the familial nature of FBE, but rather, there is segregation of a major type transmitted from one generation to the next (P < 10(-10)). An incompletely dominant inheritance model together with a polygenic component fits the data best.

For this dominant model, the estimated penetrance of the dominant allele is 0.1005 [95% confidence interval (95% CI), 0.0587-0.1667] and the sporadic rate is 0.0012 (95% CI, 0.0004-0.0042), corresponding to a relative risk of 82.53 (95% CI, 28.70-237.35) or odds ratio of 91.63 (95% CI, 32.01-262.29). This segregation analysis provides epidemiologic evidence in support of one or more rare autosomally inherited dominant susceptibility allele(s) in FBE families and, hence, motivates linkage analyses.

Read the full article on CWRUmedicine.org

UH CMC is receives Thomson Reuters Top Hospitals Award AGAIN

Thomson Reuters today released its annual study identifying the 100 top U.S. hospitals based on their overall organizational performance.
Clinical arm of Case Western Reserve School of Medicine, University Hospitals Case Medical Center has received the award two years in a row.

The Thomson Reuters 100 Top Hospitals(R):
National Benchmarks study evaluates performance in 10 areas: mortality, medical complications, patient safety, average length of stay, expenses, profitability, patient satisfaction, adherence to clinical standards of care, and post-discharge mortality and readmission rates for acute myocardial infarction, heart failure, and pneumonia. The study has been conducted annually since 1993.

“This year’s study magnified the value that 100 Top Hospital award winners provide to their communities. Even during the economic downturn, the 100 Top Hospitals maintained a profit from operations while raising the bar for clinical quality and patient satisfaction,” said Jean Chenoweth, senior vice president for performance improvement and 100 Top Hospitals programs at Thomson Reuters. “The insistence of these hospitals’ leaders — their boards, executive teams and medical staffs — on overall excellence makes the difference.”

To conduct the 100 Top Hospitals study, Thomson Reuters researchers evaluated 2,926 short-term, acute care, non-federal hospitals. They used public information — Medicare cost reports, Medicare Provider Analysis and Review (MedPAR) data, and core measures and patient satisfaction data from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare data set.

Learn more at CWRUmedicine.org

Dr James Fang discusses the VAD Approach

An alternative one-on-one, patient-oriented approach to  heart disease and heart failure

According to James C. Fang, MD, Medical Director, Advanced Heart Failure & Transplant Center and Professor, Case Western Reserve University Department of Medicine, “The mission of the Advanced Heart Failure & Transplant Center is to provide the latest and most effective therapies to patients in Northeast Ohio and surrounding regions in a personalized one-on-one, patient-centered approach.”

With a high level of expertise in treating heart failure, performing heart transplants, and implanting VADs (also known as heart pumps), the Center offers another sophisticated site in Ohio for patients to consider for their heart and vascular health. One of the most important services provided by the physicians at the Center is their ability to review a patient’s current medical and device therapies and then to provide other treatment options to improve their prognosis and quality of life. “At University Hospitals Case Medical Center, we offer many options and a very personalized approach. We are proud of the fact that we offer very individualized care,” says Dr. Fang. “Many patients don’t recognize that they are suffering needlessly.”

The VAD Option
Patients seen at the Center have refractory congestive heart failure and continue to be short of breath despite medications, device therapy (such as biventricular pacemakers) and heart surgery. These patients find that even doing simple activities like taking a shower or sitting in a chair are difficult. In addition, they cannot stay out of the hospital for very long – they are often regularly admitted for shortness of breath and fluid buildup in the legs. Such patients may be candidates for heart transplantation or a VAD.

VADs are sophisticated, miniaturized pumps that help the heart to provide sufficient blood flow throughout the patient’s body. “VADs are the newest form of a mechanical heart,” says Dr. Fang. A healthy heart can normally pump about 5 L of blood per minute around the body at rest. If, for example, a patient’s heart can pump only 1 L of blood per minute, the VAD will pump an additional 4 L, for a total of 5 L of blood per minute. “The heart pump helps,” notes Dr. Fang, “without entirely taking over the function of the heart.”

Typically, heart pumps are used temporarily while a patient awaits a heart transplant. Current first generation VADs, such as the Thoratec Heartmate XVE, are also used as a “destination” therapy – a permanent solution for heart failure. These devices can function for 12 to 18 months before they must be replaced. It is anticipated that a new, second generation of heart pumps, now undergoing investigational study, will increase the duration of ventricular assistance to two to four years. Nationwide about 2,500 heart transplant operations are performed annually and the Advanced Heart Failure & Transplant Center’s heart surgeons have collectively performed hundreds of heart transplants.

Learn more about VADs at CWRUmedicine.org

Congratulations to our Department of Medicine doctors awarded the “Best Doctors” title

The Department of Medicine would like to congratulate our doctors who have been recognized in Cleveland Magazine’s “Best Doctors” list. We want to thank the entire community of CWRUmedicine physicians, nurses and staff for the work they do every day.

Cardiovascular Medicine
Dr. Mauricio S. Arruda
Dr. John Blebea
Dr. Barry A. Effron
Dr. James Fang
Dr. Michel George Farah
Dr. Steven A. Fisher
Dr. Robert Goldstein
Dr. Austin A. Halle IIIte
Dr. Brian Hoit
Dr. Richard A. Josephson
Dr. Joseph I. Krall
Dr. Judith Mackall
Dr. Sri Krishna Madan Mohan
Dr. Carl E. Orringer
Dr. Aaron Proweller
Dr. Daniel I. Simon
Dr. Bruce S. Stambler
Dr. Albert L. Waldo

Clinical and Molecular Endocrinology
Dr. Baha Mahmoud Arafah

Gastroenterology and Liver Disease
Dr. Amitabh Chak
Dr. Fabio Cominelli
Dr. Gregory S. Cooper
Dr. Ashley L. Faulx
Dr. Gerard Isenberg
Dr. Jeffry A. Katz

Oncology and Hematology
Dr. Matthew M. Cooney
Dr. Brenda W. Cooper
Dr. Afshin Dowlati
Dr. Stanton L. Gerson
Dr. Joseph Gibbons
Dr. Smitha Subramanyan Krishnamurthi
Dr. Hillard Michael Lazarus
Dr. Nathan Levitan
Dr. Neal J. Meropol
Dr. Paula Silverman

Infectious Disease & HIV
Dr. Keith B. Armitage
Dr. Barbara M. Gripshover
Dr. Michael M. Lederman
Dr. Robert A. Salata

Nephrology & Hypertension
Dr. Donald E. Hricik
Dr. Daniel B. Ornt
Dr. Michael C. Smith

Pulmonary, Critical Care & Sleep
Dr. Rana B. Hejal
Dr. Hugo Montenegro
Dr. Robert John Schilz
Dr. Kingman P. Strohl

DNA Screening for Colon Cancer Video

Download now or watch on posterous

DNA Screening for Colon Cancer.flv (5669 KB)

It is estimated that colon cancer will kill 50,000 people in the United States this year. But found early, that number could be lowered substantially. So why do so many still die from it? The answer and the solution can be found in a medical laboratory in Cleveland, Ohio.

A team of researchers led by Sanford Markowitz, M.D., Ph.D. at the Case Western Reserve University Department of Medicine has found a way to detect colon cancer quickly and non-invasively.
Learn more at CWRUmedicine.org

Congratulations to the Department of Medicine doctors who have been awarded the “Best Doctors” title by their peers.

The Department of Medicine would like to congratulate our doctors who have been recognised in Cleveland Magazine’s “Best Doctors” list.

We want to thank the entire community of CWRUmedicine physicians, nurses and staff for the work they do every day.

Cardiovascular Medicine
Dr. Mauricio S. Arruda
Dr. John Blebea
Dr. Barry A. Effron
Dr. James Fang
Dr. Michel George Farah
Dr. Steven A. Fisher
Dr. Robert Goldstein
Dr. Austin A. Halle IIIte
Dr. Brian Hoit
Dr. Richard A. Josephson
Dr. Joseph I. Krall
Dr. Judith Mackall
Dr. Sri Krishna Madan Mohan
Dr. Carl E. Orringer
Dr. Aaron Proweller
Dr. Daniel I. Simon
Dr. Bruce S. Stambler
Dr. Albert L. Waldo

Clinical and Molecular Endocrinology
Dr. Baha Mahmoud Arafah

Gastroenterology and Liver Disease
Dr. Amitabh Chak
Dr. Fabio Cominelli
Dr. Gregory S. Cooper
Dr. Ashley L. Faulx
Dr. Gerard Isenberg
Dr. Jeffry A. Katz

Oncology and Hematology
Dr. Matthew M. Cooney
Dr. Brenda W. Cooper
Dr. Afshin Dowlati
Dr. Stanton L. Gerson
Dr. Joseph Gibbons
Dr. Smitha Subramanyan Krishnamurthi
Dr. Hillard Michael Lazarus
Dr. Nathan Levitan
Dr. Neal J. Meropol
Dr. Paula Silverman

Infectious Disease & HIV
Dr. Keith B. Armitage
Dr. Barbara M. Gripshover
Dr. Michael M. Lederman
Dr. Robert A. Salata

Nephrology & Hypertension
Dr. Donald E. Hricik
Dr. Daniel B. Ornt
Dr. Michael C. Smith

Pulmonary, Critical Care & Sleep
Dr. Rana B. Hejal
Dr. Hugo Montenegro
Dr. Robert John Schilz
Dr. Kingman P. Strohl