Lankenau Medical Center

About: Lankenau Medical Center is a healthcare organization based out in Philadelphia, Pennsylvania, United States. It is known for research contribution in the topics: Atrial fibrillation & Medicine. The organization has 436 authors who have published 414 publications receiving 7095 citations. The organization is also known as: Lankenau Hospital.

Transanal Surgery: A History of taTME Ancestry.

Abstract: Transanal total mesorectal excision (taTME) is the culmination of major developments in rectal cancer management and minimally invasive surgery. This surgical breakthrough holds great promise and excitement for the care of the rectal cancer patient. We would be remiss in discussing taTME to not acknowledge the role of transanal abdominal transanal proctosigmoidectomy, transanal endoluminal microsurgery, laparoscopy, and natural orifice transluminal endoscopic surgery that got us to this modern day explosion of the taTME approach. In this article, we detail and explain the convergence of these disparate experiences, how they culminated in the development of the taTME, and explore future directions in this field.

Drug delivery of zinc to Barrett's metaplasia by oral administration to Barrett's esophagus patients.

Abstract: Background: Delivery of a pharmacologically effective drug dosage to a target tissue is critical. Barrett’s epithelia are a unique challenge for drug delivery of orally administered zinc due to rapid transit down the esophageal lumen, incomplete absorptive differentiation of these epithelia, and the use of proton-pump inhibitor drugs abrogating intestinal uptake of supplemental zinc. Methods: Barrett’s esophagus patients were administered oral zinc gluconate (26 mg zinc twice daily) for 14 days prior to biopsy procurement. Barrett’s biopsies were analyzed for total zinc content by atomic absorption spectroscopy and by western immunoblot for cellular proteins known to be regulated by zinc. Results: Cellular levels of both the Znt-1 transport protein and the alpha isoform of PKC were over 50% lower in the zinc treatment group. Conclusion: Oral zinc administration can result in effective delivery of zinc to Barrett’s epithelia with resulting effects on intracellular signal transduction.

Bioprosthetic valve fracture for valve-in-valve transcatheter aortic valve implantation in patients with structural valve degeneration: Systematic review with meta-analysis.

Abstract: OBJECTIVES To determine the outcomes of bioprosthetic valve fracture (BVF) in valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) for patients with structural valve degeneration (SVD) of bioprosthetic surgical valves (BSV) implanted during surgical aortic valve replacement (SAVR). METHODS A systematic review was conducted including studies published by May 2021. The primary endpoints of the study were 30-day mortality, annular rupture, stroke, paravalvular leak, pacemaker implantation, and coronary obstruction. The secondary endpoints were mean valve gradients (mmHg) and aortic valve area (AVA-cm2 ). A meta-analysis was conducted using the software R, version 3.6.3 (R Foundation for Statistical Computing). RESULTS Four studies including 242 patients met our eligibility criteria. The overall proportions for 30-day mortality, annular rupture, stroke, paravalvular leak, pacemaker implantation and coronary obstruction were 2.1%, <1.0%, <1.5%, <1.0%, <1.0%, and <1.5%, respectively. After ViV-TAVI with BVF, the difference in means for mean valve gradients showed a significant reduction (random-effects model: -26.7; -28.8 to -24.7; p < .001), whereas the difference in means for AVA showed a significant increase (random-effects model: 0.55 cm2 ; 0.13-0.97; p = .029). Despite the improvement in AVA means, these remain too low after the procedure highly likely due to the small size of the bioprosthetic valves implanted during the index SAVR. CONCLUSION ViV-TAVI with BVF has proven to be a promising option but data are still too scarce to enable us to draw definitive conclusions. Despite the decrease in gradients, postprocedural AVA remains worrisome. Studies with better designs and larger sample sizes are needed to advance this treatment option.

A piece of my mind. The silent majority.

Abstract: The Silent Majority IT WAS THE END OF A LONG DAY IN THE OFFICE. ALthough I vowed I wouldn’t schedule new, complicated patients after 2 PM, the young man’s mother had pleaded with the scheduling secretary. The family was desperate for a second opinion. They were worried that their 20-year-old would collapse under the weight of his anxiety and depression. They couldn’t wait—could Dr Kowey possibly fit him in? My secretary put him on my calendar and knew I wouldn’t complain. It was a case of presyncope in an athlete. The young man had collapsed during a grueling workout on a hot day. He was brought to an emergency department where an electrocardiogram had a pattern compatible with the Brugada syndrome, a relatively rare but potentially lethal condition. The patient had no family history of sudden death, no prior history of syncope, and no medical problems. An electrophysiologist had been consulted who told the young man and his family that he needed a careful workup. There was no structural heart disease by echocardiography, genetic testing for the SCN5A mutation was negative, none of his siblings or his parents had an abnormal electrocardiogram, and intravenous drug challenge and programmed electrical stimulation were equivocal. Nevertheless, the consultant recommended implantation of a defibrillator “to be on the safe side.” The patient and his family, faced with a lifetime of defibrillator use and care, were devastated. They found me on the Internet— they wanted another opinion. After I went through the records and before I saw the patient, I decided to call the electrophysiologist, a good person who I knew to be well trained and competent. “Peter,” he confessed during our brief conversation, “I was sued over a case just like this last year, and I am not going to let it happen again.” It took me a few minutes to absorb the message, but after I did, I was able to put the case into context and make a reasoned decision. I reassured the patient and his parents that his risk of sudden death was so low that an ICD was not necessary. Yes, his near syncope was problematic, and yes, he might have an arrhythmic event, but there just wasn’t enough evidence to warrant a therapy that would literally change his life. The patient and his parents were able to accept this much uncertainty, and so could I. This case brings forth a nasty secret that physicians know full well but few will admit, at least publicly: we are afraid of being sued for malpractice. In fact, getting a summons delivered to our office is about the nastiest nightmare in our professional lives. Why physicians react so viscerally is hard to decipher and is probably, like most complicated things, multifactorial. Doctors are generally bright people who genuinely want to help others. Physicians tend to be financially conservative, so the idea of having their savings or earnings at risk is terrifying. The assault that a malpractice case makes on their ego is monumental, but physicians are uncomfortable with direct confrontation and prefer to solve problems by consensus, not in battle. Physicians believe that the practice of medicine requires their complete concentration, and the unending strife of a protracted malpractice case is maddeningly distracting. Physicians are proud of their accomplishments. When they have to disclose lawsuits (which they do frequently and formally), they are ashamed of being viewed as a failure. Like Reagan’s silent majority, most physicians have not spoken out on this issue. After all, we regularly persevere through tough situations. We are busy with our jobs, trying to sort out the causes and treatment of complex diseases. Who has time to stop what they are doing and state the problem in a compelling way? Our professional organizations represent us, but they have bigger fish to fry, like trying to prevent massive cuts in our reimbursements. Isn’t it ironic that one of the largest reasons for the cuts is that physicians are breaking the health care bank by ordering unnecessary tests? Because we have been quiet, patients and politicians have little idea how much lawsuits affect physician behavior. Physicians are leaving the profession or relocating to avoid the hurt and the cost of litigation. Frightening is the advice rendered by disillusioned doctors to bright young people to avoid medicine as a career. In a recent survey, fear of retribution for medical errors was cited as a major reason why one in 16 surgeons reported suicidal ideation. But by far the most serious ramification is the corruption of everyday patient care. Just like the electrophysiologist who recommended an ICD for our patient, after a physician has been sued (and most of us have been), he or she vows it won’t happen again. To accomplish that objective, the physician practices defensively. Defensive medicine is pervasive and takes many forms. It extends from ordering too many tests all the way to performing unnecessary surgical procedures. Lung nodules that used to be followed end up in a specimen jar in