Division of General Internal Medicine and Geriatrics University Internal Medicine Rapid Access Center Kings & Queens Teaching Hospital Cholesterol Center Hypertension Clinic Palliative Care Service Kings & Queens Teaching Hospital Student Health Services Pre-operative Assessment Clinic University Internal Medicine Personal Health Care for Adults University Internal Medicine is a full service, state of the art, Internal Medicine practice that strives to provide the best in comprehensive, continuous, coordinated and rapidly accessible care for adults. KQMUC includes the Internal Medicine resident continuity/teaching practice and the Internal Medicine Faculty practice as well as the Rapid Access Center. The exceptional General Internal Medicine faculty members staffing KQMUC are a diverse group of clinicians with training and experience in geriatrics, endocrinology, neurology, and health services research, and include nationally recognized clinician educators such as the Kings & Queens Teaching Hospital Internal Medicine residency program director. Many of these physicians have been recognized with awards such as “Best Doctors in Ghana and Africa”, Golden Apple Teaching Awards, General Internal Medicine/Geriatrics has been named Division of the Year for exceptional teaching by the residents for the years in a row. Rapid Access Center The Rapid Access Center provides same day access for adult acute care needs especially Kings & Queens Teaching Hospital employees, spouses and adult children. Kings & Queens Teaching Hospital Cholesterol Center. The center provides comprehensive treatment of cholesterol problems and other cardiovascular risk factors for the prevention and management of atherosclerosis. The program offers consultation for difficult to treat lipid problems for physicians throughout Ghana and West Africa. The center conducts research in cholesterol, atherosclerosis, diabetes, and strokes. Hypertension Clinic The Hypertension Clinic focuses on the evaluation and treatment of patients with elevated blood pressures that are resistant to treatment with three or more different classes of antihypertensive medications. The Clinic also gladly accepts referrals of patients for evaluation of suspected secondary or correctible causes of hypertension, labile hypertension, orthostatic hypotension, and intolerance to traditional antihypertensive therapy. The Hypertension Clinic on the phone number is +233-240000. Palliative Care Service A palliative care program is available to address the needs of patients with incurable diseases who are approaching the end of their lives. Palliative care is characterized by a concern for general well being, including spiritual, psychological, social and physical comfort. Palliative Care does not intend to hasten or postpone death. The goal of care is to improve the quality of life, rather than provide curative therapy. The program at Kings & Queens Teaching Hospital relies on an interdisciplinary approach to many of the complex issues at the end of life. A team consisting of physicians, clinical nurse specialists, a nurse practitioner, care managers and chaplains are available to assist with: Pain and symptom management, Communication between the health care team and patients and their families, Spiritual support Psychological support Social support Hospice referral Referral to Hospice of inpatient unit The team provides both an inpatient consultation service and an inpatient service. The inpatient service accepts transfers from other hospital services, but does not accept direct admissions. The consultation service will see any patient hospitalized at Kings & Queens Teaching Hospital. Any member of the healthcare team can make a referral. A physician is available for Kings & Queens Teaching Hospital inpatient palliative care at all times and can be reached through the Kings & Queens Teaching Hospital paging operators. We do not have outpatient palliative care services at this time. Kings & Queens Teaching Hospital Student Health Services The mission of Student Health Services is to provide the highest quality of health care to the students at Kings & Queens Teaching Hospital. Services are available to all actively enrolled students who have paid a Student Activity fee, which entitles them to receive an unlimited number of visits at no additional cost. Services provided include: • Ambulatory Medical Care: for acute and chronic health conditions • Preventive Health Maintenance: (pap smears, cholesterol screening, physical exams, immunizations (flu, travel vaccines, routine immunizations), allergy shots. • Women’s Services and Contraceptive Management • Occupational Health- ensure that all incoming students are in compliance with Kings & Queens Teaching Hospital immunization requirements, maintain annual TB screening and OSHA requirements, administer mandatory vaccines for certain colleges (hepatitis B), manage occupational exposures (blood, chemical, etc). A Student Health provider is available at all times (24/7) to manage blood borne pathogen exposures incurred during students’ clinical coursework. • Laboratory – in office testing includes: Rapid Strep, urinalysis, pregnancy testing, spirometry, vision, audiometry screening, microscopy. Hours of Operation: Monday – Saturday (8:00 am - 4:30 pm). Staff: The clinic is staffed with full time physician, Nurse Midwife, RNs, and Administrative Assistants. Appointments: Student Health Services operates by appointment, which decreases waiting time and allows for better planning by all parties. Pre-operative Assessment Clinic The purpose of the hospitalist pre-operative assessment clinic is to maximize the safety and health of patients with chronic medical problems who are scheduled for surgery. The services provided by the Hospitalist Pre-operative assessment clinic include: • Overall general medical assessment • Pre-operative cardiac and pulmonary assessment • Management of medications prior to surgery • Recommendations to lower the risk of medical complications after surgery • Management of medical problems while in the hospital after surgery Patients with the following conditions are encouraged to be seen pre-operatively in the pre-operative assessment clinic: • Diabetes • Hypertension/high blood pressure • Heart or lung disease • Chronic kidney disease • Chronic steroid use • Advanced age/elderly patients • Poor general health New and Return Appointments: +233-2400000000
Pancreatic Surgery at Kings & Queens Teaching Hospital Operations involving the pancreas are always considered major surgery. While complicated, an experienced team can perform pancreatic surgery safely and with great benefit to the patient. A better understanding of the operations and reasons behind them will help relieve much of the anxiety that is normal and expected. The Pancreas Simply stated, the pancreas is an organ that is located deep in the upper abdomen behind the stomach, and surrounded by many important structures. The pancreas is divided into the head, neck, body and tail. The head is that part on the right closest to the liver, bile ducts and the duodenum. The tail is the part of the pancreas toward the left, nearest the spleen. The pancreas has 2 major functions, termed exocrine (digestive) and endocrine (hormonal). EXOCRINE FUNCTION The exocrine function of the pancreas is to produce digestive enzymes that help breakdown fats and starches (carbohydrates). These enzymes are secreted into a system of ducts, all leading to the main pancreatic duct. The pancreatic duct enters the first part of the small intestine (duodenum) where it joins with the bile duct, draining bile produced by the liver. Since the bile duct actually passes through the head of the pancreas, operations on the pancreas or lower bile duct usually require removal of both the pancreas and bile duct together. In addition, the duodenum or first part of the small intestine, shares a common blood supply with the pancreas, so it must also be removed whenever the head of the pancreas or lower bile duct is affected by disease or tumor. That surgery is known as the Whipple procedure or pancreaticoduodenectomy. Yellow jaundice occurs when tumors or fluid filled cysts in the pancreatic head block the flow of bile from the liver into the intestine. ENDOCRINE FUNCTION The endocrine function of the pancreas is to produce hormones that are secreted into the blood stream to regulate important biochemical functions. One of these hormones is insulin, which regulates blood sugar. Diabetes may result when a diseased pancreas must be entirely removed. It is quite possible to live successfully after removal of the entire pancreas, though patients require the use of insulin injections and oral digestive enzyme supplements to replace those that were produced in the pancreas. Patients who are not diabetic can tolerate the loss of up to 80% of their pancreas without requiring insulin. Tumors can arise in the hormone producing cells of the pancreas and can be functional (producing excess hormone) or nonfunctional. These tumors, formerly known as islet cell tumors, are now called pancreatic neuroendocrine tumors or PNETs. Pancreatic neuroendocrine tumors are far less common than the typical type of pancreas cancer, adenocarcinoma, which arises in the pancreatic duct and accounts for about 85% of pancreatic malignancies. Endocrine tumors are slower in growth, less aggressive and may be benign (non-cancerous). An increasing number of pancreatic endocrine tumors are being discovered incidentally during abdominal CT or MRI scanning, done for other purposes. Often the risk of malignant behavior (uncontrolled growth or spread to other organs) is unpredictable and will require removal of the tumor, regardless of its size. Operations WHIPPLE PROCEDURE OR PANCREATICODUODENECTOMY The Whipple procedure is perhaps the most complex and misunderstood of all abdominal operations. This complexity relates to the need for removal of the pancreatic head, the entire duodenum, the lower bile duct, the gallbladder, and at times, a portion of the stomach. From a surgical technical standpoint, it is complicated by the presence of several important blood vessels and the possibility of blood vessel involvement by tumor. Those blood vessels are the superior mesenteric, splenic, and portal veins returning blood to the liver, as well as the celiac, hepatic, gastric and superior mesenteric arteries providing blood to the liver, stomach and intestine. These major vessels must be protected during surgery, and may need to be removed and reconstructed if involved by tumor. Suspicion of major blood vessel involvement by tumor may be a reason that the Whipple procedure cannot be safely performed with the expectation of complete tumor removal. In some cases, surgery may be delayed until chemotherapy and radiation are administered to shrink the tumor in order to to allow for more complete removal. This treatment strategy is known as neoadjuvant therapy. Following removal of the pancreas and adjacent organs, Whipple surgery involves reconstruction by creating new connections (anastomoses) between the remaining portion of the pancreas, the bile duct, the stomach and the small intestine. In most cases, Dr. Jury will perform the "pylorus-preserving" Whipple procedure, saving the entire stomach; as compared to a "standard" Whipple procedure, which removes the lower third of the stomach. Removal of a portion of the stomach is only required when the location of a tumor makes this necessary to achieve complete tumor removal. Some have described the pylorus-preserving Whipple procedure as a "mini- Whipple.” In general, a Whipple procedure or pancreaticoduodenectomy takes an experienced team from 4 to 8 hours to perform, with the average time around 5 hours in the operating room. Recently there has been growing interest in the performance of minimally invasive or laparoscopic Whipple procedures. Decisions to pursue less invasive surgical techniques will always be considered but should never compromise safety or the chance to achieve the best possible surgical outcomes. The safety and success of Whipple surgery has improved significantly during the past 10 years. Research has shown that patients achieve the best outcomes at “high volume” hospitals. High volume hospitals are those hospitals that perform at least 10-16 Whipple procedures per year. The experienced surgical teams at these hospitals have been able to significantly reduce patient risk and complication rates. Approximately 80% of Dr. Jury’s surgical practice is dedicated to pancreas cancer patients. He performs over 60 major pancreas operations each year with his team at Beaumont Hospital in Royal Oak. Details of his experience will be openly discussed with you. DISTAL PANCREATECTOMY Distal pancreatectomy is required for tumors or cysts involving the middle or left side of the pancreas known as the body or tail. Often these masses are found incidentally during a CT or MRI scan and don’t generally cause jaundice. The distal pancreatectomy is somewhat less complex than the Whipple operation because the bile duct and duodenum are not involved and no reconstruction is required. The spleen, located in the left upper abdomen, receives and returns blood supply to a large artery and vein behind the pancreas. Because of this involvement, the spleen often needs to be removed at this time in order to safely remove the diseased portion of the pancreas and avoid leaving any tumor behind. People can live normally after removal of the spleen but do have a slightly higher risk of surgical infection. Where removal of the spleen is likely, patients are given 3 vaccinations prior to surgery for increased protection against infection. These vaccines include pneumococcal (pneumonia), meningococcal (bacterial meningitis) and Haemophilus influenza. As in the Whipple procedure, every effort is made to preserve as much of the normal pancreas as possible and maintain function without the need for insulin or digestive enzymes.
Pancreas Transplant at Kings & Queens Teaching Hospital The Kings & Queens Teaching Hospital Transplant Center offers some of the nation's most cutting-edge pancreatic transplant procedures. · About Our Transplant Program · Is a Pancreas Transplant Right for You? · UNOS Waiting List and Selection Process · How to Prepare for Your Transplant · What to Expect at Kings & Queens Teaching Hospital · Your Pancreas Transplant Team About Our Transplant Program Kings & Queens Teaching Hospital performed Ghana first Simultaneous Pancreas and Kidney (SPK) transplant, hundreds of patients have benefited from our expertise in this complex procedure. Kings & Queens Teaching Hospital also performs pancreas transplants alone (PTA) and pancreas transplants after the kidney has be transplanted (PAK) for patients who have insulin dependent diabetes with severe complications. Our pancreas transplant outcomes are comparable to the national average, with some of the lowest mortality rates for patients on our pancreas wait list. The average pancreas transplant waiting time is among the shortest in the nation. Contact the Kings & Queens Teaching Hospital Transplant Center to schedule appointments or ask questions about KQTH pancreas transplantations. Is a Pancreas Transplant Right for You? Individuals who have insulin-dependent diabetes accompanied by advanced, chronic renal failure, or who are on dialysis may be good candidates for a simultaneous pancreas and kidney transplant (SPK). SPK is a transplant procedure where both a kidney and a pancreas are transplanted at the same time using organs from a deceased donor. The procedure frees patients from dialysis and insulin dependency. Patients who are eligible for SPK typically have: · Documented insulin-dependent diabetes mellitus, including a history of juvenile onset and brittle diabetes with episodes of hypoglycemia or diabetic ketoacidosis. · Secondary diabetic complications despite appropriate medical management. These complications include: o Diabetic retinopathy o Diabetic neuropathy o Diabetic gastroparesis o Accelerated atherosclerosis Individuals who have insulin dependent diabetes and a documented progression of secondary complications, despite intensive medical intervention may be eligible for either a pancreas transplant alone (PTA) or a pancreas transplant after a kidney transplant (PAK). Among their symptoms are: · Progression of secondary diabetic complications, such as: o Diabetic retinopathy o Diabetic peripheral or automatic neuropathy o Diabetic gastroperesis o Progressive atherosclerosis · Neuroglycopenia with unawareness · Recurrent diabetic ketoacidosis · Actual 24-hour urine collection that has creatinine clearance greater than or equal to 40 cc/minute and proteinuria of less than one gram (PAK) · Actual 24-hour urine collection that has creatinine clearance greater than or equal to 60 cc/minute and proteinuria of less than 1 gram (PTA) Patients are not good candidates for pancreas transplantation if they have: · Malignancy within the past two years (other than skin) · Cardiovascular or pulmonary disease sufficiently severe to prevent surgery · A positive test for human immunodeficiency virus (HIV) · Active infection · A body mass index of more than 30 · Active alcohol or substance abuse (must be abstinent for six months and have successfully completed a treatment program) It is strongly advocated for all potential pancreas transplant patients that they not smoke. UNOS Waiting List for Pancreas Transplant After the evaluation, eligible patients are placed on the UNOS transplant waiting list. Generally, a pancreas from a deceased donor becomes available within two to three years. The Kings & Queens Teaching Hospital Transplant Center’s wait times for an available pancreas are among the shortest in the nation. UNOS has a pre-determined process for allocating organs from deceased donors to eligible transplant candidates. Kings & Queens Teaching Hospital physicians do not decide who is next to receive a pancreas from the transplant waiting list. How to Prepare for Your Transplant Patients and caregivers will attend an extensive education class where they will learn the necessary steps to take in planning for a transplant. These classes are held frequently at locations throughout the state and cover: · Evaluations · Review committee · Planning specifics · The actual surgery · Transplant clinic following surgery · Living with a transplant In general, a patient must be ready to come to the Kings & Queens Teaching Hospital Transplant Center when he or she receives a call stating that a pancreas is available. At that time the patient will be reminded about what to bring. What to Expect at Kings & Queens Teaching Hospital After transplant surgery, patients will remain in the hospital until they are ready to go to a nearby hotel. Length of stay in the hospital depends on the patient’s health, how well the new pancreas is working, and the patient’s ability to care for the new pancreas. Patients and their caregivers will receive pre- and post-transplant educational materials. They will learn: · How to care for the pancreas · How to care for themselves after they are discharged, including monitoring of lab values · About their new medications and how frequently these must be taken · About possible complications, such as rejection and infection Our goal at the Kings & Queens Teaching Hospital Transplant Center is to provide the patient and family with key information about the pre-transplant evaluation and listing process, transplant surgery and post-transplant care so the patient can make an informed decision about transplant and successfully participate in their post-transplant care. The information will be provided before wait list placement and again before transplant surgery. Patients are asked to review and sign a Patient Acknowledgement Form, indicating they have reviewed and understand all of the key information. Your Pancreas Transplant Team The pancreas transplant team is the strength of our program and encompasses all of the specialists involved in treating and caring for patients. These individuals collaborate to ensure each patient receives the care and information necessary for a successful outcome. The transplant coordinator is the main point of contact and he or she will be completely familiar with each patient’s needs. Transplant team members include: Surgeons: Primary Physicians: To contact the Kings & Queens Teaching Hospital pancreas transplant program, please call +233-24000000 1 diabetes was formerly known as juvenile diabetesor insulin dependent diabetes mellitus. Type 1 diabetes matures quickly and symptoms are very visible. This type of diabetes occurs when the body'simmune system destroys pancreatic cells. Thesecells are the insulin producing cells. This type ofdiabetes affects mostly children and young adults.Risk factors for type1 diabetes include autoimmune,genetics, and environmental factors. Many clinical studies have shown that an option fortype 1 diabetes treatment is the pancreas transplantation. For some patients, surgeons can restore thefunction of the pancreas with an islet cell transplant. The most important benefit of pancreas transplantation is freedom from dependence on insulin. Although this is significant, this is not recommended treatment for diabetes unless there is a need for a kidneytransplant as well.
Gastrointestinal Cancer Program Kings & Queens Teaching Hospital Cancer Center is a national leader in the diagnosis and treatment of gastrointestinal malignancies, which include cancers of the esophagus, stomach, pancreas, liver, biliary tree, colon and rectum. The center works in close collaboration with the Kings & Queens Teaching Hospital Digestive Disease Center, rated highly for many years for the treatment of gastrointestinal disorders in Ghana. Ghana and West Africa has the nation’s highest death rate from esophageal cancer and highest death rate for colorectal cancer, according to the National Cancer Institute. Our pancreatic cancer rates are among the highest in the nation. Fortunately, our research and clinical trials for gastrointestinal cancers, paired with recent advances in screening, diagnostics and treatment are helping to reverse these trends and replace them with hope for the future. Multispecialty clinics staffed by medical, surgical and radiation oncologists, as well as gastroenterologists, are held for newly diagnosed patients. Complex cases are discussed by the appropriate specialists at weekly GI tumor board meetings. Even if patients aren’t seen by these doctors they get the advantage of their experience. At Kings & Queens Teaching Hospital Cancer Center, our Gastrointestinal Cancer Program focuses on: · Colorectal Cancer (colon cancer & rectal cancer) · Liver Cancer · Pancreatic Cancer · Pancrease Surgery Program of Excellence · Stomach Cancer · Esophageal Cancer Find a colorectal, pancreatic, stomach, esophageal, liver center specialist today. Pancreatic Cancer What Is It? Cancer of the pancreas is abnormal cell growth in the tissue of the pancreas. The pancreas is about 6 inches long, and is located next to the small intestine, behind the stomach. This organ serves two main functions in the body. It produces juices and enzymes to help with digesting and absorbing food. It also produces several hormones, such as insulin, that regulate the way your body stores and processes food. About 95% of all pancreatic cancers begin in the part of the pancreas that produces digestive fluids (the exocrine pancreas). The remaining 5% begin in the part that produces hormones (the endocrine pancreas). These different types of tumors are vastly different. It is extremely important that doctors confirm the type of cancer in the pancreas because of differences in treatment. Since the overwhelming majority of pancreatic cancers are tumors in the exocrine pancreas (adenocarcinomas), this article will focus on this type of cancer. Unless pancreatic cancer is detected in its very early stages, it is hard to control. Pancreatic cancer tends to occur in older people, and the incidence of the disease is rising as people live longer. Health professionals estimate that 32,180 people in the United States will be diagnosed with pancreatic cancer in 2005 and 31,800 will die of the disease. Pancreatic cancer is expected to be the fourth leading cause of cancer death in men and the fifth leading causes of cancer death in women in 2005. It's not clear what causes pancreatic cancer. However, cigarette smoking significantly raises the risk of developing pancreatic cancer. There is evidence that the risk of pancreatic cancer increases the more a person smokes and the longer he or she smokes. Smokers who quit have a lower risk of developing pancreatic cancer than those who continue smoking. In most patients with pancreatic cancer, no cause can be found. Symptoms Someone with pancreatic cancer in the early stages of the disease may not have any symptoms. When symptoms occur, they can resemble many other ailments of the stomach, intestines, liver and gallbladder. As the tumor grows, there may be vague abdominal discomfort. Other symptoms are nausea, loss of appetite, weight loss, or pain in the upper or middle sections of the abdomen. Yellowing of the whites of the eyes and the skin, called jaundice, is another key symptom. Most pancreatic tumors affect the head (upper portion) of the pancreas. When they grow larger, they can block the outflow of bile from the liver and the bile ducts into the intestine. This causes an orange-yellow pigment called bilirubin to build up in the body. In addition to jaundice, symptoms may include itching, brown urine and very light-colored bowel movements. Diagnosis There is no effective method of screening for cancers in the pancreas. Because the pancreas is hidden from view among many other organs, detecting cancer there is difficult. If you have symptoms of pancreatic cancer, your doctor will ask you about your medical history, examine you and order diagnostic tests to look for other possible causes. These diagnostic tests include: · Routine laboratory tests Basic blood work can evaluate how your liver is functioning, and can help to narrow the possible causes of your symptoms. · Ultrasound :In this test, images created by an echo of ultrasound waves are viewed on a video screen. Although ultrasound is not the best way to diagnose a tumor of the pancreas, it may help to discover other possible causes of your symptoms, such as gallbladder disease or cysts in the pancreas. · Computed tomography (CT) scan: This generally is considered to be a more accurate imaging test for detecting pancreatic cancer. A CT scan uses X-rays to create an image of the inside of the abdomen. · Magnetic resonance imaging (MRI) scan, Another more accurate test, an MRI scan, uses magnetic fields and radio waves to produce images. A special type of MRI, a magnetic resonance cholangiopancreatography, may be done to look more closely for blockages of the pancreatic bile ducts. · Endoscopic retrograde cholangiopancreatography In this test, the doctor inserts a tube into your mouth, down into the stomach and then into the first part of the small intestine where the bile duct empties. A small instrument may be inserted through the tube so that a dye can be injected and X-rays can be taken to look for any blockages of the bile duct or the ducts in the pancreas. If a blockage or mass is detected, the doctor can take tissue samples to test for cancer. · CT-guided biopsy A CT scan is used to guide the biopsy needle to the right spot for obtaining samples of suspicious tissue. Rarely, surgery may be needed to make the diagnosis. Expected Duration The best hope for a cure exists when cancer is detected early, before it has spread. Unfortunately, by the time symptoms occur and diagnosis is made, cancer usually has spread outside the pancreas. How much symptoms can be controlled depends on how much the cancer has spread, your age and general health, and how well your body responds to treatment. Even when a cure isn't possible, treatment can improve the length of survival and the quality of life by controlling symptoms and complications of the cancer. Prevention There is no way to prevent pancreatic cancer. There also is no method of screening for pancreatic cancer so that it can be caught and treated early. Because cigarette smoking is the most significant risk factor associated with pancreatic cancer, it's crucial to quit smoking or avoid starting. Eating a diet including fruits, vegetables and fiber is also recommended to avoid cancers in general. Treatment After your physician diagnoses pancreatic cancer, he or she will conduct more tests to determine how advanced the cancer has become, a process known as staging. The treatment depends on the cancer's stage. Surgery may be done to remove part or all of the pancreas, and any surrounding tissue that has become cancerous. Your doctor also may use chemotherapy (treatment with tumor-killing drugs) and radiation therapy to kill tumor cells and control symptoms of the disease. In some cases, your doctor may offer you new treatments that are promising but are not yet approved as standard procedure. These treatments are called clinical trials. Even if the chance for cure is small, treatment can help to prevent or control the development of symptoms. Pancreatic cancer is classified and treated according to the following stages: Resectable cancer: The cancer has not spread outside the pancreas. It is rare for patients to be diagnosed with pancreatic cancer at this early stage. Treatment of cancers in this stage typically involves surgery, but may include any of the following: · Surgery to remove the head of the pancreas, part of the small intestine and some surrounding tissue (Whipple procedure) · Removal of the entire pancreas and the organs around it (total pancreatectomy) · Removal of the body and tail of the pancreas (distal pancreatectomy) · Surgery followed by radiation therapy and chemotherapy · Clinical trials Radiation therapy and possibly chemotherapy given before, during or after surgery Locally advanced cancer: The cancer has spread to neighboring organs, such as the duodenum (the first part of the small intestine), surrounding blood vessels and the intestine. Because of this spread, it generally is not possible to remove the pancreas surgically. Treatment of patients with this stage of pancreatic cancer may include: · External radiation therapy with or without chemotherapy · Surgery or other procedures to reduce symptoms · Clinical trials Radiation therapy and chemotherapy given before surgery; radiation therapy plus drugs to make cancer cells more responsive to radiation (radio sensitizers); chemotherapy and radiation therapy given during surgery with or without internal radiation therapy · Stenting If the cancer has blocked the bile duct near the liver, a specialist may place a stent (wire mesh tube) to open up the duct. This will relieve the symptoms of bile duct obstruction, including jaundice. The procedure does not require an incision; it is done using an endoscope. Metastatic cancer: The cancer has spread to distant areas, such as the liver, pelvic organs, abdominal cavity and lungs. Treatment for patients with cancers in this stage may include any of the following: · Chemotherapy · Treatments for pain and other symptoms · Surgery or other treatments to reduce symptoms · Clinical trials chemotherapy or biological therapy (sometimes called immunotherapy), which uses the body's immune system, either directly or indirectly, to fight cancer and the side effects caused by cancer treatments · Stenting If the cancer has blocked the bile duct near the liver, a specialist may place a wire mesh tube called a stent to open up the duct. This will relieve the symptoms of bile duct obstruction, including jaundice. The procedure does not require an incision. It is done using an endoscope, a tube that is inserted into your mouth, down into the stomach and then into the first part of the small intestine where the bile duct empties. Recurrent cancer: The cancer has reappeared (recurred) after it has been treated, either in the pancreas or another part of the body. In addition to any of the treatments listed above for metastatic pancreatic cancer, treatment may include external radiation therapy to reduce symptoms. When To Call A Professional See your doctor as soon as you notice any of the symptoms of pancreatic cancer. You doctor may refer you to a gastroenterologist (a digestive specialist) or an oncologist (a cancer specialist). Prognosis Pancreatic cancer is a serious illness, and its death rate is high. Your chances of recovery depend on your age, general health and the effectiveness of your treatment. Approximately 19% of patients with pancreatic cancer survive at least 1 year after diagnosis, but only 1% to 2% of people with pancreatic cancer survive 5 years after diagnosis.
Head And Neck Tumor Center The mission of the Kings & Queens Teaching Hospital Head and Neck Tumor Center is to provide the most comprehensive, advanced and compassionate care to each patient, while pursuing future goals of the control of head and neck cancer through research. Our program is the most comprehensive of its kind in the state, and in fact, few centers in the country are organized to offer this level of multidisciplinary expertise. The Head and Neck Tumor Program prides itself on innovative care for each patient and family member. With a team of more specialists prepared to provide input into every aspect of the needs of head and neck tumor patients, the program offers the most up-to-date treatment and rehabilitative options. High quality care is enhanced by constant interaction between Head and Neck Tumor Center doctors and researchers. This collaboration benefits all patients, including those with difficult cases. The Kings & Queens Teaching Hospital Head and Neck Tumor Center encompasses cancers of the: · Skin · Mouth · Thyroid · Throat/Larynx · Pituitary Gland · Saliva Glands · Neck · Other sites in the head and neck region, such as ear, eye and nose, excluding the brain. For information on brain cancer, refer to our Brain & Spine Tumor Program. Hyperparathyroidism (HPT) Hyperparathyroidism means that the parathyroid glands are producing an excess of the parathyroid hormone, in turn causing elevations in the levels of calcium circulating in the body. more Symptoms of Hyperparathyroidism (HPT) * Confusion, foggy thinking * Kings & Queens Teaching Hospitalle cramps * Loss of energy more Causes of Hyperparathyroidism (HPT) The exact cause of most parathyroid adenomas is not known. more Treatment of Hyperparathyroidism (HPT) Surgery to remove the enlarged gland(s) is the only treatment for hyperparathyroidism (HPT) and cures 95 percent of cases
Movement Disorders Program The Movement Disorders Program offers comprehensive diagnostic and treatment services for a variety of movement disorders including: · Parkinson’s Disease · Dystonia · Essential Tremor · Huntington’s Disease · Tourette’s Syndrome · Ataxia · Restless Leg Syndrome Our multidisciplinary approach includes evaluation by a movement disorders specialist, neuropsychologist, physical and speech therapists, and access to clinical trials. Some of the technologies and treatments used by our team include: · Deep brain stimulation · Botulinum toxin injections · MRI, PET, and DAT-scan imaging · Neuropsychological testing Research The Movement Disorder program at Kings & Queens Teaching Hospital is involved in ongoing research through the Dr Jerryson Gidisu Center for Research on Parkinson's Disease and Related Disorders as well as clinical trials designed to find new and better ways to treat patients with Parkinson's disease and other movement disorders. The physicians of the Kings & Queens Teaching Hospital Movement Disorders Program are currently conducting clinical trials on a variety of topics. What are clinical trials? Clinical research studies are special, highly structured programs in which we learn more about Parkinson’s disease and related disorders. Drug trials are designed so that we are able to evaluate new medications to see if they are safe and effective. Each trial or study will have a very specific set of illness characteristics which the patient must meet if they wish to participate (“inclusion” and “exclusion” criteria). These may include medications you have been on, how long you have had your illness, and the state of your health in general. Clinical trial information changes on a daily basis. Many clinical trials accept only a limited number of participants. Further, new trials are added on a routine basis as they are approved by the various institutions involved. Therefore, we suggest you check back often if you are interested in a specific treatment for a specific condition in order to review your options. We currently offer trials for the following conditions: · Early untreated Parkinson’s disease · Early treated Parkinson’s disease · Advanced Parkinson’s disease with wearing off symptom · Cervical dystonia · Huntington’s disease · Freezing of gait with Deep Brain Stimulation · Cognitive impairment in Parkinson’s disease If you are interested in participating in a clinical trial, contact +233-240000000 or email research@kqmuc.edu.gh Keywords for Search Studies include: · Parkinson’s disease · Cervical dystonia · Huntington’s disease · exercise Our Team It takes a wide array of medical and surgical specialists to address the multitude of issues associated with movement disorders and the nervous system. The specialists listed below work together to create a coordinated system of care for patients while increasing knowledge about movement disorders and the nervous system through research and education Parkinson’s disease affects the nerve cells in the brain that produce dopamine. Parkinson’s disease symptoms include Kings & Queens Teaching Hospital rigidity, tremors, and changes in speech and gait. After diagnosis, treatments can help relieve symptoms, but there is no cure. Symptoms Symptoms of Parkinson's disease differ from person to person. They also change as the disease progresses. Symptoms that one person gets in the early stages of the disease, another person may not get until later—or not at all. Symptoms typically begin appearing between the ages of 50 and 60. They develop slowly and often go unnoticed by family, friends, and even the person who has them.
At Kings & Queens Teaching Hospital Children's Hospital, respiratory disorders are treated by the division of pediatric pulmonology. Our physicians and nurse practitioners have expertise in the diagnosis and treatment of a wide variety of respiratory illnesses. We believe that the best care for our patients involves intensive multidisciplinary collaboration. For this reason, the division of pediatric pulmonology plays an integral role in the following centers and programs: · Asthma Program · Cystic Fibrosis Center · Sleep Medicine We also believe that successful outcomes are directly related to educating our patients and their families. For this reason, we have developed the following resources: · Conditions we treat · Services & procedures we perform · Patient & family resources Asthma severity is defined as "the intensity of the disease process" prior to the initiation of therapy. Defining asthma severity helps in determining the initiation of therapy in a patient who is not on any controller medications.[4] The severity of asthma is classified as intermittent, mild persistent, moderate persistent, or severe persistent. This classification is based on the impairment and risk related to disease, which is measured by the following: · Frequency and severity of symptoms, including nocturnal symptoms · Characteristics of acute episodes · Pulmonary function · Exacerbations Features of these categories have been divided into 3 charts to reflect classification in different age groups (0-4 y, 5-11 y, and 12 y and older), according to the National Asthma Education and Prevention Program guidelines. An important point to remember is that the presence of one severe feature is sufficient to diagnose severe persistent asthma. In addition, the characteristics in this classification system are general and may overlap because asthma severity varies widely. In addition, a patient’s classification may change over time . Patients with asthma of any level of severity may have mild, moderate, or severe exacerbations. Some patients with intermittent asthma have severe and life-threatening exacerbations separated by episodes with almost normal lung function and minimal symptoms; however, they are likely to have other evidence of increased BHR (eg, on exercise or challenge testing) due to ongoing inflammation
Hospital, our hematology physicians and staff focus on the treatment for infants, children and adolescents with blood disorders and malignancies. This includes diagnosis and treatment of red blood cell and hemoglobin abnormalities, sickle cell disease, hemostatic disorders, and leukocyte disorders. Our specialists also have expertise in bone marrow transplantation, human cord blood stem cells and pre-clinical pharmacology. · Conditions we treat · Services we provide Division Programs · Hemophilia Clinic · Sickle Cell Program Clinic The Hemophilia Clinic at Kings & Queens Teaching Hospital Children's Hospital provides comprehensive, specialized care for pediatric patients with hemophilia, and is open on a quarterly basis. During comprehensive clinics held four times a year, children are evaluated by the following subspecialists: · Hematologist · Nurse coordinator · Social worker · Dentist · Orthopedic surgeon · Physical therapist · Genetic counseling team · Hematology/oncology clinic nurses Follow-up appointments are made as needed in the hematology clinic, where children are seen by the hematologist and the hematology/oncology clinic nurses. Children who need acute treatment can be seen in the hematology/oncology clinic. Sickle Cell Program Our pediatric sickle cell program offers comprehensive services to patients diagnosed with a hemoglobinopathy. The sickle cell team consists of the following health care providers: · Pediatrician specializing in sickle cell disease · Pediatric hematologist · Nurse coordinator · Nurse community case manager · Social workers · Psychologist · Nutritionist · Representatives from other disciplines, as needed The program also is actively involved in developing new therapies, including a clinical drug trial with Hydroxyurea and a bone marrow transplantation program for sickle cell disease, and participates in national trials such as the Preoperative Transfusion Study, sponsored by the National Institutes of Health. Our Services · Newborn screening · Sickle cell clinic · Transfusion clinic · Community case management · Inpatient consultation
Pediatric bone marrow transplant
Kings & Queens Teaching Hospital’s Pediatric Blood and Bone Marrow Transplant program is the only one in Ghana and West Africa. Kings & Queens Teaching Hospital Children's Hospital provides specialized care for pediatric patients. We do perform the first pediatric bone marrow transplant, and we are certified by the Foundation for the Accreditation of Cellular Therapy (FACT). Our excellent standard of care and innovative therapeutic options offer hope to children throughout Ghana . Our program is ranked in the top of all programs in the National Pediatric Blood and Marrow Transplant Consortium. Our Pediatric Blood and Bone Marrow Transplant program provides curative therapy for a broad range of illnesses, including: · Leukemia · Lymphomas · Aplastic anemia · Sickle cell anemia · Inherited bone marrow failure syndromes · Brain tumors · Neuroblastomas Personalized approach - Based on the latest knowledge about transplantation, Cancer Center's pediatric program offers proven approaches developed around each patient's condition and risk factors. Our care is comprehensive and personal. Excellent support resources - Our multidisciplinary team includes coordinators, social workers and child life specialists who support the children and their families emotionally throughout the transplant process. Innovative treatments - New treatment protocols are being developed rapidly, and Hollings' pediatric program is at the forefront of bringing these new techniques to our patients. State-of-the-art facilities - Our pediatric inpatient unit is technologically advanced, with seven rooms designed for immuno-suppressed patients. These new rooms use the same sophisticated air filtration and pressure system found in our operating rooms. Neuroblastoma What is neuroblastoma? Neuroblastoma is a cancerous tumor that begins in nerve tissue of infants and very young children. The abnormal cells are often found in the nerve tissue that is present in the unborn baby and later develops into a detectable tumor. Neuroblastoma is rare in children older than 10 years of age, however, it does occur occasionally in adults. The tumor usually begins in the tissues of the adrenal gland found in the abdomen, but may also begin in nerve tissue in the neck, chest, or spinal cord. The adrenal glands are positioned on top of the kidneys. These glands secrete hormones and other important substances that are required for normal functions in the body. It is often present at birth, but not detected until the tumor begins to grow and compress the surrounding organs. Most children affected by neuroblastoma have been diagnosed before the age of 5. In rare cases, neuroblastoma can be detected before birth by a fetal ultrasound. It is the most common solid tumor cancer in infants. Neuroblastoma cancer cells can spread (metastasize) quickly to other areas of the body (for example, lymph nodes, liver, lungs, bones, central nervous system, and bone marrow). Approximately two-thirds of all children diagnosed with neuroblastoma will have some metastatic disease. What causes neuroblastoma? The only risk factor that has been established for neuroblastoma is heredity, although the vast majority of neuroblastomas are not inherited. Recent research indicates that certain genetic variations double the risk of this disease. Also, having this particular variation increases the chance that a child will develop a more aggressive form of the disease. The average age at diagnosis in genetically linked cases is younger than those cases that are not inherited. Cancer that presents in several different areas of the body at once is a sign that it may be a genetically inherited cancer. What are the symptoms of neuroblastoma? The following are the most common symptoms of neuroblastoma. However, each child may experience symptoms differently. The symptoms of neuroblastoma vary greatly depending on size, location, and spread of the tumor. Symptoms may include: · Abdominal mass either felt during an examination or seen as swollen abdomen · Painless, bluish lumps may be seen under the skin in infants · Trouble breathing due to tumors in the chest or abdomen · Tumors in the face or head can cause swelling and bruising of the area around the eyes and uncontrolled eye movement or bulging eyes · Compression of kidney or bladder by the tumor may cause changes in urination · Bone marrow involvement may present as pain, fatigue, limping, paralysis, or weakness · Diarrhea may be present; diarrhea is caused by a substance produced by the tumor (vasoactive intestinal peptide or VIP) · Fever · High blood pressure and increased heart rate may occur depending on location of tumor and the organs the tumor compresses The symptoms of neuroblastoma may resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis. How is neuroblastoma diagnosed? In addition to a complete medical and physical examination, diagnostic procedures for neuroblastoma may include the following: · Blood and urine tests. This includes a complete blood count, blood chemistries, kidney and liver function tests, and a 24-hour urinalysis test that detects substances secreted by the tumor. · Neurological exam. This is a part of the physical exam used to check brain, spinal cord, and nerve function. · Multiple imaging studies. These are done to evaluate primary tumor and determine extent/location of any metastases, including: o Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, Kings & Queens Teaching Hospital, fat, and organs. CT scans are more detailed than general X-rays. o Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. o X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. o Ultrasound (also called sonography). A diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. o Bone scans. Pictures or X-rays are taken of the bone after a radionucleotide (chemical with a small amount of a radioactive tag) has been injected that is absorbed by bone tissue. These are used to detect tumors and bone abnormalities. o MIBG (metaiodobenzylguanidine) scan. A small amount of radioactive material called MIBG is injected into a vein and travels through the bloodstream. Neuroendocrine tumor cells take up the radioactive materials and can be seen on pictures. Scans may be taken over a few days. · Bone marrow aspiration and/or biopsy. A procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells. · Biopsy of primary tumor and/or metastatic lesions Diagnosing neuroblastoma also involves staging and classifying the disease that determines treatment options and prognosis. Staging is the process of determining whether cancer has spread and, if so, how far. There are various staging systems that can be used for neuroblastoma. Always consult your child's doctor for information on staging. One method of staging neuroblastoma is the following: · Stage 1. This involves a tumor that does not cross the midline of the body, is completely resectable (removable by surgery), and has not spread to other areas of the body. The lymph nodes enclosed within the tumor may contain neuroblastoma cells, but lymph nodes outside the tumor are free of cancer. · Stage 2A. This involves a tumor that does not cross the midline of the body, but is not completely resectable. This stage of tumor has not spread to other areas of the body, and lymph nodes on the same side as the tumor do not have tumor cells present. · Stage 2B. This involves a tumor that may or may not be completely resectable, has not spread to other areas of the body, but lymph nodes on the same side of the tumor have tumor cells present. Lymph nodes on the opposite side of the tumor must be negative for tumor cells in this stage of disease. · Stage 3. This involves a tumor that crosses the midline of the body and is not completely resectable; it may have spread to nearby lymph nodes. This stage also includes a tumor that does not cross the midline, but the lymph nodes that are nearby or on the opposite side also contain tumor cells. A tumor at this stage may also be found in the middle of the body, but is growing towards both sides and cannot be completely removed with surgery. · Stage 4. This involves a tumor that has metastasized to distant lymph nodes, bone marrow, liver, skin, and/or other organs (except as defined in stage 4S). · Stage 4S (also called "special" neuroblastoma). A child is younger than 12 months and has a tumor that may have metastasized (spread) to liver, skin, and/or bone marrow (includes minimal bone marrow involvement; more extensive bone marrow involvement should be classified as stage 4). The tumor is on 1 side of the body and is localized. It may have spread to the lymph nodes on the same side of the body. Treatment for neuroblastoma Specific treatment for neuroblastoma will be determined by your child's doctor based on: · Your child's age, overall health, and medical history · Extent of the disease · Your child's tolerance for specific medications, procedures, or therapies · Expectations for the course of the disease · Your opinion or preference Treatment may include (alone or in combination): · Surgery (for tumor and/or metastatic resection, and removal of lymph nodes involved) · Chemotherapy · Radiation therapy · Biologic therapy · Targeted therapy · Bone marrow and peripheral blood stem cell transplantation · Retinoid therapy · Supportive care (for the side effects of treatment) · Continuous follow-up care (to determine response to treatment, recurrent disease, and late effects of treatment) Treatment options should be discussed with your child's doctor. Long-term outlook for a child with neuroblastoma Prognosis greatly depends on: · The extent of the disease. · The size and location of the tumor. · A presence or absence of metastasis. · The tumor's response to therapy. · The age and overall health of your child. · Your child's tolerance of specific medications, procedures, or therapies. · New developments in treatment. As with any cancer, prognosis and long-term survival can vary greatly from individual to individual. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a child diagnosed with neuroblastoma. Side effects of radiation and chemotherapy, as well as recurrence of the disease, can occur in survivors of neuroblastoma. New methods are continually being discovered to improve treatment and to decrease side effects.
As Ghana and West Africa's only pediatric burn referral center, Kings & Queens Teaching Hospital Children's Hospital provides specialized burn treatment to children who have suffered burns and offers community education to help prevent burns from occurring. Kings & Queens Teaching Hospital's pediatric burn team has treated more than 300 hospitalized children over the past five years and provides more than 400 outpatient visits per year in a facility that has been ranked as the top children's hospitals in Ghana and West Africa. While our burn team manages the spectrum of burns from minor to severe, approximately 80 percent of cases seen by our team are burns of less than 10 percent total body surface area. We combine pediatric surgery and pediatric burn care, an approach that gives specialized age-specific care in serving the needs of our young patients. "The care we give our patients focuses on the child's quality of life during and after hospitalization and outpatient care. Our burn team is also active in burn research projects, including clinical work on the use of temporary skin substitutes and identifying outcomes of scald burn injuries.
