CT Surgeon | Resident | Medical Student
 
     

93rd Annual Meeting Webcast

ABMS COMPETENCIES KEY
Medical
Knowledge
Interpersonal and
Communication Skills
Patient
Care
Practice-Based
Learning and Improvement
Professionalism System-Based
Practice

This activity has been developed in recognition of the American Board of Medical Specialties Six Core Competencies. This activity will increase your competency in the areas of Patient Care, Medical Knowledge, Systems-Based Practice, Practice-Based Learning and Improvement, and Professionalism. The AATS has designated the primary competency each session will address.

SUNDAY, MAY 5, 2013
AATS/STS POSTGRADUATE SYMPOSIA
AATS/STS Adult Cardiac Surgery Symposium
7:40 a.m. - 5:00 p.m.
Course Chair: John G. Byrne, MD, Vanderbilt University Medical Center

This symposium will address important new developments and updates in the broad field of adult cardiac surgery, particularly in the areas of aortic and mitral valve disease and therapies, as well as the treatment of thoracic aortic disease, coronary artery disease, and acute and chronic heart failure. Participants will gain a better understanding of the current available results of percutaneous coronary and Valvular therapies, the appropriateness of these interventions, and other novel approaches such as robotic revascularization. Participants will also hear presentations on the optimal management of postcardiotomy cardiogenic shock, the role of stent grafting techniques in chronic and acute aortic disease, and the results and indications for ventricular remodeling operations.

Finally, a review of available mechanical support systems for chronic heart failure, as well as a status update on stem cell therapy research, will be presented. Panel discussions will follow each session to allow time for questions and answers.

Course Objectives
At the conclusion of this course, the participants will be able to:

  • Appreciate indications and limitations of minimally invasive mitral valve surgery
  • Understand the indications, limitations and overall results of TAVR
  • Describe surgical options for complex aortic valve surgery
7:40 a.m. - 8:00 a.m. Social Media and Medicine
Lee Aase, Mayo Clinic Center for Social Media
8:00 a.m. - 8:10 a.m. Welcome and Introduction
John G. Byrne, MD, Vanderbilt University Medical Center
 
Mitral Valve
8:10 a.m. - 8:40 a.m. MV Repair: Outcomes vs. Technique Choice: Which Technique is best for Which Lesion?
David H. Adams, MD, Mount Sinai Medical Center
Download Slides
8:40 a.m. - 8:50 a.m. Question and Answer
8:50 a.m. - 9:10 a.m. Debate: Minimally Invasive Technique is the Preferred Method
Aubrey C. Galloway, Jr., MD, New York University School of Medicine
Download Slides
9:10 a.m. - 9:30 a.m. Debate: Open Trans-Sternal Techniques is the Preferred Method
Patrick M. McCarthy, MD, Northwestern University
Download Slides
9:30 a.m. - 9:40 a.m. Question and Answer
9:40 a.m. - 9:50 a.m. Break
 
Treatment of Endocarditis: Judgment Calls
9:50 a.m. - 10:10 a.m. When to Replace vs. Spare the Valve and Root
Tirone E. David, MD, Toronto General Hospital
Download Slides
10:10 a.m. - 10:20 a.m. Question and Answer
10:20 a.m. - 10:40 a.m. When to Repair vs. Replace the Mitral Valve/Avoid AV Dehiscence
Michael R. Petracek, MD, Vanderbilt University Medical Center
Download Slides
10:40 a.m. - 10:50 a.m. Question and Answer
10:50 a.m. - 11:10 a.m. Reconstruction Fibrous Skeleton: Techniques, Pitfalls, Results
Gosta B. Pettersson, MD, Cleveland Clinic
Download Slides
11:10 a.m. - 11:20 a.m. Question and Answer
 
TAVR
11:20 a.m. - 11:40 a.m. TAVR Update: Open vs. Closed, Future Directions
Michael J. Reardon, MD, Methodist DeBakey Heart Center
Download Slides
11:40 a.m. - 12:00 p.m. Question and Answer
12:00 p.m. - 1:30 p.m. Luncheon Symposium
Albert Starr, MD, Oregon Health and Science University
"The Price of Innovation"
Download Slides
 
When Not to in Cardiac Surgery: Judgment Calls
1:30 p.m. - 1:50 p.m. When not to in Cardiac Surgery: David Procedure
Joseph E. Bavaria, MD, University of Pennsylvania Medical Center
Download Slides
1:50 p.m. - 2:00 p.m. Question and Answer
2:00 p.m. - 2:20 p.m. When not to in Cardiac Surgery: Off-Pump CABG
Ralph J. Damiano, Jr., MD, Washington University School of Medicine
Download Slides
2:20 p.m. - 2:30 p.m. Question and Answer
2:30 p.m. - 2:50 p.m. When not to in Cardiac surgery: Minimally Invasive Mitral Valve Repair
Stephen K. Ball, MD, Vanderbilt Heart and Vascular Institute
Download Slides
2:50 p.m. - 3:00 p.m. Question and Answer
3:00 p.m. - 3:20 p.m. When not to in Cardiac Surgery: Repair of Type A Dissection
R. Scott Mitchell, MD, Stanford University
Download Slides
3:20 p.m. - 3:40 p.m. Question and Answer
3:40 p.m. - 3:50 p.m. Break
 
Practice Models
3:50 p.m. - 4:10 p.m. Integrated CV Practice: Private
Kevin D. Accola, MD, Cardiovascular Surgeon, P.A., Orlando, FL
Download Slides
4:10 p.m. - 4:20 p.m. Question and Answer
4:20 p.m. - 4:40 p.m. Integrated CV Practice: Academic
Bruce W. Lytle, MD, Cleveland Clinic
Download Slides
4:40 p.m. - 4:50 p.m. Question and Answer
5:00 p.m. Adjourn
 
AATS/STS Congenital Heart Disease Symposium
7:40 a.m. - 5:00 p.m.
Course Chair: Joseph A. Dearani, MD, Mayo Clinic

While there are many "corrective" procedures for most congenital heart defects, there still remains a large percentage of patients who will be confronted with repeated interventions and operations over the course of their lifetime. As the cumulative number of procedures accumulates, the complexity increases and the outcome worsens in many categories. Participants will be provided data to assist them; it will be comprehensive in terms of addressing the challenges with preoperative evaluation and patient selection for reoperation, and intraoperative techniques for the redo. The most commonly encountered clinical problems will be the focus and it will cover patients of all ages with congenital heart disease and topics ranging from valve-related issues and arrhythmias to heart failure. In addition, there will also be attention given to the various monitoring techniques during surgery and in the ICU following operation. Finally, outcome data for this growing group of patients from will be presented.

Course Objectives
At the conclusion of this course, the participants will be able to:

  • Understand issues and strategies to approach reoperation and reintervention in congenital heart disease.
  • Analyze risks and outcome of reoperation in congenital heart disease.
  • Gain exposure to recurrent problems in congenital heart disease in children and adults.
7:40 a.m. - 8:00 a.m. Social Media and Medicine
Lee Aase, Mayo Clinic Center for Social Media
8:00 a.m. - 8:05 a.m. Opening Remarks
Joseph A. Dearani, MD, Mayo Clinic
8:05 a.m. - 8:25 a.m. What can the Database tell us about Reoperation?
Jeffrey P. Jacobs, MD, All Children's Hospital
Download Slides
8:25 a.m. - 8:45 a.m. Strategies for the High Risk Redo
Joseph A. Dearani, MD, Mayo Clinic
Download Slides
8:45 a.m. - 9:05 a.m. Therapeutic/Prophylactic Arrhythmia Management
Constantine Mavroudis, MD, Florida Hospital for Sick Children
Download Slides
9:05 a.m. - 9:35 a.m. Panel Discussion
Jeffrey P. Jacobs, MD, All Children's Hospital
Joseph A. Dearani, MD, Mayo Clinic
Constantine Mavroudis, MD, Florida Hospital for Sick Children
Bohdan J. Maruszewski, MD, Children's Memorial Health Institute, Poland, EACTS
9:35 a.m. - 10:15 a.m. Break
10:15 a.m. - 10:35 a.m. Repair of Atrioventricular Valves
Viktor Hraska, MD, German Pediatric Heart Center, EACTS
Download Slides
10:35 a.m. - 10:55 a.m. Prosthesis Selection When Repair Is Not Possible
Harold M. Burkhart, MD, Mayo Clinic
Download Slides
10:55 a.m. - 11:15 a.m. Percutaneous Valve-In-Valve Therapy
Evan M. Zahn, MD, Cedars-Sinai Heart Institute
Download Slides
11:15 a.m. - 11:45 a.m. Panel Discussion
Viktor Hraska, MD, German Pediatric Heart Center
Harold M. Burkhart, MD, Mayo Clinic
Evan M. Zahn, MD, Cedars-Sinai Heart Institute
Christian Schreiber, MD, German Heart Center Munich, EACTS
12:00 p.m. - 1:30 p.m. Luncheon Symposium
Albert Starr, MD, Oregon Health and Science University
"The Price of Innovation"
Download Slides
1:30 p.m. - 1:50 p.m. Management of the Dilated Aorta in CHD
Duke E. Cameron, MD, Johns Hopkins Hospital
Download Slides
1:50 p.m. - 2:10 p.m. HLHS - What to Expect Down the Road
Edward L. Bove, MD, University of Michigan
Download Slides
2:10 p.m. - 2:30 p.m. Full Metal Jacket...Reoperation in Stentland
Thomas L. Spray, MD, Children's Hospital of Philadelphia
Download Slides
2:30 p.m. - 3:00 p.m. Panel Discussion
Duke E. Cameron, MD, Johns Hopkins Hospital
Edward L. Bove, MD, University of Michigan
Thomas L. Spray, MD, Children's Hospital of Philadelphia
Tom Karl, MS, MD, Mater Children's Hospital, Australia
3:00 p.m. - 3:35 p.m. Break
3:25 p.m. - 3:45 p.m. End Stage CHD - When It Is Time for Transplant
Anees J. Razzouk, MD, Loma Linda University Medical Center
Download Slides
3:45 p.m. - 4:05 p.m. VAD Strategies & Outcome in CHD
James K. Kirklin, MD, University of Alabama at Birmingham
Download Slides
4:05 p.m. - 4:25 p.m. All This Monitoring - What's Necessary, What's Not
James S. Tweddell, MD, Medical College of Wisconsin
Download Slides
4:25 p.m. - 4:55 p.m. Panel Discussion
Anees J. Razzouk, MD, Loma Linda University Medical Center
James K. Kirklin, MD, University of Alabama at Birmingham
James S. Tweddell, MD, Medical College of Wisconsin
James Jaggers, MD, University of Colorado
4:55 p.m. - 5:00 p.m. Closing Remarks
Joseph A. Dearani, MD, Mayo Clinic
5:00 p.m. Adjourn
 
AATS/STS General Thoracic Surgery Symposium
7:40 a.m. - 5:00 p.m.
Course Chair: Cameron D. Wright, MD, Massachusetts General Hospital
Moderator: Claude Deschamps, MD, Mayo Clinic

The General Thoracic Surgery Symposium will review and elucidate a wide variety of persistent clinical problems faced by the thoracic surgeon and offer solutions that surgeons can put into practice. Covered topics include surgery for tuberculosis, navigational bronchoscopy, the treatment of inoperable stage 1 NSCLC, robotic lobectomy, extended VATS lung cancer resections, the use of cardiopulmonary bypass for T4 tumor resections, tracheobrochoplasty for tracheomalacia, methods of esophageal anastomosis, management of esophageal leaks with stents, laparoscopic repair of paraesophageal hernias, SVC resections, the use of VAC therapy for complicated thoracic infections and quality improvement in thoracic surgery.

Course Objectives
At the conclusion of this course, the participants will be able to:

  • Integrate new knowledge of treatment strategies for MTB patients referred for surgery and select the appropriate treatment. Review and assimilate the current literature for inoperable stage I NSCLC and recommend the best treatment strategy-RFA or SBRT.
  • Implement new techniques for sub lobar resection of T1a NSCLC and understand both the benefits and recognize the limitations of lessor resections.
  • Implement stenting as a viable technique for treating esophageal perforations. Learn new methods of esophageal anastomosis, their advantages and disadvantages, and implement the best method.
  • Understand the role of SVC resection in lung and mediastinal tumors and learn new techniqies for resection.
7:30 a.m. - 7:40 a.m. Welcome
Cameron D. Wright, MD, Massachusetts General Hospital
7:40 a.m. - 8:00 a.m. Social Media and Medicine
Lee Aase, Mayo Clinic Center for Social Media
8:00 a.m. - 8:20 a.m. Lung Resection for MTB and NTM
John D. Mitchell, MD, University of Colorado School of Medicine
Download Slides
8:20 a.m. - 8:40 a.m. Stage I Inoperable NSCLC-RFA or SBRT?
Michael Lanuti, MD, Massachusetts General Hospital
Download Slides
8:40 a.m. - 9:00 a.m. Navigational Bronchoscopy
Douglas Minnich, MD, University of Alabama at Birmingham
Download Slides
9:00 a.m. - 9:20 a.m. Tracheoplasty for TBM
Sidu Gangadharan, MD, Beth Israel Deaconess Medical Center
Download Slides
9:20 a.m. - 9:40 a.m. Panel Discussion
9:40 a.m. - 10:10 a.m. Break
10:10 a.m. - 10:30 a.m. Sublobar Resection for T1a NSCLC
David C. Rice, MD, MD Anderson Cancer Center
Download Slides
10:30 a.m. - 10:50 a.m. Robotic Lobectomy
Bernard J. Park, MD, Hackensack University Medical Center
Download Slides
10:50 a.m. - 11:10 a.m. Management of Intraoperative Complications during VATS Lobectomy
Scott J. Swanson, MD, Brigham and Women's Hospital
Download Slides
11:10 a.m. - 11:30 a.m. Persistent N2 Disease after Induction Therapy - What Next?
Valerie W. Rusch, MD, Memorial Sloan-Kettering Cancer Center
Download Slides
11:30 a.m. - 11:50 a.m. Lung Cancer Resection on Cardiopulmonary Bypass
Daniel J. Boffa, MD, Yale University School of Medicine
Download Slides
12:00 p.m. - 1:30 p.m. Luncheon Symposium
Albert Starr, MD, Oregon Health and Science University
"The Price of Innovation"
Download Slides
1:30 p.m. - 1:50 p.m. Stenting of Esophageal Leaks and Perforations
Richard K. Freeman, MD, St. Vincent's Health and Hospital System
Download Slides
1:50 p.m. - 2:10 p.m. Esophageal Anastomotic Techniques
Raphael Bueno, MD, Brigham and Women's Hospital
Download Slides
2:10 p.m. - 2:30 p.m. Induction Therapy for Esophageal Cancer-Cross Trial Results
Stephen C. Yang, MD, Johns Hopkins Medical Institutions
Download Slides
2:30 p.m. - 2:50 p.m. Laparoscopic Paraesophageal Hiatus Hernia Repair
Stephen D. Cassivi, MD, Mayo Clinic
Download Slides
2:50 p.m. - 3:10 p.m. Panel Discussion
3:10 p.m. - 3:50 p.m. Break
3:50 p.m. - 4:10 p.m. SVC Resection
Kenneth A. Kessler, MD, Indiana University Download Slides
4:10 p.m. - 4:30 p.m. Use of VAC Therapy in Thoracic Surgery Infections
Gaetano Rocco, MD, National Cancer Institute, Italy, ESTS
Download Slides
4:30 pm - 5:00 pm Panel Discussion
5:00 p.m. Adjourn
 
AATS/STS Cardiothoracic Critical Care Symposium
7:40 a.m. - 5:00 p.m.
Course Co-Chairs: Nevin M. Katz, MD, Johns Hopkins University
Michael S. Mulligan, MD, University of Washington Medical Center

Emphasis will be placed on the unique specialty aspects of Cardiovascular-Thoracic (CVT) Critical Care including ECMO, pharmacologic and mechanical hemodynamic support, resipiratory failure, renal failure, and palliative care. Fundamental areas of critical care will be presented in a case related format in order to practically relate them to specific clinical applications.

Course Objectives
At the conclusion of this course, the participants will be able to:

  • Evaluate new technologies for hemodynamic and respiratory system monitoring.
  • Assess the latest clinical approaches to acute lung injury and ARDS.
  • Understand latest lung transplant management strategies.
  • Evaluate how current ventricular assist devices are employed in CT surgical patients and the process of device selection.
  • Apply latest approaches to management of refractory pneumonias.
  • Assess management of extremity ischemia in CT surgical patients.
7:40 a.m. - 8:00 a.m. Social Media and Medicine
Lee Aase, Mayo Clinic
8:00 a.m. - 8:10 a.m. Welcome and Opening Remarks
Michael S. Mulligan, MD, University of Washington Medical Center
8:10 a.m. - 8:30 a.m. CT Critical Care: Meeting the Challenges
Nevin M. Katz, MD, Johns Hopkins University
Download Slides
8:30 a.m. - 9:00 a.m. Latest Technologies for Hemodynamic & Respiratory Monitoring
Daniel T. Engelman, MD, Baystate Medical Center
Download Slides
9:00 a.m. - 9:30 a.m. Ventilatory Support for Acute Lung Injury & ARDS
Neil R. MacIntyre, MD, Duke University
Download Slides
9:30 a.m. - 10:00 a.m. Case Scenarios: ALI & ARDS
Matthew Bacchetta, MD, MBA, MA, Columbia University
10:00 a.m. - 10:30 a.m. Break
10:30 a.m. - 11:00 a.m. Post-Cardiotomy Circulatory Support: Integration of Currently Available Strategies
Francis D. Pagani, MD, University of Michigan
Download Slides
11:00 a.m. - 12:00 p.m. Hemodynamic Simulation
Lyle D. Joyce, MD, Mayo Clinic
Nevin M. Katz, MD, Johns Hopkins University

Download Slides
12:00 p.m. - 1:30 p.m. Luncheon Symposium
Albert Starr, MD, Oregon Health and Science University
"The Price of Innovation"
Download Slides
1:30 p.m. - 2:00 p.m. Lung Transplant Management
Michael S. Mulligan, MD, University of Washington Medical Center
Download Slides
2:00 p.m. - 2:30 p.m. Development and Implementation of Clinical Pathways in the CTICU
Rakesh C. Arora, MD, Sr. Boniface General Hospital
Download Slides
2:30 p.m. - 3:00 p.m. Case Scenarios
Aaron Cheng, MD, University of Washington
Download Slides
3:00 p.m. - 3:30 p.m. Break
3:30 p.m. - 4:00 p.m. Management of Refractory Pneumonias in CT Surgical Patients
Dennis G. Maki, MD, University of Wisconsin
Download Slides
4:00 p.m. - 4:30 p.m. Management of Postoperative Extremity Ischemia
Jonathan W. Haft, MD, University of Michigan
Download Slides
4:30 p.m. - 5:00 p.m. Case Scenarios
Michael S. Mulligan, MD, University of Washington
Download Slides
5:00 p.m. Adjourn
 
SUNDAY, May 5, 2013
C. WALTON LILLEHEI RESIDENT FORUM SESSION
3:00 p.m. - 5:00 p.m. 16th Annual C. Walton Lillehei Resident Forum
Chairs: Thomas Waddell, MD, PhD, University of Toronto
Y. Joseph Woo, MD, University of Pennsylvania
(7 minute presentation, 8 minute discussion)
L1. Functional Recovery Following a Brief Period of Ischemia is Enhanced in Hearts from Inducible Cardiomyocyte-Specific CD36 Deficient Mice
Nagendran, Jeevan1, Pulinilkunnil, Thomas2, Kienesberger, Petra3, Febbraio, Maria4, Dyck, Jason R.B.3
1Surgery, University of Alberta, Edmonton, AB, Canada, 2Biochemistry and Molecular Biology, Dalhousie University, Saint John, NB, Canada, 3Pediatrics, University of Alberta, Edmonton, AB, Canada, 4Molecular Cardiology, Cleveland Clinic, Cleveland, OH, USA

Invited Discussant: Vivek Rao
Download Slides

L2. Mesothelin Overexpression Imparts an Aggressive Phenotype and Decreases Recurrence-Free Survival in Early Stage Lung Adenocarcinoma
Kachala, Stefan S.1, Bograd, Adam J.1, Rodriguez, Luis1, Servais, Elliot1, Kadota, Kyuichi2, Sima, Camelia3, Rusch, Valerie W.1, Travis, William D.2, Sadelain, Michel4, Adusumilli, Prasad S.1
1Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA, 2Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA, 3Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA, 4Center for Cell Engineering, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

Invited Discussant: Walter Weder

L3. Alpha 2a Agonist Dexmedetomidine Promotes Ischemic Tolerance in a Murine Model of Spinal Cord Ischemia-Reperfusion
Bell, Marshall T.1, Puskas, Ferenc2, Freeman, Kirsten A.1, Cleveland, Joseph C., Jr1, Fullerton, David A.1, Herson, Paco S.2, Mares, Joshua M.1, Weyant, Michael J.1, Meng, Xianzhong1, Reece, T Brett1
1Surgery, University of Colorado, Aurora, CO, USA, 2Anesthesiology, University of Colorado, Aurora, CO, USA

Invited Discussant: John S. Ikonomidis
Download Slides

L4. Safety and Efficacy of Ex Vivo Adenoviral IL-10 Gene Therapy in a Lung Transplantation Large Animal Survival Model
Machuca, Tiago N.1, Cypel, Marcelo1, Bonato, Riccardo1, Yeung, Jonathan C.1, Chen, Man Yin1, Juvet, Stephen2, Guan, Zehong1, Iskender, Ilker1, Saito, Tomohito1, Waddell, Thomas K.1, Liu, Mingyao1, Hwang, David M.3, Keshavjee, Shaf1
1Thoracic Surgery, University of Toronto, TORONTO, ON, Canada, 2Respirology, University of Toronto, TORONTO, ON, Canada, 3Laboratory Medicine and Pathobiology, University of Toronto, TORONTO, ON, Canada

Invited Discussant: TBD
Download Slides

L5. Effects of Angiotensin II on Sirtuin Expression
Greiten, Lawrence E., Hagler, Michael, Zhang, Bin, Roos, Carolyn M., Miller, Jordan D
Surgery, Mayo Clinic, Rochester, MN, USA

Invited Discussant: Juan A. Crestanello
Download Slides

L6. Humoral Tolerance to Murine Cardiac Allografts by Targeting the Critical Homeostatic Regulator of B-lymphocyte Selection, BLyS-BAFF
Noorchashm, Hooman1, Rodriguez, Eduardo2, Parsons, Ronald3, Rostami, Susan Y.4, Reed, Amy J.5, Cancro, Michael P.6, Naji, Ali7
1Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA, 2Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA, 3Cardiac Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA, 4Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA, 5Anesthesiology and Critical Care, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA, 6Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA, 7Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

Invited Discussant: Pirooz Eghtesady
Download Slides

L7. Ex Vivo Lung Perfusion with Concomitant Adenosine 2A Receptor Agonism Treatment Provides a Superior Strategy for Non-heart-beating Lung Rehabilitation
Stone, Matthew L., Sharma, Ashish K., Mulloy, Daniel P., Fernandez, Lucas G., Lau, Christine L., Laubach, Victor E., Kron, Irving L.
Department of Surgery, University of Virginia, Charlottesville, VA, USA

Invited Discussant: Michael J. Weyant
Download Slides

L8. Resveratrol Regulates Autophagy Signaling in Chronically Ischemic Myocardium
Sabe, Ashraf A., Elmadhun, Nassrene Y., Dalal, Rahul S., Robich, Michael P., Sellke, Frank W.
Division of Cardiothoracic Surgery, Warren Alpert Medical School Brown University, Providence, RI, USA

Invited Discussant: Michael C. Fischbein
Download Slides

5:00 p.m. ADJOURN TO WELCOME RECEPTION IN EXHIBIT HALL

 
We Model Excellence
Follow AATS on Facebook
Copyright © 2013 American Association for Thoracic Surgery
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide general guidance and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult a doctor about any specific medical problem or question.