Continuum Achieving Broad-Based Excellence

Transcription

Continuum
Achieving Broad-Based Excellence
Department of Surgery Annual Report 2012
Letter from the Chairman 1
Introduction 2
Our Heritage 4
Division of Public Health Sciences 8
Division of General Surgery
Section of Acute and Critical Care Surgery 10
Section of Colon and Rectal Surgery 12
Section of Endocrine and Oncologic Surgery 14
Section of Hepatobiliary-Pancreatic and Gastrointestinal Surgery 16
Section of Minimally Invasive Surgery 18
Section of Transplant Surgery 20
Section of Vascular Surgery 22
Division of Cardiothoracic Surgery
Section of Cardiac Surgery 24
Section of General Thoracic Surgery 26
Section of Pediatric Cardiothoracic Surgery 28
Division of Pediatric Surgery 30
Division of Plastic and Reconstructive Surgery 32
Division of Urologic Surgery 34
Education 36
Research 38
Clinical Operations 40
Giving 42
Faculty 44
Letter from the Chairman
THE SUCCESSFUL ACADEMIC DEPARTMENT
train our leadership. More recently, we began work-
OF SURGERY OF THE FUTURE will be built on the
groups on surgical quality and effectiveness, clinical
tradition and values of the past, but will plan for the
quality of care, and innovations in surgical education.
future. This idea summarizes my presidential address
In this report, you will see surgeon-scientists
to the American Surgical Association in April 2012,
continuing in the tradition of their predecessors, yet
and I drew from our own department’s experience
adapting to the new realities of the research environ-
as an example of how such a model can work.
ment; surgeons participating in multidisciplinary
centers and engaging in well-controlled clinical trials,
quality and outcomes initiatives; and educators creating
of Robert Brookings, president of the Washington
new paradigms for surgical education through early
University Board of Trustees, led to a modernized
specialization and the academy model, which moves
medical school with a full-time faculty model. One of
away from learning by osmosis.
the school’s first full-time leaders was Evarts Graham,
TIM PARKER
Past leaders in the medical school and our Department of Surgery laid a strong foundation. The vision
Timothy Eberlein, MD
Mark Twain once said, “Plan for the future, because
MD, Bixby Professor and chairman of the Department
that is where you are going to spend the rest of your
of Surgery, a surgeon-scientist who helped develop the
life.” Our faculty has heeded this advice by embracing
oral cholecystogram and performed the first successful
change, building on the past and focusing on the future.
single-stage total pneumonectomy. Later in this report,
there is a profile of the past leaders of the department
and their exceptional record of contributions to surgery.
William K. Bixby Professor of Surgery
In recent years, our department has continued to
Chairman, Department of Surgery
evolve and innovate in response to outside forces such
Director, Alvin J. Siteman
as declining clinical reimbursement, increased compe-
Cancer Center
tition for peer-reviewed funding, and higher levels of
professional and personal stress. To address these realities, six years ago, we created a program to first examine
the viewpoints of our faculty and then create a more
supportive environment, and enhance and formally
1
Continuum
Introduction
TIM PARKER
2
surgery.wustl.edu
Achieving
BROAD-BASED EXCELLENCE
The Department of Surgery at Washington University School
of Medicine is fortunate to have a rich history of success on which
to build. As it moves forward to meet the challenges of the current academic health care environment, the department draws
upon its historic strengths in collaboration and research to foster
excellence in research, education and patient care across all
surgical subspecialties.
The department’s comprehensive research efforts range from
conducting basic science to leading major national multicenter
clinical trials to engaging in public health, quality improvement
and patient safety research. An interdisciplinary approach to
investigation allows the department’s physician-scientists to
address increasingly complex issues more effectively than would
otherwise be possible and to more quickly translate findings
into clinical solutions.
Building on the success of the past, the department offers comprehensive clinical care in every surgical subspecialty; it aims to
increase its impact regionally and nationally through geographic
expansion and emphasis on interdisciplinary, team-based care.
In education, department faculty are leading the development
of innovative, efficient approaches to surgical training.
Its collective strengths in all three missions create a synergistic
momentum that positions the department to meet the challenges
ahead as it continues working to improve human health.
3
Our Heritage:
GROUNDED IN
RESEARCH
Chairs of the
Department
of Surgery
Frederick Murphy performing Barnes Hospital’s
first operation in 1914
1914-19
1919-51
Frederick
Murphy,
MD
Evarts
Graham,
MD
THE DEPARTMENT OF SURGERY
Washington University President
historically has been a leader in clinical
Robert S. Brookings created a full-time
innovations, research and graduate
faculty model for the medical school,
medical education and is positioned to
Murphy did not agree and abruptly
remain an influential force in academic
resigned. With the help of Brookings,
surgery in the critical years ahead.
the medical school engaged philan-
The medical field was changing
thropist William Bixby, who helped
when the department was established,
endow a full-time chair of surgery,
just as it is today. Frederick Murphy,
and Evarts Graham, MD, was selected
MD, recruited from Harvard, was the
as the first William K. Bixby Professor
first surgeon-in-chief and performed
and chair. Another benefactor, Mary
Barnes Hospital’s first operation (an
Culver, endowed the department,
appendectomy) in 1914. But when
which is today known as the Mary
Culver Department of Surgery.
McMillan
Hospital,
circa 1940
Graham is known for the development of the oral cholecystogram,
HISTORICAL PHOTOS COURTESY
BECKER MEDICAL LIBRARY ARCHIVES
performing the first single-stage total
pneumonectomy in which the patient
survived, and research linking cigarette
smoking to lung cancer. The chairs
who have followed — Carl Moyer,
MD; Walter Ballinger, MD; Samuel
Jessie Ternberg, MD, PhD, right, taught
hundreds of surgical interns, urging them
to have “the eye of an eagle, the heart of
a lion, and the hand of a lady.”
Evarts
Graham, MD,
circa 1953
4
surgery.wustl.edu
Wells Jr., MD, and Timothy Eberlein,
MD — have also made important
1967-78
1981-97
1998-Present
Carl
Moyer,
MD
Walter
Ballinger,
MD
Samuel
Wells Jr.,
MD
Timothy
Eberlein,
MD
AoRTic traNscathetER) Trials, inves-
ing graduate medical education. All
Clinical Innovation,
Collaboration
and Prevention
have been leaders in their field with
In 1933, James Gilmore, a Pittsburgh
and high-risk patients with aortic
Graham, Wells and Eberlein serving
obstetrician, was admitted to the
stenosis. Cardiac surgeons have
as presidents of the American Surgical
chest clinic at Barnes Hospital with a
worked together with car-
Association. Many other Washington
suspected lung abscess and a collapsed
diologists in these trials.
University surgeons, including Eugene
lung. Doctors diagnosed squamous
Bricker, MD, who developed the ileal
cell carcinoma, and Graham per-
ment advances have also
conduit for urinary diversion and was
formed the first successful removal of
come from collaborative
president of the American Surgical
an entire lung. Gilmore led a long life,
efforts. This integrated
Association, also have helped shape
and for more than 20 years after the
approach, pioneered by
the field of surgery.
operation, Gilmore and Graham cor-
Bricker and embraced
responded with and visited each other.
by Ballinger and Wells,
contributions: in medical and surgical
treatment, research and/or shap-
Today, academic departments
of surgery face many challenges to
The introduction of new treat-
TIM PARKER
1951-65
tigating the placement of an aortic
valve using a catheter in inoperable
Many other treat-
can be seen today in the
their historic missions. These include
ments — including the use of silver
Washington University
lower reimbursement, threats from
nitrate solution to treat acute burns,
and Barnes-Jewish Heart
other disciplines, increased competi-
made possible by Moyer’s research,
& Vascular Center, which
tion for peer-reviewed funding, and a
and the development of the Cox-Maze
incorporates cardiology,
dramatic increase in monitoring and
procedure to treat atrial fibrillation
cardiac surgery and vascular surgery;
oversight. At Washington University,
— continues to benefit patients in
and the Washington University and
the Department of Surgery is explor-
the current era. Recently, Washington
Barnes-Jewish Transplant Center,
ing key opportunities to remain at the
University has been a leading enroller
with specialists in surgery and medi-
leading edge of academic surgery.
for two PARTNER (Placement of
cine. Eberlein also uses this model
The Center for Advanced Medicine,
which opened in fall 2001, houses 18
outpatient clinical centers that provide
collaborative specialty services.
5
Points of
Distinction
Performed first successful
surgical removal of a lung
(Evarts Graham, 1933)
Developed Maze procedure,
the first surgical cure for
atrial fibrillation (James
Cox, John Boineau, Richard
Schuessler, 1987)
Performed first nerve
transplant using nerve tissue
from a cadaver donor
(Susan Mackinnon, 1988)
in directing the Alvin J. Siteman
Research
ing the gene responsible for the
of the first mouse model of lung
Cancer Center at Barnes-Jewish
Department of Surgery chairs have
MEN syndromes — which result
transplantation to help understand
Hospital and Washington University
carried on a strong tradition as
in thyroid cancer — led to the first
the molecular mechanisms that
School of Medicine, an international
scientists wanting to solve practical
surgical prevention of cancer based
control lung transplant rejection; the
leader in cancer treatment, research,
problems. Graham performed impor-
on genetic testing. And Eberlein, a
study of ATP channel heart muscle
prevention, education and commu-
tant work in gallbladder imaging and
surgical oncologist, has helped to
cell contractility and the potential
smoking, and Moyer in the study of
establish Siteman as an international
use of a drug to lessen the impact of
silver nitrate for burns; in addition,
leader in clinical trials, basic science
myocardial stunning; and the work
become important benchmarks, and
Ballinger was well regarded for his
and translational research, including
of several faculty members with a
will become even more critical in the
nity outreach.
Quality care and prevention have
studies in the pathophysiology
work with Washington University’s
world-renowned biomedical engineer
coming years. Surgeon Bruce Hall,
of gastrointestinal diseases such as
Genome Institute to sequence the
in the development of photoacoustic
MD, plays a key role in the American
ulcers. The work of Wells in identify-
first cancer genome.
imaging to screen for precancerous
In recent years,
College of Surgeons National Surgical
collaboration —
esophagus, to identify the sentinel
NSQIP®), and renowned epidemi-
among surgical
lymph node in breast cancer patients,
ologist Graham Colditz, MD, DrPH,
faculty and with
and to identify single-cell melanoma
oversees the Division of Public Health
scientists in other
tumor cells in planning a wide exci-
Sciences, formed in 2011 to promote
departments —
sion for melanoma.
disease prevention and improve qual-
has led to a critical
ity and access to health care.
mass in a number
Education
of groundbreaking
Graham was an early leader in surgical
projects. These in-
residency education who stressed the
clude development
importance of the basic sciences in the
The BJC Institute of Health at Washington University School
of Medicine houses several interdisciplinary research centers
dedicated to translational research. 6
tissue in patients with Barrett’s
Quality Improvement Program (ACS
surgery.wustl.edu
Performed first laparoscopic kidney removal
(Ralph Clayman, 1990)
In work on thyroid cancer,
developed first surgical
prevention of cancer
based on genetic testing
(Samuel Wells, 1994)
Today, ranks among the top U.S.
academic surgery departments
in annual National Institutes
of Health (NIH), non-federal and
corporate-supported grants (2012)
training of surgeons and believed that
G. Phillips City Hospital, one of
of the first to introduce a surgical
the study of general surgery should
only three institutions at the time
skills lab. Klingensmith now serves
constitute a large share of the time
where this type of training occurred.
as vice chair of education and leads
spent in preparing for a career in a
Wells took surgical training a step
efforts to look at early specializa-
surgical specialty.
further, transitioning the department
tion in all subspecialty fellowships.
to a completely full-time model
Michael Awad, MD, the newly
for faculty.
appointed general surgery
Moyer was best known as a
wonderful teacher who took great
For most of the 20th century,
residency program director, is
superb role model. He also had
the motto of general surgery
overseeing design of a residency
a strong social conscience and
residency training was “see one, do
web portal and migration to an
supported the education of African-
one, teach one,” and residents spent
academy model in which general
American physicians at the Homer
long hours in surgical training. As
surgery residents discuss goals
these trends began
with a faculty member, receive
to change at the mil-
feedback and undergo a formal
lennium, former
assessment. Both Eberlein and
General Surgery
Klingensmith are leading a
Residency Program
national initiative to create a
Director Mary
new model of more efficient
Klingensmith, MD,
and effective surgery training.
led the adoption
of duty-hour
restrictions
and was one
Caption
ST. LOUIS CHILDREN’S HOSPITAL
interest in his students and was a
The School of Medicine’s affiliated
hospitals, Barnes-Jewish Hospital
and St. Louis Children’s Hospital,
are both ranked among the best
in the nation and are an integral
component of the Department
of Surgery’s ongoing success.
Trauma fellows and general surgery residents benefit from the
involvement of Douglas Schuerer, MD, in national patient safety
initiatives. Schuerer, second from left, is director of the Surgical
Critical Care Fellowship.
7
Division of
Public Health Sciences
Master’s degree program:
SHARPENING RESEARCH SKILLS
Highlights
Washington University researchers reported that more
than half of all cancer is preventable in a review article in
Science Translational Medicine. Graham Colditz, MD, DrPH,
and co-authors found that lifestyle choices play a significant
role in causing cancer, with smoking alone responsible for a
third of all U.S. cases and excess body weight accounting for
another 20 percent.
Kimberly Kaphingst, ScD, is collaborating with Jennifer Ivanovich, MS,
and researcher Paul Goodfellow, PhD,
in a proposed study to examine how to
communicate genome sequencing results
to young breast cancer patients.
A grant from the Centers for Disease Control and Prevention enables the Young Women’s Breast Cancer Program
(YWBCP) to provide support and education services for
women 45 and younger diagnosed with breast cancer.
Program director Jennifer Ivanovich, MS, is principal investigator. The YWBCP is also developing a genetics navigation
tool to help young survivors understand their family-based
cancer, learn about new developments in genetic testing and
prepare them for the next wave of clinical genetic testing,
specifically gene panels and whole exome sequencing.
Bettina Drake, PhD, MPH, extended
her community-based research on minority
recruitment into clinical studies to include the
participation of African-American men in pancreas cancer trials. African-American men have
a higher incidence of pancreas cancer but less
involvement in studies than whites.
Public health researchers created a health app called
Zuum, which provides risk estimates for heart disease,
stroke, diabetes, lung cancer and colon cancer, breast cancer
and prostate cancer. The tool, available on iTunes, also
explains how to lower risk and to see the impact of positive
changes on future risk.
Instructor Su-Hsin Chang, PhD, is working with
bariatric surgeon Esteban Varela, MD, MPH, to study the costeffectiveness of various forms of weight-loss surgery.
8
surgery.wustl.edu
As a student in the Master of Population Health Sciences program, Lola Fayanju, MD, MPHS, left, worked with MPHS
instructor Aimee James, PhD, MPH, to hone her skills in studying breast cancer care disparities.
THE MASTER of Population Health
the late stages of the disease. And
Sciences (MPHS) degree program was
Fayanju had been struck by treatment
launched by the Division of Public
disparities on a number of rotations
Health Sciences to give clinicians a
she had served.
strong foundation in clinical effec-
“I had seen striking, systematic
tiveness and outcomes research. The
differences among patients with
program, which began in 2010, has
different socioeconomic status,”
already opened such a pathway for
Fayanju says.
medical students, residents and fellows.
The next year, Fayanju chose
For one surgical resident, the program
to do a research elective with
provided the expertise to interpret
Margenthaler, who had joined the
the data,” says Fayanju. “It’s notable
and apply research findings to better
faculty as a breast surgeon. With a
that women are actually getting
address disparities in treating breast
grant from the Program for the
mammograms at a fairly high rate.
cancer patients.
Elimination of Cancer Disparities
But there are other points along the
at the Alvin J. Siteman Cancer
time line of care at which to inter-
Center at Barnes-Jewish Hospital
vene and improve outcomes.”
Oluwadamilola “Lola” Fayanju,
MD, MPHS, and breast surgeon Julie
Margenthaler,
MD, Washington
University breast
surgeon at BarnesJewish Hospital,
met when Fayanju
was a third-year
medical student
and Washington
“I used the skills I
acquired in the
MPHS program to do
justice to the data.”
Lola Fayanju, MD, MPHS
and Margenthaler
Graham Colditz, MD, DrPh,
University School
chief of the Division of Public
of Medicine, the
Health Sciences and the Niess-Gain
two launched a
Professor in the School of Medicine,
research project
says Margenthaler, in her work with
to interview
Fayanju and another surgery resident
women about
who entered the MPHS program this
their health
year, is helping the next generation of
history prior to
breast surgeons focus on the causes
was a breast disease fellow at
their diagnosis with breast cancer.
of and solutions for disparities in
Washington University. Working
Fayanju continued the project as a
breast cancer treatment.
at a ConnectCare clinic for low-
resident through her first residency
income patients, Margenthaler
research year, which she used to
perspective with her. “It’s
had already observed that a high
complete the MPHS degree in 2011.
a lifelong commit-
percentage of women with breast
cancer were first being seen in
“I used the skills I acquired in
Lola Fayanju, MD, MPHS, left,
works with breast surgeon
Julie Margenthaler, MD, to
study barriers to breast
cancer screening.
Fayanju will take this
ment,” she says.
the MPHS program to do justice to
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Section of Acute and Critical Care Surgery
Secondary brain injury:
PURSUING PREVENTION
Highlights
The Washington University and Barnes-Jewish Trauma
Center recently received Level I designation from the
State of Illinois. The program is now designated as a Level
I trauma center in both Missouri and Illinois, and was also
re-verified by the American College of Surgeons (ACS) as a
Level I trauma center. The ACS designation is considered a
gold standard for trauma centers. Barnes-Jewish cares for
approximately 14,500 trauma patients a year.
BJC HEALTHCARE
The Surgical and Wound Care Clinic
moved into the new Barnes-Jewish Center
for Outpatient Health, which provides
upgraded facilities for patients and physicians. Formerly located on the first floor
of Barnes-Jewish Hospital, the clinic treats
acute care surgery patients and many other
patients with wounds. Among its new
services is hyperbaric oxygen therapy, used
to treat wounds that won’t heal as a result
of diabetes or radiation injury.
The Section of Acute and Critical Care Surgery welcomes
Robert Winfield, MD, as an assistant professor. He joins
the section after completing a fellowship in trauma surgery
and critical care at the University of California-San Diego
and a surgical residency at the University of Florida in
Gainesville. Winfield’s practice includes a full range of critical care, trauma surgery and acute care surgery.
Douglas Schuerer, MD,
Barnes-Jewish Hospital director of
trauma, has been elected chair of
the East Central Region Emergency
Medical Services (EMS) Committee.
As a subcommittee of the state
advisory council of the Missouri
Department of Health and Senior
Services, the committee serves as a
liaison to the regional emergency
medical services and hospital community.
Husband-and-wife team Grant Bochicchio, MD, MPH, right, and senior research administrator Kelly Bochicchio, RN,
MS, evaluates the diabetes drug glyburide for its potential to prevent secondary brain injury resulting from trauma.
10
surgery.wustl.edu
THE IMPACT of improvised explosive
used to treat diabetes that blocks the
devices (IEDs) and other blast injuries
SUR1 ion channel in the brain. This
trial comple-
has been devastating for American
medication has been shown to pre-
ments the efforts
soldiers in Iraq and Afghanistan. Many
vent secondary brain injury in animal
of Washington
times, when there is trauma to the
studies performed by Marc Simard,
University plastic
head, it is not the initial blast that kills
MD, PhD, and Bochicchio. As the ba-
and reconstruc-
the soldier; rather, he or she dies from
sic science research continues in ani-
tive surgeons,
secondary effects to the brain. This
mals, a human trial will soon begin to
who have created
has prompted Grant Bochicchio, MD,
study whether this drug can be given
a website showing surgeons how
MPH, chief of the Section of Acute
safely to healthy adults who are un-
nerve transfer techniques can be
and Critical Care Surgery, to study
dergoing physical exercise to simulate
used to restore function in the
the sequelae of traumatic brain injury
the characteristic activities of soldiers
limbs of soldiers injured in explo-
and has led to a clinical trial testing
in the military. Bochicchio will serve
sions and combat.
the safety of a promising drug that
as principal investigator
may diminish the effects of traumatic
of this randomized trial,
brain injury.
which will recruit healthy,
“First, you have the initial trauma
non-diabetic volunteers
— the contusion from the event itself,”
to exercise on a treadmill
says Bochicchio, also the Harry Edison
three times a day under
Professor of Surgery. “However, over
careful medical supervi-
the next 24 to 48 hours, you have
sion to guard against any
swelling that occurs, which is really
potential side effects.
what causes death in a lot of patients
Basic research by Grant
Bochicchio, MD, MPH, right,
shown with staff scientist
Christopher Davis, revealed
the potential for a diabetes
drug to prevent brain injury.
“We hope someday to give
this medication in order to
prevent secondary brain
injury and potentially
save lives.”
Grant Bochicchio, MD, MPH
“Results of this
or soldiers. And in those who do
important work may also
survive, it can cause permanent and
be applicable to brain injury in the
debilitating brain damage.”
civilian world,” says Bochicchio. “If
Bochicchio is the co-principal
The clinical
patients are in a bad car crash, we
investigator of a Department of
hope someday to give this medication
Defense grant evaluating the impact
in order to prevent secondary brain
of glyburide, a medication originally
injury and potentially save lives.”
11
TI
M
R
PA
KE
R
Section of Colon and Rectal Surgery
Highlights
The section welcomes back former fellow Paul Wise,
MD, as an associate professor of surgery. Wise received his
medical degree from Johns Hopkins University and completed a general surgery residency at Vanderbilt University,
where he had served on the faculty since 2004. The former
president of the Collaborative Group of the Americas on
Inherited Colorectal Cancer, Wise will direct Washington
University’s Inherited Colorectal Cancer and Familial
Polyposis Registry. His clinical practice focuses on colorectal cancer treatment and inheritance, inflammatory
bowel disease and benign anorectal diseases.
Elisa Birnbaum, MD, is rolling out the
online colorectal education system for the
American Society of Colon and Rectal Surgeons (ASCRS). The system will encompass
all of the educational material owned by the
society — about 60 modules — including
the ASCRS textbook, journal, post-graduate
courses and self-assessments.
IMPROVE QUALITY OF LIFE
IN THE 1970s, the Washington
removing the rectum and without an
University colon and rectal surgery
abdominal incision.
service became one of the earliest to
“We began using the TEM pro-
offer radiation therapy in combina-
cedure for polyps in 2006,” says Hunt.
tion with surgery to treat rectal cancer.
“In the early stages, we only used the
Operative treatment has since evolved,
procedure in rectal cancer patients who
improving patients’ quality of life,
we did not think would survive a large
and stands at the threshold of several
abdominal operation.”
new frontiers.
“In the earliest days, if you had
But when the medical literature
showed TEM alone could be curative
cancer in the lower part of the rectum,
for early-stage rectal cancer, Hunt
you ended up with a colostomy bag —
began offering it. And now that studies
because the technology didn’t allow us
show TEM with chemoradiation may
to take out very small tumors without
be effective for some advanced rectal
using this option,” says Steven Hunt,
cancers, its use may be expanded in
MD, Washington University colorectal
coming years.
As chairman of the ASCRS Committee for Self-Assessment,
Matthew Mutch, MD, is in charge of producing the latest
edition of the Colon and Rectal Surgery Educational Program.
surgeon at Barnes-Jewish Hospital.
“We’ve come a long way in avoiding
in rectal cancer treatment at Alvin J.
Under the leadership of Ira Kodner, MD, Washington
University colorectal surgeons oversee residents and provide
services to low-income patients at ConnectCare.
these types of resection.”
Siteman Cancer Center at Barnes-Jewish
Sekhar Dharmarajan, MD, received the
Career Development Award from the ASCRS
Research Foundation. It will fund his project
with Nicholas Davidson, MD, on the study
of liver fatty acid binding protein and its effect
on polyp development in a mouse model.
Section Chief James Fleshman Jr., MD,
was named an associate editor of the Annals
of Surgery. He is also a member of an American College of
Surgeons Board of Governors committee that is developing
educational materials on stress, substance abuse and other
health issues for surgeons.
12
Minimally invasive techniques
surgery.wustl.edu
Although open surgery has
TEM is not the only advancement
Hospital and Washington University
improved to preserve bowel function
School of Medicine. Radiation oncolo-
in many cases, the use of a minimally
gist Parag Parikh, MD, is now work-
invasive technique — transanal endo-
ing with colorectal surgeons to offer
scopic microsurgical (TEM) exci-
patients a one-week radiation course,
sion — is further transforming rectal
followed by early chemotherapy, before
cancer surgery. During this procedure,
surgery. This compares to a traditional
a 20-cm-long proctoscope placed
through the anus allows
surgeons to visualize and
resect tumors without
regimen of about three months before
surgery, which may allow some
cancers to spread to the liver
and other organs.
Letha Nell and Richard Stallard
Healthy Retirement
Richard Stallard, 71, of Granite City, Ill.,
is back to riding his trike motorcycle,
fishing and spending retirement with his
wife, Letha Nell, after successful treatment
of appendiceal cancer that had spread to
his abdomen.
TIM PARKER
Steven Hunt, MD, performs a transanal endoscopic microsurgical (TEM) excision. The minimally invasive tumor removal
technique preserves function and is one of many advances improving quality of life for rectal cancer patients.
A new technology called gene
Clinic to see whether the technique can
expression profiling may also shape
identify who will benefit from radiation
the future of treatment. Washington
and chemotherapy, and what regimen
University colorectal surgeon Mat-
to use.
“If we can accomplish that, we will
Matthew Kalady, MD, of the Cleveland
develop a therapeutic trial,” Mutch says.
TIM PARKER
thew Mutch, MD, is collaborating with
In April 2010, Section Chief James
Fleshman Jr., MD, operated to remove
Stallard’s appendix, colon and rectum and
enrolled him in a trial at Siteman Cancer
Center to treat carcinomatosis of the
abdomen. The trial combined the current
standard of care – debulking the cancer,
stripping the lining of the abdominal
cavity and chemotherapy – with surgical
insertion of catheters into both sides of the
abdomen. Chemotherapy was administered intravenously and via the catheters.
Stallard did not receive the full course
of catheter treatment because of pain
but responded well overall. When tests
showed there was no return of the cancer,
Fleshman removed the catheters, created a
new rectum out of small intestine, and created a diverting ileostomy. Three months
later, the ileostomy was closed to restore
normal bowel function.
Today, Stallard is cancer free and enjoying
retirement once again.
13
National initiatives target
PATIENT SAFETY AND OUTCOMES
Section of Endocrine
and Oncologic Surgery
Highlights
Julie Margenthaler, MD, has been
named surgical director of the Joanne
Knight Breast Health Center in the Center for
Advanced Medicine. At the center in 2011,
Margenthaler and colleagues evaluated and
treated roughly 560 new breast cancer patients and more than 1,500 new patients with
other breast disorders. As surgical director,
Margenthaler organizes the surgical services
for breast patients, including clinical, research, patient education and training components. She also serves as the liaison
between the surgical services and other sections.
A randomized study led by
Rebecca Aft, MD, PhD, found
TIM PARKER
that zoledronic acid (Zometa®)
administered with chemotherapy
improves disease-free and overall
survival in the subset of patients
with estrogen receptor-negative
stage II and III breast cancer.
Findings will appear in the British
Journal of Cancer.
A clinical trial is under way to test whether photoacoustic
tomography is effective in finding the sentinel lymph node
in breast cancer patients. The new technology couples ultrasound and a laser system to identify the sentinel node. Julie
Margenthaler, MD, collaborated with Lihong Wang, PhD,
the Gene K. Beare Distinguished Professor of Biomedical
Engineering, to develop the technology.
Rebecca Aft, MD, PhD, and medical oncologist Cynthia
Ma, MD, PhD, will open a randomized clinical trial evaluat-
TIM PARKER
ing the effect of a potential anti-cancer drug called hedgehog
inhibitor LDE225 on bone marrow-disseminated tumor cells
in women with early stage estrogen receptor-negative and
HER2-negative breast cancer. LDE225 is known to be a potent
inhibitor of the Hh signaling pathway, which has been implicated in the development and maintenance of breast cancer.
Bruce Hall, MD, PhD, MBA, center, spearheads Barnes-Jewish Hospital’s quality improvement efforts with chief
medical officer John Lynch, MD, Mitzi Hirbe, RHIA, CPHQ, hospital president Richard Liekweg, surgical clinical
reviewer Louise Schrama and others. He also is involved with national efforts of the American College of Surgeons.
14
surgery.wustl.edu
Coreen Jones is grateful for the
scientific breakthrough and resulting
treatment she and her daughters have
received at Washington University.
OVER THE PAST SEVERAL YEARS,
Washington University endocrine
reimbursement for Medicare and
surgeon Bruce Hall, MD, PhD, MBA,
Medicaid to quality issues have come
has helped to advance the growing
to the forefront in the past seven to
movement to measure and improve
eight years,” says Hall. “I would say
surgical patient safety and outcomes
it’s a sea change.”
at Barnes-Jewish Hospital and beyond.
He serves as a leader and surgeon
Barnes-Jewish Hospital was
one of the original 14 hospitals par-
to collect data
on surgical complications, which
hospitals can
analyze and use for
guidance in fixing
ticipating in ACS
“The profession of
surgery has a very
strong history in
measuring quality.”
Bruce Hall, MD, PhD, MBA
problem areas and
NSQIP®, which
began in 2001
and now includes
roughly 500
hospitals. As the
hospital’s surgeon
care across all institutions will become
champion for the
better, as well as more consistent and
program, Hall is
standardized,” Hall says.
improving overall care. Hall is also
working with surgical leaders and
Hall also serves as a liaison to
working to expand this data collec-
hospital administrators to address
both the National Quality Forum
tion and to advance quality initiatives
specific concerns, such as surgical site
(NQF) and the Centers for Disease
within BJC HealthCare hospitals
and urinary tract infections. As the
Control (CDC).
and nationally.
surgical quality information officer for
The American College of Sur-
Data collection for ACS NSQIP®
BJC HealthCare, he is also working to
at Barnes-Jewish, which began with
geons National Surgical Quality
expand ACS NSQIP from three BJC
general and vascular surgery, has been
Improvement Program (ACS NSQIP®)
hospitals to the remaining institutions.
expanded to include all specialties
“The goal is to establish a BJC-
within the Department of Surgery.
collects data on surgical infection
rates and other postoperative compli-
®
wide surgical collaborative, so surgical
In addition, the department has
cations. Hall describes the program
launched a Clinical Effectiveness
as having a vital role in the emerging
Group to develop quality improve-
trend to link reimbursement to
ment initiatives.
performance measures.
Coreen Jones, of Portland,
Ore., knew where to go for
help when her daughters were
born with Multiple Endocrine
Neoplasia Type 2A (MEN 2A), a
rare inherited syndrome that
leads to aggressive thyroid
cancer and other endocrine
diseases. Coreen herself
was an early beneficiary of a
successful MEN 2A treatment
developed at Washington
University — genetic testing
and surgical removal of the
thyroid. So when her daughters were
diagnosed with the same condition, she
made an appointment with Jeffrey Moley,
MD, chief of the Section of Endocrine and
Oncologic Surgery.
COURTESY JEFFREY MOLEY, MD
champion of a
national program
Successful
prevention
a family affair
“Government efforts to tie
Abilene, 8, and Madison, 6, had their thyroids removed by Moley on Dec. 23, 2012,
and were soon back to normal life.
The treatment is the result of research
conducted more than 20 years ago by
Washington University’s Samuel Wells,
MD, Moley, and others. They identified the
gene for the MEN syndromes, leading to
development of genetic testing and the
preventive-surgery treatment approach —
the first surgical prevention of cancer
based on genetic testing.
Coreen, who also has MEN 2A, came from
Seattle as a teenager to have her parathyroid glands removed by Wells; her thyroid
had been removed by another surgeon
when she was 7.
15
Pancreatic cancer:
IMPROVING OUTCOMES
Section of Hepatobiliary-Pancreatic
and Gastrointestinal Surgery
Highlights
Ryan Fields, MD, has received the
American Surgical Association Research
Foundation Fellowship Award to compare
the genetic differences between primary and
metastatic colorectal cancers in individual
patients. The ultimate goal is to determine
mechanisms of metastasis with the hope of
using genetic information to improve and
guide treatments. Fields is also collaborating with David Curiel, MD, PhD, director of the Biologic
Therapy Core and an expert in gene therapy, and has
received a grant from the Siteman Cancer Center to treat
patients with advanced extremity melanoma with a novel
viral gene therapy/isolated limb infusion approach.
William Hawkins, MD, received an
R01 grant from the National Institutes of
Health (NIH) to study a novel treatment for
pancreas cancer using sigma-2 receptors,
which are over-expressed in proliferating
cancer cells. He has developed and will be
testing several novel drugs where a ligand
of the sigma-2 receptor is utilized to target
and kill pancreas cancer cells.
Steven Strasberg, MD, is principal investigator of
the Drug Eluting Bead, Irinotecan (DEBIRI) Trial at Siteman
Cancer Center. The treatment is for liver cancer that has
metastasized from colon cancer. The beads are given
directly to the liver tumor through interventional radiology techniques to shrink the tumor for surgical removal.
TIM PARKER
Three Washington University teams
received a $400,000 grant from the
Foundation for Barnes-Jewish Hospital
to study mechanisms of chemotherapy
resistance in pancreas cancer. David
Linehan, MD, is leading the grant, with
David DeNardo, PhD, of the Molecular
Oncology Section of the Department of
Pathology and Immunology.
David Linehan, MD, right, performing surgery with Steven Strasberg, MD, says the HPB section strives to reduce surgical
morbidity for pancreatic cancer and to advance earlier diagnosis. It also aims to enroll all patients in clinical trials.
16
surgery.wustl.edu
COURTESY WILLIAM
HAWKINS, MD
INCREDIBLE PROGRESS has been
very safe at Washington University
event after surgery is recorded.
made in the safety of operations for
and other major treatment centers.
The result was only two higher-
“Two main things have improved
level complications and no
years. Washington University hepato-
the mortality rate for the Whipple
biliary-pancreatic and GI (HPB-GI)
procedure,” says Steven Strasberg,
surgeons have contributed to this ad-
MD, HPB-GI surgeon at Barnes-
HPB-GI surgeons, led by
vancement — especially in the area of
Jewish Hospital. “The first is a better
William Hawkins, MD, also
reducing complications — and contin-
overall understanding of patient
recently reported on the use
ue to look at ways to improve operative
selection, operative care, anesthesia,
of mesh to reduce leakage in a
outcomes and patient survival.
post-operative care and the general
procedure for adenocarcinoma
health of patients. The other factor
of the pancreas body and tail.
is a better understanding of how to
These improvements are
Most pancreatic cancers are
adenocarcinomas — aggressive tumors
— that appear in the
head of the pancreas
and spread to other
organs. In the 1930s,
surgeon Allen Whipple modified the
pancreato-duodenectomy procedure
for pancreatic cancer,
“Washington
University is
a leader in
multi-modality
cancer therapy.”
David Linehan, MD
in which the head of
deaths in the first 75 patients.
perform the proce-
incremental steps as doctors
dure safely.”
seek to improve a five-year
Since 1990,
survival rate of just six percent
major improvements
for all pancreatic cancers. Section
have occurred in the
Chief David Linehan, MD, says
rate of postopera-
surgeons have begun to perform
tive fistulas, or leaks
pancreatic resections laparoscopi-
— complications
cally, further reducing morbidity.
that cause sickness
in patients. In 2002,
the pancreas, the gallbladder, portions
Washington University HPB-GI
of the stomach and small intestine,
surgeons reported on a new tech-
and the bile duct are removed. In 1945,
nique that resulted in a fistula rate of
when Whipple converted the operation
just 1.5 percent, the lowest reported
from a two- to a one-stage procedure,
in any large surgical series. In August
patient mortality was 31 percent.
2011, these surgeons and Barnes-
Today, the Whipple procedure — the
Jewish Hospital nurses implemented
definitive operation for cancer of the
an intensive postoperative plan
head of the pancreas — is considered
in which every negative
COURTESY IHPBA
pancreatic cancer over the past 70
“Washington University is a
leader in multi-modality cancer
therapy,” says Linehan.
Steven Strasberg, MD, right, receives an
international lifetime achievement award.
Strasberg Receives
International Award
Steven Strasberg, MD, the Pruett Professor
of Surgery and Carl Moyer Departmental Teaching Coordinator, has received
the Lifetime Achievement Award/Gold
Medallion of the International HepatoPancreato-Biliary Association (IHPBA) for
his numerous contributions to the field
of HPB surgery.
Strasberg received the award at the
10th World Congress of the IHPBA, held in
Paris on July 1-5. A number of other faculty
members from the sections of HPB-GI
Surgery and Transplant Surgery also
attended the meeting.
A leading academic surgeon, Strasberg is
the author of nearly 250 peer-reviewed
journal articles, some of which are among
the most highly cited in the HPB field;
has given 120 invited talks around the
world; is a current or former member
of the executive committees of several
national and international organizations,
including the IHPBA; and is a past
president of the American HepatoPancreato-Biliary Association.
17
Section of Minimally Invasive Surgery
Sports hernia treatment
GETS ATHLETES BACK TO FORM
Highlights
A clinical trial will test whether
photoacoustic endoscopy is more
effective than biopsies in detecting
precancerous tissue in patients with
Barrett’s esophagus. Brent Matthews,
MD, will conduct the trial. Collaborator
Lihong Wang, PhD, the Gene K. Beare
Distinguished Professor of Biomedical
Engineering invented photoacoustic
endoscopy, which applies photoacoustic
tomography by way of an endoscope.
Brent Matthews, MD, was elected treasurer and
secretary of the American Hernia Society, which serves
as a professional forum for the exchange of information
about the diagnosis and treatment of abdominal wall
abnormalities. Matthews will become president-elect of
the organization in March 2013.
The biomaterials lab of Corey Deeken,
PhD, is developing a synthetic mesh for
hernia repair. The mesh is made of polycaprolactone, a material that will trigger
a biologic response in the body to aid
soft tissue repair. Deeken and Matthew
MacEwan, an MD/PhD student, received a
Bear Cub grant from Washington University
to develop the mesh. Deeken has spent
two years analyzing specifications of FDAapproved meshes; the ultimate goal is to
develop a commercially available mesh.
Michael Awad, MD, PhD, was named program director of the Washington University General Surgery Residency
(see page 37) and elected to represent the Association of
Program Directors in Surgery to the Society of American
Gastrointestinal and Endoscopic Surgeons (SAGES). Education is a core mission of SAGES, a worldwide community of
surgeons that promotes minimal-access surgery, endoscopy and other emerging techniques.
A multidisciplinary approach combines surgery with an innovative rehabilitation program to return athletes to their
pre-injury performance level. Above, Michael Brunt, MD, left, consults with diagnostic radiologist David Rubin, MD.
18
surgery.wustl.edu
COURTESY RICK BARNES, DO
Although sports hernias, also called athletic pubalgia, can
occur in recreational athletes, they are more common among
professional and college athletes. The condition differs from a
true hernia in that there is no hole in the abdominal wall, but
rather a weakening. It can be repaired in an open procedure.
MICHAEL BRUNT, MD, is a familiar
or a tear in the rectus sheath where it
face to many Midwestern professional
attaches onto the pubic bone.
and collegiate athletes who have suf-
Brunt began offering surgical
fered what are commonly known as
treatment for these injuries in the early
sports hernias. In many cases, these
1990s and has been the St. Louis Blues
injuries could be career-limiting, but
team general surgeon for 18 years.
the use of surgery over non-
with proper treatment and rehabilita-
Over the past 10 years, referrals have
operative management for athletes
tion, the athlete can return to the field
increased substantially, and he esti-
with chronic groin pain in whom
or the rink at full strength.
mates only two or three other centers
other causes have been excluded.
“Hockey, soccer and football are
the three most common sports for
in the United States have a similar
Surgeons who treat athletic pub-
“It’s probably related
to the sudden
accelerating
movements,
the change of
direction that’s
required in
improving treatment of athletic
case volume.
these types of injuries,” says Brunt.
“The biggest opportunity
for improving treatment
of athletic pubalgia may
be prevention.”
Michael Brunt, MD
says Brunt. “Athletes do a lot of
understand
weight training. They get out of
other injuries
balance between their lower body,
in the hip and
thigh muscles and abdomen, and
pelvis and be
this creates an imbalance across
able to rule
the pubis. Better recognition of
them out.
some of the risk factors in training
When Brunt
could help prevent this.”
lar sports. It’s less common in baseball
pubalgia and surgery is indicated, he
and basketball, but can be seen in
usually performs an inguinal floor
almost any sport.”
repair using tension-free mesh as an
The sports hernia, more accurately called an athletic pubalgia, occurs
Rick Barnes, DO, 48, an ENT surgeon, is
typical of the patients seen by surgeon
Michael Brunt, MD, for sports injuries.
A former runner at the University of
Mississippi, Barnes continues to run
competitively and compete in triathlons
and raced in a stage of the Tour de France
in the summer of 2010.
But it was a backwards flip and spill
down a Black Diamond hill while snow
skiing that tore his rectus abdominis
muscle and led Barnes to seek out Brunt.
After the accident, it was very painful
to run, and Brunt operated on Barnes’
athletic pubalgia in July 2011.
Barnes was back to racing competitively
three months later and did not feel limited
less than a year after the surgery.
open procedure. Brunt works with
a multidisciplinary team including
when there is chronic exertional lower
sports orthopedists, athletic trainers,
abdominal or inguinal pain that affects
physical therapists and radiologists.
Most groin injuries respond
CK
BA
RN
ES
,D
O
says, trials support
RI
but there is a weakening and deterio-
SY
management. But, Brunt
TE
to rest and more conservative
sense that there is not a hernia bulge,
UR
level. It is not a true hernia, in the
CO
an athlete’s ability to perform at a high
pubalgia may be prevention,”
algia must
diagnoses a
those particu-
“The biggest opportunity for
Back on Track
ration of tissue in the inguinal floor
19
Section of Transplant Surgery
Cross training promotes
BROADER PERSPECTIVE
Highlights
Yiing Lin, MD, PhD, joined the faculty after completing
a general surgery residency and transplant surgery fellowship at Washington University. Lin will focus his research
on the genetics of hepatocellular carcinoma. He will be
involved in all areas of abdominal transplantation.
Providing vascular access for kidney
dialysis — and the high failure rate of
arteriovenous fistulas, which are created
surgically to connect a vein and an artery
to increase blood flow — is a major cost
and health care issue. Juxta-anastomotic
stenosis (JAS), or narrowing of a vein at the
connection of the artery to the vein, is a
major cause of arteriovenous fistula failure
and occurs in up to 65 percent of cases.
Surendra Shenoy, MD, PhD, was the
senior author of an article in the Journal of Vascular Surgery
showing that a novel technique, the piggyback Straight
Line Onlay Technique (pSLOT), significantly reduces JAS and
improves the maturation of arteriovenous fistulas.
Transplant surgeons are working with hepatologists
Thomas Kerr, MD, PhD, and Jacquelyn Fleckenstein,
MD, who recently joined Washington University
Physicians, to expand access to liver transplant services
to more patients outside the St. Louis region. Jeffrey
Crippin, MD, medical director of liver transplantation,
already sees patients in Cape Girardeau, Mo.
TIM PARKER
Transplant surgery is one of the most active
specialties within the Division of General Surgery
to offer clinical trials to patients. Transplant
surgeons currently offer more than 30 trials,
including trials of immunosuppressive drugs,
liver cancer therapy, and novel hemostatic techniques during liver surgery to limit blood loss
after resection. Washington University is a top
enroller in one of the hemostasis trials with
more than 40 patients.
Hepatobiliary-pancreatic surgeon Steven Strasberg, MD, mentored former transplant fellow Yiing Lin, MD, PhD, as part
of a new cross-training program that gives fellows in both specialties a broader understanding of the other service.
20
surgery.wustl.edu
Hepatobiliary-pancreatic fellow Kamran
Idrees, MD, consults with Julie Colicchio,
MSN, RN, NP-C, nurse practitioner on
the transplant service.
A NEW ARRANGEMENT between
participating in transplant confer-
two fellowship programs — transplant
ences, he also developed critical
surgery and hepatobiliary-pancreatic
thinking skills that will allow him to
(HPB) surgery — allows trainees to
assess the appropriate treatment for
spend a two-month rotation cross
liver cancer patients, with options
Lin says he also gained valuable
such as resection or downstaging
arrangement has broadened trainees’
experience in working with cancer
perspectives and strengthened both
patients during all phases of treatment.
William Chapman, MD,
programs, according to fellows and
“How they deal with issues in
chief of the Section of Transplant
program leaders.
The approach makes sense because
the two specialties are closely related
and treat many similar conditions,
especially in the area of liver disease.
Surgery and the Eugene M. Bricker
I am going to practice in the future,”
Professor of Surgery, says the
says Lin.
Transplant Fellowship is the first in
ed an HPB fellowship in 2012, helped
“I spent several weeks with
each of the HPB
surgeons and participated in liver,
pancreas and bile
duct surgeries,”
says Yiing Lin,
“How they deal with
issues in their specialty
really informs the way
I am going to practice
in the future.”
MD, PhD, who
the cancer before transplant.
their specialty really informs the way
Kamran Idrees, MD, who complet-
Yiing Lin, MD, PhD
completed the
the United States to offer certification by both the American Society
procure organs
of Transplant Surgeons and the
from donors
American Hepato-Pancreato-Biliary
with irrevers-
Association. The cross-training has
ible brain
helped make both fellowships
damage at
highly competitive, which is
Mid-America
especially important in the trans-
Transplant
plant field, where a number of
Services in
fellowships go unfilled. This is
St. Louis
partly because prospective fellows
and also
see that the number of openings for
transplant fellowship in June 2012
took part in liver, kidney and
transplant surgeons is limited by
and has since joined the transplant
pancreas transplants.
the scarcity of donor organs.
faculty. “There are some unique aspects
Idrees says even the kidney
to surgery with both groups. For
transplants were valuable because they
example, with liver transplants, the
involved sewing blood vessels and
way transplant surgeons handle and
creating anastomoses, or connections,
cut through the liver is different than
between vessels, which is also
the techniques used by non-transplant
required during pancreas
hepatobiliary surgeons.”
tumor removal. By
TIM PARKER
training on the other service. The
Chapman Receives
Endowed Chair
William Chapman, MD, chief of the Division
of General Surgery and the Section of Transplant Surgery, was installed as the Eugene
M. Bricker Chair of Surgery in July.
Chapman became the transplant surgery
section chief in 2002 and the general surgery
division chief in 2007. He worked with BarnesJewish Hospital Transplant Center Program
Director Gene Ridolfi and Jeffrey Crippin, MD,
medical director of liver transplantation, to
organize the five organ transplant programs
— liver, kidney, pancreas, heart and lung —
under one center. Under his leadership, the
abdominal transplant programs have seen
growth in volume with excellent survival
rates despite treating patients with the
most challenging conditions.
In research, he worked with a team of
biomedical engineers to develop an imageguidance system for liver surgery that
has improved pre-operative imaging and
enables surgeons to better track anatomical
location of instruments.
The chair was named in honor of Bricker,
an internationally renowned surgeon whose
career at Washington University spanned
more than 35 years.
21
Antibiotic holds promise to
CONTROL ANEURYSM GROWTH
Section of Vascular Surgery
Highlights
COURTESY LUIS SANCHEZ, MD
A clinical trial of a new “off-the-shelf”
fenestrated stent graft that could broaden
the ability of vascular surgeons to treat
patients with complex aneurysms began
accepting patients at Washington University
in the spring of 2012. Fenestrated stents are
designed for patients with aneurysms close
to the arteries that feed the kidneys and feature small openings that can be strategically
positioned to allow blood to pass into the
renal arteries. Currently, only custom-made
devices are available in a few referral centers
like Barnes-Jewish Hospital.
The section enrolled the first intern of the new Vascular
Surgery Residency program in June 2012. The five-year
program (known as a 0+5 track) focuses training after medical
school exclusively on vascular surgery, endovascular surgery
and the management of patients with vascular disease. The
residents will learn the necessary skills from general, vascular
and critical care surgeons. They will also receive important
specific training in radiology and benign hematology, among
other areas. The section will maintain a traditional fellowship
(5 + 2 track) — two years of specialized training in vascular
surgery after a five-year general surgery residency.
Brian Rubin, MD, worked with Barnes-Jewish Hospital
to produce a video on peripheral vascular disease, which
was used as part of a campaign to raise awareness of
the condition and treatment available from Washington
University vascular surgeons.
Patrick Geraghty, MD, was elected as secretary of the
Midwestern Vascular Surgical Society, which promotes the
advancement of diagnosis and treatment of vascular disease
and has members in 12 Midwestern states.
Jeffrey Jim, MD, was the lead author of an article in the
Journal of Vascular Surgery that addressed the possible future
shortage of vascular specialists in the country; he also worked
on the Society for Vascular Surgery Fellowship Development
Task Force to address this important issue.
Basic research by Robert Thompson, MD, and John Curci, MD, lays the foundation for a promising clinical trial to
evaluate an antibiotic as a potential non-surgical method to control the growth of abdominal aortic aneurysms.
22
surgery.wustl.edu
RESEARCH BEGUN in the 1990s
of the national principal investigators,
by Washington University vascular
and his laboratory will perform the
surgeons may lead to the first non-
blood analyses.
surgical treatment to control the
“Patients will receive treatment
growth of small aortic aneurysms,
for at least two years from enrollment,”
if a multicenter clinical trial now
says Thompson. “Even if doxycycline
under way proves successful.
successfully slows the rate of growth
Work by Robert Thompson, MD,
John Curci, MD,
hopes a common
antibiotic will
reduce the need
for surgical placement of stent
grafts to treat
abdominal aortic
aneurysm.
of aneurysms, we’re going to be left
activation of MMP-9 in human
and John Curci, MD, Washington
with questions about dose, duration of
aneurysm tissue.
University vascular surgeons at Barnes-
treatment and other variables. Further-
Jewish Hospital, showed in mice and
more, if it works, it’s potentially a huge
the Non-Invasive Treatment of
humans that the antibiotic doxycycline
breakthrough in the clinical treatment
Abdominal Aortic Aneurysm
inhibits an enzyme called matrix me-
of aneurysms.”
Clinical Trial (N-TA3CT), will track
talloproteinase 9 (MMP-9), important
in aneurysm formation; further, they
found that doxycycline actually
suppresses the
formation of
aortic aneurysms
in mice. Doxycycline is now
being tested in
MMP-9 degrades structural
components of the aortic wall such
“If it works, it’s potentially
a huge breakthrough
in the clinical treatment
of aneurysms.”
Robert Thompson, MD
humans with
aneurysm growth through computed tomography scans conducted
every six months in patients given
and elastin,
either doxycycline or a placebo.
thus con-
Through blood samples, investiga-
tributing to
tors will check levels of doxycycline
aneurysms.
and analyze blood biomarkers of
Thompson’s
aneurysm disease.
testing doxy-
lion patients in the country at any
one time who have these small
aneurysms,” says Curci, “Most
of a National Institute on Aging ran-
tetracycline class — in rat and mouse
will eventually grow to rupture or
domized clinical trial at Washington
models of aneurysm disease; they
require surgery. If we have some-
University and 15 other sites.
chose doxycycline because tetracyclines
thing to slow or stop the growth of
Thompson is lead investigator
were already known to inhibit MMPs.
aneurysms, so they never rupture or
of the Washington
Curci, then in postgraduate train-
need surgical treatment, it revolu-
University trial.
ing, helped conduct animal research
tionizes aneurysm therapy. They can
and a later study showing that even
be screened with an ultrasound and
reduced the expression and
TIM PARKER
cycline —
a cheap, commonly used drug in the
brief treatment with doxycycline
Section Chief Luis Sanchez, MD, and
Department Chair Timothy Eberlein, MD,
unveil Gregorio Sicard’s portrait.
“There are likely half a mil-
abdominal aortic aneurysms as part
Curci is one
Gregorio Sicard, MD, the founding vascular
surgery chief, was honored for 35 years
of leadership and service in May 2012. A
symposium titled “The Past, Present and
Future of Vascular Surgery” drew national
and international speakers and focused on
education and aortic, carotid and peripheral
vascular disease. Sicard became the first
chief of vascular surgery in 1983 and served
in that role until 2011, when he transitioned
leadership to Luis Sanchez, MD. Sanchez
also became the first Gregorio A. Sicard Distinguished Professor of Vascular Surgery.
The national trial, called
as collagen
lab started
Gregorio Sicard Honored
treated with a drug, reducing both
risk and cost for the patient.”
23
Advanced treatment through
MULTIDISCIPLINARY APPROACH
Section of Cardiac Surgery
Highlights
TIM PARKER
The FDA approved the use of a transcatheter aortic valve — which is placed
by threading a catheter from the femoral
artery in the leg to the heart — in patients
who cannot undergo an open operation to
replace the valve. Washington University
has been a leading enroller at Barnes-Jewish
Hospital for both the first PARTNER (Placement of AoRTic traNscathetER) Trial, which investigated
the valve for inoperable patients, and the second PARTNER
Trial, which is investigating the use of next-generation
valves in both inoperable and high-risk patients.
Heart surgeons also performed 415 open valve procedures, almost double the number of cases in 2007. They
work closely with cardiologists in the treatment of valve
disease and offer a minimally invasive approach to valve
surgery using small incisions made in the chest.
Washington University was the largest
enroller in the Concomitant Utilization of
Radio Frequency Energy for Atrial Fibrillation
(CURE-AF) Study, which demonstrated that
radiofrequency ablation used in a modified
Cox-Maze procedure can safely and effectively treat patients with atrial fibrillation. The set of lesions
used in the trial were developed by Cardiac Surgery Chief
Ralph Damiano Jr., MD, for the Cox Maze IV procedure.
the Division of Vascular Surgery and
Thoracic Aorta was established in 2001
the Gregorio A. Sicard Distinguished
as a referral center for patients with
Professor of Vascular Surgery, and all
acute and chronic aortic dissections,
of the other vascular surgeons; and
thoracic aortic aneurysms and Marfan
cardiologist Alan Braverman, MD, the
syndrome. Its success stems not only
Alumni Endowed Professor of Cardio-
from the advanced treatments offered
vascular Disease in Medicine, all play
at a major academic center, but from
an active role in evaluating patients.
the collaboration of a multidisciplinary
mary care physician or cardiologist,
and with the primary care physicians
the team may recommend surgical
and cardiologists who refer patients.
intervention, endovascular intervenpressure control and long-term sur-
nists to keep up with the latest treat-
veillance. Moon surgically treats aortic
ment options,” says Marc Moon, MD,
conditions in the ascending aorta, but
Washington University cardiothoracic
works together with vascular surgeons
surgeon at Barnes-Jewish Hospital and
on problems in the descending and
surgical director of the center. “It’s not
thoracoabdominal aorta.
our goal to take over care of the entire
“Patients now present with more
patient, but we provide support and
complex aneurysms than they did
input into decisions of how to treat
years ago, due in part to our ability to
these uncommon diseases.”
get them through an acute pathologi-
Patients who are referred to the
cal state,” says Moon. “We can offer
center generally already have been
not only an open approach or endo-
diagnosed with an aneurysm or a dis-
vascular approach, but a combined
section — a potentially life-threatening
approach that brings together all the
condition in which there is bleeding
positives that both the thoracic and
into and along the wall of the aorta.
vascular surgeons can contribute.”
of Surgery; Luis Sanchez, MD, chief of
surgery.wustl.edu
tion or a medical approach with blood
fairly rare, and it’s difficult for inter-
Moon, the Joseph Bancroft Professor
24
Working with the patient’s pri-
team of specialists — with each other
“Diseases of the thoracic aorta are
COURTESY PAMELA WOODARD, MD
The volume of heart surgery cases
continued to grow in 2011. Heart
surgeons performed more than 1,300
major cases — an increase of eight
percent over 2010. Heart transplants and
ventricular-assist device implantations
have also steadily increased. Surgeons
performed 35 heart transplants in 2011,
compared to 29 in 2010, and 93 surgeries
to implant ventricular assist devices, 15
more than in 2010.
THE CENTER for Diseases of the
Yet Moon says medical prevention
is the most important piece of
Throughout the department,
trainees are taught a highly
collaborative and multidisciplinary approach to medicine —
an approach that prepares
them well as the next generation
of leaders in the field. Above,
research fellow Shoichi Okada,
MD, right, confers with cardiothoracic surgeon Marc Moon, MD.
the puzzle. Hypertension is the most
common risk factor for the development
of aneurysms and aortic dissections,
with the patient’s primary care
The Center for Diseases of the Thoracic
Aorta offers advanced multidisciplinary
treatment. Cardiothoracic and vascular
surgeons work with primary care
physicians to offer surgical or medical
interventions and long-term surveillance.
physician or cardiologist playing
an intimate role in controlling
this aspect of the disease.
“Our combined
approach brings
together all the
positives that both
the thoracic and
vascular surgeons
can contribute.”
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Marc Moon, MD
25
Lung cancer studies evaluate
LONGEVITY, QUALITY OF LIFE
Section of General Thoracic Surgery
Highlights
COURTESY TRAVES CRABTREE, MD
Traves Crabtree, MD, was the lead
author in a study showing that a patient
education process may alleviate the emotional and physical difficulties lung cancer
patients face before and after surgery. He
and co-authors reported that lung procedure
patients who watched a 30-minute preparation video reported less anxiety about the
procedure, less physical pain after the operation and higher overall satisfaction with the
operative experience. The study, comparing 136 patients
who were given the video with 134 patients who received
only the standard physician’s consultation and written
materials, was published in the Journal of the American
College of Surgeons.
Varun Puri, MD, is leading a clinical
trial in the Prevention of Post-Operative
Pneumonia (POPP). In this trial, patients
undergoing a major thoracic operation first
undergo an intensive oral hygiene regimen
to reduce pathogenic bacteria in the mouth
and lessen the impact of aspiration that may
occur at the time of surgery. Goals are to
improve survival and decrease the cost and
length of hospitalization.
TIM PARKER
Traves Crabtree, MD, served as
the 2012 co-director of STS University,
an educational program held at the
Society of Thoracic Surgeons Annual
Meeting. This program allows thoracic
surgeons to try new technology and
to receive input from expert surgeons.
Crabtree organized the thoracic courses,
which included a simulated version of
video-assisted thoracic surgery (VATS)
lobectomy and techniques for esophageal and bronchial
interventions. STS University drew hundreds of participants
at the 2012 Annual Meeting.
In clinical trials, radiation oncologist Jeffrey Bradley, MD, and thoracic surgeons Varun Puri, MD, and Bryan Meyers, MD,
MPH, are comparing the relative merits of surgery versus stereotactic radiation therapy for early-stage lung cancer.
26
surgery.wustl.edu
WASHINGTON UNIVERSITY
thoracic surgeons continue to break
new ground in advancing more effective lung cancer therapies, drawing on
recent studies comparing widely used
“We are studying
what patients’ lives
are like after different
treatments of stage I
lung cancer, not simply
how long they live.”
Stephen Broderick, MD
of treating the disease.
All six thoracic surgeons have
joined radiation oncologists at the
which you don’t randomly
assign therapies to patients.
We are quite eager to support
the new prospective trial and
get an unbiased answer.”
to establish within that middle ground,
where do patients fall?”
Within the past year, the thoracic
Stephen Broderick, MD, who
joined the faculty in July 2012 after
completing a cardiothoracic surgery
Alvin J. Siteman Cancer Center
surgery section has reported on two
fellowship at Washington University,
at Barnes-Jewish Hospital and
retrospective studies comparing treat-
is looking at yet another angle in the
Washington University School of
ment options for patients with stage I
treatment of lung cancer: the qual-
Medicine in a multicenter lung cancer
lung cancer. One study found that
ity of life resulting from different
clinical trial. The trial randomly
stereotactic body radiation therapy
therapies. “We are studying what
assigns patients with stage I non-small
was less costly, but patients eligible
patients’ lives are like after different
cell lung cancer and diminished lung
for surgical intervention had longer
treatments of stage I lung cancer,
function to either surgical removal of
survival than those not eligible, and
not simply how long they live.”
a portion of the lung or stereotactic
surgery appeared to meet reasonable
body radiation therapy.
standards for cost effectiveness. The
tradition of Washington University
other concluded that, for patients who
thoracic surgeons in the treatment
clearly fall into one of three categories,”
cannot undergo removal of an entire
of lung cancer. Evarts Graham,
says Varun Puri, MD, Washington
lobe of the lung, sublobar resection
MD, the first chairman of the
University thoracic surgeon at Barnes-
looks comparable to and competitive
Department of Surgery, performed
Jewish Hospital. “The first includes
with stereotactic radiotherapy.
the first successful removal of an
removal of a lobe, which remains the
Bryan Meyers, MD, MPH, chief
gold standard. At the other end are
of the Section of Thoracic Surgery
patients who are clearly poor operative
and the Patrick and Joy Williamson
candidates and are suitable for stereo-
Professor of Surgery. “But there
tactic radiation therapy. This trial tries
is always concern about bias
R
best to overcome selection bias,” says
KE
status and can undergo surgical
entire lung in 1933.
PA
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“In both studies, we tried our
M
individuals who are good performance
Evarts Graham, MD, published
the first evidence linking smoking with lung cancer in 1950.
The paper is now considered the
seminal contribution to research
on smoking and cancer.
All of the studies continue the
TI
“Early-stage lung cancer patients
COURTESY BECKER MEDICAL LIBRARY ARCHIVE
treatment options and a long history
in retrospective studies in
27
Artificial heart provides
BRIDGE TO TRANSPLANT
Section of Pediatric Cardiothoracic Surgery
Highlights
The Section of Pediatric Cardiothoracic Surgery
welcomes Umar Boston, MD, as an associate professor.
Boston served as director of the Adult Congenital Heart
Surgery Program at LeBonheur Children’s and Methodist
University Hospitals in Memphis, Tenn. At Washington
University, he continues his work with adult patients who
underwent congenital heart surgery while treating the
full range of children with heart and lung conditions at
St. Louis Children’s Hospital.
TIM PARKER
Pediatric Cardiothoracic Surgery Chief Pirooz
Eghtesady, MD, joined with Alec Patterson,
MD, chief of the Division of Cardiothoracic
Surgery, and Varun Puri, MD, to perform what
— to the surgeons’ knowledge — was the first
lung autotransplantation in a patient who had
undergone a previous lung transplant. The
9-year-old boy had developed life-threatening
complications after a surgeon had transplanted both lungs
into his left chest cavity, reasoning that the chest cavity on
the right side was too small. During the 14-hour operation,
the surgeons removed the right lung from the left side of
the chest, reconstructed the anatomy and placed the lung
in the correct side. The patient is doing well.
TIM PARKER
The Washington University and Barnes-Jewish Heart &
Vascular Center — which comprises caregivers in pediatric
cardiothoracic surgery, pediatric cardiology, critical care and
anesthesiology — has developed a scorecard with nearly
300 metrics as team members focus on quality of care.
ST. LOUIS CHILDREN’S HOSPITAL
The volume of on-pump, open-heart
surgeries increased dramatically in
early 2012 over the number performed
in January-March 2011. This happened,
in part, because of new insurance
agreements made by Children’s Hospital that expand coverage in other states
and the number of children who were
referred for transplant but received an
alternative surgical approach.
Pirooz Eghtesady, MD, left, shown with cardiothoracic surgery colleague Umar Boston, MD, heads a team that
annually performs roughly 300 open congenital cardiac repairs, 100 closed procedures and 25 heart transplants.
28
surgery.wustl.edu
TIM PARKER
TIM PARKER
STANISLAW “STAS” BARTLETT was
gravely ill when he was transported to
St. Louis Children’s Hospital by medi-
The FDA had recently approved
help Stas. With limited options,
cal helicopter in November 2011. A few
the use of the Berlin Heart, a ventricu-
Stas’ family agreed to try the
months short of his fourth birthday, he
lar-assist device, as a bridge to trans-
device, and Eghtesady performed
already had undergone two surgeries
plant in children. But the device had
a 12-hour operation in which he
for a congenital heart defect. He was
not been used very effectively in pa-
modified the implantation.
listed for heart transplantation, but
tients with single-ventricle physiology.
Rebecca Bartlett saw Stas
needed extensive therapy to bridge him
Instead, doctors started Stas on drugs
improve after the Berlin implanta-
to a successful transplant in April 2012.
to help his heart contract and later
tion, and he received his new heart
27 days later. She reported Stas
circulation continued to deteriorate,
was gaining strength and behav-
Eghtesady, MD, chief of pediatric
doctors tried implanting the Impella
ing like a normal 4-year-old two
cardiothoracic surgery at The St. Louis
cardiac-assist device, which caused
months after the surgery.
Children’s and Washington University
kidney dysfunction, then removed it
Heart Center. “Essentially, part of his
and employed a different cardiac-sup-
single ventricle anatomy to be
heart never formed completely, and
port technique called extracorporeal
bridged successfully to heart
the blood flow to his lungs was
membrane oxygenation (ECMO).
transplantation. He also is unusual
“Stas was born with single-
dependent on passive circulation.
ECMO is only used for short-term
“Stas is the first child with
in that he was sicker than most
There was no chamber pumping
cardiac support and wasn’t helping
children who undergo heart
blood through his lungs.”
much. The Berlin Heart offered a way
transplant,” says Eghtesady. “But
to restore circulation and organ func-
I’m happy to say that his long-
tion, but there was a risk it would not
term prognosis is now similar to
Two months after he was born,
Stas had undergone a procedure to
prepare his heart for a second correc-
that of any other child receiving
tive surgery he would need a few years
a heart transplant.”
COURTESY BARTLETT FAMILY
placed him on a ventilator. When his
ventricle anatomy,” says Pirooz
A ventricular-assist device supported circulation for Stanislaw
Bartlett until he could receive a
heart transplant at age 4.
later to correct his heart physiology.
Shortly after that second surgery in
October 2011, his heart began to fail.
In November, his mother, Rebecca,
took him to Children’s Hospital &
Medical Center in Omaha, Neb., and
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from there he was flown to St. Louis
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Division of Pediatric Surgery
Pediatric Acute Wound Service:
MEETING CHILDREN’S NEEDS
Highlights
The Division of Pediatric Surgery welcomes Adam
Vogel, MD, as an assistant professor of surgery. Vogel
completed a general surgery residency at the University
of Chicago and a pediatric surgery fellowship and surgical
critical care fellowship at the University of Texas in Houston.
Vogel will work with the Extracorporeal Membrane Oxygenation (ECMO) Program and serve as the pediatric surgery
representative in the Vascular Malformations Clinic at
The American College of
Surgeons (ACS) has verified
Children’s Hospital as a Level 1
Pediatric Trauma Center. During
the verification process, the ACS
confirms the presence of resources
for the optimal care of injured
patients. Children’s is the only ACSverified Level 1 pediatric hospital
in Missouri and Illinois.
Pediatric surgeon Marty
Keller, MD, and adult thoracic
surgeon Alexander Krupnick,
MD, are spearheading a multidisciplinary effort in the treatment
of chest wall deformities, such as
pectum excavatum and pectus
carinatum. Others involved in
the care of pediatric patients
include specialists in radiology, orthopedics, cardiology
and pulmonary medicine. A prosthetist offers non-surgical
options to children.
Inflammatory bowel diseases such as Crohn’s disease
and ulcerative colitis affect all aspects of children’s lives.
Pediatric surgeons provide surgical consultation and work
as part of a team with pediatric gastroenterologists, nurses,
dietitians, radiologists and social workers to provide a
full range of care to patients in the Inflammatory Bowel
Disease Center at St. Louis Children’s Hospital.
The Pediatric Acute Wound Service (PAWS) at St. Louis Children’s Hospital offers comprehensive care for skin
wounds to meet the special needs of children. Above, Kate Bernabe, MD, treats a burn on a young patient.
30
surgery.wustl.edu
Intensive diagnostics and treatment by Kate Bernabe,
MD, and the PAWS unit laid the foundation for Adi Hayes
to begin recovering from a persistent foot infection.
children includes putting
atric surgeons at St. Louis Children’s
a gel roll under the head,
Hospital have taken on long-standing
using special mattresses,
medical challenges in recent years.
frequent turning, and
They have improved survival for infants
good nutrition. Bernabe
born with congenital diaphragmatic
is working through the
hernia and are part of a national
Skin and Wound
quality-improvement program analyz-
Committee at St. Louis Children’s
ing outcomes of surgical procedures.
Hospital, as well as communicating
Most recently, they stepped up efforts
directly with caregivers, to raise
to help some of the sickest children
awareness of the problem.
with skin wounds.
“The patients at highest risk for
TIM PARKER
WASHINGTON UNIVERSITY pedi-
“Nurses are at the forefront of
detecting these because part of their
skin wounds are the sickest patients,
daily assessments is a skin exam of the
and many times it’s not possible to
entire body,” says Bernabe. “They want
do a normal skin care routine for
to take good care of these patients,
those patients to prevent any skin
but more education needs to be done
breakdown, whether it’s a pressure
to recognize the starting of a pressure
ulcer or device skin breakdown or
ulcer, and then how to take care of it,
an IV infiltration breakdown,” says
so it doesn’t progress.”
Kate Bernabe, MD, surgical director
The scientific literature on
of the Pediatric Acute Wound Service
pressure ulcers in children is sparse
at St. Louis Children’s Hospital and
and does not entirely reflect different
Missouri Baptist Medical Center.
weights and body size proportions.
The problem of pressure ulcers has
By tailoring wound care to pediatric
typically been associated with older
patients, Bernabe is continuing the
adults, but Bernabe says they have
tradition of adopting surgical care
become a greater issue at pediatric
to the special needs of children
hospitals since Medicaid has
TIM PARKER
narrowed its criteria for
coverage. The gold
started by Jessie Ternberg,
MD, PhD, who pioneered
surgical care at St. Louis
standard for treating
Children’s Hospital.
Specialized Wound
Care for Kids
Adi Hays, 13, was referred to Kate
Bernabe, MD, director of the Pediatric
Acute Wound Service (PAWS), because of
a persistent infection in her foot that had
continued on and off for several years.
Adi has spina bifida with poor circulation
in her lower extremities.
Bernabe says Adi’s case is an example of
the type of complex wound often seen
on the PAWS Unit. Simpler wound care
over the course of nine months had not
been effective, so Bernabe suggested
Adi undergo an MRI. When the MRI
showed a deeper bone infection, doctors
expanded Adi’s antibiotic regimen to
include intravenous antibiotics.
The wound healed enough that it
became easier for Adi to walk, but infection persisted. The next step was a bone
biopsy to learn more about the infection
and the type of treatment that may
eliminate it.
Since then, Adi has been placed on a
new intravenous antibiotic, and her
orthopedic surgeon is continuing her
care. Bernabe believes the diagnostic
work and treatment she received on
the PAWS Unit helped move Adi and
her family along the path to healing.
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Division of Plastic and
Reconstructive Surgery
Peripheral nerve transfer
RESTORES HAND FUNCTION
Highlights
The faculty welcomes Amy Moore, MD, and Alison
Snyder-Warwick, MD, as assistant professors of surgery.
Both completed plastic surgery residencies at Washington
University. Moore, who spent last year as a hand surgery
fellow at the Mayo Clinic, joins Amy Kells, MD, and Ida
Fox, MD, with a focus on complex nerve and wrist surgery.
Snyder-Warwick, after completing a pediatric plastic fellowship at the Hospital for Sick Children in Toronto, joins Pediatric Plastic Surgery Chief Albert Woo, MD, and Kamlesh
Patel, MD, adding depth to the management of complex
pediatric nerve injuries and facial reanimation expertise.
Division Chief Susan Mackinnon, MD,
received both the Clinician of the Year award
and the Award for Outstanding Achievement
in Basic & Translational Research at the 2012
Annual Meeting of the American Association of
Plastic Surgeons. She was also one of three U.S.
physicians to be honored with a Clinical Excellence Award by Castle Connolly Medical Ltd.,
which publishes America’s Top Doctors and
other guides to choosing physicians.
lowest bone in the neck. Instead of
and reconstructive surgeons have
operating on the spine itself, the sur-
restored some hand function in a
geons rerouted working nerves in the
quadriplegic patient with a spinal
upper arms. These nerves still “talk”
cord injury at the C7 vertebra, the
to the brain because they attach to
the spine above the injury.
Following the surgery, performed
at Barnes-Jewish Hospital, and one
C7
year of intensive physical therapy, the
patient regained some hand function,
specifically the ability to bend the
thumb and index finger. He can now
feed himself bite-size pieces of food
and write with assistance.
The case study, published
online in the Journal of Neurosurgery,
Nerve
Transfer
is, to the authors’ knowledge, the
first reported case of using nerve
transfers to restore the ability to
flex the thumb and index finger
after a spinal cord injury.
“This procedure is unusual for
treating quadriplegia because we do
not attempt to go back into the spinal
cord where the injury is,” says plastic
surgeon Ida Fox, MD. “Instead, we go
out to where we know things work —
in this case the elbow — so that we
ERIC YOUNG
A website developed by Washington
University plastic and reconstructive
surgeons to serve as an open-access,
educational resource for surgeons treating persons with complex peripheral
nerve trauma has been visited by physicians world-wide. The site was originally
created in response to concern about
the number of soldiers returning from
Iraq and Afghanistan with nerve injuries
impairing use of their arms, legs and
hands. Andrew Yee, who served as
videographer of the surgeries on the
site, presented a paper on assessing
the development of the website at the American
Society for Peripheral Nerve Annual Meeting in
January 2012.
WASHINGTON UNIVERSITY plastic
A groundbreaking new peripheral nerve transfer procedure developed by Susan Mackinnon, MD, has restored
limited hand function in one patient with C7 spinal cord injury. The technique is appropriate for C6 and C7 injuries.
32
surgery.wustl.edu
can borrow nerves there and reroute
injuries to peripheral nerves, she has
them to give hand function. If we
pioneered similar surgeries to return
can restore the ability to pinch
function to injured arms and legs.
between the thumb and index
Mackinnon operated in the
finger, it can return some very
upper arms; she took a non-working
basic independence.”
nerve that controls the ability to
The surgery was developed
pinch and plugged it into a working
and performed by the study’s senior
nerve that drives one of two muscles
author Susan Mackinnon, MD, the
that flex the elbow. After the surgery,
Sydney M. Shoenberg Jr. and Robert
the bicep still flexes the elbow, but the
H. Shoenberg Professor and chief
nerve to the brachialis muscle, which
of the Division of Plastic and Re-
also flexes the elbow, now bends the
constructive Surgery. Specializing in
thumb and index finger.
Mackinnon does not anticipate a
Ida Fox, MD
limited window of time for performing the surgery. Spinal cord injury,
unlike peripheral nerve injury, allows
for repair in the right circumstances
JOURNAL OF NEUROSURGERY
“If we can restore
the ability to pinch
between the thumb
and index finger, it
can return some very
basic independence.”
even years after injury. But it will
not benefit patients with higher
injuries, in vertebrae C1 through C5,
and it cannot restore leg or bowel/
bladder function.
After surgery to restore hand
function, intensive physical
therapy is required to retrain
the brain to communicate with
new nerve connections.
33
Division of Urologic Surgery
PSA screening data suggest
NUANCED APPROACH
Highlights
Seth Strope, MD, MPH, presented findings on a long-term study of follow-up care
to bladder cancer at the American Urological
Association Annual Meeting in May 2012. He
and collaborators found that patients who get
some follow-up care generally do better, but
that visiting the doctor — urologists, primary
care and other specialists — has more impact
on survival than cross-sectional imaging.
Gino Vricella, MD, became the first fellow in the
Pediatric Urology Fellowship, which was launched
on July 1, 2012. Vricella joined the program after a
urologic surgery residency at Case Western Reserve
University. Douglas Coplen, MD, director of
pediatric urology, is the program director for the
two-year, ACGME-accredited fellowship, which
consists of a clinical and a research year.
Erica Traxel, MD, is working to implement early specialization and improved
skills assessment for urology residents. The
approach would allow trainees to complete
the residency and one of four urologic fellowships at Washington University a year
earlier. The residency will begin requiring
Fundamentals of Laparoscopic Surgery (FLS)
certification; educators are looking at further
ways to assess competency.
Seth Strope, MD, MPH, won the Scholar’s
Abstract Award for a poster presentation at the conference Translational Science 2012: Improving Health
Through Research and Training, held in April 2012 in
Washington, DC. The research from a large database
of hospitals showed laser therapy for benign prostatic hyperplasia had better short-term outcomes,
but transurethral resection of the prostate (TURP)
had a lower re-treatment rate over four years.
34
surgery.wustl.edu
THE U.S. PREVENTIVE SERVICES
who could potentially be harmed,” says
Task Force recommendations against
Andriole. “On the other hand, if you
routine PSA testing for healthy
screen only men who are at higher risk
men age 50 and older drew spirited
for dying of prostate cancer — about
opposition among many urologists
10 to 15 percent — there is a greater
and advocates for those with prostate
percentage of men who stand to ben-
cancer. Washington University Chief
efit and commensurately fewer who
of Urologic Surgery Gerald Andriole
stand to be harmed.”
Jr., MD — a leading expert in prostate
In the journal European Urology,
cancer screening — believes it would
Andriole and other scientists advo-
be a mistake to universally dismiss the
cated a risk-based approach that would
screening test and argues men are best
encourage PSA testing for
served with a more nuanced approach.
African-American men, the ethnic
Andriole acknowledges that
group at highest risk for prostate
widespread testing has led many men
cancer; men with a strong family
with slow-growing tumors to be over
history of prostate cancer; and those
diagnosed and over treated with ag-
with additional risk factors related to
gressive therapies. For these men, who
age, other illnesses, prostate volume
are unlikely to die from their prostate
and previous biopsy status.
cancer, the cost and side effects of
Andriole, the Robert K. Royce
biopsies and treatments outweigh the
Distinguished Professor of Uro-
benefits of PSA testing.
logic Surgery, has played a key role in
“If you screened all men, since
only about three out of 100 are going
to die of prostate cancer, there are
only three men who would
potentially benefit and 97
developing prostate cancer screening
guidelines as chairman of the prostate
committee for the Prostate, Lung,
Colorectal and Ovarian
(PLCO) Cancer Trial.
The first systematic evaluation
found that annual prostate cancer
of the PSA test was conducted by
screening does not reduce deaths from
Washington University urologists
the disease, even among men in their
more than 20 years ago. Since then,
50s and 60s and those with underlying
the division’s urologists have contin-
health conditions.
ued to evaluate use of the test.
TIM PARKER
This major national study has
“Mass screening
is not the way to
go. We have to take
a more nuanced
approach.”
From left, Brian Benway, MD, clinical fellow
Youssef Tanagho, MD, resident Elizabeth
Roth, MD, and research fellow Jonathan
Mobley, MD, try out new 3-D technology.
Gerald Andriole, MD
3-D Tools Provide
Edge in Laparoscopy
It seems intuitive that 3-D eyewear
would help surgeons better visualize
laparoscopic surgery. Washington University urologists have taken a scientific
look at their value and reported results
at the American Urologic Association
Meeting in May 2012.
The study had subjects with various
ability levels — from expert surgeons
to people with no medical training —
perform three tasks from the Fundamentals of Laparoscopic Surgery skill set
developed by the Society of American
Gastrointestinal and Endoscopic Surgeons: using laparoscopic instruments
to transfer an object from one peg to
another, cutting a piece of pre-traced
gauze, and suturing and knot tying.
PHIL SHOULBERG
“We found that, overwhelmingly, the
3-D imaging confers an advantage,” says
Brian Benway, MD, who led the study.
“Tasks were completed more quickly and
there were fewer errors in 3-D. Advantages were seen for all groups, and the
side effects of 3-D such as headaches,
dizziness and disorientation were no
more common than with standard 2-D.”
Since performing the large-scale clinical trials that launched the prostate specific antigen (PSA) test into clinical
practice in the 1990s, Washington University urologists led by Gerald Andriole, MD, have continued refining its use.
35
Early specialization
Education
STREAMLINES TRAINING
Highlights
Three surgeons have been appointed associate program
directors of the General Surgery Residency: Hepatobiliarypancreatic and GI surgeon Ryan Fields, MD, director of
resident research, meets with junior residents before their
lab year to guide them in selecting appropriate research
or other options. Breast surgeon Amy Cyr, MD, provides
breast education and helps residents prepare for boards.
Colorectal surgeon Bashar Safar, MD, supervises residents in the ConnectCare Clinic, which provides medical
care to underserved populations.
The Nexus Project, an online resource to help U.S.
medical schools, surgical residencies and surgical fellowships develop curricula, launched in April 2012. General
Surgery Residency Program Director Michael Awad, MD,
is spearheading the project, funded by the U.S. Department
of Education.
36
surgery.wustl.edu
COURTESY MARY KLINGENSMITH, MD
Mary Klingensmith, MD, Mary Culver Distinguished
Professor of Surgery, received the 2012 Parker J. Palmer
Courage to Teach Award at the ACGME 2012 Educational
Conference. The award recognizes those who exemplify the
spirit of Palmer, an author and educator who encourages
other educators to “give heart” and have “the courage to
explore one’s ignorance as well as insight, to yield some
control in order to empower the
group, to evoke other people’s lives as
well as reveal one’s own.” Klingensmith
also was elected as a director of the
American Board of Surgery and as
a director of the American Board of
Thoracic Surgery.
COURTESY MICHAEL BRUNT, MD
Michael Brunt, MD, was
inducted into the Alpha Omega
Alpha Honor Medical Society as
faculty, along with Susan Pitt,
MD, chief resident, general surgery, and Washington University
medical students who are going
into a surgical specialty.
Residents hone laparoscopy skills:
Above, assistant professor Erica Traxel,
MD, instructs urology chief resident
Shaun Grewal, MD; below, professor Mary Klingensmith works with
research resident Lindsey Saint, MD.
Surgical residents gain
hands-on robotics training from Michael Awad,
MD, PhD, in the surgical
skills laboratory.
says Mary Klingensmith, MD,
postgraduate medical education
vice chair for education and the
are undergoing significant transfor-
Mary Culver Distinguished Professor
mations within the Department of
of Surgery. “And there is a lot of
Surgery, with a faculty workgroup
concern that medical students are
serving as a springboard and forum
not interested in surgical training
provided synergy as educators look
on ideas to increase training efficiency.
because it takes so long.”
at early specialization, preparedness
The department’s training takes
In addition to the early special-
RAY MARKLIN
TRADITIONAL MODELS of
for practice and other issues. Educa-
place at Barnes-Jewish Hospital and
ization programs in vascular and
tors in the urology residency and the
cardiothoracic surgery, the plastic
colorectal, hepatobiliary-pancreatic
The department already had
surgery residency moved to a six-year
and minimally invasive surgery
taken a lead in the trend toward early
integrated program in 2011-12, rather
fellowships are developing innova-
than require three
tive ways to allow trainees to reach
years of general
subspecialty training earlier. Work-
surgery and three
group members are seeking ways to
years of plastic
improve measuring proficiency.
specialization with
programs that allow
general surgery
residents to begin
fellowships in vascular or cardiothoracic
surgery a year early.
When the American
Board of Surgery approved early specialization for almost
all specialties, other
surgical fellowship
“As medical care
becomes increasingly complex, it’s
evident that not
every individual
needs to learn
the entire breadth
of surgery.”
surgery training.
Mary Klingensmith, MD
directors began
looking at ways to adopt the model.
“As medical care becomes
increasingly complex, it’s evident
And the vascular
is piloting an “academy model”
surgery fellowship
in which, akin to medical school
took a step further
courses, general surgery residents
in 2012-13 by
discuss goals with a faculty member
offering a track in
as they begin a rotation, receive mid-
which trainees do
term feedback and undergo a formal
not enter a general
assessment at the end. The model
surgery residency,
contrasts with current advancement
but rather spend
based on time spent in training.
five years learning vascular surgery,
with some general surgical skills taught
early in the program.
that not every individual
For all training programs,
needs to learn the entire
an Innovations in Surgical
breadth of surgery,”
The general surgery residency
Education Workgroup has
“We are going to see changes in
general surgery residency education,
the likes of which we haven’t seen
in the last 50 years,” says General
Surgery Residency Program Director
Michael Awad, MD, PhD.
Awad Directs General
Surgery Residency
Michael Awad, MD, PhD, has been
appointed program director of the General
Surgery Residency Program at Washington
University. He assumed his new role in
February 2012, succeeding Mary Klingensmith, MD, who now serves full-time as the
department’s vice chair for education.
Awad earned a medical degree from
Brown University and completed a surgical
residency at The Johns Hopkins Hospital.
He completed a fellowship in laparoscopic
and endoscopic surgery at Legacy Health
Systems in Portland, Ore., before joining the
Washington University faculty in 2009.
As an associate program director for the
general surgery residency, Awad served as
director of the Surgical Skills Laboratory. In
2010, he received a grant from the U.S. Department of Education to develop an online
resource to help educators in U.S. medical
schools, surgical residencies and surgical
fellowships develop curricula and meet
national accreditation requirements.
Klingensmith began as program director
of the general surgery residency in 2001.
Under her leadership, the program introduced one of the earliest surgical skills labs
for general surgery residents, implemented
duty hour restrictions before they were
mandated, and worked in concert with
cardiothoracic and vascular fellowships to
introduce early specialization programs.
37
Research
Surgeon-scientists
MEET CHALLENGES OF RESEARCH
COURTESY RICHARD SCHUESSLER, PHD
John P. Boineau, MD
Heart researchers in the Division of Cardiothoracic
Surgery lost a friend and colleague, and the field
of electrophysiology a giant, when John Boineau,
MD, 78, died of leukemia on Nov. 7, 2011.
Boineau was a pioneer in the surgical treatment
of Wolf-Parkinson-White (WPW) syndrome, a
heart condition that can lead to episodes of rapid
heart rate, and atrial fibrillation (AF), a condition where the heart
rhythm is irregular and too fast. At Washington University, he was
involved in the development of the Cox-Maze procedure to treat AF.
Boineau joined the faculty in 1984 as a professor of surgery and of
medicine and co-director of the Cardiothoracic Surgery Research
Laboratories. In addition, he was director of the Department of
Medicine’s Pacemaker Center and Outpatient Pacemaker Services
and medical director of cardiac rehabilitation at the Heart Care
Institute at Barnes-Jewish West County Hospital.
Surgery who are meeting these
in basic science and translational re-
challenges to make major contribu-
search bring a unique clinical perspec-
tions in the treatment of disease.
tive to the laboratory, but more than
MD, who joined the faculty in 2007,
can make this component of their life’s
had a unique pathway to a major
work difficult. Namely, it is difficult to
multicenter research project on pelvic
balance clinical duties with a whole-
pain, the cause of which often eludes
hearted approach to research, fund-
doctors. Unlike many other young
ing has become scarcer, and there is a
researchers, Lai did not get his start
strong movement toward more collab-
through a National Institutes of
orative work, with surgeon-scientists
Health (NIH) career development
doing less basic science research.
award; he recruited researchers from
Three surgeonscientists are among
a sizeable group of
faculty members in
the Department of
Richard Schuessler, PhD, research professor of surgery, who
worked with Boineau and Cox on the development of the surgical
treatment of AF in the mid-1980s, describes Boineau as a brilliant
scientist who came up with hundreds of ideas every week.
“John was a superb and caring physician,” says Schuessler. “He was
an outstanding mentor to me and hundreds of cardiology, surgery,
and biomedical engineering students, residents and fellows.”
Boineau earned a medical degree from Duke University School of
Medicine and completed a residency in cardiology at Georgetown
University School of Medicine. He returned to Duke for a fellowship
in adult and pediatric cardiovascular disease, and then served on
the faculty until 1972. Prior to joining the Washington University
faculty, Boineau was on the faculties at the University of Southern
California and the Medical College of Georgia.
Henry Lai, MD
38
surgery.wustl.edu
Urologic surgeon Henry Lai,
ever, they are facing challenges that
TIM PARKER
James Cox, MD, Emeritus Evarts A. Graham Professor of Surgery,
credits Boineau as among the first to describe the mechanisms of
the WPW syndrome, ventricular tachycardia/fibrillation and atrial
flutter/fibrillation. “Ninety-nine percent of all arrhythmias fall into
one of those three categories,” says Cox. “That’s 30 percent of all
heart disease. I think that’s a pretty good legacy.”
SURGEONS WHO ARE IMMERSED
other departments and submitted a
has an R01 NIH grant and has joined
successful U01 grant application with
with colleagues Andrew Gelman,
the National Institute of Diabetes
PhD, and Alexander Krupnick,
and Digestive and Kidney Diseases
MD, to study innate and adaptive
(NIDDK) for his basic science research
immune responses in the lung.
and clinical studies on pelvic pain
Gillanders has worked collabora-
phenotypes and epidemiology.
tively with basic scientists to develop
Thoracic surgeon Daniel Kreisel,
a clinical trial of a mammaglobin-A
MD, PhD, and breast cancer sur-
DNA vaccine for breast cancer
geon William Gillanders, MD, both
patients with metastatic disease
received NIH career development
and to explore the use of genomics
grants and were able to build on the
to develop personalized breast
to do research, but at the same time,
will be perceived as a purely
early departmental support. Kreisel
cancer vaccines.
I think if surgeons are not involved
technical field,” says Kreisel.
“It’s certainly more challenging
in basic research, our specialty
“We have a lot of insight from
taking care of patients on a daily
basis. I think we should be at the
forefront of doing research into
surgical diseases.”
TIM PARKER
Daniel Kreisel, MD, PhD
William Gillanders, MD
39
Clinical
Operations
New facilities and faculty
KEYS TO CLINICAL GROWTH
INITIATIVES TO GROW clinical
In recent years, expansion of clini-
As the Alvin J. Siteman Cancer
volume continued to yield favorable
cal practices to outlying areas and the
Center at Barnes-Jewish Hospital
results for the Department of Surgery
addition of new faculty members and
and Washington University School of
in the 2012 fiscal year as the number
services have helped sustain growth.
Medicine has opened new facilities,
of visits and procedures grew for the
This trend held true in 2012 and holds
various services have expanded to
eighth consecutive year.
promise for the new year.
treat patients at these centers. Colorectal and hepatobiliary-pancreaticGI (HPB-GI) surgeons travel to offer
treatment at Siteman’s West County
facility in Creve Coeur, Mo., while a
thoracic and a breast cancer surgeon
are based at Siteman’s location in
St. Peters, Mo. These services have
made it possible for patients to receive
advanced cancer care from top
specialists close to home.
In early 2013, when Siteman
opens a new facility in South St. Louis
County, four surgical specialties will
work with medical and radiation
oncologists to treat patients in this
highly populated area. Colorectal,
HPB-GI, thoracic and urologic
surgeons will offer consultations at
the new facility, where patients can
undergo their initial visit, chemotherapy and radiation therapy.
MARK GILLILAND
From left, Hersh Maniar, MD, Ralph Damiano Jr., MD, Mitchell Faddis, MD, and Philip Cuculich, MD,
exemplify the team approach needed for advanced care. With joint expertise in cardiac surgery,
cardiology and electrophysiology, they provide leading-edge treatment for atrial fibrillation.
40
surgery.wustl.edu
New Clinical Services
In 2012, the department added
four new surgeons, some of
whom offer services that were
previously unavailable.
Surgeon Combines
Plastics, Trauma Care
BSA LIFESTRUCTURES
HPB-GI surgeon Ryan Fields,
Artist’s rendering of Siteman Cancer Center
South County
MD, treats not only liver and gastrointestinal disease but skin cancer,
a leadership role in the American
including melanoma, Merkel cell
College of Surgeons’ surgical quality
carcinoma, and basal and squamous
improvement programs, which gather
cell carcinoma. Plastic and reconstruc-
data on surgical complications at
tive surgeon Amy Kells, MD, PhD,
Barnes-Jewish Hospital and St. Louis
uses her skills in hand and microsur-
Children’s Hospital, and remains com-
gery to treat patients who come to
mitted to addressing areas of concern.
With fellowship training in both hand
and trauma surgery, plastic and reconstructive surgeon Amy Kells, MD, PhD,
brings a high level of expertise to an
important part of her practice: treating
patients who come to the emergency
department with severe injuries to
the extremities.
While on call with the emergency
departments of Barnes-Jewish Hospital
and St. Louis Children’s Hospital, Kells
treats such injuries as severed hands
and fingers, electrical and other types
of burns, and crush injuries.
“I focus from the shoulder down,”
says Kells.
Recent patients include an Arkansas man
who got his hand caught in a cement
mixer, whose treatment saved three of
his fingers, and a young man with electric
burns on both hands and arms, who was
Amy Kells, MD, PhD
treated with a fasciotomy to improve
circulation to the injured tissue.
Kells estimates her work in the emergency department makes up about 50
to 75 percent of her practice. She also
treats problems in the hand such as carpal
tunnel syndrome and performs general
and lower-extremity reconstruction.
Kells completed a trauma fellowship at
the University of Maryland, hand surgery
fellowships at New York University and
SUNY Syracuse, and a plastic surgery residency at the University of Texas Branch
Hospitals in Galveston, Texas.
the emergency room with limbthreatening injuries — treating
patients at an earlier stage than other
reconstructive surgeons. And the
D e p a r t ment o f Su rger y Clinic al Ac t ivit y
Wound Healing Program — based in
the new Center for Outpatient Health
in the Central West End — began
offering hyperbaric oxygen to treat
wounds that won’t heal as a result
of diabetes or radiation injury.
Challenges Ahead
Despite positive growth, the Department of Surgery faces the dual
challenges of decreased overall
reimbursement and the trend toward
tying reimbursement to performance
measures. The department has played
Visits
Ancillary
Procedures
Work RVUs
The Department of Surgery’s growth in clinical
activity includes increased volume at off-site facilities.
41
Giving
Ballinger honored through
EDUCATIONAL ENDOWMENT
“He was the consummate gentleman, a very astute
thinker and a real
Renaissance man.”
42
surgery.wustl.edu
clinical experience on their path to
the Department of Surgery. He didn’t
honoring the late Walter Ballinger,
becoming surgical leaders. Faculty and
take sides, but was always genuinely
MD, a former chair of the Depart-
friends of the department have made
concerned about you, much the way
ment of Surgery, and his wife, Mary
gifts to the fund, as well.
your grandfather would be about your
Randolph, was recently established
“He was the consummate gentle-
career or schooling. He was a real
to benefit surgical residents in the
man, a very astute thinker and a real
steward of the department and took
coming years.
Renaissance man,” says Timothy
extraordinary pride in hearing about
what the department was doing.”
Ballinger, professor emeritus of
Eberlein, MD, who became the Bixby
surgery, died in April 2011 at the age
Professor of Surgery and chair of the
of 85. The Ballingers established the
Department of Surgery in 1998 and
University School of Medicine in 1967
fund to help residents who wish to
developed a friendship with Ballinger
at age 42 as the Bixby Professor, chair
devote additional time to scholarly
over the years. “He had a real, genuine
of the department and surgeon-in-
activities over and above the standard
love of Washington University and
chief at Barnes Hospital. He stepped
Washington University Medical
Center enjoyed considerable
growth during the tenure of
Walter Ballinger, MD, as chair of
the Department of Surgery from
1967 to 1978.
circa 1978
Ballinger arrived at Washington
PHOTOS COURTESY BECKER MEDICAL LIBRARY ARCHIVES
circa 1966
AN EDUCATIONAL ENDOWMENT
Walter Ballinger’s decades of dedication and
service to the department are being honored
through establishment of an educational
fund to support surgical resident training.
eliminated diabetes in a primate by
and retired as a surgeon in 1991, but
transplanting insulin-producing
continued to teach in the school’s for-
cells called islets of Langerhans from
mer Health Administration Program.
a healthy primate pancreas.
A general surgeon, most of
COURTESY BECKER MEDICAL LIBRARY ARCHIVES
down as department chair in 1978
Ballinger earned a medical
Ballinger’s work was in intestinal and
degree from the University of
vascular surgery; his research focused
Pennsylvania. He completed
on the effects of surgery on the vagus
residencies at Bellevue Hospital and
nerve in the small intestine. In the
Columbia-Presbyterian Medical
College in Philadelphia before be-
mid-1970s, Ballinger and the late
Center in New York. He was a cap-
coming associate professor of surgery
Paul Lacy, MD, a world leader in
tain in the medical corps of the U.S.
at The Johns Hopkins University
the study of the physiopathology
Army in the early 1950s. He spent
School of Medicine, where he was
of insulin-dependent diabetes,
several years at Jefferson Medical
a Markle Scholar.
Gifts to the
Department
of Surgery
Dr. James Adams
Dr. Charles Anderson
The Bakewell Foundation
Mr. David Ballinger
Mrs. Mary Randolph Ballinger
Bank of America
Charitable Foundation
Dr. Jay Belani
Ms. Lori Bell
Dr. Thomas Blanke
Dr. and Mrs. Isaac Boniuk
Dr. Richard Bradley
Mr. and Mrs. Stephen Brauer
Dr. James Barrett Brown
Foundation
Dr. Ross Brownson
Drs. Michael and
Elizabeth Brunt
Dr. James Clanahan
Mr. Jerry Clinton
Dr. John Dillon
Dr. Steven Dresner
Mr. and Mrs. John Dubinsky
Dr. Harry Ellis
Dr. Thomas Ferrer
Dr. Leonard Furlow Jr.
Dr. Henning Gaissert
Mr. and Mrs. Thomas Gallagher
Mr. and Mrs. Kamran Hakim
Dr. David Hardy
Ms. Lottie Hardy
Dr. Charles Janda
Mr. Parviz Kamangar
Ms. Sandy Kaplan
Mrs. Raymond Keltner
Dr. Gilbert Lee
Dr. LaSalle Leffall Jr.
Dr. and Mrs. Lee Liberman
Dr. Harry Lichtwardt
Dr. Zelig Lieberman
Dr. Charles Manley
Dr. James Miller
Dr. Joseph Misischia
Dr. Seymour Nash
Dr. George Oliver
Dr. Havner Parish Jr.
Dr. James Patton
Ms. Kimberly Perry
Mr. and Mrs. Raymond
Peters II
Mrs. Janelle Phillips
Dr. Richard Prinz
Dr. George Reinhardt
Dr. Joseph Reinkemeyer
Dr. Robert Royce
Mr. and Mrs. Marc Rubenstein
Mr. Harvey Saligman
Mr. James Schiele
Dr. Kathleen Schwarz
Mr. Donald Sher
Dr. Gregorio Sicard
Dr. Mark Siegel
Dr. Alan Stein
Mr. Howard Stephens
Dr. and Mrs. Paul Stockmann
Dr. Jessie Ternberg
Dr. Lewis Thomas Jr.
Mr. Joseph Thomure
Vein Institute of New Jersey
Dr. Wesley Walker
Dr. Virginia Weldon
WTFC Organization, Inc.
Walter Ballinger, front
row center, and surgical
colleagues, circa 1970
To Make a Gift
The Department of Surgery welcomes your
support. Ways to make a gift include annual
unrestricted giving such as membership
in the Eliot Society, gifts for education of
residents and fellows, support for research
and endowment, and planned gifts and
bequests. For additional information,
please contact the Office of Medical Alumni
and Development at (314) 935-9690.
43
Faculty
Section of
Cardiac Surgery
Section of General
Thoracic Surgery
Critical Care Service
in the Cardiothoracic
Intensive Care Unit
Michael S. Avidan,
MBBCh, FCA, Chief
Associate Professor of
Anesthesiology and Surgery
Timothy J. Eberlein, MD,
Chairman
William K. Bixby Professor
of Surgery; Director, Alvin J.
Siteman Cancer Center
Gregorio A. Sicard, MD
Executive Vice Chair
Ralph J. Damiano Jr., MD
John M. Shoenberg Chair
in Cardiovascular Disease;
Vice Chair for Clinical Services
Mary E. Klingensmith, MD
Mary Culver Distinguished
Professor of Surgery;
Vice Chair for Education
Robert W. Thompson, MD
Vice Chair for Research
Division of
Cardiothoracic
Surgery
Ralph J. Damiano Jr., MD,
Chief
John M. Shoenberg Chair in
Cardiovascular Disease
Marc R. Moon, MD
Joseph C. Bancroft Professor
of Cardiothoracic Surgery
William A. Gay Jr., MD
Jennifer S. Lawton, MD
Nabil A. Munfakh, MD
Michael K. Pasque, MD
Professors of Surgery
Richard B. Schuessler, PhD
Research Professor of Surgery
Thomas B. Ferguson, MD
Professor Emeriti of Surgery
Scott C. Silvestry, MD
Surgery
Brian P. Cupps, PhD
Research Associate Professor
of Surgery
Michael Crittenden, MD
Associate Professor
of Surgery; Chief of
Cardiothoracic Surgery,
St. Louis VA Medical CenterJohn Cochran Division
G. Alexander Patterson,
MD, Chief
Evarts Ambrose Graham
Professor of Surgery
Bryan F. Meyers,
MD, MPH, Chief
Patrick and Joy Williamson
Chair in Cardiothoracic
Surgery
G. Alexander Patterson, MD
Evarts Ambrose Graham
Professor of Surgery; Director
of Lung Transplantation
Charles L. Roper, MD
Professor Emeritus of Surgery
Daniel Kreisel, MD, PhD
Associate Professor of Surgery
Traves D. Crabtree, MD
Andrew E. Gelman, PhD
Alexander S. Krupnick, MD
Varun Puri, MD
Assistant Professors of Surgery
surgery.wustl.edu
Heidi K. Atwell, DO
Daniel A. Emmert, MD, PhD
Thomas J. Graetz, MD
Isaac P. Lynch, MD*
Adnan Sadiq, MD
Assistant Professors of
Division of
General
Surgery
Stephen Broderick, MD*
Instructor in Surgery
Section of Pediatric
Cardiothoracic Surgery
Jeffrey Bailey, MD
Kareem D. Husain, MD
Robert E. Southard, MD
Robert D. Winfield, MD*
Thomas Blanke, MD
Stephanie Bonne, MD*
Stephen Eaton, MD*
Instructors in Surgery
Section of Colon and
Rectal Surgery
William C. Chapman, MD,
Chief
Eugene M. Bricker Professor
of Surgery
Section of Acute and
Critical Care Surgery
Hersh S. Maniar, MD
Sunil M. Prasad, MD
Stefano Schena, MD, PhD
Assistant Professors of
Surgery
James W. Fleshman Jr.,
MD, Chief
Elisa H. Birnbaum, MD
Sekhar Dharmarajan, MD
Steven R. Hunt, MD
Bashar Safar, MBBS, MRCS
Grant V. Bochicchio,
MD, MPH, Chief
Harry Edison Professor
of Surgery
Bradley D. Freeman, MD
John E. Mazuski, MD, PhD
Julie A. Margenthaler, MD
Amy E. Cyr, MD
Assistant Professor of Surgery
Cancer Research
Paul J. Goodfellow, PhD
Yian Wang, MD, PhD
Timothy P. Fleming, PhD
Research Professor of Surgery
Jennifer L. Ivanovich,
MBA, MS
Research Assistant Professor
of Surgery
Section of
HepatobiliaryPancreatic and
Gastrointestinal
Surgery
Matthew G. Mutch, MD
Paul E. Wise, MD*
Associate Professors of Surgery
Section of Endocrine
and Oncologic Surgery
Pirooz Eghtesady, MD,
PhD, Chief
Cardiothoracic Surgeon-inChief, St. Louis Children’s
Hospital; Co-Director,
St. Louis Children’s and
Heart Center
Rebecca L. Aft, MD, PhD
William E. Gillanders, MD
Bruce Lee Hall, MD, PhD,
MBA
Peter S. Goedegebuure,
PhD
of Surgery
Ira J. Kodner, MD
Solon and Bettie Gershman
Chair in Colon and Rectal
Surgery
Wenjun Li, MD
of Surgery
Umar S. Boston, MD
Associate Professor
of Surgery
44
Charl J. de Wet, MBChB
Michael H. Wall, MD
Associate Professors of
John P. Kirby, MD
Tiffany M. Osborn, MD
Douglas J.E. Schuerer, MD
Jeffrey F. Moley, MD, Chief
Timothy J. Eberlein, MD
William K. Bixby Professor of
Surgery; Chairman,
Department of Surgery
David C. Linehan, MD,
Chief
Steven M. Strasberg, MD
Pruett Family Professor
of Surgery; Carl Moyer
Departmental Teaching
Coordinator
David P. Jaques, MD
Vice President of Surgical
Services, Barnes-Jewish
Hospital
William G. Hawkins, MD
Ryan C. Fields, MD
Dirk M. Spitzer, PhD
Research Instructor in Surgery
Sabarinathan
Ramachandran, PhD
Christopher R. Erwin, PhD
of Surgery
Section of
Vascular Surgery
Kathryn Q. Bernabe, MD
Jacqueline M. Saito, MD
Adam M. Vogel, MD*
Jun Guo, PhD
of Surgery
Section of Minimally
Invasive Surgery
Brent D. Matthews, MD,
Chief
Mary E. Klingensmith, MD
Mary Culver Distinguished
Luis A. Sanchez, MD,
Chief
Gregorio A. Sicard
Distinguished Professor
of Vascular Surgery
John A. Curci, MD
Patrick J. Geraghty, MD
J. Christopher Eagon, MD
J. Esteban Varela, MD, MPH
Associate Professors of
Surgery
Jeffrey Jim, MD
Kathleen G. Raman,
MD, MPH
Corey R. Deeken, PhD
Section of
Transplant Surgery
Division of
Pediatric
Surgery
William C. Chapman, MD,
Chief
Eugene M. Bricker Professor
of Surgery
Thalachallour
Mohanakumar, PhD
Jacqueline G. and William E.
Maritz Chair in Immunology
and Oncology
Jeffrey A. Lowell, MD
Surendra Shenoy, MD, PhD
Maria B. Majella Doyle, MD
Yiing Lin, MD, PhD*
Jason R. Wellen, MD
Division of Plastic
and Reconstructive Surgery
Brian G. Rubin, MD
Gregorio A. Sicard, MD
Robert W. Thompson, MD
L. Michael Brunt, MD
Michael M. Awad, MD, PhD
Division of
Public Health
Sciences
Brad W. Warner, MD, Chief
Jessie L. Ternberg, MD, PhD
Distinguished Professor of
Pediatric Surgery; Surgeon-inChief, St. Louis Children’s
Hospital
Patrick A. Dillon, MD
Martin S. Keller, MD
Graham A. Colditz,
MD, DrPH, Chief
Neiss-Gain Professor in
the School of Medicine;
Associate Director, Prevention
and Control, Siteman Cancer
Center; Deputy Director,
Institute for Public Health
Ross C. Brownson, PhD
Professor of Surgery and
Professor, George Warren
Brown School of Social Work
Susan E. Mackinnon, MD,
Chief
Sydney M. Jr. and Robert H.
Shoenberg Chair in Plastic
and Reconstructive Surgery
Keith E. Brandt, MD
William G. Hamm Professor
of Plastic Surgery
Donald V. Huebener, DDS,
MS, MA Ed
Terence M. Myckatyn, MD
Thomas H. Tung, MD
Ida K. Fox, MD
Philip J. Johnson, PhD
Amy F. Kells, MD, PhD
Amy M. Moore, MD*
Kamlesh B. Patel, MD
Alison K. Snyder-Warwick,
MD*
Marissa M. Tenenbaum, MD
Albert S. Woo, MD
Sarah Gehlert, PhD
E. Desmond Lee Professor of
Racial and Ethnic Diversity,
George Warren Brown
School of Social Work
Jeff Gill, PhD, MBA
Director, Center for
Applied Statistics;
Professor, Department
of Political Science
Matthew W. Kreuter,
PhD, MPH
Professor, George Warren
Brown School of Social Work
Margaret Olsen, PhD, MPH
Surgery; Research Associate
Professor of Medicine
Yan Yan, MD, PhD
of Surgery
Bettina F. Drake, PhD, MPH
Melody S. Goodman,
MS, PhD
Christine M. Hoehner,
PhD, MSPH
Aimee S. James, PhD, MPH
Kimberly A. Kaphingst,
ScD, ScM, MA
Rebecca Lobb, ScD, MPH
Mary C. Politi, PhD
Katherine A. Stamatakis,
PhD, MPH
Siobhan Sutcliffe,
PhD, MHS, ScM
Adetunji T. Toriola,
MD, MPH, PhD*
Erika Waters, PhD, MPH
Kathleen Y. Wolin, ScD
Jenifer E. Allsworth, PhD
Assistant Professor of Surgery;
Assistant Professor of
Obstetrics and Gynecology
Kenneth Carson, MD
Medicine
Pamela L. Owens, PhD
of Medicine
Jean S. Wang, MD, PhD
Medicine
Joaquin Barnoya, MD
of Surgery
Su-Hsin Chang, PhD*
Ying Liu, MD, PhD
Instructors in Surgery
Division of
Urologic
Surgery
Gerald L. Andriole Jr.,
MD, Chief
Robert Killian Royce, MD,
Distinguished Professor
of Urologic Surgery
R. Sherburne Figenshau,
MD
Taylor Family and
Ralph V. Clayman Chair in
Minimally Invasive Urology;
Jeffrey M. Arbeit, MD
Steven B. Brandes, MD
Arnold D. Bullock, MD
Carl G. Klutke, MD
Paul F. Austin, MD
Sam B. Bhayani, MD
Douglas E. Coplen, MD
Brian M. Benway, MD
Alana C. Desai, MD
Robert L. Grubb III, MD
H. Henry Lai, MD
Seth A. Strope, MD, MPH
Erica J. Traxel, MD
Zhi Hong Lu, PhD
of Surgery
David A. Hardy, MD
Instructor in Surgery
*Joined faculty in
fiscal year 2013
FACULTY PHOTOS BY TIM PARKER
45
For More
Information about
the Department of
Surgery, Contact:
Timothy J. Eberlein, MD
William K. Bixby Professor
and Chairman
Department of Surgery
School of Medicine
Campus Box 8109
660 S. Euclid Ave.
St. Louis, MO 63110
Phone: (314) 362-8020
Fax: (314) 454-1898
Jamie Sauerburger
Executive Director,
Business Affairs
Phone: (314) 362-6770
surgery.wustl.edu
Other Contact
Information
Division of
(314) 362-6025
Section of
Cardiac Surgery
(314) 362-7327
Section of General
Thoracic Surgery
(314) 362-8598
Section of Pediatric
(314) 454-6165
(314) 362-7792
Section of Acute and
Critical Care Surgery
(314) 362-9347
Section of Colon and
Rectal Surgery
(314) 454-7183
Section of Endocrine and
Oncologic Surgery
(314) 747-0064
Section of HepatobiliaryPancreatic and
Gastrointestinal Surgery
(314) 747-2938
Section of Minimally
Invasive Surgery
(314) 454-7195
Section of Transplant Surgery
(314) 362-7792
Section of Vascular Surgery
(314) 362-7408
Division of Pediatric Surgery
(314) 454-6066
Division of Plastic and
Reconstructive Surgery
(314) 362-4586
Division of Public
Health Sciences
(314) 454-7940
Division of Urologic Surgery
(314) 362-8212
OUR PARTNER INSTITUTIONS
Washington University School of Medicine’s 2,100 employed and volunteer faculty
physicians are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals.
Barnes-Jewish
Hospital
St. Louis Children’s
Hospital
The Alvin J. Siteman
Cancer Center
Barnes-Jewish Hospital, a 1,158-bed
facility, has been listed on the elite
U.S. News & World Report Honor Roll
of America’s best hospitals for 20
consecutive years.
St. Louis Children’s Hospital is listed
on U.S. News & World Report‘s Honor
Roll of America’s best hospitals
and is ranked fifth in the nation by
Parents magazine.
The Alvin J. Siteman Cancer Center
at Barnes-Jewish Hospital and
Washington University School
of Medicine is the only National
Cancer Institute comprehensive
cancer center within 240 miles.
All photographs by Robert Boston
unless otherwise noted.
Washington University encourages and gives full consideration to all applicants for admission, financial aid and employment. The university
does not discriminate in access to, or treatment or employment in, its programs and activities on the basis of race, color, age, religion, sex, sexual
orientation, gender identity or expression, national origin, veteran status, disability or genetic information. Inquiries about compliance should be
addressed to the university’s Vice Chancellor for Human Resources, Washington University, Campus Box 1184, One Brookings Drive, St. Louis, MO
63130. The School of Medicine is committed to recruiting, enrolling and educating a diverse student body.
MPA 6050 10.12

Continuum Achieving Broad-Based Excellence

Transcription

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