2006 - Health Care Professionals - Dartmouth

Transcription

Department of Surgery
2006 Annual Report
Administration
Richard W Dow, MD, FACS
Chair
Daniel Walsh, MD
Vice Chair
Residency Program Director
Kerry Ryan, MBA
Director
Linda Barie
Administrative Manager
Audrey Carr
Budget and Grant Coordinator
Christina Cole
Assistant to the Chair
From left to right—Back row: Kerry Ryan; Christina Cole; Richard Dow, MD; Donald Likosky, PhD. Front row:
Audrey Carr, Dawn Robinson, Linda Barie, John Higgins. (Not pictured: Daniel Walsh, MD; Debra Ludington)
Donald Likosky, PhD
Departmental Epidemiologist
Contents
Department of Surgery Sections
Cardiothoracic Surgery
General Surgery
Neurosurgery
Ophthalmology
Otolaryngology
Pediatric Surgical Specialties
Plastic Surgery
Transplantation Surgery
Urology
Vascular Surgery
Maxillofacial Surgery John Higgins
Database Manager
6
8
10
12
14
16
18
20
22
24
26
Program Highlights
Thoracic Surgery Program
Trauma Program
27
28
Office of Surgical Education
Medical Student Education Programs
Training Programs
30
31
Sponsored Research
Clinical Trials
Federal & Corporate
32
33
Awards
34
Invited Speakers
34
Publications
35
Debra Ludington
Clerkship Program Coordinator
Dawn Robinson
Residency Program Administrator
Department
of Surgery
Donald Likosky, PhD
Assistant Professor of Surgery
Surgical
Research Lab
Jeffery Bergeron, DVM
P Jack Hoopes, DVM, PhD
Associate Professor
of Surgery and Medicine
Chair’s Letter
E
ach year the preparation of the Annual Report reminds me of the exciting,
vibrant, and dynamic environment that characterizes our Medical
Center, the Department of Surgery and the entire field of health care. Just
as an anecdote, we recently re-transplanted a patient as part of a “four person
swap.” It was a situation where two couples were incompatible to donate
to their spousal partners; however, they were appropriately matched for
a transplant to the spouse of the other couple and all four people were
anxious to proceed. One of the recipients had previously received a
kidney transplant—from another live donor—about 25 years ago. Her
“in-hospital” recovery in the 1980’s extended to three weeks, but she
was anxious to leave the hospital and continue her recovery at home just
three days after this second transplant. Her story is simply illustrative
of the developments over the past decades in anesthesia, perioperative
care, immunosuppression, infection control, and the management of the
common co-morbidities. Progress in providing safe, effective, and reliable
surgical care that has been nothing short of breathtaking.
In the pages of this report, you will see evidence of these changes as they
are incorporated into the fabric of the surgical care which we provide to
our patients. Under the collaborative leadership of Drs. Tony DiScipio and
Mark Fillinger, we’ve established an Aortic Center—offering endovascular
and open surgical repairs and reconstructions not envisioned only a few years
ago. Our Cochlear Implant Program offers an ability to hear to those who were
born without, or who had lost this key sense. Our Pancreas Transplant Program
offers patients freedom from insulin, normalized glycemic control, and the hope
of forestalling the ravages of diabetes. Our Bariatric Surgical Program provides an
effective option to improve the quality
and duration of life for the morbidly
obese patient. Our Comprehensive
Breast Care Program offers a variety
of strategies to improve the outlook
for patients with breast cancer—and
accomplishes this goal in the context of
preserving the patient’s body image and
sense of self. Our Lasik and refractive
surgery program offers the opportunity
to achieve unaided normal vision.
Our Radiosurgery Program, using
technologies both spectacularly complex
but functional and reliable, enables
new approaches to control a variety of
cranial and extracranial lesions. And, these are only a few highlights of the dramatic
developments in health care—it’s truly an exciting time and our Transforming
Medicine Campaign is aptly named.
While I’m proud and excited about all the technical and care accomplishments
of members of the Department of Surgery, I’m equally proud of their attention
to the issues of Patient Safety, Quality Improvement, and Patient Satisfaction.
We’ve enthusiastically embraced the 100,000 Lives Campaign, developed
safeguards around patient identification and confirmation of operative site and
plan, established protocols to address the several strategies known to reduce
the incidence of surgical site infection, operationalized policies focused on the
prevention of line associated sepsis, and initiated a host of other activities to
improve the safety and reliability of the care we provide.
These are exciting times and we look forward to the upcoming year with even
greater enthusiasm.
Sincerely,
Richard W Dow, MD, FACS
Chair, Professor of Surgery
Department of Surgery OR Cases
Department of Surgery Gross Revenue (in millions)
12,000
11,000
10,000
9,000
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
120M
110M
100M
90M
80M
70M
60M
50M
40M
30M
20M
10M
FY01
FY02
FY03
FY04
FY05
FY06
FY01
FY02
FY03
FY04
FY05
FY06
Department Of Surgery Statistics
Associate
Research
Clinical
Provider
Projects
Trials
Faculty
Residents
Section
CT
7
7
General
21
3
34
4
2
Maxillofacial
1
Neurosurg
4
3
5
1
Ophthal
10
3
2
ENT
7
1
1
1
Peds Surg
7
2
2
Plastics
7
1
2
2
2
Transplant
3
Urology
6
2
6
2
1
Vascular
9
2
2
10
15
TOTAL
82
24
50
23
21
Publications
14
32
2
33
4
6
17
11
6
11
30
166
Outpatient Visits
OR Cases
(full-time faculty) (full-time faculty)
1,919
12,391
1,703
4,444
32,608
18,093
5,227
10,008
1,897
12,553
7,325
108,168
709
2,805
129
793
1,316
1,224
937
1,249
273
944
935
11,314
T
he Section of Cardiothoracic Surgery
is now The Section of Cardiac and
Thoracic Surgery.
William C Nugent Jr, MD
Section Chief
Professor of Surgery
The Migration is Complete
The past twelve months have seen both
functional and structural changes within
the Section of Cardiac and Thoracic
Surgery. As our practice responds to the
clinical and technological challenges
of today’s health care system, the
Cardiac and General Thoracic initiatives
have continued to grow and redefine
themselves. Many of the dreams of last
year have matured into the realities of
today as we have worked together to
provide the very highest quality surgical
care to patients with diseases of the chest.
all appropriate
diagnostic and
surgical therapies
including 3-D
aortic imaging,
hypothermic
circulatory arrest
and endovascular
aortic repair.
When surgical
intervention is
Anthony DiScipio, MD
appropriate, a
specific team of nursing, anesthesia,
perfusion, and critical care personnel has
gained the necessary experience to now
consider these complex cases “routine.”
Results have been excellent as we now
perform over 35 cases annually.
The Aortic Center at Dartmouth
Under the directorship of Dr. Anthony
DiScipio, Dartmouth-Hitchcock Medical
Center has formally instituted a multidisciplinary approach to patients with
complex diseases of the aorta. Patients
with aneurismal diseases of the aorta
harbor life threatening conditions
which, in order to repair, require some
of the most sophisticated surgical
interventions performed today. The
Aortic Center at Dartmouth is the result
of the collaborative efforts of Cardiac
Surgery, Vascular Surgery, Cardiovascular
Medicine and Diagnostic Radiology.
This has allowed patients to benefit from
General Thoracic Surgery
Over the past year, general thoracic
surgery at DHMC has continued
to flourish. As our surgical volume
continues to increase, our nursing
and paraprofessional staff has gained
experience and expertise in the care of
these patients.
Endobronchial therapy (laser, stents,
brachytherapy) is now routinely available
in the OR or Endoscopy Suite. This
service has matured under the leadership
of Dr. David Johnstone and Dr. Peter
DeLong of Pulmonary Medicine,
who have worked to provide seamless
coverage and useful collaboration in
Cardiothoracic Surgery Gross Revenue (in millions)
20M
18M
16M
14M
12M
10M
8M
6M
4M
2M
FY01
6
Cardiothoracic Surgery Cases
3,000
2,700
2,400
2,100
1,800
1,500
1,200
900
600
300
FY02
FY03
FY04
FY05
FY06
FY01
FY02
FY03
FY04
FY05
FY06
Dartmouth-Hitchcock Medical Center Department of Surgery 2006 Annual Report
this challenging
population of
patients.
Esophageal
surgery, both
malignant and
benign, has
gradually increased
over the past
year. Interest in
minimally invasive
Lawrence Dacey, MD
approaches to this
disease remains, and we hope to gradually
move forward with that in the next year.
Finally, the multidisciplinary thoracic
oncology clinic is expected to begin
this fall, with all specialties available in
the same location, to provide patients
with efficient comprehensive lung
cancer care. This is the result of a year of
collaborative effort between the various
sections involved and Norris Cotton
Cancer Center.
Outcomes
Cardiac surgery remains the most closely
scrutinized specialty in all of medicine.
Healthcare payers and their patients have
insisted on transparency in outcomes and
thus have expectations of low mortality
and morbidity rates, short lengths of stay,
and high patient satisfaction ratings. In
keeping with this movement towards
transparency, DHMC now provides
patients web access to our cardiac surgical
outcomes in a patient friendly format.
Outcome data comes directly from the
Northern New England Cardiovascular
Disease Study Group, allowing our
results to be compared regionally and
can be accessed at www.dhmc.org/
QualityReports/list.cfm?metrics=CT.
Cardiothoracic
Surgery
J Pearce Beissinger, PA-C
Instructor in Surgery
Jean Clark, ARNP
Lawrence Dacey, MD
Associate Professor of Surgery and
Community & Family Medicine
Robert Dunton, MD
Carlos Garcia, MD, MHA
Adjunct Assistant Professor
Thomas Gervais, PA-C
Ryan Hafner, PA-C
David Johnstone, MD
Associate Professor of Surgery
Elizabeth Maislen, ARNP
Jimmy Maneksha, MBBS, MS
John Sanders, Jr, MD
Patricia Uhlig, PA-C
www.dhmc.org/goto/surgery_annual_report
7
General Surgery
T
he past year was marked by the
addition of Dr. Gina Adrales to the
Division of Minimally Invasive Surgery.
Dr. Adrales has taken on the role of
the Director of the Hernia Center and
will be taking a growing leadership role
in surgical simulation to support our
residency training program.
Dr. Kimberly Grafton relocated this
summer to California. She is deeply
missed by our Section and her patients.
We have been fortunate to hire Dr. Kari
Rosenkranz, who completed her General
Surgery residency at Dartmouth in 2005,
and has just finished a Fellowship in
Breast Surgery at MD Anderson Cancer
Center.
Richard J Barth, Jr, MD
Section Chief
Patient Care
Patient care remains organized under the
Division of Trauma and Acute Surgical
Illness, led by Dr. John Sutton; the
Division of Minimally Invasive Surgery,
directed by Dr. William Laycock; and the
Division of Surgical Oncology, directed
by Dr. Richard Barth.
General Surgery patients continue
to be very satisfied with the care they
receive. Our patient satisfaction scores
are significantly above the DHMC mean,
placing us ninth out of 52 DHMC
sections. Seventy-seven percent of patients
reported their overall rating of their
provider was “excellent.” The Referring
Provider Satisfaction Survey also noted
General Surgery’s results were well above
the DHMC mean.
The Division of Minimally Invasive
Surgery has increased its volume of hernia
repairs with the addition of Dr. Adrales.
We have also initiated a fellowship
position in laparoscopic surgery.
The Division of Surgical Oncology
formally began the Interdisciplinary
Breast Clinic in January. We now offer
breast cancer care in one location in the
Norris Cotton Cancer Center with many
providers seeing the patients during one
visit. This program has continued to
grow and patients have access to several
measures of success of the breast program
on our DHMC web page. Dr. Rosenkranz
will be traveling to Manchester one day
each week to reach out with her expertise
in breast cancer care to patients in
southern NH.
The Division of Trauma and Acute
Surgical Illness continues to work with a
large interdisciplinary team to expand and
improve trauma and acute surgical care.
Our newest trauma surgeon, Dr. Rajan
Gupta, has brought a wealth of experience
in both clinical care and trauma program
coordination and is sharing his expertise
to continue to build on our solid Trauma
Program. During this past year, three
General Surgeons have taken on formal
patient care responsibilities with the
Critical Care Service.
General Surgery Gross Revenue (in millions)
20M
18M
16M
14M
12M
10M
8M
6M
4M
2M
3,000
2,700
2,400
2,100
1,800
1,500
1,200
900
600
300
FY01
8
General Surgery Cases
FY02
FY03
FY04
FY05
FY06
FY01
FY02
FY03
FY04
FY05
FY06
General Surgery
Education
Dr. Sam Finlayson continues in his
position of Assistant Director of the
General Surgery Residency Program.
Education demands the concerted efforts
of several faculty members. Dr. Paul
Kispert continues to balance the critical
questions that arise during the Morbidity
and Mortality conference with his own
style of humor. Drs. Finlayson, Kispert
and Barth also lead resident teaching
conferences on a bi-weekly basis. Drs.
Burchard and Henriques co-direct the
surgery clerkship for medical students.
Research
Dr. Finlayson has been mentoring the
work of several residents, leading to
three presentations on surgical outcomes
at the American College of Surgeons
meeting. The Division of Surgical
Oncology continues its multidisciplinary
efforts in the treatment of pancreatic
cancer patients. In collaboration with
our colleagues in medical oncology
and radiation oncology, Drs. Thomas
Colacchio, John Sutton and Barth
demonstrated that neoadjuvant
chemoradiation can be used to enable
patients with borderline or unresectable
pancreatic cancers to undergo complete
tumor resections with a low local
recurrence rate. Dr. Sarah Greer was
awarded first prize in the resident paper
competition at the New England Surgical
Society meeting for her presentation of
our experience. Dr. Burton Eisenberg
published several papers on the treatment
of gastrointestinal stromal tumors and
was invited to discuss the management of
these tumors at several national meetings.
Dr. Eisenberg also has continued to work
with general surgery residents in the lab
on his NIH grant studying the molecular
basis of action of Gleevec.
Gina Adrales, MD
Lori Alvord, MD
Assoc. Dean, Student & Minority Aff.
Kenneth Burchard, MD
Prof. of Surgery and Anesthesiology
Thomas Colacchio, MD
Burton Eisenberg, MD
Samuel Finlayson, MD
Asstistant Professor of Surgery and
Benjamin Forbush, MD
Rajan Gupta, MD
Jeffrey Harnsberger, MD
Horace Henriques, III, MD
Paul Kispert, MD
and Anesthesiology
William Laycock, III, MD
Jean Liu, MD
Elizabeth McCabe, ARNP, MS
Ellen McKinnon, ARNP
Joseph Meyers, MD
Adj. Assoc. Professor of Surgery
Maureen Quigley, ARNP, MS
Nick Perencevich, MD
Adj. Assoc. Professor of Surgery
Frank Pindyck, MD
Kari Rosenkranz, MD
John Sutton, Jr, MD
9
Neurosurgery
T
he Section of Neurosurgery
completed its move into new offices
this spring, and coupled with our new
clinical space at 3C, this long-awaited
transition has provided much needed
room for both the patient-care and
academic missions. Completion of our
library—in storage for the past two
years—is slated for later this summer.
Patient Care
Our newest faculty member, Dr. Kadir
Erkmen, has rapidly come up to full
speed, with his subspecialty training
in skull-base neurosurgery bringing
new capabilities to the Section and the
Medical Center. He is also heading up
the cerebrovascular program and together
with Dr. Tim Lukovits, in Neurology,
and Dr. Cliff Eskey, in Interventional
Radiology, led advances in the Medical
Center’s Stroke Program. He has been on
the faculty of national skull-base surgery
workshops, and has already had a major
impact on our training program.
Other new faces in the Section include
Sharon Morgan, ARNP, and Alyssa Pearl,
PA, who, in developing our associate
provider initiative, have enabled the
Section to clinically grow. David Sargent,
PA, will be joining them in September.
Dr. Nathan Simmons has managed
to both increase his clinical activity in
pituitary, spine, tumor, and general
neurosurgery, while at the same time
David Roberts, MD
Section Chief
training for and successfully competing
in the Lake Placid Ironman Triathlon
this summer. Dr. Perry Ball continues
his work in spine and in general
neurosurgery as well as remaining an
integral part of the Critical Care service.
He continues to work on the Admissions
Committee of DMS and has been
promoted to Lieutenant Colonel in the
Medical Corps of the Army Reserve.
Dr. Henry Schmidek, whose retirement
this past fall was honored by a research
forum, published the 5th edition of his
Operative Neurosurgical Techniques
(the most widely used neurosurgery
textbook), capping off a most
distinguished academic career. Dr. Tina
Duhaime and Dr. Susan Durham have
expanded their pediatric neurosurgery
practice to outpatient clinics in
Manchester, NH. Dr. Duhaime’s NIH
funding for investigation in head injury
was successfully renewed, and she was
elected to membership in the Society
of Neurological Surgeons this past year.
Dr. Durham (a new mom this spring)
has entered her second year in the CECS
program.
Education
The Neurosurgery residency has had
another outstanding year. Our most
recently graduated chief resident, Dr.
Kendall Lee, has joined the neurosurgery
faculty of the Mayo Clinic in Rochester,
Neurosurgery Gross Revenue (in millions)
Neurosurgery Cases
20M
18M
16M
14M
12M
10M
8M
6M
4M
2M
3,000
2,700
2,400
2,100
1,800
1,500
1,200
900
600
300
FY01
10
FY02
FY03
FY04
FY05
FY06
FY01
FY02
FY03
FY04
FY05
FY06
MN. During the past year he completed
his AANS/CNS Research Fellowship
work, and added to his previous
distinctions a Mentoring Award from
the Society for Neuroscience and from
the Korean Neuroscience Society,
the Presidential Award (for the “Best
Paper”) at the meeting of the Society
for Neuroscience. Dr. Patricia Quebada,
this year’s chief resident, won the
national AANS/CNS Joint Section
for Pediatric Neurosurgery Traveling
Fellowship, which she used to study at
the University of Toronto this spring.
Dr. Scott Lollis was successful in his
grant application to the NIH for work
in magnetic resonance elastography.
Dr. Symeon Missios was awarded a
Top Ten Poster award at the national
meeting of the AANS. In undergraduate
medical education,
the Section had a very
successful initiation of
a new DMS elective in
neurosurgery which was
oversubscribed.
Programmatically,
Dartmouth enrolled the
first three patients in
the current Neuropace
multicenter national
trial using closedloop intracranial
stimulation for the
treatment of intractable
seizure disorders.
The joint Radiation
Oncology/Neurosurgery
Radiosurgery Program
brought the newest
technology in this field
(The Trilogy system)
into clinical use this
spring. Our program,
in the use of robotic
instrumentation for
stereo tactic procedures
using the SurgiScope
operating system, one of
whose patent licenses is
held by Dartmouth, remains the largest in
this country. Advanced Neuromodulation
Systems, Plano, TX, is finalizing licensing
agreements for two additional Dartmouth
patents involving deep brain stimulation.
Neurosurgery
Perry Ball, MD
Anesthesiology
Kadir Erkmen, MD
Sharon Morgan, ARNP, MSN
Alyssa Pearl, PA-C
David Sargent, PA
Nathan Simmons, MD
Research
The Section is represented on eight
editorial boards, two international
advisory boards, and two national
advisory boards. The chairmanship of
the editorial board of the Journal of
Neurosurgery was held in Dartmouth this
past year. Stereo tactic and Functional
Neurosurgery, with its editorial offices
at Dartmouth, completed full transition
to electronic manuscript submission and
review, and in its four years since moving
here has seen a three-and-a-half-fold
increase in its impact factor.
11
Ophthalmology
U
nder the leadership of Dr. Donald
Miller, our Refractive Surgery
Program has been re-launched and
expanded and is now on site for all phases
of care. We have acquired the state of the
art Wavelight Allegretto laser. Our refractive
patients will now receive their initial
ophthalmic evaluations, laser treatment
and postoperative care at DHMC. Nancy
Patterson will serve as the Refractive
Surgery Coordinator. We have been very
pleased with the growing popularity of
this service and our outstanding clinical
outcomes.
Dr. Christopher Chapman, Section
Chief, has established the Dartmouth
Electrophysiologic Testing Center which
will include ERG, EOG, VEP and color
vision testing. Kim McQuaid, COMT, is
the coordinator for clinical services.
Dr. Sandra M. Johnson continues
to provide clinical service at DHMCManchester. She provides comprehensive
ophthalmology, cataract, and glaucoma
consultation on a monthly basis.
Dr. Alexandra Elliott, pediatric
ophthalmologist, has expanded her
children’s practice into the new CHaD
facility. We have added specialized
ophthalmic testing equipment for
children to her service. We now offer
sub-specialty clinics in pediatric neuroophthalmology and pediatric optometry
within CHaD as well. Dr. Susan Pepin
will add expertise in pediatric neuro-
Christopher B Chapman, MD
Section Chief
and Pediatrics
ophthalmology and Dr. Christopher
Fields in optometry. Dr Christopher
Soares will also provide medical and
surgical consultation for pediatric
patients.
The Section’s new OCT-3 instrument
has been installed and is operational for
optic nerve and macular imaging. We
expect the ocular coherence tomography
to be most helpful in following the
clinical course of our glaucoma and retina
patients. Tom Monego serves as head of
Ophthalmic Photography and Imaging.
Faculty Research
Dr. Susan Pepin was appointed a Harmes
Scholar in the Department of Surgery
last year. Dr. Pepin is conducting research
in vision and Alzheimer’s disease and has
presented at local, regional, and national
meetings.
Dr. Michael Zegans is principal
investigator for the national study,
“Steroids in Corneal Ulcers Trial.”
Dr. Zegans is a National Eye Institute
investigator in biofilm formation and
pseudomonas infections. Dr. Zegans
also serves as a reviewer for Archives of
Ophthalmology and the American Journal
of Ophthalmology.
Dr. Chapman has initiated studies
in retinal cell transplantation and a new
clinical trial for diabetic retinopathy.
Dr. Rosalind Stevens serves as expert
consultant to Helen Keller International.
Ophthalmology Gross Revenue (in millions)
20M
18M
16M
14M
12M
10M
8M
6M
4M
2M
3,000
2,700
2,400
2,100
1,800
1,500
1,200
900
600
300
FY01
12
Ophthalmology Cases
FY02
FY03
FY04
FY05
FY06
FY01
FY02
FY03
FY04
FY05
FY06
Dr. Stevens has also organized the
Orbis International eye care project in
conjunction with Dartmouth Medical
School’s Global Health Initiative project
in Tanzania. Dr. Stevens will also be
coordinating the Flying Eye Hospital
project in Vietnam later this year. Dr.
Stevens serves on the advisory board for
the Cybersight Telemedicine project. Dr.
Stevens will continue to serve as senior
instructor for the annual Academy of
Ophthalmology Trauma course.
Dr. Miller is co-investigator for the
Steroids in Corneal Ulcers Trial and
serves as lecturer for the annual Academy
of Ophthalmology review course on eye
trauma. Dr. Miller has presented locally
at grand rounds programs as well as
regionally and nationally.
Dr. David Campbell, chief of the
glaucoma service, lectures at the Lancaster
course held annually and
is conducting studies
in pseudo exfoliation
and glaucoma as well as
developing approaches in
glaucoma.
Dr. Chris Fields has
conducted annual eye care
missions into Nicaragua and
has been honored nationally
for his efforts. Dr. Fields
will be providing an elective
course on International
Ophthalmology for
Dartmouth Medical
Students.
Douglas Jabs from the Wilmer Ophthalmic
Institute at Johns Hopkins was this year’s
visiting Curts professor. Dr. James Tsai, an
international expert in glaucoma, presented
new information on neuro-protection. Dr.
Jack Witcher, an international expert on
corneal ulcers, presented issues surrounding
corneal ulcers in the developing world. Dr.
William Anninger, from The Children’s
Hospital of Philadelphia, presented
“Retinopathy of Prematurity Issues in the
21st Century.”
The Future
The Section has completed the initial phases
of developing a three year residency training
program in Ophthalmology. In discussions
with both our referring physician partners
and national leaders, we have the support
and commitment required to launch the
highest quality training program possible.
Ophthalmology
David Campbell, MD
Alexandra Elliott, MD
Chris Fields, OD
Sandra Johnson, MD
Peter Lapre, OD
Donald Miller, MD
Susan Pepin, MD
Assistant Professor of Surgery and
Pediatrics
John Petrowski, III, OD
William Rosen, MD
Christopher Soares, MD
Adjunct Assistant
Professor of Surgery and
Instructor of Surgery
Rosalind Stevens, MD
Michael Zeagans, MD
Microbiology & Immunology
Grand Rounds and
Hosted Meetings
Our monthly Grand
Rounds at the Hanover
Inn or DHMC continue
to be well attended by our
referring ophthalmologists.
Topics include: Color
Vision, Case studies in
Neuro-Ophthalmology,
Tumor Conference, Uveiis
and Orbital disease. Dr.
13
Otolaryngology
T
he Section of Otolaryngology
continues to grow and change to
meet the needs of our local and regional
patient base. This past year has seen the
addition of Dr. Daniel Morrison, as an
otologist and neurotologist, and Dr.
Mark Smith in pediatric otolaryngology.
Dr. Smith will be developing a dedicated
pediatric otolaryngology service, the first
of its kind for DHMC. Both of these
additions have greatly improved access to
care for patients with otologic concerns.
After serving as section chief for 11
years, Dr. J.Oliver Donegan stepped down
from that position in June of 2006. He
continues his full-time practice in general
otolaryngology and we look forward to
many years of ongoing expert involvement
in medical and surgical care, education,
and research. He leaves behind a Section
that is clinically very strong, financially
viable, and poised to continue to grow
and develop in many ways. Stepping into
the section chief position is Dr. Morrison.
Daniel Morrison, MD
Section Chief
Patient Care
Clinically, we continue to do what we
do best—that is, to deliver the highest
quality comprehensive otolaryngology
care in New England. Victoria Keetay,
PhD heads an Audiology division that
is second to none. The head and neck
surgical oncology service continues to
grow. Our skull base surgical capabilities
are considerable with Drs. Benoit
Otolaryngology Gross Revenue (in millions)
20M
18M
16M
14M
12M
10M
8M
6M
4M
2M
Education
Under Dr. Morrison’s leadership,
the Otolaryngology section will be
venturing into the world of full-time
otolaryngology resident training. Several
hurdles in the residency application
process have been cleared and an
initial decision by the otolaryngology
residency review committee is expected in
February. Running parallel to this effort
is a vigorous clinical research emphasis
within the division. Drs. Paydarfar and
Gosselin simultaneously received the
Harmes Scholarship last year and have
been actively pursuing lines of research
within the field of head and neck surgical
oncology. Drs. Morrison and Smith also
have active lines of research in progress.
This has resulted in several presentations
Otolarnygology Surgery Cases
3,000
2,700
2,400
2,100
1,800
1,500
1,200
900
600
300
FY01
14
Gosselin and Joseph Paydarfar sharing
expertise in anterior skull base, Dr. Smith
in craniofacial reconstruction and Drs.
Glenn Johnson and Morrison in lateral
skull base procedures. (The addition
of Dr. Kadir Erkmen to the section of
Neurosurgery has been a vital step in this
effort.) The cochlear implant program,
under Dr. Johnson’s able leadership,
continues to strengthen, especially in the
area of pediatric implants. Under Dr.
Smith’s guidance, we expect the pediatric
otolaryngology service to flourish. We
have set the bar high for ourselves, and
continue to meet and exceed our goals.
FY02
FY03
FY04
FY05
FY06
FY01
FY02
FY03
FY04
FY05
FY06
at national meetings and publications in
peer reviewed journals.
The division has solidified relationships
with the VA Outcomes Group and their
otolaryngologist, Dr. Louise Davies. Dr.
Davies is a fully participating Section
member, has several publications in print
or pending, and will play a large role in
the residency program as research director.
As the Section becomes more focused
on the educational process, we have
expanded our involvement in medical
student education with plans to further
augment this activity. A curriculum for
the rotating surgical intern has been
developed and the role of the visiting
University of Vermont otolaryngology
resident has been refined.
Otolaryngology
Louise Davies, MD
Peter Dixon, PA
J Oliver Donegan, MB, BCh
JJ Benoit Gosselin, MD
Glenn Johnson, MD
Joseph Paydarfar, MD
Mark Smith, MD
Pediatrics
Audiology Program
Julie Johnson, AuD
Victoria Keetay, PhD
Maria Stella McHugh, MA-CCC
Leah Mosenthal, MEd
Michael Norris, MA-AuD
Cynthia Nulton, MS-CCC
Erin Pospychala, CCC-A
15
Pediatric Surgical Specialties
W
ith a comprehensive team finally
in place in 2006, the Section
of Pediatric Surgical Specialties, which
includes Pediatric General and Thoracic
Surgery, Pediatric Neurosurgery, and
Pediatric Urology, was able to focus all
of its attention on its mission: to provide
outstanding emergent, maintenance, and
preventive health care to the children
we serve, to educate and support their
families, to advance our disciplines by
innovative research, and to train future
health care providers.
Patient Care
The successful recruitment of a second
Pediatric Urologist, Dr. Daniel Herz,
completed our ‘two
of every specialty’
quest and enables
the Section to
provide aroundthe-clock pediatric
coverage in all three
surgical specialties.
Dr. Herz trained in
Pediatric Urology
at the Hospital for
Sick Children, in
Daniel Herz, MD
Toronto, Ontario,
and brings added expertise in the area of
minimally invasive urologic procedures.
In order to improve patient access
and convenience, each specialty added
clinics at the CHaD outpatient facility in
Laurie Latchaw, MD
Section Chief
and Pediatrics
Manchester this year. Pediatric General
and Thoracic surgeons are available in
Manchester one day a week, Pediatric
Urologists two days a week, and Pediatric
Neurosurgeons twice a month. In
addition, Dr. Laurie Latchaw and Dr.
Paul Merguerian continue to perform day
surgical procedures at the Manchester
Ambulatory Surgery Center.
The Section also provides patients
with highly specialized treatments and
multidisciplinary clinics. Dr. Susan
Durham offers a clinic to evaluate and
treat lesions and injuries of peripheral
nerves in both children and adults. Dr.
Ann-Christine Duhaime performs deep
brain stimulation and now provides the
added safety of intraoperative brainstem
monitoring. Working together with Dr.
Doug Hyder and Dr. Candice Aitken, Dr.
Duhaime established a multidisciplinary
approach to the treatment of pediatric
brain tumors. Dr. Daniel Croitoru, a
world renowned expert and creator of
the minimally invasive repair of pectus
excavatum deformities, established a
chest wall deformity program that is
continuing to grow and recently began
to offer shared medical appointments.
Dr. Latchaw, along with Neonatology
and Maternal Fetal Medicine, provides a
comprehensive consultation for parents
with prenatal diagnosis of congenital
anomalies. Pediatric Urology provides
sophisticated urodynamic studies and
Pediatric Surgery Gross Revenue (in millions)
20M
18M
16M
14M
12M
10M
8M
6M
4M
2M
FY01
16
Pediatric Surgery Cases
3,000
2,700
2,400
2,100
1,800
1,500
1,200
900
600
300
FY02
FY03
FY04
FY05
FY06
FY01
FY02
FY03
FY04
FY05
FY06
innovative nonsurgical treatment of VUR
for their patients.
Education
Educational activities for the Section
of Pediatric Surgical Specialists
included didactic and informal sessions
with residents in General Surgery,
Neurosurgery, Urology, and Pediatrics.
Dr. Merguerian gave Urology Grand
Rounds in May 2006, Dr. Croitoru gave
General Surgery Grand Rounds in August
2006, and Dr. Durham gave Pediatric
Grand Rounds in February 2006.
The Section’s physicians and nurse
practitioners traveled across the globe
presenting and participating in specialty
specific conferences. Dr. Merguerian
presented to both the American
Urological Association and American
Academy of Pediatrics. Dr. Durham
presented at the annual meeting of the
American Association of Neurologic
Surgeons, and Dr. Duhaime served as an
invited speaker and visiting professor at
numerous conferences and institutions as
far away as the International Neurotrauma
Society Meeting in The Netherlands and
as close as Richmond Middle School in
Hanover, NH.
As a testament to our mission to train
future providers, three DHMC surgical
residents, Dr. Erin Rowell, Dr. Dimitrios
Nikas, and Dr. Sean Corbett have been
accepted into fellowships in Pediatric
Surgery, Pediatric Neurosurgery, and
Pediatric Urology, respectively.
Research
Research productivity by Section
members was high this year. Dr. Croitoru
published two papers in peer reviewed
journals. Dr. Merguerian had two papers
accepted for publication in 2006, and
received a scholarship to pursue his
Masters in Clinical Science at the CECS
program starting in the fall of 2006. He
continued to serve as the Director of the
Section of Urology Research Program and
mentor the Urology residents assigned
to their laboratory year. Dr. Herz, the
new Pediatric Urologist, who joined the
Section from Mount Sinai Medical Center
in New York, will pursue his laboratory
research in bladder smooth muscle and
urothelial cell tissue engineering for use in
genitourinary reconstruction at DHMC.
Dr. Duhaime is the Resident
Research Coordinator for the Section of
Neurosurgery. She continues her research
in traumatic injury to the immature brain
and has present outside funding as well
as additional grant applications awaiting
review. Recent productivity from her
research includes three book chapters, seven
peer-reviewed journal articles and three
additional abstracts submitted. She has an
active laboratory with a post-doctoral fellow
as well as one of the Neurosurgery residents.
She is also the mentor for Dr. Durham, as
Dr. Durham has applied for a K 08 grant.
In addition, Dr. Durham was awarded the
Harmes Scholarship by the Department of
Surgery for her study entitled “An Analysis
of Head Acceleration Impact in Helmeted
Alpine Sports.”
Section Highlights
Dr. Merguerian, as Chair of the Resource
Committee for the CHaD Ambulatory
Clinic and Dr. Duhaime, as Chair of
the CHaD Radiology, Anesthesia, and
Surgical Specialties Committee, were
named to the new CHaD Operations
committee.
Dr. Duhaime continues to serve as
Secretary of the Joint Section for Pediatric
Neurosurgery of the American Association
of Neurological Surgeons. In addition,
she served on the Nominating Committee
for the American Society of Pediatric
Neurosurgeons.
Dr. Latchaw was elected to
membership in the New England Surgical
Society.
Ms. Sharon Haire, ARNP, is
an Associate Professor for Clinical
Instruction for the University of New
Hampshire School of Nursing responsible
for pediatric inpatient nursing education.
Pediatric Surgical
Specialties
Pediatric General
and Thoracic Surgery
Daniel Croitoru, MD
Pediatrics
Sharon Haire, ARNP, MSN
Pediatric Neurosurgery
Ann-Christine Duhaime, MD
Professor of Surgery and Pediatrics
Susan Durham, MD
Pediatrics
Pediatric Otolaryngology
Mark Smith, MD
Pediatrics
Pediatric Urology
Christine Danielson, CPNP
Daniel Herz, MD
Pediatrics
Paul Merguerian, MD
Professor of Surgery and Pediatrics
17
Plastic Surgery
T
he Section of Plastic Surgery
continues to integrate improvement
work in our daily activities. Our goal is
to ensure our patients can be seen when
and by whom they choose. We expanded
our Shared Medical Appointment (SMA)
initiative where groups of patients are
seen together for consultation. Patients
find they create an optimal learning
environment and improve access to
visits. Providers find they facilitate
shared decision making with patients
and improve efficiency. Donna Seiffert,
RN, and Sharon Kuiken, RN, published
an excellent article on SMAs in the
Plastic Surgical Nursing Journal. In
support of the SMA initiative, DHMC
has approved a project manager and
dedicated space with adjacent exam
rooms which is available to groups at
DHMC offering SMAs.
Last year we embraced the concept of
a surgeon booked into two rooms in the
main OR. We expanded this initiative
into our minor surgery suites, resulting
in the elimination of provider down-time
while rooms were being turned over.
We incorporated weekly team
‘huddles’ into our practice this
year whereby physicians, nurses,
and secretaries review upcoming
appointments and surgeries to
identify potential errors in scheduling
(overbooking, under booking, etc.).
This has resulted in less work toxicity,
Carolyn Kerrigan, MDCM, MSc
Section Chief
improved team satisfaction, and
improved communication that has led to
a better understanding of our co-workers’
roles and how our actions affect the
whole patient experience.
In the spring we initiated collaborative
participation in Dartmouth’s CECS
Microsystems course. This brought
together the Section of Plastic Surgery,
Department of Orthopedics, and Section
of Rehab Medicine to address the need
for a multidisciplinary hand service
at DHMC. Our premise was that the
highest quality patient centered care and
resident education can be delivered in a
multidisciplinary setting where providers
work together to meet the needs of these
patients.
The Section also continues to pilot a
project to make web based health surveys
available to our patients so they can selfreport a health history and quality of life
prior to a clinical visit - for more timely
and focused “face-to-face” care.
Education
Our ACGME accredited residency
training program expanded to a three-year
format. Two external rotations have been
established to complement the experience.
The first rotation is burn care at the
University of Southern California and
the second rotation is a private practice
experience in conjunction with the Maine
Medical Center.
Plastic Surgery Gross Revenue (in millions)
20M
18M
16M
14M
12M
10M
8M
6M
4M
2M
FY01
18
Plastic Surgery Cases
3,000
2,700
2,400
2,100
1,800
1,500
1,200
900
600
300
FY02
FY03
FY04
FY05
FY06
FY01
FY02
FY03
FY04
FY05
FY06
Research
Several research projects have been
initiated in our Section this year. Dr.
Renee Comizio began a review of breast
reconstruction cases and Dr. Christopher
Jensen initiated a study on the post
bariatric patient undergoing body
contouring surgery. Dr. Christopher
Demas is working with industry to assess
the utility of DIRI (thermal imaging) as a
tool for planning perforator flap surgery.
Dr. E. Dale Collins has recently been
named as the PI on a multimillion dollar
grant from the Foundation on Informed
Medical Decision Making. This project
focuses on implementing shared decision
making in General Internal Medicine
and further integrating it into the breast
cancer population. Dr. Collins is also the
clinical PI on an NCI grant to develop a
platform for patient reported outcomes in
oncology at DHMC.
Dr. Mitchell Stotland has three research
projects underway. His first project is examining novel dosing regimen for botulinum toxin in an effort to achieve a permanent paralysis effect (in collaboration with
Dr. Jeffrey Cohen, Neurology). His second
project involves exploring fMRI signal
patterns in response to facial deformity
(in collaboration with Anne Krendl, PhD,
at Dartmouth Psychological and Brain
Sciences.) His third project is The Psychological and Social Effects of Glabellar
Botox Cosmetic® (botulinum toxin type A)
Injections. In addition, Cynthia Metzler,
RN, was awarded a quality grant to work
with Dr. Stotland to develop “Patient-Held
Health Documents” (PHDs) for Craniofacial Clinic patients to improve their organization and processing of information.
Dr. Joseph Rosen is working on two
grant projects. His first project is to
develop a healthcare system for Vietnam
using a windows based hand held
platform for a distributed networked
telemedicine system (funded by Microsoft
Corporation.) His second project is the
evaluation of various simulation systems
for a range of threats against America
such as transportation accidents, natural
disasters, nuclear and biological attacks
(supported by the Institute of Security
and Technology Studies).
Plastic Surgery
Forst Brown, MD
Emeritus Active Professor
of Surgery
E Dale Collins, MD
Christopher Demas, MD
Gerald Doherty, PA
Joseph Rosen, MD
Radiology
Mitchell Stotland, MD, CM
Pediatrics
Simone Topal, MD
Physician Highlights
Dr. Carolyn Kerrigan has served as
President-Elect of the Plastic Surgery
Educational Foundation and will assume
the responsibilities of President of this
foundation for the 2006-2007 year. Dr.
Christopher Demas continues the development and expansion of the Cosmetic
Surgery program at DHMC and Dr.
Rosen has been active with the reconstruction of soldiers returning from Iraq
through his activities at the Walter Reed
Medical Center. Dr. Stotland is completing his degree at the Center for Evaluative
Clinical Sciences. He also coordinated
our first annual Radford C. Tanzer, MD,
Scientific Day. Dr. Collins has been an
invited speaker at national forums to
show case integration of “Shared Decision
Making and Computerized Patient Self
Assessment” for women being treated at
DHMC’s Comprehensive Breast Program.
19
Transplantation Surgery:
Pancreas & Kidney Transplant
D
David Axelrod, MD
Surgical Director of Kidney
and Pancreas Transplant
and Community & Family Medicine
uring the past year, the transplant
program at Dartmouth-Hitchcock
Medical Center has reached several
exciting milestones. For the first time,
the total number of kidneys transplanted
exceeded 50 in a 12 month period. This
represents an important threshold for
the program and establishes DHMC as
a major provider of transplant services
in Northern New England. We have also
successfully performed the first pancreas
transplant in New Hampshire in October
2005. This marked the initiation of a
successful program which has thus far
eliminated the need for insulin in ten
patients with diabetes mellitus.
Renal Transplantation
Kidney transplantation remains a core
competency of the DHMC solid organ
transplant program. During the previous
10 years, DHMC has established itself
as a leader in the care of renal transplant
patients. DHMC’s results, using an
innovative immunosuppression regimen
designed by Dr. Michael Chobanian,
were recently presented at the World
Transplant Congress. There, we reported
on our experience with over 200
transplant patients. Among these patients,
over 75% were managed with a single
immunosuppression medicine rather than
the standard three medication cocktail.
Transplant Surgery Gross Revenue (in thousands)
3,000K
2,700K
2,400K
2,100K
1,800K
1,500K
1,200K
900K
600K
300K
Transplant Surgery Cases
350
315
280
245
210
175
140
105
70
35
FY01
20
Despite this minimalist approach, the
overall rate of kidney rejection was <3%
and patients did exceptionally well. This
report was one of the largest series ever
reported for this approach.
The past 12 months have witnessed
important changes designed to improve
efficiency of care. A newly designed
kidney intake process has dramatically
reduced the time from evaluation to being
placed on the waiting list. In addition,
most patients require only a single visit
to DHMC to be listed for transplant,
leading to improved patient satisfaction
and referrals. Once transplanted, patients
are cared for using a new clinical pathway
which has reduced length of stay nearly
40%. Despite this short stay, overall
kidney graft survival exceeds 98% among
patients transplanted this year.
Over the next year, we expect
continued growth. We plan to initiate
satellite clinics to improve patient
referrals from distant points around
New Hampshire including Nashua
and the sea coast. In addition, we have
scheduled the first donor swap in which
two kidney recipients that have willing
but incompatible donors will exchange
kidneys. These procedures will be
performed simultaneously and promises
to expand access to kidney transplant to a
greater number of patients in need.
FY02
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FY05
FY06
FY01
FY02
FY03
FY04
FY05
FY06
We anticipate future
growth in this business
as the institutional
initiatives in the areas
of gastroenterology
and hepatology
further develop.
Pancreas Transplant
The pancreas transplant program has
grown rapidly during its short life span.
Among the ten patients who have received
a pancreas, six were performed after a
previous kidney transplant and four were
performed as part of a combined kidney/
pancreas transplant. Overall, the program
has been very gratifying. Currently, 100%
of patients and organs are surviving. In
addition, no patient has required a single
unit of insulin once they have left the
operating room. This success has led to
a growth in interest in the program and
currently 20 patients are waiting for an
acceptable organ.
Non-Transplant Surgery
Members of the Section have also
participated in the institutional program
to provide state of the art, collaborative
care to patients with liver disease and liver
cancer. A variety of operative approaches
are now offered to liver patients including
laparoscopic radio frequency ablation.
The technique offers the opportunity to
treat and potentially cure liver cancer even
in patients with very poor liver function.
Transplantation
Surgery
Michael Chobanian, MD
and Pediatrics
Richard Dow, MD
Promotional
& Educational
Activities
This year, the Section
has developed a
new, patient-friendly
website. We are
also participating
in the transparency
initiative and are
publicly reporting our
outcomes following
kidney and pancreas
transplantation.
We are pleased to report that at one
and three years, outcome at DHMC
has significantly eclipsed the national
average. The Section has also developed
an interactive CD educational tool with
the support of the Quality Research Grant
Program. It is the hope that this CD will
improve the effectiveness and efficiency of
the discharge process following renal and
eventually pancreas transplantation.
Looking Ahead
DHMC is becoming a more widely
recognized multi-organ transplant
program serving the population of
Northern New England. Over the next
year, we plan to reach out further into
the community to ensure that all New
Hampshire patients who can benefit
from transplantation are afforded this
opportunity. This commitment to serving
the needs of this population has led to
our request for, and subsequent approval
of, a liver transplant center by the United
Network for Organ Sharing which
controls organ distributions. We hope to
be able to initiate a clinical program in
liver transplantation in the near future.
21
Urology
T
he Section of Urology enjoyed a year
of professional and staff stability and
significant growth in clinical productivity
and case diversity. Already established
as a regional referral service in oncology
and voiding dysfunction, the Section
expanded its tertiary repertoire in the
areas of reconstruction, male reproductive
medicine, and obstructive uropathy.
Improvements in surgical volumes,
especially in the areas of stone disease
and obstructive uropathy, and an increase
in new patient appointments, reflect
the Section’s commitment to timely,
comprehensive service to the DHMC
community.
William Bihrle, MD
Section Chief
Patient Care
Urology has completed a successful year
in terms of improving care to our patients.
Over the past year,
we have continued
to work on
improving access to
our patients. Kelley
Hamill Lemay, NP,
joined Urology
in February of
2005, and has
worked with Dr.
Ann Gormley to
improve access for
Kelley Hamill Lemay, NP
our female urology
and voiding dysfunction patients. Dr.
John Heaney and Dr. John Seigne, aided
by Laura Stempkowski, NP, continue
to expand the GU oncology program,
providing comprehensive evaluation and
treatment to a widening community of
patients and physicians.
With two experienced laparoscopic
surgeons, the Institution is uniquely
positioned to remain on the forefront of
this important and evolving approach
to the treatment of GU malignancies.
Collaborating with his colleagues in
diagnostic radiology, Dr. Seigne has
established a dedicated PSA/prostate
biopsy clinic which will be adding
another dedicated clinic this fall in
the Norris Cotton Cancer Center. The
laparoscopically-assisted live donor
nephrectomy program continues to
expand under the guidance of Dr.
Seigne and represents an example of
successful collaboration with the Section
of Transplantation Surgery. Dr. Lori
Lerner continues to provide a minimally
invasive laser-based option for the
treatment of BPH (benign prostatic
hyperplasia). Employing holmium laser
energy, obstructing prostatic tissue is
either ablated or enucleated, resulting in
decreased hospitalization and shortened
convalescence.
Dr. Ajay Nangia has brought
vasectomy procedures from the OR’s
minor procedure room to our clinic’s
new procedure room, which is allowing
better access to this service every Friday.
Urology Gross Revenue (in millions)
Urology Cases
20M
18M
16M
14M
12M
10M
8M
6M
4M
2M
3,000
2,700
2,400
2,100
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900
600
300
FY01
22
FY02
FY03
FY04
FY05
FY06
FY01
FY02
FY03
FY04
FY05
FY06
Our operating block is increasing this fall
to match our growing demand of surgical
cases, which will improve our surgery
wait times. As a Section, we continue to
look at ways to improve access and care
to our patients.
Education
The Urology RRC of the ACGME
approved Dartmouth’s petition to train two
residents per year, completing a transition
begun by Drs. Heaney and Gormley four
years ago. The approval recognizes the
growth in clinical GU services at DHMC
and the important addition of the Concord
Hospital affiliation. Eight residents—two
in the research year—allows greater
flexibility in the educational block and
guarantees a more uniform clinical
experience for our trainees.
Hosting four DMS subinterns this
summer, each of whom plans a career in
urology, speaks to the beguiling nature of
the specialty and the mentoring of a staff
committed to education. Dr. Nangia,
our student clerkship director, deserves
credit for the growing local interest in
our specialty.
Dr. Dan Herz, a pediatric urologist
coming from Mt. Sinai Medical Center
in New York, joined Dr. Paul Merguerian
in the Section of Pediatric Surgery,
solidifying what has become a very strong
aspect of the residency program.
Faculty Activities
Section faculty remain generously active
in regional and national organized
urology; we count no fewer than 10
officer and committee assignments in
our various societies. Dr. Gormley,
Vice President of the Society of Female
Urology and Urodynamics, has been
invited to sit on the AUA Residency
Training Task Force; she continues as her
Society’s editor for the Journal of Urology.
Dr. Gormley and Dr. Lerner delivered
the “Take Home Message” synopsis for
urodynamics and BPH respectively, at
this year’s annual AUA meeting. Dr.
Lerner was named
to represent the
New England
Section in the
AUA Leadership
Program. Climbing
the organized
infertility ladder,
Dr. Nangia
chairs the Ethics
Committee of
Lori Lerner, MD
the American
Andrology Association and is a new board
member of the Society for the Study of
Male Reproduction. Dr. Seigne recently
delivered a state of the art presentation
on penile cancer at the annual meeting of
ASCO. He continues to represent New
Hampshire on the NES - AUA Board of
Directors and sits on the AUA Superficial
Bladder Cancer Guidelines Panel.
Urology
E Ann Gormley, MD
John Heaney, MB, BCh
Kelly Hamill Lemay, ARNP
Lori Lerner, MD
Ajay Nangia, MBBS
Obstetrics & Gynecology
John Seigne, MB
Laura Stempkowski, ARNP
Research
Dartmouth residents are authoring four
podium and poster presentations at this
year’s annual NES - American Urological
Meeting. In collaboration with Dr. Bin
Chen at Borwell Labs, Dr. Curtis Crane
has demonstrated increased tumor
vascular permeability following PDT in a
rat prostate cancer model. His co-resident,
Dr. Kwabana Pobi, under the direction
of Dr. Merguerian, has defined the
parameters for a successful hypospadias
repair and presents the CHaD experience
with (Deflux) in the treatment of pediatric
vesicoureteral reflux. At the same meeting,
recent graduate Dr. Tom Schwaab
presented the DHMC experience with
autologous dendritic cell vaccine in
combination with immunomodulators
in the treatment of metastatic RCC,
work performed in conjunction with Dr.
Seigne and Dr. Marc Ernstoff. Dr. Peter
Steinberg, our rising research resident,
is developing an efficient algorithm for
the treatment of muscle invasive bladder
cancer and expanding a database to assess
the impact on diabetes and hyperglycemia
on cystectomy outcomes.
23
Vascular Surgery
O
Jack Cronenwett, MD
Section Chief
and Community & Family Medicine
n a national level, major changes
have occurred this year in vascular
surgery. Board certification no longer
requires prerequisite general surgery
certification, and new paradigms have
been approved for training vascular
surgeons without full general surgery
training. We are pleased to report that our
application for a new five-year vascular
surgery training program was approved
by the ACGME in June 2006, the first
independent vascular training program
to be approved in the United States.
Medical students will match directly into
this training program, with one resident
per year. We will continue our current
two-year vascular residency for training
residents who have completed general
surgery, such that eventually two residents
will complete training each year, one from
the five-year program and one from the
two-year program. In the interim, we
have added a third vascular resident to our
current two-year program.
Dr. Christopher Alessi, our 17th vascular fellow, completed training this year. He
performed 178 open vascular operations
and 355 interventional procedures during his two-year fellowship, including 30
carotid artery stent procedures. We were
pleased to recruit Dr. Alessi to join our
faculty in June.
Section faculty delivered 25
international, national and regional
continuing medical education
presentations this year. The Section also
hosted four visiting professors, including
the 12th annual Rodger E. Weismann
Visiting Professor.
Vascular Surgery conferences are
held each Monday from 7-11 am when
faculty and trainees have protected time
to attend. They include a bi-weekly
clinical conference at which interesting
patients are discussed, a bi-weekly
Clinical Didactic Conference, a bi-weekly
Morbidity & Mortality conference, a
bi-weekly Research Conference, and a
weekly pre-operative conference to discuss
procedures to be performed that week.
Vascular Journal Club is held twice per
month to review contemporary articles of
interest, and a Basic Science Conference
and Vascular Laboratory Conference are
held monthly. Interested clinicians are
welcome to attend these conferences.
Research
The vascular biology research laboratory
continues to focus on smooth muscle
cell biology, investigating the molecular
regulation of events leading to smooth
muscle proliferation. Dr. Richard Powell
and Dr. Eva Rzucidlo have NIH funding
for this research. Dr. Rzucidlo received
new funding this year from Pfizer to
investigate the impact of statins in this
area. Translational research concerning
gene therapy using hepatic growth
factor to stimulate lower extremity
Vascular Surgery Gross Revenue (in millions)
20M
18M
16M
14M
12M
10M
8M
6M
4M
2M
3,000
2,700
2,400
2,100
1,800
1,500
1,200
900
600
300
FY01
24
Vascular Surgery Cases
FY02
FY03
FY04
FY05
FY06
FY01
FY02
FY03
FY04
FY05
FY06
angiogenesis has been initiated by Dr.
Powell. Dr. Mark Fillinger is the national
principal investigator for both the
Gore low permeability and Pythagoras
endoprosthesis trials for AAA repair, and
continues to serve as the local principal
investigator for seven endovascular AAA
research protocols. He has initiated
an international study to predict
AAA rupture risk based on wall stress
measurement using 3-D CT data, with
over 200 patients entered worldwide. Dr.
Powell is the local principal investigator
for 5 carotid artery stent trials. The
Vascular Study Group of Northern New
England continues to accrue registry data
from hospitals in Maine, New Hampshire
and Vermont, now with more than 5,000
vascular surgery operations analyzed to
provide hospital-specific feedback for
improving outcomes. Research activity
resulted in 22 peer-reviewed journal
articles and 8 book chapters published
by the faculty this year, in addition to 14
presentations at surgical society meetings.
Section faculty participated in 28 external
research grants and contracts this year.
Patient Care
Reflecting national trends, the volume of
open vascular operations remained stable,
while interventional and endovascular
procedures continued to increase this
year. Under the direction of Dr. Fillinger,
thoracic endovascular procedures have been
successfully introduced with more than 30
procedures performed for aortic aneurysm
and dissection. Retrograde stenting of the
superior mesenteric artery during open
operation for acute mesenteric ischemia
has been invented by Section faculty and
introduced nationally in a presentation by
Dr. Mark Wyers. Carotid artery stenting
has been fully integrated into our clinical
practice, with more than 200 procedures
having been performed.
Faculty Activity
Section faculty continued to be
extensively involved in national and
Vascular Surgery
Christopher Alessi, MD
Mark Fillinger, MD
Brian Nolan, MD
Richard Powell, MD
Radiology
Eva Rzucidlo, MD
Daniel Walsh, MD
Mark Wyers, MD
Robert Zwolak, MD, PhD
regional vascular societies where they
hold 15 officer or committee roles, in
addition to 4 positions on the editorial
boards of peer-reviewed journals. Dr.
Jack Cronenwett was elected President
of the Association of Chairs in Vascular
Surgery and was named an honorary
member of the Society for Clinical
Vascular Surgery. Dr. Daniel Walsh was
elected to the Executive Council of the
Vermont Medical Society. Dr. Robert
Zwolak was elected Treasurer of the
Society for Vascular Surgery. Dr. Fillinger
was promoted to Professor of Surgery.
Dr. Powell chaired the Research Council
of the Society for Vascular Surgery and
the Program Committee of the New
England Society for Vascular Surgery. Dr.
Rzucidlo was elected to membership in
the American College of Surgeons. Dr.
Wyers was appointed medical co-director
of the DHMC noninvasive vascular
laboratory and elected to membership
in the American College of Surgeons.
Dr. Brian Nolan received the Alma Hass
Milham Endowment Scholarship to
allow enrollment in the masters program
at the Center for the Evaluative Clinical
Sciences.
Vascular Research Lab
Mary Jo Mulligan-Kehoe, PhD
Research Associate Professor
of Surgery
Kathleen Ann Martin, PhD
Research Assistant Professor
of Surgery
25
Maxillofacial Surgery
O
ral and Maxillofacial Surgery
provides a wide array of care, from
primary to tertiary levels. Complex
cases involving pathology and structural
deformities of the maxillofacial region are
referred to Dartmouth-Hitchcock from
the tri-state area.
Dr. Rocco Addante remains active
academically as a journal reviewer for
articles submitted for publication to the
Journal of Oral and Maxillofacial Surgery
and Oral Medicine, the Journal of Oral
Surgery and the Journal of Oral Pathology.
In addition, he has two chapters slated for
publication this fall – one in the Oral and
Maxillofacial Surgery Clinics of North
America (Verrucous Carcinoma of the Oral
Cavity) and one in Oral and Maxillofacial
Surgery Knowledge Update, Volume IV
(The Comprehensive Evaluation of the Oral
Tumor Patient). He continues to mentor
students from Dartmouth with an interest in
careers combining medicine and dentistry.
DHMC provides comprehensive
care in several interdisciplinary clinics
and Dr. Addante plays an active role in
Rocco Addante, MD, DMD
Section Chief
and Anesthesiology
Maxillofacial Surgery Gross Revenue (in thousands)
1,800K
1,620K
1,440K
1,260K
1,080K
900K
720K
540K
360K
180K
Maxillofacial Surgery Cases
350
315
280
245
210
175
140
105
70
35
FY01
26
the Craniofacial Anomalies Clinic and
Head and Neck Cancer. In addition, Dr.
Addante provides care for patients from
the Hematology Oncology Service, who
typically exhibit coagulation disorders and
immune suppression along with their need
for oral surgery.
Locally, Dr. Addante hosts monthly
meetings for the hospital dental staff and
provides periodic lectures to the dental
community on topics of mutual interest.
On the national level, he has completed
his term as chairman of the Commission
on Ethics and Professional Conduct of
the American Association of Oral and
Maxillofacial Surgeons, but he continues to
serve on the commission. He also serves as
regional consultant to the American Board
of Oral and Maxillofacial Surgery.
Although there is no residency in
Maxillofacial Surgery at DHMC, Dr.
Addante maintains close affiliations
with the Sections of Plastic Surgery and
Reconstructive Surgery and is a valued
contributor to the resident teaching program
in that specialty.
FY02
FY03
FY04
FY05
FY06
FY01
FY02
FY03
FY04
FY05
FY06
Program Highlights
Thoracic Surgery Program
O
ver the past year, general thoracic
surgery at DHMC has continued
to flourish, building upon the trend
of the previous two years. Most
initiatives described a year ago have
developed and matured. Surgical volume
continues to increase over the previous
year, and now includes an increasing
number of esophageal cases (benign
and malignant). Having two surgeons,
Dr. David Johnstone and Dr. William
Nugent, dedicated to thoracic surgery,
has been a critical factor, allowing the
nursing and paraprofessional staff to
gain experience and expertise in the care
of these patients.
We are now entering our third year
with PGY-4 housestaff rotating as the
senior thoracic resident. The residents
now regard this rotation as one of their
best “operating” rotations and have
provided outstanding patient care as well
as leadership of the junior cardiothoracic
housestaff. The Section provides regular
didactic sessions covering topics in
cardiac and thoracic surgery. We
continue to develop a more robust
thoracic curriculum.
Endobronchial therapy (laser,
stents, brachytherapy) is now routinely
available in
the OR or
Endoscopy Suite.
This service has
matured under
the leadership of
Dr. Johnstone
and Dr. DeLong
of Pulmonary
Medicine, who
have worked
to provide
seamless coverage
and useful
collaboration in
this challenging
population of
patients.
Esophageal surgery, both malignant
and benign, has gradually increased
over the past year. We have taken on
reoperative procedures for failed antireflux operations, resections for achalasia,
and repair of diverticula. In conjunction
with Dr. Sutton of General Surgery and
members of the GI Oncology services,
DHMC offers first-class treatment
of cancer of the esophagus. Interest
in minimally invasive approaches to
this disease remains, and we hope to
gradually move forward with that in the
next year.
Finally, the multidisciplinary thoracic
oncology clinic is expected to begin this
fall, with all specialties available in the
same location to provide patients with
efficient comprehensive lung cancer
care. This is the result of a year of
collaborative effort among the various
sections involved and Norris Cotton
Cancer Center. As the breast clinic has
demonstrated, we expect the lung cancer
clinic to raise regional awareness of our
expertise in cancer care and research,
increase patient visits, and boost surgical
volume over the coming years.
David W Johnstone, MD
27
Program Highlights
Trauma Program
T
John Sutton, MD, FACS
Director of Trauma Services
he sudden and unpredictable nature
of traumatic injuries not only creates
problems for patients and their families,
but challenges medical care system
resources as well. In order to meet this
challenge, the DHMC Section of General
Surgery created the Trauma and Acute
Surgical Care Service in 1998. Dr. John E.
Sutton, Jr., Division Chief, and the other
Trauma/Consult staff attendings; Drs.
Kenneth Burchard, Horace Henriques,
Paul Kispert, and Rajan Gupta have
dedicated interests and certification in
trauma and acute surgical care. Working
with the General Surgery residents and
nurse practitioner, this team is focused
on the prompt coordination of care
for patients with multi-system trauma,
critical surgical illness, and a wide variety
of acute surgical problems seen at a Level
I trauma center. While on service, the
attending does not carry any other clinical
responsibilities, which allows them to
be available day or night for emergent
patient care.
Clinical Service
The number of trauma patients admitted
to DHMC has increased over 50% in
the past four years. Currently, more than
1,200 patients are admitted annually.
Much of this increase is a result of
subspecialty unavailability at referring
hospitals, requiring DHMC to play an
increasing role in the care of the injured
patients of Vermont and New Hampshire.
To meet this demand, our in-house
subspecialty services have expanded as
well with the addition of specialists in
Orthopedic, Spine, Pediatric Surgery, and
Pediatric Neurosurgical trauma.
The newest addition to the Trauma/
Consult service is Dr. Rajan Gupta. Dr.
Gupta completed his Trauma/Critical
Care Fellowship at the University of
Pennsylvania. In addition to his clinical
skills, Dr. Gupta has a particular interest
in performance improvement (PI)
28
and has been
appointed as the
trauma program’s
Performance
Improvement
Director. He
is currently
implementing a
new performance
improvement
program that will
Rajan Gupta, MD
enable the trauma
program to more
accurately identify problems and enable
us to make systems changes that will
ultimately enhance care. This process is
labor intensive and has required us to add
a PI nurse coordinator as well as a second
trauma registrar to assist in the collection
and entry of important data.
Education/Research
Providing access to national and local
trauma care experts, our annual trauma
conference provides CME for local
physicians, nurses, and EMS providers.
The success of this conference over 15
years has enabled us to establish the
Trauma Research Fund, which supports
clinical investigation by DHMC staff
and residents. Recently, the fund has
provided support for Dr. Ian Paquette (a
PGY-3) to present a retrospective study
on “Hypoadrenalism in Trauma” at the
American College of Surgeons Regional
Residents’ Paper Competition. This work
will be continued in a larger prospective
study, under Dr. Burchard’s direction, to
study hypoadrenalism in severely injured
patients admitted to the ICU.
In addition to yearly presentations
at the New England Regional Trauma
Conference, Dr. Sutton and Dr. Kispert
have presented abstracts at the annual
meeting of the New England Surgical
Society. Topics have included patterns
of head injury management, injury and
cost associated with not wearing seatbelts,
and delays in transfer of trauma patients
in New Hampshire. Dr. Kispert has also
authored 4 chapters in “Common Errors
in the ICU.” Dr. Henriques’ work on
establishing a pain management protocol
for trauma patients in the emergency
room will soon be published in the
Journal of Trauma.
Trauma service education is provided
by weekly trauma conferences. At these
meetings, attending physicians, residents,
and specialty services gather to discuss
recent trauma cases, listen to didactic
presentations, participate in journal
club, or work with interactive DVD
programs to provide trauma education.
This also allows concurrent discussion of
trauma system issues to provide timely
intervention to improve patient care.
Advanced Trauma Life Support (ATLS)
courses are also given two to three
times per year for residents and outside
physicians.
Computerized mannequins, called
simulators, are currently being used
in medicine to provide experience for
physicians-in-training. DHMC has such
a simulator which can be programmed to
re-create a severely injured trauma patient
arriving in the emergency room. The
procedures and decision making involved
in the work-up of a trauma patient can
thus be practiced without harm to a
real patient. The trauma program has
created such an experience for residents,
which has been incorporated into their
education experience.
Goals for the future
• Develop, with the New Hampshire
Division of EMS, a trauma simulator
program for hospitals to teach trauma
team cooperation and organization of
resuscitation skills.
• Increase the number of telemedicine
trauma case conferences with referring
hospitals.
• Video record resuscitations in the
Emergency Room for Performance
Improvement and educational purposes.
• Complete research projects:
Hypoadrenalism of critical illness
Trauma in the elderly
Hypertonic saline during elective
surgery
• Further development of the
multidisciplinary trauma PI program.
Regional/National Activities
Dr. Sutton (Chair), Dr. Gupta and
Eileen Corcoran, RN, serve on the New
Hampshire Trauma Medical Review
Committee. This committee is responsible
for the trauma system planning and
development of protocols for the state of
New Hampshire. Dr. Gupta represents
the state of New Hampshire on the
American College of Surgeons Committee
on Trauma.
29
Office of Surgical Education
Medical Student Education
T
Ken Burchard, MD
Surgery Clerkship Co-Director
Consult/Trauma Learning Leader
Horace Henriques, MD
Surgery Clerkship Co-Director
General Surgery Learning Leader
30
he formal engagement of faculty
and residents in the third-year
clerkship Director of Learning Program
has successfully reminded us that learning
is a two way street. While fund of
knowledge typically resides on the side
of the ‘teacher,’ we are all ‘students’ in
our understanding of core competencies
such as communication, interpersonal
skills, and professionalism. We recognize
understanding concepts as a role equal
to the acquisition of factual knowledge.
Formalizing this learning process provides
the opportunity to model the core
competency of self-learning. Incorporating
these core clinical competencies into
the clerkship’s formal curriculum allows
minimal transition in expectations as
students move from their third-year
clerkship into fourth-year sub-internship
programs, and finally into residencies.
The seven rotation options; Vascular,
Trauma/Consult, Transplant/IBD,
Oncology/Breast, Cardiothoracic,
Minimally Invasive, and the
multidisciplined (General, Vascular,
Plastics, ENT, Orthopaedics) VA rotation,
continue to offer a broad view of the
many disciplines within surgery as well
as providing students with a diversity of
practice models. All students continue
to participate in night call with the
Trauma/Consult team. This configuration
continues to have strong support and
allows a reasonably balanced experience of
elective and emergent surgical situations.
Night call also allows students to
routinely interact and experience non-core
surgical disciplines such as Orthopaedics,
Neurosurgery, Urology, Plastics,
Ophthalmology, and Pediatrics.
The Class of 2006 graduated with
18% of students entering a surgical
field, above the national average of 10
to 12%. Dr. Meredith Sorensen was this
year’s recipient of the Arthur Naitove
Surgical Scholar Award and she will
receive her training at Dartmouth. The
Naitove Award commemorates one of
Dartmouth’s great clinician scientists
and is awarded by the Faculty of the
Dept. of Surgery. Dr. Philip Goodney,
a General Surgery chief resident, was
this year’s recipient of the Thomas P.
Almy Housestaff Teaching Award. This
honor is awarded to a resident by the
graduating medical school class. This
year marks the third year in a row, and
the eighth time in ten years, that a
surgery resident has been awarded this
unique honor.
For additional information on the
Surgery Clerkship and the Sub-Internship
Program, the web page remains active and
is updated regularly.
Clerkship Advisory Board
The Clerkship Advisory Board meets
monthly and is comprised of individuals
actively involved in student education.
The committee conducts ongoing reviews
of the curriculum, making revisions
as necessary to maintain a current
curriculum and advancing an educational
climate. It is the forum by which the
surgery clerkship formally interacts
with the Dean’s Office in student and
curriculum issues.
Training Programs
Research and Preventive Medicine
Training Opportunities
We offer research opportunities in molecular labs and
outcomes research. Some residents elect to join our
Leadership in Preventive Medicine Residency Program
where they get formal training in outcomes research, earn
an MPH, and become eligible for Preventive Medicine
certification.
2005-2006
• Justin Dumouchel, MD—Vascular Research, DHMC
• Lydia Choi, MD—Cancer Research, Memorial Sloan Kettering
• Sarah Greer, MD—Cancer Research - National Institute of
Health
• David Hughes, MD—Research - DHMC
• Daniel Wiener, MD—Cancer Research, Dana Farber Cancer
Institute
2004-2005
• Jared Barton, MD—Leadership in Preventive Medicine
• Lydia Choi, MD—Cancer Research, Memorial Sloan Kettering
• Michael Van Bibber, MD—Research, Outcomes—
DHMC/VAMC
•Daniel Wiener, MD—Cancer Research,
Dana Farber Cancer Institute
2003-2004
•Richard Kutz, MD—Research, Outcomes—
DHMC/VAMC
•Melissa Meyers, MD—Research, Outcomes—
DHMC/VAMC
•Elsa Valsdottir, MD—Research, Outcomes—
DHMC/VAMC
•Daniel Wiener, MD—Cancer Research,
Dana Farber Cancer Institute
2002-2003
• David Brown, MD—Research, Vascular Surgery
• Philip Goodney, MD—Research, Outcomes—DHMC/VAMC
• Erin Rowell, MD—Research, Vascular Surgery
•Brent White, MD—Research, Outcome—
DHMC/VAMC
Fellowship Programs:
• Plastic Surgery
• Vascular Surgery
Training Programs
Neurosurgery
Vascular
Urology
Plastic Surgery
Otolaryngology
General Surgery
Resident Training 2005-2006
General Surgery
Established: 1946
Prerequisite Training: 4 years of medical school
Description: 5-year program, training in all divisions
Residents per year: 4
Neurosurgery
Established: 1947
Prerequisite Training: 1 year internship
Description: 6-year program includes 4 years clinical
neurosurgery with 6 months of pediatric neurosurgery, 3
months neurology, 3 months of related clinical rotations in
the ED and critical care; 1 year of independent research; and
1 year Chief Resident experience.
Plastic Surgery
Established: 1960
Prerequisite Training: 3 years of general surgery or
completion of a residency in another surgical discipline.
Description: 3-year training with a period of research
integrated into the program.
Urology
Established: 1949
Prerequisite Training: 2 years of general surgery
Description: 4 years, including 6 months of research.
Training in pediatric and adult urology including oncology,
laparoscopy, female urology, infertility, and endourology.
Residents per year: 2 every second year—we will start 2
every year effective July 2006
31
Sponsored Research
Research: Clinical Trials
General Surgery
Vascular Surgery
John E. Sutton, Jr., MD
• Laparoscopic-Assisted Colectomy
Mark F. Fillinger, MD
• Zenith-Protocol TX2 - Thoracic TAA
• Pythagoras Study
• Valor Study -Protocol
• AneuRx
• Cordis Endovascular Quantum LP
—Protocol No P01-4601
• Edwards Lifepath AAA 2001-2002
• Gore (Modified) Bigurcated Excluder
—99-04
• Gore Excluder 31mm - Protocol #AAA
03-02
• Gore04-04 Protocol #AAA 04-04
• CaridoMEMS AAA pressure sensor
system
Thadeus L. Trus, MD
• SAGES
Neurosurgery
David W. Roberts, MD
• Stereotactic Microscope Project
Plastic Surgery
E. Dale Collins, MD
• Contour Profile Gel Mammary
Prosthesis
• Integrating Decision Support in Breast
Cancer Care
Carolyn L. Kerrigan, MD, MSc
• CLOSEX
Mitchell A. Stotland, MD
• Botox Intervals R&E - MAS
Urology
Richard J. Powell, MD
• Anges 0205
• EXACT-Protocol $640-0063-01
• VIVA Protocol #17683
• Genzyme/IMPROVE Study - Protocol
#PADHIF00704
• Advance Protocol #P03-5203
Ajay K. Nangia, MB BS
• BPH Registry - (Protocol #L8890)
Clinical Research
Neurosurgery
Urology
General
Surgery
Plastic
Surgery
Vascular
32
Research: Federal & Corporate
Audiology
Urology
Victoria Keetay, PhD
• Dynamic Assessment of Hearing Aids
John Heaney, MB, BCh
• Prostate Cancer
Prevention Trial PCPT
Companion Long Term
Follow Up Study for Men
with Diagnosed Prostate
Cancer
• Selenium and Vitamin E
Cancer Prevention Trial
(SELECT)
General Surgery
Richard J. Barth, Jr, MD
• ACOSOG Studies Z10 and Z11
Burton L. Eisenberg, MD
• The Molecular Actions of Imatinib
Mesylate in GISTs
• RTOG Committee Chair Agreement
Samuel Finlayson, MD
• Medical and Surgical Treatment of
Esophageal Reflux
• Evaluating the Safety and Effectiveness
of Endovascular Stent Grafts for AAA
Plastic Surgery
E.Dale Collins, MD
• Implementing Shared Decision Making
in Clinical Care
Carolyn L. Kerrigan, MD, MSc
• Carpal Tunnel Syndrome: Diagnosis &
Treatment Study
Pediatrics
• Trauma to the Immature Brain:
Response, Repair, & Treatment
• Biomechanics of Pediatric Head
Trauma
Vascular Surgery
Federal & Corporate Research
General
Surgery
Ophthalmology
Pediatric
Surgery
Jack Cronenwett, MD
Audiology
• Northern New England
Vascular surgery Quality Urology
Improvement Initiative
• Ultrasound Screening
for Abdominal Aortic Aneurysm
Surgical Res Lab
Vascular Research Lab
Kathleen Martin, PhD
• Sub of 5-38049
• Induction of Vascular Smooth Muscle
Cell Differentiation by Rapamycin
Richard J. Powell, MD
• Endothelial Cell Regulation of Smooth
Muscle Phenotype
• Carotid Revascularization
Endarterectomy vs Stenting Trial
(CREST)
Eva M. Rzucidlo, MD
• mTOR Regulation of VSMC
Differentiation
• Statin Effect on Vascular Smooth
Muscle Cell Differentiation Through the
mTOR Pathway
Surgical Research Lab
Jeffrey Bergeron, MD
• In Vivo Feline Study
• Evaluation of Prototype
Electrosurgical Instruments
P. Jack Hoopes, DVM, PhD
• Wave Contract
• GlycoFi Rituxan Project
• Ethylene Vinyl Alcohol
(EVOH) for Obesity
Plastic Surgery
Vascular
• Mechanisms of PAI-1 Induced AntiAngiogenesis
• Philips Master Collaborative Research
Agreement
Ophthalmology
Michael E. Zegans, MD
• Biofilm Formation Associated with P.
aeruginosa Infection of the Eye
• Steroids in Corneal Ulcers Trial
Grant Funding 1998 - 2006
3,500,000
3,150,000
2,800,000
2,450,000
2,100,000
1,750,000
1,400,000
1,050,000
700,000
350,000
FY98
FY99
FY00
FY01
FY02
FY03
FY04
FY05
FY06
33
Department of Surgery Awards
The Arthur Naitove
Distinguished Teaching
Award
Thadeus Trus, MD
General Surgery
The Arthur Naitove Distinguished
Teaching Award was instituted by
the residents in 1997 to recognize
a faculty member’s commitment
to the housestaff. The award is
presented to an attending staff for
their commitment to enhance the
residency educational experience. The
2006 recipient was Dr. Thadeus Trus.
The Harmes Surgical
Scholar Award
Susan R Durham, MD
Pediatric Neurosurgery
The Harmes Surgical Scholar Award
is awarded annually to a faculty
member at the Assistant or Associate
Professor level in the Department
of Surgery. The annual financial
award is provided over three years
to facilitate career development by
strengthening individual professional
skills; enhancing contributions to the
academic, clinical, and administrative
programs of the Department;
improvising the regional and national
visibility of DHMC; and increasing
each individual’s sense of professional
competence and satisfaction. The
Harmes Scholar named for 2006 was
Dr. Susan Durham.
Invited Speakers
The New Face of War,
Combat Casualties from the Global War on Terrorism.
Raymond Harshbarger, MD, MAJ, MC, Director of Left
Craniofacial Surgery, Walter Reed Army Medical Center
Cardiac Risk in Vascular Surgery:
Current Evaluation and Management.
William Mackey, MD, New England Medical Center,
Surgeon-in-Chief, Tufts New England Medical Center, Chair,
Department of Surgery, Tufts University School of Medicine
Bedside to Bench:
Translational Research in Vein Graft Disease.
Michael Conte, MD, Division of Vascular Surgery, Brigham &
Women’s Hospital
Carotid Endarterectomy in the Endovascular Era.
Bruce Perler, MD, Julius H. Jacobson II Professor of Surgery,
The Johns Hopkins University School of Medicine
Medicine, Money and Manpower:
Are we approaching the Perfect Storm?
Pardon Kenney, MD, Professor of Surgery, Chief of Surgery,
The Faulkner Hospital
Transition to Molecular Triage
for the Treatment of Breast Cancer: The ISPY Trial.
Laura Esserman, MD, Professor of Surgery and Radiology,
University of California, San Francisco
Learning to Operate:
From Lab Coats to Arm Chairs to Simulators.
Gerald M. Fried, MD, Professor of Surgery and Adair Chair of
Surgical Education, McGill University
A Surgical Conundrum:
Malignant Bowel Obstruction.
Robert Krouse, MD, FACS, University of Arizona
The Surgical Chair’s Award
Thomas Colacchio, MD
On the clinical front, the Department
has continued to highlight the
quality of patient care. In 2005, Dr.
Thomas Colacchio was selected to
receive the Surgical Chair’s Award
for his ongoing contributions to
the Department, his emphasis on
patient care and his focus on quality
throughout the organization.
General Surgery
President, DartmouthHitchcock Clinic
34
Department of Surgery Publications: 2006
Lawrence J. Dacey, MD
Dacey LJ, Likosky DS, Charlesworth DC, Leavitt
BJ, Lahey SJ, Quinn RD, Hernandez F, Quinton HB,
O’Connor GT: Perioperative stroke and long-term
survival after coronary bypass surgery. Annals of
Thoracic Surgery 2005; 70:532-6.
Malenka DJ, Leavitt BJ, Hearne MJ, Robb JF,
Baribeau YR, Ryan TJ, Helm RE, Kellett MA,
Dauerman HL, Dacey LJ, Silver MT, VerLee PN,
Weldner PW, Hettleman BD, Olmstead EM, Piper
WD, O’Connor GT. Comparing Long-term Survival
of Patients With Multivessel Coronary Disease
After CABG or PCI: Analysis of BARI-like Patients
in Northern New England. Circulation 2005; 112(9
Suppl):I371-6.
Dacey LJ, Johnstone DW. Reducing the Risk of Lung
Cancer. (Editorial) JAMA 2005 28;294(12): 1550-1.
Baskett RJ, O’Connor GT, Hirsch GM, Ghali WA,
Sabadosa KA, Morton JR, Ross CS, Hernandez F,
Nugent WC, Lahey SJ, Sisto D, Dacey LJ, Klemperer
JD, Helm RE, Maitland A. The Preoperative
Intraaortic Balloon Pump in Coronary Bypass
Surgery: A Lack of Evidence of Effectiveness. Am
Heart J 2005; 150(6):1122-7.
DiScipio AW, Shemin RJ. Acquired Cardiac Disease.
Essentials of Surgery, ed.Becker, (citation info not
available).
Yeager MP, Rassias AJ, Fillinger MP, Discipio
AW, Gloor KE, Gregory JA, Guyre PM. Cortisol
antiinflammatory effects are maximal at
postoperative plasma concentrations. Crit Care
Med. 2005 Jul; 33(7):1507-12.
David Johnstone, MD
Chang JY, Moughan J, Johnstone D, et al. Surgical
patterns of care in operable lung carcinoma
treated with radiation. Submitted to J Thorac
Oncol 2006
Johnstone DW. Modified intrapleural cisplatin
treatment for lung cancer with positive pleural
lavage cytology or malignant effusion. (Editorial) J
Surg Oncol 2006; 93:255-256.
Dacey LJ, Johnstone DW. Reducing the risk of
lung cancer. (Editorial) JAMA 2005; 294:1550-1.
Y. Chen, K. J. Pandya, T. Smudzin, R. Qazi, B. D.
Smith, O. Hyrien, DW Johnstone, et al. Phase
II study of induction docetaxel/cisplatin with
rhG-CSF followed by concurrent pulsed docetaxel
chemoradiation for stage III non-small cell
lung cancer (NSCLC). J Clin Oncol 2006; ASCO
Proceedings 24 (18S): 17034
Strauss GM, Herndon JE, Maddaus MA, Johnstone
DW, et al. Adjuvant chemotherapy in stage IB nonsmall cell lung cancer (NSCLC): Update of Cancer
and Leukemia Group B (CALGB) protocol 9633. J
Clin Oncol 2006; ASCO Proceedings 24 (18S): 7007.
William C. Nugent, Jr., MD
Baskett RJ, O’Connor GT, Ross CS, Sabadosa KA,
Dacey LJ, Hernandez F, Lahey SJ, Nugent WC, Sisto
D,Klemperer J, Helm RE. The Preoperative intraaortic balloon pump in Coronary Artery Bypass
Surgery: A lack of evidence of effectiveness.
American Heart Journal, December 2005;
150(6):1122-1127
Surgenor SD, DeFoe GR, Leavitt BJ, Likosky DS,
Helm RE, Groom RC, Fillinger MP, Klemperer JD,
Krumholz CF, Westbrook BM, Clark C, Galatis DJ,
Frumiento C, Ross CS, Olmstead EM, O’Connor GT.
Risk of low output heart failure is associated with
treatment of hemodilutional anemia by red blood
cell transfusion during coronary artery bypass
graft surgery. Circulation Supplement. (in press)
Likosky DS, Nugent WC, Ross CS. Improving
Outcomes of Cardiac Surgery Through
Cooperative Efforts: The Northern New England
Experience. Seminars in Cardiothoracic and
Vascular Anesthesia, June 2005; 9:2:119-121.
Likosky DS. A Primer on Reviewing and
Synthesizing Evidence. Journal of Extracorporeal
Technology. (in press)
Likosky DS, Nugent WC, OConnor GT. A
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Surgery Mortality for the Northern New England
Cardiovascular Disease Study Group. Ann Thorac
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Donald S Likosky, PhD
Dacey LJ, Likosky DS, Leavitt BJ, Lahey SJ, Quinn
RD, Hernandez F, Quinton HB, DeSimone JP, Ross
CS, O’Connor GT. Perioperative Stroke and LongTerm Survival After Coronary Bypass Surgery.
Annals of Thoracic Surgery 2005; 79: 532-7.
Likosky DS, Nugent WC, Ross CS. Improving
Outcomes of Cardiac Surgery Through
Cooperative Efforts The Northern New England
Experience. Seminars in Cardiothoracic and
Vascular Anesthesia 2005; 9: 119-21.
Nelson EC, Homa K, Mastanduno M, Fisher
E, Batalden PB, Colacchio T, Formella N,
Foster TC, Likosky DS, Gardent PB, Guth J,
Malcolm E, Trombly S, Varnum J. A Healthcare
System’s Experience with Publicly Reporting
Comprehensive Quality and Cost Data: A
Transparency Initiative. Joint Commission Journal
on Quality and Patient Safety 2005; 31: 573-84.
Likosky DS, Donegan DJ, Groom RC, Buchanan SA,
Morton JR, Ross CS, O’Connor GT. Embolic activity
subsequent to injection of the internal mammary
artery with papaverine hydrochloride. Heart
Surgery Forum 2005; 8: E434-6.
Likosky DS, Nugent WC, Clough RA, Weldner PW,
Quinton HB, Ross CS, O’Connor, GT. A Comparison
of Three Measurements of Cardiac Surgery
Mortality. Annals of Thoracic Surgery 2006; 81:
1393-5.
Likosky DS. A Primer on Randomized Clinical
Trials. Journal of Extracorporeal Technology 2006;
38: 10-13.
Shann KG, Likosky DS, Murkin JM, Baker RA,
Baribeau YR, DeFoe GR, Dickinson TA, Gardner
TJ, Grocott HP, O’Connor GT, Rosinski DJ, Sellke
FW, Willcox TW. An Evidence-Based Review of the
Practice of Cardiopulmonary Bypass in Adults.
Journal of Thoracic & Cardiovascular Surgery. (in
press)
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Kenneth Burchard, MD
Rowland PA, Coe NPW, Burchard KW, Pricolo
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physicians. Curr Surg 2005; 62:214-219.
Burchard KW, Rowland PA, Berman NB, Hanissian
PD, Carney PA. Clerkship Enhancement of
Interpersonal Skills. The American Journal of
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Burton L. Eisenberg, MD
Mullenix PS, Brown, TA, Meyers MO, Giles LR,
Sigurdson ER, Boraas MC, Hoffman JP, Eisenberg
BL, Torosian MH. The association of cytokeratinonly-positive sentinel lymphnodes and
subsequent metastases in breast cancer. Am J
Surg 189(5):606-609; discussion 609, 2005.
Tarn C, Merkel E, Canutescu AA, Shen W,
Skorobogarko Y, Heslin MH, Eisenberg B, Birbe
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MV, Goodwin AK. Analysis of KIT mutations in
sporadic and familial gastrointestinal stromal
tumors: therapeutic implications through protein
modeling. Clin Cancer Res 11(10):3668-3677, 2005.
Eisenberg BL. Soft tissue sarcomas: opportunities
for defining the molecular phenotype of a solid
tumor malignancy. Curr Opin Oncol 17(4):355-356,
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Blanke C, Eisenberg BL, Heinrich Ml. Epidemiology
of GIST. Am J Gastroenterol 100(10):2366, 2006.
Benjamin RS, Blanke CD, Blay JY, Bonvalot S,
Eisenberg B. Management of gastrointestinal
stromal tumors in the imatinib era: selected case
studies. Oncologist 11(1):9-20, 2006.
Kraybill WG, Harris J, Spiro IJ, Ettinger DS, DeLaney
TF, Blum RH, Lucas DR, Harmon DC, Letson GD,
Eisenberg B. Phase II study of neoadjuvant
chemotherapy and radiation therapy in the
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Tarn C, Skorobogatko YV, Taguchi T, Eisenberg
B, Mehren MV, Godwin AK. Therapeutic effect
of imatinib in gastrointestinal stromal tumors:
AKT signaling dependent and independent
mechanisms. Cancer Res 66(10):5477-5486, 2006.
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Samuel R. Finlayson, MD
Trus TL, Pope GD, Finlayson SRG. National trends
in utilization and outcomes of bariatric surgery.
Surg Endosc; 5:616-620, 2005.
Gupta R, Carpenter J. Surveillance of Deep Venous
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Pohl H, Finlayson SRG, Sonnenberg A, Robertson,
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Mancini DJ, Gupta R. Acute Mesenteric Ischemia.
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VanBibber M, Zuckerman RA, Finalyson SRG. Rural
vs. Urban in-patient care-mix differences in the
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Finlayson SRG. Evidence-based Surgery in Souba
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Rajan Gupta, MD
Brady KA, Berry S, Gupta R, Weiner M, Turner BJ.
Seasonal variation in undiagnosed HIV infection
on the general medicine and trauma services of
two urban hospitals. JGIM 20:1-7, 2005.
Reilly PM, Schwab CW, Kauder DR, Dabrowski GP,
Gracias VH, Gupta R, Pryor JP, Braslow B, Kim P,
Wiebe DJ. The invisible trauma patient: emergency
department discharges. J Trauma 58(4):675-85,
2005.
Mancini DJ, Gupta R. Chylothorax & Chylous
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PA: Lippincott Williams & Wilkins, 2006. (in press)
Mancini DJ, Gupta R. Glasgow Coma Score (GSC)
in the ICU. In: Marcucci L, Martinez E, Haut E, et al.
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PA: Lippincott Williams & Wilkins, 2006. (in press)
Horace Henriques, MD
Curtis KM, Henriques HF, Fanciullo G, Reynolds
CM, Suber F. Fentanyl based Pain Management
Protocol provides a Safe and Effective Method
to reduce time to analgesia among adult trauma
patients. Journal of Trauma, accepted April 2006.
Erkmen K, Al-Mefty O. Diagnosis and Treatment of
Atypical and Anaplastic Meningiomas: A Review.
Neurosurgery 57:538-550, 2005.
Erkmen K, Al-Mefty O. Review, Use of Ultrasonic
Aspiration for Dural Opening in Cranial Reoperations: Technical Note. Neurosurgery 57(1) Operative Neurosurgery Supplement 1:E216, July 2005.
Erkmen K, Al-Mefty O. Review, Transcranial
Resection of Olfactory Neuroblastoma. Skull
Base: An Interdisciplinary Approach. Volume 15,
Number 3, 2005.
John Sutton Jr., MD
Pipas, J M, Barth R, Zaki B, Meyer L, Bettman M,
Colacchio T, Gordon S, Sutton J, Perez R, Cates
J, Lewis N, McDonnell C, Cole B. Docetaxel/
Gemcitabine followed by Gemcitabine and
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Adenocarcinoma. Ann of Surg Onc accepted 2006.
Erkmen K, Al-Mefty O. Review, Surgical
Management of Petroclival Chordomas: Report
of Eight Cases. Skull Base: An Interdiciplinary
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Gupta R, Gracias VH. Sepsis in trauma. Panam J
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Addante R. Verrucous Carcinoma. Oral & Maxillofacial Clinics of North America, Vol. 18, #4, 2006.
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Kadir Erkmen, MD
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management of petroclival meningiomas: factors
determining the choice of approach. Neurosurg
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Erkmen K, Al-Mefty O. Review, Clinicoradiological
and Surgical Considerations in the Treatment of
Cholesterol Granuloma of the Petrous Pyramid.
Skull Base: An Intercisciplinary Approach. Volume
15, Number 4, 2005.
Rocco Addante, MD, DMD
Addante R. Comprehensive Evaluation of the Oral
& Maxillofacial Tumor Patient. Oral & Maxillofacial
Surgery Knowledge Update, Volume #4, section:
Pathology and Oncology, 2006.
Gracias VH, Sicoutris CP, Meredith DM, Horan AD,
Gupta R, Haut ER, Auerbach S, Sonnad S, Hanson
CW, Schwab CW. Critical care nurse practitioners
improve compliance with clinical practice
guidelines in a “semi-closed” surgical intensive
care unit. (Submitted) CCM, 2006.
Morone MA, Ball PA. Spinal Traction. In Benzel EC
(ed): Spine Surgery: Techniques, Complication
Avoidance, and Management. Vol.2. Second Edition.
Philadelphia: Elsevier Churchill Livingstone, 2005.
Burchard K, Henriques HF, Walsh D, Ludington, D,
Rowland P, Likosky D. Is it Live or is it Memorex?
Student oral examinations and the use of video for
additional scoring. American Journal of Surgery
accepted June 2006.
Cotton BA, Gracias VH, Insko EK, Gupta R, Born
C, Schwab CW. The use of goniometry to predict
inadequate flexion-extension radiographs: A
preliminary study. J Trauma 59(2):396-401, 2005.
Gracias VH, Horan AD, Kim PK, Puri NK, Gupta R,
Gallagher JJ, Sicoutris CP, Hanson CW, Schwab
CW. Digital output pulmonary artery catheters
eliminate inter-operator variability and improve
consistency of treatment decisions. (Submitted)
Chest, 2006
Rosner MJ, Halliday AL, Ball PA. Medical
Management of the Patient with Spinal
Cord Injury. In Benzel EC (ed): Spine Surgery:
Techniques, Complication Avoidance, and
Management. Vol.2. Second Edition. Philadelphia:
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Neurosurgery
Perry A. Ball, MD
Loyd RD, Ball PA, Fanciullo, GJ. Surgical procedures
for intractable cancer pain. Techniques in Regional
Anesthesia & Pain Management 9:167-176, 2005.
Steinmetz MP, McCormick WE, Valadka A, Ball
PA, Yazbak PA, Benzel EC. Penetrating Spinal
Cord Injuries. In Benzel EC (ed): Spine Surgery:
Techniques, Complication Avoidance, and
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Elsevier Churchill Livingstone, 2005.
Erkmen K, Al-Mefty O. Review, Combined Anterior
and Anterolateral Approaches to the Cranial
Base: Complication Analysis, Avoidance, and
Management. Neurosurgery 58(4) Operative
Neurosurgery Supplement 2:ONS-327-ONS-337,
April 2006.
David W. Roberts, MD
Sun H, Roberts DW, Farid H, Wu Z, Hartov A,
Paulsen KD. Cortical surface tracking using a
stereoscopic operating microscope. Neurosurgery,
56 [ONS Suppl 1]: ONS-86-ONS-97, 2005.
Lunn KE, Paulsen KD, Lynch DR, Roberts DW,
Kennedy FE, Hartov A. Assimilating intraoperative
data with brain shift modeling using the adjoint
equations. Med Imag Anal 9:281-293, 2005.
Lee KH, Hitti FL, Shalinsky MH, Kim U, Leiter JC,
Roberts DW. Abolition of spindle oscillations and
3-Hz absence seizurelike activity in the thalamus by
using high-frequency stimulation: potential mechanism of action. J Neurosurg 103:538-545, 2005.
Sun H, Paulsen KD, Lunn KE, Farid H, Roberts DW,
Wu Z, Hartov A. Stereopsis-guided brain shift
compensation. IEEE Transactions Medical Imaging
24:1039-1052, 2005.
Whedon J, Quebada PB, Roberts DW. Spinal
epidural hematoma following spinal manipulative
therapy: Case report and review of the literature.
J Manipulative and Physiological Therapeutics (in
press).
Lee KH, Blaha CD, Harris BT, Cooper S, Hitti FL,
Leiter JC, Roberts DW, Kim U. Dopamine efflux in
the rat striatum evoked by electrical stimulation
of the subthalamic nucleus: Potential mechanism
of action in Parkinson’s disease. European J
Neuroscience 23:1005-1014, 2006.
Lollis SS, Weider DJ, Phillips JM, Roberts DW.
Ventriculoperitoneal shunting for the treatment of
refractory perilymphatic fistula. J Neurosurg 105:15, 2006. (in press)
Roberts DW. The principles and applications
of stereotactic neurosurgery and frameless
neuronavigation. In Latchaw RE, Kucharczyk J,
Moseley ME (eds): Imaging of the Nervous System,
Diagnostic and Therapeutic Applications, Vol. 2.
Philadelphia: Elsevier Mosby, 2005, pp 1357-1366.
Lee KH, Harris B, Roberts DW. Frame-based
stereotactic brain biopsy. In Schmidek HH, Roberts
DW (eds): Operative Neurosurgical Techniques:
Indications, Methods, and Results, 5th Edition,
in two volumes. Philadelphia, PA: W.B. Saunders
2005, pp 625-638.
Roberts DW: Section of the corpus callosum
for epilepsy. In Schmidek HH, Roberts DW (eds):
Operative Neurosurgical Techniques: Indications,
Methods, and Results, 5th Edition, in two volumes.
Philadelphia, PA: W.B. Saunders 2005, pp 1413-1421.
Roberts DW. Comment (on Oiwa Y, Nakai K,
Itakura T: Histological effects of intraputaminal
infusion of glial cell line-derived neurotrophic
factor in Parkinson disease model Macaque
monkeys. Neurol Med Chir (Tokyo) 46:267276,
2006). Neurol Med Chir (Tokyo) 46:276, 2006.
Joseph Paydarfar, MD
Paydarfar JA and Likosky DS. Organ preservation
and wound complications after salvage head and
neck surgery: Survey results of the membership
of the American Head and Neck Society. In
preparation.
Roberts DW. Comment (on Sinha TK, Miga MI,
Cash DM, Weil RJ: Intraoperative cortical surface
characterization using laser range scanning:
Preliminary results. Neurosurgery, in press).
Neurosurgery (in press).
Black C, Zarovnaya E, Marotti J, Paydarfar J. Frozen
section evaluation of head and neck margins.
Modern Pathology. 2006; 19: 204A-204A 949
Suppl. 1.
Roberts DW. Comment (on Campero A, Troccoli
G, Martins C, Fernandez-Miranda JC, Yasuda A,
Rhoton AL: Microsurgical approaches to the
medial temporal region: An anatomical study.
Neurosurgery, in press.) Neurosurgery (in press).
Roberts DW. Editorial, Fleet street redux. Stereotact
Funct Neurosurg 84, 2006. (on-line & in press)
Nathan E. Simmons, MD
Simmons NE. Surgical techniques in the
management of thoracic disc herniations.
In Schmidek HH, Roberts DW (eds): Operative
Neurosurgical Techniques: Indications, Methods,
and Results, 5th Edition, in two volumes.
Philadelphia, PA: W.B. Saunders 2005, pp 2007-2016.
Ophthalmology
Michael E. Zegans, MD
Zegans ME, Shanks RMQ, O’Toole GA. Bacterial
Biofilms and Ocular Infections. The Ocular Surface,
April 2005 3(2):12-19.
Roberts DW, Darcey TM. Applications in epilepsy
surgery. In Barnett GH, Maciunas RJ, Roberts DW
(eds): Computer-Assisted Neurosurgery, 2nd ed.
(in press)
Yang, P, Zegans ME. Immune Reconstitution
Uveitis. Specialty Clinical Update, http://www.aao.
org/vp/edu/uveitis/v1m2, American Academy of
Ophthalmology August, 2005.
Roberts DW. Fundamentals of registration. In
Barnett GH, Maciunas RJ, Roberts DW (eds):
Computer-Assisted Neurosurgery, 2nd ed. (in press)
Toutain CM, Zegans, ME, O’Toole GA. Evidence for
Two Flagellar Stators and Their Role in the Motility
of Pseudomonas aerugniosa. J. Bact. January 2005:
187(2); 771-777.
Roberts DW. Corpus callosotomy. In Engel Jr
J, Pedley TA (eds): Epilepsy: A Comprehensive
Textbook, 2nd Edition. Philadelphia, Lippincott
Williams & Wilkins. (in press)
Barnett GH, Maciunas RJ, Roberts DW (eds):
Computer-Assisted Neurosurgery, 2nd Edition.
New York, NY: Marcel Dekker Publishers/Taylor &
Francis Group, November, 2005.
Shanks RM, Donegan NP, Graber ML, Buckingham
SA, Zegans ME, Cheung AL, and O’Toole GA.
Heparin stimulates S. aureus biofilm formation.
Infection and Immunity, August 2005 73(8); 45964606.
Otolaryngology
Schmidek HH, Roberts DW (eds). Operative
Neurosurgical Techniques: Indications, Methods,
and Results, 5th Edition, in two volumes.
Philadelphia, PA: W.B. Saunders 2005.
Louise Davies, MD
Davies L, Welch HG. Increasing Incidence of
Thyroid Cancer in the US: 1973-2002. JAMA. 2006
295(18).
Roberts DW. Editorial, Deep brain stimulation. J
Neurosurg 103:399, 2005.
Davies L, Welch HG. Trends in the Epidemiology of
Head and Neck Cancer in the U.S. OtolaryngologyHead and Neck Surgery. In press.
Roberts DW. Comment (on Fujita Y, Muragaki
Y, Nambu K, Hori T, Iseki H: Three-way bipolar
forceps: A novel bipolar coagulator system
for nerve stimulation and detection of nerve
potentials. Neurol Med Chir (Tokyo) 46:169-175,
2006). Neurol Med Chir (Tokyo) 46:175, 2006.
Davies L, Hardin NJ, Beatty BG. Ki-67: Can it
predict recurrence for early tongue squamous
cell carcinoma? Annals of Otology, Rhinology and
Laryngology 2006 115(1).
Paydarfar JA, Birkmeyer NJ. Complications
in head and neck surgery: A meta-analysis of
postlaryngectomy pharyngocutaneous fistula.
Arch Otolaryngol Head Neck Surg. 2006;132:1-6.
Pediatric Surgery
Daniel Croitoru, MD
Lawson ML, Mellins RB, Tabangin MT, Kelly Jr
RE, Croitoru DP, Goretsky MJ, Nuss D. Impact
of pectus excavatum on pulmonary function
before and after repair with the Nuss procedure.
Presented at the American Pediatric Surgical
Association Meeting May 2004. J Pediatr Surg
2005 40:174-180.
Croitoru DP, Kelly Jr RE, Goretsky M, Gustin
T, Keever R, Nuss D. The Minimally Invasive
Nuss Technique for Recurrent or Failed Pectus
Excavatum Repair in 50 Patients. Presented at the
American Pediatric Surgical Association Meeting
May 2004. J Pediatr Surg 2005 40:181-187.
Coates EW, Karlowicz MG, Croitoru DP, Buescher
ES. Distinctive Distribution of Pathogens
Associated with Peritonitis in Neonates with Focal
Intestinal Perforation Compared with Necrotizing
Enterocolitis. Pediatrics 2005 116:e241-246.
Duhaime AC. When Should I Suspect Child Abuse
in Head-Injured Children? In: Neurotrauma:
Evidence-Based Answers to Common questions.
Valadka AB, Editor. Thieme Publishers, New York,
2005, 184-189.
Duhaime AC. Non-Accidental Head Injuries. In:
Albright L, Ed., Principles and Practice of Pediatric
Neurosurgery, Thieme Medical Publishers, 2006.
(in press)
Duhaime AC. Craniopharyngiomas: A Decade
Later. In: Schmidek H and Roberts D, Eds.
Operative Neurosurgical Techniques, 5th Edition.
Elsevier, Philadelphia, 2006, 433-436.
Gilles EE, Duhaime AC. Inflicted childhood
neurotrauma. In: Swaiman, Ashwal, and Ferriero,
Eds., Pediatric Neurology, Elsevier, Philadelphia,
2006, 1445-1470.
Duhaime AC. Evaluation and management of
shunt infections in children with hydrocephalus
(review). Clinical Pediatrics 2006. (in press)
Judkins ER, Porter B, Cook N, Clancy RR, Duhaime
AC, Golden JA. Dystrophic neuritic processes in
epileptic cortex. Epilepsy Research, April 2006.
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Lollis SS, Hug EB, Gladstone DJ, Chaffee S,
Duhaime AC. Acquired Chiari I malformation after
fractionated radiation therapy to the anterior skull
base in a 20 month old boy. J Neurosurgery 104(2
Suppl):133-137, Feb 2006.
Duhaime AC, Saykin AJ, McDonald BC, Dodge
CP, Eskey CJ, Darcey TM, Grate LL, Tomashosky
P. Functional magnetic resonance imaging of
the primary somatosensory cortex in piglets. J
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Duhaime AC. Large animal models of traumatic
injury to the immature brain. Developmental
Neuroscience, 2006. (in press)
Durham SR, Duhaime AC. Maturation-dependent
response of the immature brain to experimental
subdural hematoma. Journal of Neurotrauma
2006. (in press)
Susan Durham, MD
Selden N, Durham S, Anderson G, Braner D.
Intracranial navigation using a novel device for
endoscope fixation and targeting: Technical
innovation. Pediatric Neurosurg 41:233-236, 2005.
Durham S, Duhaime AC. Maturation-dependent
response of the immature brain to experimental
subdural hematoma. J Neurotrauma, in press.
Durham S, Liu K, Selden N. Utility of serial
computed tomography in pediatric head trauma, J
Neurosurgery, in review.
Durham S. Huang J. Surgical Management of
Sciatic Nerve Lesions. In Operative Neurosurgical
Techniques: Indications, Methods and Results,
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Plastic Surgery
Hegel M, Collins E, Kearing S, Gillock K, Moore C,
Ahles T. Sensitivity and Specificity of the Distress
Thermometer for Depression in Recently Diagnosed
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Carolyn Kerrigan, MDCM, MSc
Kerrigan CL, Discussion: Prospective Study of
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Cunningham BL, Gear AJL, Kerrigan CL, Collins
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2005. 115(6): p. 1597-1604.
Joseph Rosen, MD
Rosen Joseph, Koop J. Everett, Grigg Elliott:
The Biological Disaster Challenge. Journal of
Emergency Management, January/February 2005
or March/April 2006
Mitchell Stotland, MD, CM
Ouhilal, S, Turco J, Nangia A, Stotland MA, and
Manganiello PD, True hermaphroditism presenting
as bilateral gynecomastia in an adolescent
phenotypic male. Fertil Steril. 2005 Apr;83(4):1041
Stotland MA and Chang WT. A Better Template for
Microtia Reconstruction: The Waterproof, MirrorImage Digital Photograph of the Contralateral Ear.
Accepted for publication, 10-2005, in press Plast.
Recons. Surg.
Stotland MA, Kowalski JW, Ray BB. PatientReported Benefit and Satisfaction with Botulinum
Toxin Type A Treatment of Moderate to Severe
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Transplantation Surgery
E. Dale Collins, MD
Collins ED, Kerrigan CL. New Trends in Clinical
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York, NY 2006
David Axelrod, MD
Kaufman DB, Leventhal JR, Axelrod DA, Gallon LG,
Parker MA, Stuart FP. Campath 1-H induction and
prednisone-free maintenance immunotherapy
in kidney transplantation. Comparison with
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Cunningham BL, Gear AJL, Kerrigan CL and Collins
ED. Analysis of Breast Reduction Complications
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Axelrod DA, Al-Saden P, McNatt G, Sumner S,
Dixler I, Vaci M, Abecassis MM. The economic
impact of MELD on liver transplant centers. Amer J
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Collins ED. Invited discussion: Randy S. Roth,
Ph.D., Julie C. Lowery, Ph.D., Jennifer Davis,
M.H.S.A. and Edwin G. Wilkins, M.D., M.S, Quality
of Life and affective distress in women seeking
immediate versus delayed breast reconstruction
following mastectomy for breast cancer. Plastic and
Reconstructive Surgery 116 (4): 1003-1005, 2005.
Axelrod DA, Leventhal JR, Gallon LG, Parker
MA, Kaufman DB. Reduction of CMV Disease
with Steroid-free Immunosuppresssion in SPK
Transplant Recipients. Amer J Transplantation.
2005;5:1423-9.
Hegel M, Moore C, Collins E, Kearing S, Gillock
K, Riggs R, Clay K, Ahles T. Pre-surgical Distress,
Psychiatric Syndromes and Health Related
Function In Women with Newly Diagnosed Breast
Cancer. Submitted to Cancer.
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Axelrod DA, Guidinger MK, Metzger RA, Wiesner
RH, Webb RL, Merion RN. Transplant Center
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Surgical Lab
P. Jack Hoopes, DVM, PhD
Chen B, Pogue BW, Zhou X, O’Hara JA, Solban N,
Demidenko E, Hoopes PJ, Hasan T. Effect of Tumor
Host Microenvironment on PDT in a Rat Prostate
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Hoopes PJ, Bergeron JA, Eskey C, Patel S, Attawia
M, Pelligrino R, Ryan TP. Radiofrequency ablation
of the basivertebral nerve as a potential treatment
of back pain; pathologic assessment of an ovine
model. Invited paper / manuscript. Proc SPIE,
volume 5617, pg 156-175, 2005.
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2006 - Health Care Professionals - Dartmouth

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