Spring/Summer 2012 - Health Care Professionals

Transcription

department of surgery newsletter SPRING/SUMMER 2012
Department of Surgery
NEWS
SPRING/SUMMER 2012
CONTENTS
A Note from the Chair......................................................................2
12 D-H Surgeons Top Doctors in NH................................................. 3
Pancreas Autoislet Cell Transplant Program . . ................................... 4
New Hope for Peripheral Artery Disease Patients............................ 6
Care Path Update . . ........................................................................... 8
2012 Surgery Graduates.................................................................... 8
2012 Internship/Residency Placements . . ........................................... 9
New Faculty.................................................................................... 10
Grant, Clinical Trials & Research News........................................... 11
Awards & Personal Accomplishments.............................................. 12
Calendar of Events.......................................................................... 13
In Memorium, Richard (Dick) Karl, MD. . .......................................... 14
VISIT THE DEPARTMENT OF SURGERY WEB SITE
Newsletter contact: [email protected]
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copyright © 2012, Dartmouth-hitchcock
chair’s note | Richard B. Freeman Jr., MD
Dear Colleagues:
As you will see from this second newsletter,
the Department of Surgery is vibrant and vital
here at Dartmouth with many new exciting
developments. Notably, Dartmouth Medical
School has been renamed The Geisel School of
Medicine at Dartmouth in honor of Audrey and
Theodor Geisel, and their generosity to Dartmouth
during their lifetimes and in their estate plan.
Richard B. Freeman Jr., MD
Theodor Geisel, better known as Dr. Seuss, was a
Dartmouth alumnus and long-time benefactor of Dartmouth. In time, the Geisel’s
philanthropy will directly benefit students and faculty in our Department and
across the School. In addition to this exciting development, you will see that the
Department of Surgery at The Geisel School is growing and pursuing many new
ventures, only some of which can we outline here.
Cell-based therapies for surgical diseases have taken front stage in two
separate areas in our Department. Dr. Richard Powell and the Section of
Vascular Surgery have published interim results from the RESTORE trial
(see page 6 ), showing improved limb salvage for patients with critical
limb ischemia who received stem cells compared with placebo. These
encouraging results suggest that there may be hope for patients with critical
limb ischemia and who have no other revascularization options. Drs. David
Axelrod and Kerrington Smith in collaboration with Dr. Tim Gardner from
Gastroenterology performed our first auto islet cell transplant here at DHMC
in May (see page 4). In this novel treatment, patients with intractable pain
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from chronic pancreatitis undergo total pancreatectomy, have their islet cells
isolated from the excised pancreas and then have these insulin producing cells
re-infused to prevent the brittle diabetes that usually complicates the total
pancreatectomy procedure. This treatment can offer a good chance at curing
the chronic pain with normal or near normal blood sugar control.
In other developments, members of the Department
visited Muhimbili University Medical Center in Dar
Es Salaam Tanzania in April as part of an education
exchange program and planed for a more robust
exchange of faculty and residents in the future.
Many surgeons are now involved in development of surgical care paths.
These are defined patient trajectories in which documentation and orders are
standardized along pre-defined process flow charts and for which outcomes
are tracked in real time. These are a first step in meeting the need to “bundle”
surgical care.
Lastly, as federal funding for graduate medical education gets cut again,
we are asking for your help. Our trainees need funding for research, travel
to meetings, seminars, and a variety of other opportunities all aimed at
enhancing their educational experiences. Please help to support resident
research and education within the Department (see page 14). Your generosity
will ensure our ability to continue to train the best and the brightest.
department of surgery
NEWS
12 Dartmouth-Hitchcock Surgeons Cited as Top Doctors in NH
New Hampshire Magazine named 51 Dartmouth-Hitchcock physicians,
spanning 40 different specialties, to its list of the leading physicians in New
Hampshire, in the magazine’s April edition.
The 2012 edition of “Top Doctors” also features Q & A sessions with cover
photographs of six New Hampshire clinicians including ophthalmologist Susan
M. Pepin, MD. In her response on the rewards of her profession, Pepin cites
“helping a patient better understand what is going on with their health (or)
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symptoms, even if it can’t be fixed.” And she describes that understanding as
a two-way street: “Medicine has limitations in what it can do. Sometimes we
may fall short of their expectations—not due to any particular failings, but
due to the fact that although we can try to improve quality of life, none of us
will live forever.”
12 Top Surgeons
Rocco R. Addante, DMD, MD – Oral & Maxillofacial Surgery
M. Shane Chapman, MD – Dermatology
Lawrence Dacey, MD, MS - Cardiothoracic
Anthony W. DiScipio, MD - Cardiothoracic
Benoit J. Gosselin, MD – Otolaryngology
Susan M. Pepin, MD – Ophthalmology
Richard Powell, MD - Vascular Surgery
David W.Roberts, MD - Neurosurgery
Kari M.Rosenkranz, MD – Breast Surgery
John D. Seigne, MD – Urology
Rosalind A. Stevens, MD – Ophthalmology
NEWS
Pancreas Autoislet Cell Transplant Program
In 2012, DHMC initiated a new program for patients with a history of
chronic pancreatitis who live with severe, unrelenting pain. Chronic
pancreatitis is a life-long condition that results from a variety of factors
including mutations in the CF gene, hypertriglyceridemia, abnormal
ductal development and alcohol abuse. Patients frequently have severe
pain resulting in chronic narcotic dependence, employment disability
and depression.
Chronic pancreatitis requires a multi-disciplinary care approach
including pancreatology, interventional gastroenterology, pain
management, social work and surgery. Medical management of
this condition can improve nutrition, manage malabsorption from
exocrine insufficiency, and improve pain management leading to
reduced narcotic requirements. However, for patients who fail medical
management, surgery offers improved pain control. Traditional surgical
approaches for patients with chronic pancreatitis include procedures
to improve drainage, partial resection of head of the pancreas or total
pancreatectomy. As these procedures remove functional endocrine
tissue, patients frequently develop brittle type I diabetes, further
impairing their quality of life.
Surgeons Kerrington
Smith, MD (above) and
David Axelrod, MD (left)
performed DartmouthHitchcock’s first
autoislet transplant on
May 2, 2012.
The autoislet cell transplant procedure involves total or near total
pancreatectomy, recovery of the islet cells from the resected specimen
and reinfusion of the islets into the patient’s liver via the portal vein.
The islets function within the liver restoring glycemic control. In the
largest series, 2/3 of patients remained insulin free or required only a
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Pancreas Autoislet Cell Transplant Program (continued)
low dose of insulin. These patients are largely pain free or on minimal doses
of narcotics.
On May 2, 2012, DHMC performed our first autoislet transplant. Our patient
was a young man who underwent a subtotal pancreatectomy for a disrupted
pancreatic duct from severe pancreatitis. He underwent a series of complex
endoscopic interventions by Tim Gardner MD. Despite these procedures,
he had persistent pain. Surgeons Kerrington Smith, MD and David Axelrod,
MD removed the distal 80% of the patient’s pancreas. Dr. Axelrod then drove
the pancreas to our partners at Massachusetts General Hospital where the
islets were recovered, while Dr. Smith completed the surgical reconstruction.
Dr. Axelrod then returned and together they infused the islets into the liver.
Interestingly, the patient developed hyperglycemia requiring insulin infusion
during the time that the islets were being recovered. Following infusion,
his insulin requirement abated. He is now insulin free, off narcotics and very
satisfied.
We have several additional patients who are currently completing their
multidisciplinary evaluation and are being prepared for transplant. There
are currently no other programs in the North Eastern United States actively
pursuing this innovative approach. We anticipate a significant growth in
the program given the large pancreatology care team led by Dr. Gardner in
Gastroenterology. We are pleased to have developed a true, collaborative
multidisciplinary team lead by Drs. Gardner, Axelrod and Smith.
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NEWS
Dartmouth-Hitchcock Research Offers New Hope for Patients with Critical Limb Ischemia (CLI)
Research led by vascular surgeons at Dartmouth-Hitchcock may offer new hope
to sufferers of peripheral artery disease, the cause of nearly 60,000 lower-limb
amputations annually, through the use of a patient’s own stem cells.
Richard J. Powell, MD, Chief of Vascular Surgery at Dartmouth-Hitchcock,
is the principal investigator on a national study—involving 550 patients at
80 sites around the country—of so-called “no option” patients, for whom
the disease is so advanced that amputation is the only available treatment.
Powell’s study is now a three-year, third-stage clinical trial, after second-stage
trials showed remarkable success at treating patients with CLI. The final
results of the second-stage clinical trial have been published in the April, 2012,
issue of Molecular Therapy.
Peripheral artery disease (PAD) afflicts more than 9 million patients in the
United States. The condition results from blockage in blood vessels caused
by atherosclerosis—hardening of the arteries—which can be a consequence
of diabetes, high cholesterol, smoking, genetic predisposition and other
circumstances. In many cases, endovascular therapies such as insertion of
stents or bypass surgery – similar to surgical processes used to treat blockages
in the arteries of the heart – are used to reintroduce blood flow to the legs.
But in about 150,000 patients with the most-severe forms of CLI, the disease
is so extensive that endovascular therapy isn’t an option. That’s where
Powell’s stem cell study comes in.
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Richard J. Powell, MD, chats with a patient at Dartmouth-Hitchcock Medical
Center.
Dartmouth-Hitchcock Research Offers New Hope for Patients with CLI (cont)
“All of us have stem cells in our bone marrow, and these stem cells can be utilized to repair other
parts of our bodies,” says Powell. “By taking the patient’s own stem cells and injecting them into
the ischemia leg, our hope is that we will improve the blood flow in that part of the leg.”
In the study, bone marrow is removed from the patient’s hip, and then sent to a lab where stem
cells are separated from the marrow and incubated over a two-week period, allowing more stem
cells to grow. The stem cells are then re-injected intramuscularly into about 20 different spots in
the patient’s leg.
“We found that patients who received the stem cell therapy had a significantly lower incidence of
amputation at six months than patients who received a placebo,” said Powell. After six months of
the second-stage trials, approximately half of the patients who received a placebo died, required
an amputation or saw their leg wounds worsen. Of those receiving the stem cell therapy, only a
quarter died, required amputation or saw wounds worsen. Many showed significant improvement
in blood flow in the ischemic limb.
The final results of the secondstage clinical trial have been
published in the April, 2012,
issue of Molecular Therapy.
“What is truly remarkable was that it was a relatively small number of patients, but that we saw
clinically significant improvement in the stem cell-treated patients” he says. “It’s compelling
enough that there’s no question that the pivotal trial needs to be done as quickly as possible.”
The phase three trial has just begun, in which half of the patients will receive stem cell therapy
and half will receive the placebo, measuring incidents of amputation or death one year after
the treatment. “We really want to see a therapy that’s effective out to a year.” says Powell.
“Nonetheless, the results so far are really promising.” (See video of Dr. Powell discussing
Peripheral Artery Disease and his study on Dartmouth-Hitchcock’s YouTube Channel at
http://www.youtube.com/playlist?list
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NEWS
2012 surgery graduates
Care Path Update
2012 Surgery Graduates
This has been an exciting year for the Department of Surgery’s Clinical
Pathway Development Program. There are currently 13 teams participating in
this year’s competition. The planned submission deadline is in mid-October,
after which judging will commence. The prize remains at $25,000, to be
awarded at a November 28th ceremony. The Section of Otolaryngology, led
by Section Chief Dan Morrison, MD, was the winner of last year’s inaugural
competition for their Head and Neck Cancer submission. The ENT team has
used their winnings to hire a microsystems expert, who has facilitated the
implementation and methods of measurement for that pathway.
General Surgery
Kathyrn Davis, MD - Vascular Surgery, Emery
Isak Goodwin, MD - Plastic Surgery, Utah
We have developed a training guide and specific judging criteria to
bring increased clarity of departmental expectations. Many sections
have broadened their scope and are designing pathways that are truly
multidisciplinary. The Value Institute has helped with facilitation and has
begun providing Lean Greenbelt training, which will speed up pathway
development and dissemination of data.
This year’s competition put a stronger focus on measurement, which includes
financial, process and outcomes-based data. Data will be obtained from
a variety of sources including the National Surgical Quality Improvement
Project (NSQIP), The University Health Consortium and from the electronic
medical record itself. This data will help to better understand how we deliver
care and will serve as an excellent tool for continuous process improvement.
We look forward to sharing this data freely with all, and will continue to send
updates on our progress as the months go on.
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Neurosurgery
William (BJ) Spire, MD – Private practice. Billings, Montana
Otolaryngology
P. Tate Maddox, MD – Private practice. Abingdon ENT, Abingdon VA.
Affiliated with Johnston Memorial Hospital
Plastic Surgery
Michael M. Van Vliet, MD – Critical Care & Burn Fellowship, University of
Southern California & Los Angeles County
Urology
Peter Jones, MD – Private practice, Idaho
Einar Sverrisson – Urologic Oncology, Moffitt Cancer Center, Tampa, FL
THE geisel school of medicine at dartmouth
NEWS
Surgery Clerkship Expands
The Surgery Clerkship at The Geisel School of Medicine at Dartmouth
underwent transformative changes for the 2012-2013 academic years.
The third-year rotation expanded to an 8-week block, allowing the
students to rotate on two services or surgical subspecialty. Expansion
of faculty learning leaders, revision of didactic weekly sessions with
a multidisciplinary approach, the addition of biopsy skills teaching to
our suture course, and a great effort to provide timely and frequent
feedback have improved the education we provide to our third-year
clerkship. Dr. Gina Adrales joined Dr. Horace Henriques this year as
co-director of the clerkship program. Dr. Kenneth Burchard remains an
integral educator and Dr. Andrew Crockett has taken on a more active
role. Our efforts in teaching and modeling communication skills have
been recognized by Dr. Richard Simons, our new Senior Associate
Dean for Medical Education.
The Geisel School of Medicine at Dartmouth
Class of 2012
Internship/Residency Surgical Placements
General Surgery
Dartmouth-Hitchcock Medical Center – 1
UC Davis Medical Center – 1
Dermatology
Massachusetts General Hospital – 1
Neurological Surgery
Brigham & Women’s Hospital – 1
Ophthalmology
Massachusetts Eye and Ear Infirmary – 1
Scheie Eye Institute – University of Pennsylvania – 1
Plastic Surgery
University of Texas Southwestern Medical School - 1
Urology
University of Connecticut Health Center – 1
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New Faculty
General Surgery
Pediatric Neurosurgery
Konstantinos Spaniolas, MD
David Bauer, MD
Ophthalmology
Urology
Ronald Swendris, MD
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Elias Hyams, MD
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Grant, Clinical Trials & Research News
Neurosurgery
5/4/12: Kimon Bekelis, MD – MRI/MRA Fusion Technique for Intraoperative
Navigation during Microsurgical Resection of Cerebral Arteriovenous
Malformations
5/4/12: Kimon Bekelis, MD – Motor and Somatosensory Evoked Potential
Monitoring during Aneurysm Surgery: Effect on Outcome and Surgical
Strategy
12/6/11: David Roberts, MD – Subdural Inter-hemispheric Grid Electrodes for
Intracranial Epilepsy Monitoring: Feasibility, Safety and Utility
Otolaryngology
2/23/12: Eunice Chen, MD – The Role of Hypoxia and Hypoxia-Inducible
Pathways in the Pathogenesis of Head and Neck Diseases
Plastic Surgery
7/30/12: Carolyn Kerrigan, MD – Evaluating Accuracy and Reliability of Hand
Symptom Diagrams in the Diagnostic Workup of Carpal Tunnel Syndrome
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Vascular
12/6/11: Mark Fillinger, MD – The Pivotal Study of Aptus Endovascular AAA
Repair System
4/5/12: Mark Fillinger, MD – Clinical Trial Protocol, CP-0004, Rev. 02.
Prospective, Multicenter, Single Arm Safety and Effectiveness Trial of the
Endologix Fenestrated Stent Graft System for the Endovascular Repair of the
Juxtarenal/Pararenal Aneurysms
5/9/12: Mark Fillinger, MD – INSPIRATION: A Multcenter, Open Label,
Prospective, Non Randomized, Study of the INCRAFT Stent Graft System in
Subjects with Abdominal Aortic Aneurysms
6/26/12: Mark Fillinger, MD – ANCHOR: Aneurysm Treatment using the
HeliFX Aortic Securement System Global Registry
2/22/12: Richard Powell, MD – 55-1009-01 A Mutli-center Randomized
Double-blind, Placebo-controlled Parallel Group Study to Evaluate the
Efficacy, Safety, and Tolerability of Ixmyelocel-T in Subjects with Critical Limb
Ischemia and No Options for Revascularization
7/19/12: Richard Powell, MD – SuperNOVA: Stenting of the Superficial
Femoral and Proximal Popliteral Arteries with the Boston Scientific INNOVA
Self-Expanding Bare Metal Stent System
5/11/12: Eva Rzucidlo, MD – Pivotal Study of the Safety and Effectiveness of
Autologous Bone Marrow Aspirate Concentrate (BMAC) for the Treatment of
Critical Limb Ischemia due to Peripheral Arterial Disease
awards & personal accomplishments
Richard Barth JR., MD has been invited as a speaker for the GIST seminar
at the ACS meeting in October. He has also been selected as a specialty
physician in the top 1% nationally in the recent best hospital edition of the
U.S.News and World Report
Crichlow Award: Eunice Chen, MD – Otolaryngology – Correlation
and assessment of tumor hypoxia and nanoparticle-based intracellular
hyperthermia cancer treatment using murine and spontaneous pet animal
head and neck tumor models.
Dow Award: Eva Rzucidlo, MD – Vascular – Novel Targets of Statins in the
Treatment of Intimal Hyperplasia.
Dale Collins Vidal, MD has received funding from the Informed Medical
Decisions Foundation (formerly Foundation for Informed Medical
Decision Making- FIMDM) to continue demonstration projects focused on
implementing shared decision making in practice for patients in the spine,
diabetes and primary care practices. This award also makes it possible to
continue to provide high quality, evidence-based video decision aids for
patients through the Center for Shared Decision Making (CSDM) located at
3P. Visit the CSDM intranet site DHMC CSDM intranet for a list of available
video decision aids (DAs), instructions for ordering DAs in EPIC, provider
summary tools and clinician SDM resources.
The Dartmouth College Board of Trustees is receiving an award to collaborate
with 15 large health care systems around the country to hire Patient and
Family Health Coaches (health coaches). The health coaches will be trained
to engage in shared decision making with patients and their families, focusing
on preferences and supplying sensitive care choices. Health coaches may
work with patients at a single decision point or over multiple visits for those
with chronic conditions. It is anticipated that this intervention will lead to
a reduction in utilization and costs and provide invaluable data on patient
engagement processes and effective decision making—leading to new
outcomes measures for patient and family engagement in shared decision
making. Dr. Vidal will play an important role as a shared decision making
clinical innovation lead for the effort.
Jessica Wallaert, MD – Lead author and researcher: (Reuters Health) – One
in five people who get artery-clearing surgery to prevent a stroke are likely too
old and sick to live long enough to benefit from the procedure, according to a
new study
Ronald Yap, MD has created mobile apps “Prostate Pal” and “Bladder Pal”
to empower patients worldwide to track urologic health. To date, there have
been over 10,000 visits from 69 countries. Dr. Yap can be reached @ ryap@crhc.
org
Kathryn Zug, MD, Mari Paz Castanedo, MD(1st year resident) and Courtney
Kozlowski (Research Assistant) presented results on a study of results on a
study from patch testing at the European Society on Contact Dermatitis in
Sweden, June 2012
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calendar of events
TAKE NOTE
Department of Surgery Grand Rounds
Dermatology Moving to Heater Road, Fall 2012
9/14/12Plastic Surgery
Carolyn Kerrigan, MD – DHMC
Dale Collins Vidal, MD – DHMC
9/21/12Neurosurgery
Matthew A. Howard, III, MD – University of Iowa
9/28/12 Vascular Surgery
Cantwell Clark, MD – DHMC
Steven Yule, PhD – Brigham and Women’s Hospital
Dartmouth-Hitchcock Heater Road, which is now
under construction and scheduled to open in the
fall of 2012, will house primary care, outpatient
rehabilitation, functional restoration, dermatology,
phlebotomy and the sleep disorders center.
10/5/12Teaching Teachers Robert Witherspoon – President, Performance and
to Teach
Leadership Development, Ltd
Richard M. Frankel, PhD – University of Indiana
Ann Davis, MD – The Geisel School of Medicine at Dartmouth
Richard Simons, MD MBA – The Geisel School of Medicine
at Dartmouth
10/19/12General Surgery
Anthony J. Beisler, MD, MBS, FAC – Medical Director,
Permedian, Inc.
an HMS Company
Robert Montgomery, MD – Johns Hopkins
12/14/12Transplant
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in memoriam
DONATE TO THE DEPT. OF SURGERY
Richard (Dick) Karl, MD
DOS Chair 1970 – 1980
In 1970 Dr. Karl became
the first Chair of the
Department of Surgery
at Dartmouth. In his role
as clinical leader he was
admired for his clear
thinking and advocacy
for medical students
and residents. Dr. Karl
served as chair for ten
years and continued in a
clinical capacity until his
retirement in 1990. New
Hampshire particularly suited Dick Karl. He and his wife,
Lucy, held frequent dinners and gatherings at their house in
Etna for residents and faculty. The Karl family hopes that you
will make a contribution to your own life, take time to smell
the flowers, enjoy your own gardens and savor time with your
loved ones.
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Remember when . . .
Think back to when you were a resident at Dartmouth-Hitchcock. Was there a
professional meeting that you wanted to attend? Was there a research question you
were dying to sink your teeth into? How did you find the money you needed to take
advantage of such opportunities? Surgical residents at Dartmouth-Hitchcock are
eager for research, training, and networking opportunities. Right now, our residents
are in need of funding to conduct research, to travel to professional meetings, do
rotations in global surgery and further enrich this critical time in their professional
lives. With a gift to the Department of Surgery at Dartmouth-Hitchcock, you can
advance a young doctor’s career in real and meaningful ways. To make a gift today,
go online to http://dartmouth-hitchcock.org/surgery donate or make a check out to
the Surgical Educational Fund and mail it to: Office of Development / D-H and The
Geisel School of Medicine / One Medical Center Drive, HB 7070 / Lebanon, NH,
03756-0001. For more information, contact Rick Peck, Director of Gift Planning, at
(603) 653-0735. Our residents and faculty thank you for your generosity.
keep in touch
Alumni News: We are interested in what you are up to now and any individual
accomplishments. Send a quick note and your contact information to Jo-Ann.
[email protected]

Spring/Summer 2012 - Health Care Professionals

Transcription

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