Newsletter  - Fall 2006

From Where l Sit..
Richard L. Gamelli, MD, FACS

At Loyola our Catholic heritage and Jesuit traditions has embodied within in it a commitment to serve. Albert Schweitzer noted "I don't know what your destiny will be, but one thing I know: The ones among you who will be really happy are those who have sought and found how to serve". Service takes many diverse forms and happens every day on an institutional, departmental and personal level at Loyola. How we give back to society is often a hidden reflection of the character of our people. Over my years as Chair I have seen many forms of service performed by members of our department. Much of it takes place not in public view but buried within our everyday lives. For most it takes the form of volunteerism. We may sit on boards, chair committees, and help within our schools. It is quiet and often unrecognized as most us would want it to be.

In our department there are two members of our faculty who deserve special mention for their commitment. In this edition of the newsletter, we reported on the work of Dr. Elizabeth Kovacs, Vice Chair for Research and Associate Director of the Burn and Shock Trauma Institute and her efforts with the Corazón Community Services to provide work and educational opportunities to the youth of the Town of Cicero. This is but one example of Dr. Kovacs’ longstanding commitment to such activities. Her laboratory each summer is often filled with students who have by her efforts the opportunity to learn about science and medicine early on in their educational career.

I am also in great admiration of life long service of Dr. Juan Angelats.  His Medical Mission to Peru has been the focus of a number of our newsletter reports. This mission brings healthcare to the underserved in Peru has not been just a one time event. It has been a lifetime of service. For Juan I believe the statement "If, in the course of my life, it has been in any degree useful to the cause of humanity, the fact itself bears its full reward" likely is sufficient recognition for him. (TJ to D Barrow, L&B.14.296 1815 May 1)

In the spirit of service and in recognition to Juan’s life long commitments I am making two announcements.  First, the Department of Surgery will begin to support a service project for senior year residents in our department to participate these efforts. There will be two awards per year and residents will compete for these awards and present their experiences at the Department’s Grand Rounds. This experience can be assisting Dr. Angelats with the Medical Mission to Peru or other such service missions. Second, the Department of Surgery is establishing an award in Dr. Angelats’ name to recognize service by our faculty, staff, alumni, fellows and residents. Although the individual award winners like Dr. Angelats have never sought recognition it is proper and more that appropriate that that we acknowledge their efforts. We will announce the recipient of this year’s award at our annual farewell and welcome dinner in June 2007.  

Feature Articles

Departmental Website Unveils The Endowment Fund Section

The Department of Surgery Website has a new section that was unveiled on September 8, 2006.  The Endowment Fund section outlines the Surgical Education &  Research Endowment Fund.  The goal for this Endowment is to raise a total of $5 million over the next five years. The Department has been in the silent phase of raising money for that endowment and has made a sizable contribution. 

Ms. Miller’s career was in the field of home economics education as well as retailing for 40 years, 27 of which were in Vermont. She retired from the South Burlington school system, where she was department chairwoman of family living.    She  invited Dr. Gamelli to speak with her class regarding trauma injuries and burns.    Dr. Gamelli shared some personal reflections on Ms. Miller saying she was an amazing and elegant woman.   They developed a life-long relationship and kept in touch with one another.  

Physicians Earn Ph.D. During Residency

Two Loyola general surgery residents felt so called to do basic science research that they took the unusual step of taking three years out of their residency to earn their Ph.D.

Luke Brewster, M.D., M.A., third-year resident, and Ankush Gosain, M.D., fourth-year resident, completed their doctoral studies in cell biology at Loyola University Chicago Stritch School of Medicine this year. They will receive their Ph.D. in December. The doctors are now serving their clinical rotations in the Department of Surgery. 

Both residents believe that their basic science knowledge will help their clinical skills.  

“Basic science allows you to have a more rigorous and methodologic approach to solving problems,” Brewster stated. His research was in vascular biology. 

Gosain, whose research focused on wound healing, said, “One of the big advantages of lab work is that you learn to ask the right questions to get to the answer.” 

Improving wound healing 

Gosain did his first three years of residency at Rosalind Franklin University of Medicine and Science (formerly Chicago Medical School). He chose to complete his general surgery residency at Loyola, he said, because it offers a broad range of surgical experience and because Department Chair Richard Gamelli, M.D., “has an international reputation in the world of surgery.”  

After his third year of residency, Gosain was funded by a National Institutes of Health (NIH)-sponsored research fellowship in the Burn and Shock Trauma Institute of Loyola University. He studied how the sympathetic nervous system modulates immune function during wound healing. 

“I saw that the project I was working on had a lot of potential,” Gosain said. He then decided to add a third year in the lab and get a Ph.D. Another aspect of his research was to find a way to regulate blood vessel formation to promote scarless healing. 

After completing his residency in June 2008, Gosain plans to do a pediatric surgery fellowship. He said he finds it rewarding to perform successful operations in ill children, especially those with pyloric stenosis. “Almost immediately after surgery, these children are better,” he said. 

Eventually Gosain hopes to have a lab of his own, where he can do translational research in an academic setting.  

Preventing complications of vascular surgery 

Brewster, who also did an NIH postdoctoral research fellowship at Loyola, described his Ph.D. work as developing two novel combined treatment approaches for vascular disease. His faculty mentor was Howard P. Greisler, M.D., professor of surgery at Stritch. 

“After vascular surgery, the endothelium doesn’t grow back completely, and vascular smooth-muscle cells proliferate,” he said. “I attempted to create a new gene protein to stimulate endothelial cell regeneration after injury due to surgical intervention and to limit vascular smooth-muscle cell activation after angioplasty or endarterectomy.” 

Already, Brewster has won several research awards, including from the American Vascular Association and the International Society of Applied Cardiovascular Biology. He also holds a master’s degree in bioethics and health policy from Stritch. 

The treatment approaches that Brewster developed will be helpful, he believes, in testing other therapeutic approaches in the field of vascular surgery. After completing his residency, he plans to become a vascular surgeon and basic science researcher in an academic setting.

“Without basic science,” Brewster said, “drug development will stagnate.”  

Clinical Spotlight

Plastic Surgeon Enjoys Challenges of Microvascular Surgery

When Loyola plastic and reconstructive surgeon Darl Vandevender, M.D., begins reconstruction of a large anatomical defect, such as in a head and neck cancer patient, he sometimes thinks there is no possible way to fix it.

And then he finds a way.

An associate professor of surgery in the Stritch School of Medicine, Vandevender said many of the surgical cases he sees are technically challenging. “A lot of the decision making is done on your feet during the surgery,” he said.

Reconstruction is a challenge he clearly enjoys. Vandevender most often performs head and neck reconstruction after cancer, but his work also includes reconstruction of craniofacial defects, breast reconstruction, hand surgery and reconstruction of the lower extremity.

Fellowship trained

Since 1995, Vandevender has been chief of the section of microvascular surgery within the Department of Surgery. He frequently uses free tissue transfers, which he said can heal almost any defect, whether due to a tumor, trauma or surgery. “Most of the time, a free tissue transfer is a procedure of necessity,” said Vandevender. “Nothing else will work.” Such situations may involve a patient who was heavily irradiated or had much of the jawbone removed.

Vandevender was so interested in microvascular surgery after completing his general surgery and plastic surgery residencies at Loyola University Medical Center that he went on to perform a clinical fellowship in hand surgery and microsurgery. He received his fellowship training at the Medical College of Wisconsin in 1995.

A team player

In the decade since then, Vandevender has worked closely with many other Loyola surgeons, including orthopedic surgeons, otolaryngologists, obstetrician-gynecologists, and oral and maxillofacial surgeons.

One of the colleagues who call Vandevender a dedicated and talented surgeon is Mark Steinberg, D.D.S., M.D., professor of surgery and chief of the oral and maxillofacial surgery section. Steinberg said he relies heavily on Vandevender’s expertise to make cases of head and neck reconstruction successful.

“I rarely see one of his free tissue transfers not work,” Steinberg said. “He gets fantastic results with microvascular anastomoses. He is a great resource.”

Guy J. Petruzzelli, M.D., Ph.D., professor, Department of Otolaryngology-Head and Neck Surgery, has witnessed Vandevender’s surgical care of more than 200 patients with malignant tumors of the head and neck and calls him a “truly amazing surgeon.”

“Dr. Vandevender has skillfully, thoughtfully and with outstanding technical expertise performed truly spectacular reconstructions on our patients,” Petruzzelli said. “He has restored their ability to speak and swallow and has done so in a way that provides for normal social interactions, including returning to work and living active and productive lives.”

Indeed, making a difference in patients’ lives is what Vandevender finds most rewarding about his work. He said, “Occasionally I get a letter from a patient who said I’ve given them back their life. It’s nice to hear, because it’s tough for patients in these situations.”

Resident Corner

The Department of Surgery is pleased to unveil a new segment to our quarterly newsletter titled  “A Journey Through Residency”, an insightful commentary written by one of the newest members to our General Surgery residency, Dr. Christine Gresik.  Dr. Gresik, a homegrown Loyola SSOM graduate, joined our program in July and has brought great energy and enthusiasm to her work.  We are grateful that this dynamic, young surgeon has agreed to share the myriad of experiences of a new resident with the rest of us.  For those of us non-physicians, Dr. Gresik’s perspectives may perhaps open our eyes a bit.  For the surgeons amongst us, her column may stir old memories and help us to appreciate the great distance we have come.  We hope that you will enjoy this running commentary, which will continue throughout her training at Loyola.      

A Journey Through Residency by Dr. Christine Gresik

The First Night on the Job

I was told by many, well actually by EVERYBODY, that my surgical residency would contain the most challenging years of my life. Boy were they correct, everything sure does change once you are allowed to introduce yourself as “Doctor” so and so. Thus far it has been an interesting experience to say the least.  I hope that this column may serve as a glimpse inside the daily life of a surgical intern so that others may live vicariously through the wonderfully terrific, overwhelming and exciting journey that I have just begun.

I arrived at the first day of orientation refreshed, excited and eager to learn what this residency bit would be all about.  I was anxious to learn about my new chief and service and well let’s just face it…I couldn’t wait to see what my schedule was going to be like.  My fellow interns and I sat around laughing, and reflecting on our casual, relaxing summers as we shuffled through the 200+ page booklet of orientation information, all secretly wondering about the only key facts that really mattered.  First, what service would we be placed on during our inaugural month and second, which of us would be the lucky ones on call that very first night.  Lucky me, I won.

As if the first day of residency wasn’t frightening enough, I couldn’t get over the fact that I would actually be responsible for several patients’ lives until the next morning. Perhaps even more frightening was the fact that the “signout” I was receiving was coming from other brand new interns who had only met the patients themselves about five hours prior.  I watched as all the other interns left one by one, as I clutched a stack of papers with random names and medical record numbers scribbled on them. That’s when it started…the ringing of the pager.  A medication had fallen off in EPIC, could I please renew the prescription?  No problem. I managed to scoot by the first few hours without much distress, confidence growing by the moment. That was until I got a page saying, “Doc, I think you better come see this patient, he’s sweating and not breathing well and what should we do?” Panic mode sank in immediately when I realized that I was the so called “Doctor” that needed to care for this patient.  I did what any bright and successful intern would do, glanced down at my signout sheet to gather more information and found the dreadful letters “NTD” scribbled next to the patient’s name. That was really helpful.

I quickly scurried to the patient’s bedside thinking about Dr. Luchette’s Airway-Breathing-Circulation lecture and how to approach this patient.  To my surprise, I remained calm and thought through the process and everything turned out just fine.  Of course, the intermediate that was on call that day arrived at the bedside shortly after myself to guide the transfer to the unit, but I like to think that I handled the situation appropriately and to the very best of my ability.  I decided at this moment I had learned two very important lessons from my first night on the job.  First off, never be afraid to ask for help from your seniors, and second, never trust your signout sheet!

Keeley Award Reflection - Dr. Julie Barone

As I reflect on my recent visit to the European Institute of Oncology (EIO) in Milan, Italy, I realize that this experience has greatly impacted my current work as a surgical breast fellow and my future career.  I was interested in pursuing the Keeley Scholarship to study at the EIO as the center is renowned for breast cancer research and innovative treatments. I spent two weeks at the EIO under the mentorship of the Breast Director, Dr. Mattia Intra.  I learned how the breast clinic functions and spent a significant amount of time in the operating room learning new procedures and techniques.  I also enjoyed the hospitality of the other departments including radiology, pathology, and nuclear medicine. 

Many of the routine procedures performed at the EIO are not currently used in the United States.  Specifically, ELIOT (electron beam intraoperative radiotherapy) for conservative breast cancer therapy and ROLL (radioguided occult lesion localization) are two modalities which we may see in future trials in the United States.  Additionally, nipple sparing mastectomies are performed routinely and are often combined with intraoperative radiotherapy.  I was also fortunate to learn oncoplastic principles from both the breast and plastic surgeons.   

Dr. Intra was an exceptional mentor and dynamic person who was eager to share his ideas and experiences.  He was available to answer all my questions and actively included me in the procedures.  I also pent time with Drs. Umberto and Paolo Veronesi as well as with a plastic surgeon, Dr. Petit.  The most exciting part of the trip was to meet new friends and colleagues from all over the world.  My mini-fellowship at the European Institute of Oncology was a once in a lifetime opportunity that has greatly inspired me as I embark on my career as a breast surgeon.  I wish to thank the Loyola Department of Surgery and the Keeley Scholarship Foundation for this incredible opportunity.

Medical Students:

Awards
 

Dr. Brems was named Top Doctor in America for Cancer for 2006

Dr. Schermer - NIH NIAAA PI R01- Trauma Center Brief Alcohol Treatments Benefits and Cost Effectiveness

Dr. Juan Angelats, Division of Plastics, was awarded “Citizen of the Year” by Rotary International.  He was also named a Paul Harris Fellow (Founder of Rotary International) for his work on behalf of the World Community.

On August 4, 2006 the Universidad Nacional de Cajamarca - Peru named the Center for Investigation of Chronic and Degenerative Diseases after Dr. Angelats for all the work that he has done to improve the health of the people of Cajamarca

Publications

MB Klein, D Hayden, C Elson, AB Nathens, RL Gamelli, NS Gibran, DN Herndon, B Arnoldo, G Silver, D Schoenfeld, RG Tompkins and the Inflammation and the Host Response to Injury Collaborartive Research Program. The Association between Fluid Administration and Outcome Following Major Burn Injury: A Multicenter Study.  Accepted for Publication at the Annals of Surgery.

MB Klein, G Silver, RL Gamelli, NS Gibran, DN Herndon, JL Hunt, RG Tompkins, and the Inflammation and the Host Response to Injury Investigators. An Overview of the Multicenter Study of the Genomic and Proteomic Response to Burn Injury, 2006, JBCR. (Jul-Aug) 27(4):448-51.

Schermer CR Editorial Comment on Effectiveness of Brief Interventions after alcohol related vehicular injury: a randomized controlled trial. J Trauma 2006; 61:532-533.

G Silver, MB Klein, DN Herndon, RL Gamelli, NS Gibran, JL Hunt, L Altstein, GP McDonald Smith, RG Tompkins and the Inflammation and the Host Response to Injury Collaborartive Research Program.  Accepted for Publication in the JBCR Sept./October Issue.

Presentations

Dr. Brems  was  an invited visiting professor at  Iowa Methodist Medical Center in Des Moines,  Iowa.  He presented  " Surgical treatment of  500 patients with Colorectal metastases to the liver " at Grand Rounds.

Abstracts

Alumni News

Alumni Tell of Unexpected Benefit of Loyola Residency 

It was a match in more ways than one when Matt Troy, M.D., and Monica Lorimer, M.D., matched for their surgical residencies at Loyola University Medical Center. Loyola is where the couple, now married 11 years, met and began dating.

Lorimer and Troy married in 1995 at the end of Lorimer’s residency, which included a year of research. Troy finished his training in 1994.

Partners in practice

Unusual as it is for surgeons to marry each other, the pair also practiced together for 11 years, most recently on the medical staff of Saint Anthony Memorial Hospital in Michigan City, Ind.

“We were the only married couple in surgery practice together at the hospital,” Lorimer said.

She recently left their private practice for a public service setting. Since September Lorimer has been a general surgeon at Provident Hospital of Cook County, a teaching facility for Loyola University Chicago Stritch School of Medicine.

Troy, who still has a general surgery practice in Michigan City, said he liked performing surgery with his wife. They had a similar surgical approach, he said.

That doesn’t mean the two surgeons always agreed in the operating room. Lorimer admitted that from time to time, “We would argue about what we do in surgery.”

Despite the occasional professional disagreement, Lorimer and Troy knew they could count on each other as well-trained surgeons.

Enthusiastic about Loyola training

“Loyola was a fantastic learning experience to develop the personality and skill sets to become an excellent surgeon,” said Troy, who also earned his medical degree from Stritch. “Coming out of residency, there were very few clinical situations that I had not experienced before.”

He said he chose Loyola because of the good reputation of the Department of Surgery and its chair, Robert Freeark, M.D. Troy remembers the surgeons who trained him as being very dedicated to surgical education.

Lorimer is also grateful for her Loyola residency. “I am an extremely well-trained and competent surgeon, and I owe Loyola for that,” she said.

In her current position at Provident, which has a largely indigent patient population, Lorimer tries to carry on Loyola’s mission of “We also treat the human spirit.”

“You can see the human spirit in these people,” she said. “And they are so appreciative of people being kind to them.”

Lorimer said she enjoys developing strong personal relationships with her patients. But she added: “Being a doctor is what I do. The most important thing in my life is my children and husband. I’m most proud of my five children, and I hope the best job I do in my life is raising them.”