Newsletter  - Spring 2006

Welcome to the Department of Surgery Newsletter. We hope you find this information helpful.

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

Over 20 years ago a physician had a vision.  His thought was to create a gift that would be fiscally enduring and provide a rich educational experience for surgical residents or fellows.  John L. Keeley, M.D the seventh Chair of our Department of Surgery created what has been generously supported by his family and grateful patients and is now known as the John L. Keeley Traveling Fellowship.  The purpose of this Fellowship is to allow residents and fellows to have unique experiences during their senior year of training that takes them beyond the boarders of Chicago. In 1989 the first recipient of this award Dr. Ricardo Izquierdo used the funds to travel to Glasgow, Scotland and Melbourne, Australia to study techniques in micro-vascular surgery and free flap tissue transfer. Since that time we have sent 20 residents and fellows to over 40 programs in 10 countries and 8 states.

For almost 20 years Dr. Keeley’s vision has been realized by surgeons in training. Residents and fellows have been able to witness firsthand unique procedures from nationally and internationally renowned physicians at institutions known for providing innovative care. Whether it is studying the immunologic control of cancer at the University of Melbourne in Australia or learning cutting edge endovascular techniques in at John Hopkins University in the early 1990s the experience that this award provides is unparalleled.  Throughout my years as a teacher of future surgeons I can think of few other examples that provide such an opportunity as does the John L. Keeley Award.

It comes as no surprise that such a unique opportunity has created a high degree of competition among the potential award recipients. Competition for this award seems to grow each year. This year was no different and with generous support of the Keeley Fellowship the department of surgery is able to sponsor two fellowships for 2006.  Dr. Julie Barone a Chief Surgical Resident who will be continuing her surgical training doing a fellowship in Breast Surgery at the Beth Israel Medical Center and St. Luke’s-Roosevelt Hospital Center in New York and will be traveling to the European Institute of Oncology in Milian, Italy. There Dr. Barone will study intraoperative ablation techniques in the management of breast cancer and the evolving role of MRI for evaluating breast disease. Dr. Wellington Davis who is completing his Plastic Surgery Fellowship and is pursuing a career in Pediatric Craniofacial Plastic Surgeon, will be traveling to the Toronto Facial Paralysis Group in Toronto, Canada and the Children’s Hospital of Los Angeles, California. Dr. Davis will be studying the role of surgery in managing the functional and cosmetic consequences of facial palsy in children.

In the last department of surgery newsletter I spoke of the creation of a surgical education and research endowment within our department. Such an endowment is necessary if we are to continue in the tradition of Dr. Keeley. This endowment will allow a resident or fellow to step outside of their clinical responsibilities for a year or more to join an established research laboratory and learn cutting-edge research. It will also allow a junior faculty member to establish their own independent research career in basic, translational, or clinical outcomes research. This endowment would also support our minority student’s surgical scholarship program, advancements in surgical education and training, and further development of our surgical learning resource center.

Throughout my career I have been most impressed by those gifts that are designed to give well beyond the initial award.  Those that have benefited the most from such an endowment are not our institution or department or even the fellowship recipients. It is the patients and their families who have benefited from the new knowledge and skills gained by our residents during their fellowship experience. There may be those individuals who ask why with so much going on should this be our focus?  They need to look no further than last line of our department’s mission statement for the answer. “We will do all of this because it is our responsibility and life long passion.”

Our duty is to provide the best educational experience we can for our residents and fellows. The patients and families they care for throughout their professional life will magnify many times over the power of these gifts. Our goal for today is to find new solutions for problems facing our patients and educate our students, residents and fellows to be able to carry this on for future generations of patients. New knowledge in the service of humanity has moved to this place in healthcare and will move us to the future.

Feature Article

Research Lab of Douglas E. Faunce, Ph.D.

A research laboratory of the Burn and Shock Trauma Institute is conducting potentially ground-breaking studies in understanding how particular cells in the immune system play a role in suppressing immunity following severe trauma and identifying possible cell-based therapies to protect the immune system, with promising early results.

After severe injury, the immune system loses its ability to defend the body against infection, leading to a high rate of infection and mortality among trauma patients.

Leading the research is Douglas E. Faunce, Ph.D., who has been working with a team of researchers since 2003 in the Burn and Shock Trauma Institute, which is part of the Loyola University Chicago Stritch School of Medicine Department of Surgery. Faunce, who received his Ph.D. in 1998 from the Department of Cell Biology, Neurobiology and Anatomy with an emphasis on inflammation and immunity in trauma, and went on to conduct post-doctoral studies in immunology at Harvard Medical School. He returned to Loyola in 2003 upon the invitations of Richard Gamelli, M.D., Robert J. Freeark Professor and chair of the Department of Surgery and Elizabeth Kovacs, Ph.D., Professor of Cell Biology, Neurobiology, and Anatomy, to continue his research in the areas of trauma and immunology.

 While preliminary, the results to date have been very encouraging. Using a burn model in animals, the research team identified that a special type of immune cell, called CD1d-restricted NKT (natural killer T cells), plays a key role in controlling T cell immunity. As part of their studies, researchers injected mice with an antibody that blocked the NKT cells from becoming activated without directly affecting the activation of other cells. “We found that if we blocked the NKT cells from becoming activated after injury, we could prevent the suppression of immunity,” said Dr. Faunce.

 Considered a sentinel finding, the results were published in the Journal of Leukocyte Biology (73:747-755, 2003). Two other papers on related topics currently are under review. While many labs are investigating the importance of NKT cells in regulating autoimmunity and protecting against cancer, very little attention has been paid to the role of these cells in relationship to immune response to injury, according to Faunce. Currently, he and his researchers are investigating the role of NKT cells in immune suppression with funding from the National Institutes of Health.

 To further validate their results, Faunce and his researchers confirmed their findings using two transgenic models. “Both models involved mice there were genetically engineered to be deficient in that cell type only,” explained Faunce. “And when we looked again at immune function in injured animals that were genetically engineered to be deficient in these NKT cells, we found the same observation. The immune system of the mice was not suppressed nearly as bad after injury.”

The research team then explored how NKT cells suppress immunity. Often, cells in the immune system will suppress other immune cells by secreting factors called cytokines, which immune cells use as “signal molecules” to talk to each other. “What we found is that in response to injury, the NKT cells turned off the cytokines that normally promote protective immunity, including one cytokine called interferon gamma,” said Faunce. But at the same time, the NKT cells turned on cytokines that are known to suppress immune function, one of which in particular is called interleukin 4.  “So we decided to ask if the NKT cell-derived interleukin 4 was really suppressing immune function,” he said. “Our studies confirmed that the interleukin 4 made by the NKT cells in response to injury was indeed a very important factor in suppressing immune function,” he added.

“So now a lot of work in the lab is in understanding why NKT cells become potent producers of interleukin 4 and how the molecular mechanisms in the genes that control interleukin 4 in the cells get turned on,” explained Faunce. The overall goal is to find ways to alleviate the suppression of the immune system in trauma patients, which can be done in a number of ways, he said. One strategy is to create a drug to manipulate the NKT cells to not produce interleukin 4, but rather to manufacture immunity-enhancing cytokines like interferon gamma following a severe injury. 

Faunce and his team are collaborating with a Japanese company, Kirin Pharmaceuticals, who identified and developed an NKT cell-specific compound that has been shown to promote protective immunity in both mice and humans. “We have given an NKT-cell specific compound called KRN 7000 to animals with very successful results so far,” said Faunce.

In addition to these findings, Faunce and his team made an unexpected, but exciting discovery along the way. The wounds in animals with blocked NKT cell activation appeared to heal in a way that was uniform, controlled, and cosmetically desirable. Normally, burn wounds often result in severe inflammation and necrosis, significant scarring and contraction of tissues.  The scarring and contraction leaves patients with severe scarring that results in functional but equally as important, psychological impact. “In our studies, we found that if mice were treated to block NKT cell activation after burn injury, then the wounds healed in a manner that involved significantly less necrosis, scarring, and contraction,” Faunce said. “They also healed almost twice as fast as wounds from mice that were not treated in this way.”

With promising early results, Dr. Faunce’s research team is working hard to confirm their observations, using a number of different models. “It’s important work and it’s a lot of fun, but you sometimes have to keep the excitement at the back of your mind to not let it influence the science,” Dr. Faunce stressed. “We have to be able to show that these observations can be reproduced by other laboratories.”

Dr. Faunce can be reached by e-mail at dfaunce@lumc.edu or by phone at 708-327-2663.

Clinical Spotlight

Cruz-Gonzalez Leads Dental Medicine Section, General Practice Residency Program

Wanda I. Cruz-Gonzalez, D.M.D., has been named chief of the Section of Dental Medicine and director of the General Practice Residency Program of the Division of Oral and Maxillofacial Surgery and Dental Medicine within the Department of Surgery of Loyola University Chicago Stritch School of Medicine.

An assistant professor of surgery in the Stritch School of Medicine, Cruz-Gonzalez graduated cum laude from the University of Puerto Rico School of Dentistry in San Juan with a doctorate in medical dentistry in 2002. She performed her general practice residency at the University of Illinois at Chicago and University of Chicago Hospitals from 2002 to 2003, and served as chief resident from 2003 to 2004. Before coming to Loyola, Cruz-Gonzalez was in private dental practice in LaGrange. Her special interests are dental care for medically compromised patients, general dentistry, cosmetic dentistry, dental implants and pediatric dentistry.

As the chief of the Section of Dental Medicine, Cruz-Gonzalez intends to promote the section’s services to the larger Loyola community, as well as the general public. “Many people aren’t aware that Loyola offers general dental care to the community, as well as more specialized services for medically compromised patients, such as those undergoing cancer treatment and organ transplantation, for example,” she added. “I also want to stress the importance of good oral health and its impact on a person’s overall health.”

Patients receive dental care at the Oral Health Center located in the Maguire Center on the Maywood campus and can make appointments by calling (708) 216-3678.

As director of the General Practice Residency Program, Cruz-Gonzalez oversees the educational experience of eight residents per year. The goal of the program is to provide dentists with comprehensive oral health care experience in the hospital environment, with special focus on medically compromised patients. “The General Practice Residency Program gives participants more polished skills and prepares them more fully for all types of patients, especially patients with special needs,” explained Cruz-Gonzalez. “Graduates of our program are well prepared for careers in private dental practice, a hospital practice and academics.”

Within the 12-month residency, residents provide oral health care to patients of the inpatient dental clinic of Loyola University Medical Center, Oral Health Center, Loyola inpatient and outpatient operating rooms, and the dental clinic at Edward Hines Jr. Department of Veterans Affairs Hospital. The diverse patient population is referred from Loyola University Medical Center departments and services, faculty, students, employees and members of the surrounding community. Under the supervision of seasoned full-time and part-time dental faculty, residents gain vital new knowledge and skills in an academic environment that is committed to research and training, as well as excellence in patient care.

The General Practice Residency Program offers three-week rotations on the internal medicine and anesthesia services and a two-week rotation in the emergency department. Residents also rotate to Hines VA Hospital for six-and-one-half weeks of general dentistry, and six-and-one-half weeks of oral and maxillofacial surgery, as well as on-call service in Loyola’s emergency department.

Cruz-Gonzalez has plans to strengthen the general practice residency program further. “I want to enhance their clinical and didactic experience in general dentistry, incorporating more knowledge about dental implants, as well as hospital dentistry,” she added.

For more information about the General Practice Residency Program, call (708) 216-3625.

Resident Corner

Keeley Award Winners

The Department of Surgery is pleased to announce that Dr. Julie Barone and Dr. Wellington Davis are the 2006 recipients of the John L. Keeley Traveling Surgical Fellowship. The Keeley Award, starting in 1989 and named after the long standing Chair of the department John L. Keeley, is intended to be utilized by a senior surgical resident or fellow to visit prominent surgical departments or institutions. Over the awards history its recipients have crisscrossed the United States and have visited nearly every continent. Award winners share with the department new ideas and alternative surgical viewpoints during a special Departmental Grand rounds.

Dr. Barone, Surgical Chief Resident, will be visiting the European Institute of Oncology in Milan, Italy. Dr. Barone state that “My reasons for pursuing a breast fellowship are driven by my commitment to patient care and interest and breast oncology. The opportunity to explore a premier European breast oncology center will expose me to alternative modalities that are not used in the United States, allow me to interact with leading experts in breast oncology, and learn the fundamentals to build a multidisciplinary breast clinic. The center performs routine intraoperative cryoablation, radiofrequency, and radiation.  The role of MRI and evaluating the role of ablation and radiation modalities is an evolving field in breast oncology. MRI is routinely used in Europe and now the standard of care for evaluating certain breast diseases. MRI is experiencing new growth in the United States as well.  Next year during my breast fellowship I plan to participate in some of the ablation and intraoperative radiotherapy trials including ACOSOG z1052.  Additionally, many of the principle investigators in the European trials are professors at the European Institute of Oncology in Milan.”

Dr. Wellington Davis, Plastic & Reconstructive Surgery Fellow, whose goal is to become a Pediatric Craniofacial Plastic Surgeon, will be traveling to the Toronto Facial Paralysis Group in Toronto Canada and the Children’s Hospital of Los Angeles, California. Dr. Davis stated that “facial palsy is not simply a cosmetic effect; it has significant functional and emotional effects on the lives of affected patients.  Creating a functional oral commissure and dynamic facial musculature is critical for the control of oral secretions, mastication, improvement of speech, facial expression, as well as protection of the eye for preservation of vision.  In many instances it may help patients reintegrate into society by alleviating psychological issues generated by their abnormal facial expression, extensive drooling, and abnormal speech secondary to facial paralysis.  This is a surgical procedure that has the potential to substantially improve a patient's quality of life.  Currently, there's no better place in the world to learn the principles of this unique surgery and the management of facial palsy patients at the Toronto Facial Paralysis Group at the Hospital for Sick Children in Toronto Canada.”

Dr. Davis will also be exploring ear reconstruction with polyethylene implants at Children’s Hospital of Los Angeles. On this subject Dr. Davis said “In the past it was believed that ear reconstruction would never be achieved with alloplastic material.  The concern: infection and eventual exposure requiring implant removal.  The majority of the leaders and ear reconstruction are still adamantly against the use of alloplastic material for this purpose.  The Rubin Best Paper Award is a testament to the quality of the clinical importance of Dr. Reinisch’s work.  His passion for ear reconstruction has without a doubt proven that alloplastic reconstruction can be done.  His demonstrated to the plastic surgery community that alloplastic ear reconstruction can be safe, durable and the results are equivalent and sometimes exceeds autogenous reconstruction.

The Department of Surgery congratulates both Drs. Barone and Davis and look forward to hearing of what they learned during a Grand Rounds Presentation.

Past Keeley Award Winners

First Annual “Orientation to the Application Process for Surgery” Session

 Dr. Raymond Joehl, Vice Chair, Education and Program Director of the General Surgery residency recently held an information session for current third-year Loyola SSOM medical students titled “Orientation to the Application Process for Surgery”.  The timing, in mid-February, was chosen specifically to assist them as they begin to make their selections for senior electives.  The function was casual, a light dinner was provided, and a variety of topics were covered such as:  when and how to ask for a letter of recommendation, whom should be asked, details about the application process, the qualities a Program Director looks for in a candidate, the number of programs to target, and criteria for selecting programs.  The session provided an ample opportunity for students to ask questions about the application process, in general, and about Surgery, specifically. 

Contributing to the discussion were Dr. David Holt, Surgery Clerkship Director, Ms. Teresa Wronski, Associate Dean, Student Affairs, SSOM, Leibert Morris, Assistant Dean, Student Affairs, SSOM and Ms. Kim Echert, Education Coordinator, Dept. of Surgery. 

Attendance expectations were exceeded with 30 students attending the presentation.  The reports from the students were very favorable and Dr. Joehl plans to offer this session to future third-year medical students on an annual basis. 

Residents/Attendings Receive Excellent Ratings

The following Surgical Residents/Fellows were rated excellent by 3^rd year medical Students

Sewit Amde, Julie Barone, Raymond Candage, Kimberly Cradock, Sandeep Devata, Andrew Gassman, Susan Hahm, Ziad Hanna, Cory Hugen, Melissa Hulvat, Susannah Jensen, M. Kamran Khan, Shawn Obi, Jateen Patel, Dane Salazar, David Schneider, Thomas Sylvester, Ranna Tabrizi, and Victor Tsirline.

The following Department of Surgery Faculty members were rated excellent by 3^rd year medical Students

Gerard Aranha, Richard Gamelli, Raymond Joehl, Peter Kalman, Fred Luchette, Stathis Poulakidas, Larry Reed, Heron Rodriguez, John Santaniello, Vafa Shayani, Margaret Shoup, and Katharine Yao.

Incoming Residents

In the News

Dr. Fred Luchette was in the front section of the New York Times, Wednesday, February 22 regarding Governor Pataki's Surgery Complications.

http://www.nytimes.com/2006/02/22/nyregion/22condition.html?_r=1&oref=
slogin&pagewanted=print

Awards

• Dr. Kimberly Davis and Dr. Margaret Shoup are new members in the Society of University Surgeons

• Dr Kathy Yao was the unanimous choice to win the $10,000 CSAF Enrichment Award.

Alumni News

Some of  the letters we received from our past Keeley Award winners.

I went to the University of Hong Kong to observe Dr. Wong, who is one of the world’s experts in esophageal surgery. The Keeley was invaluable to me in furthering my academic goals in my current specialty of cardiothoracic surgery. I truly appreciate the opportunity that the Keeley award afforded me and agree that Dr. Gamelli should continue this Loyola tradition.

Thanks
Chris Malaisrie MD