Newsletter  - Spring 2008

                  Printer friendly format

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

Since coming to Loyola in 1990, I have had the good fortune to get to know many of the faculty in and outside of this department. Many of those physicians had called Loyola home long before I arrived. These physicians have touched many lives. This extends not only to the patients they treated but also the students, residents and fellows they taught. As a result of our teaching we touch many more lives than we ever do as treating physicians. The students, residents, and fellows carry on what we have taught them in the care management of their own patients. It is not difficult to see that anyone of us in the course of our professional lives will literally impact the care of thousands of patients and their families. At times this is more than a sobering thought. I can think of many examples of how our Department of Surgery faculty has changed the lives of those we taught, but there are a few sterling examples that we must pay homage to and they include Drs. Freeark, Pickleman, Baker and Warpeha. They have truly meant a great deal to many students, residents, and fellows.

About six months ago, one of our Division Chiefs approached me with the idea of forming a new lectureship series that embodied the teaching philosophy of Ray Warpeha. The idea was simple, let us talk with those that have gained the most from his experience and with the help of the department create the lectureship series. Therefore, I am pleased to announce the formation of the Warpeha Plastic Surgery Lectureship Series.  This annual lectureship series will continue the fine work started at Loyola by Dr. Warpeha more than 36 years ago.  Both Drs. Angelats and Cimino have been working with the Development Office contacting former fellows about funding the lectureship series in Dr. Warpeha’s name. The response has been what we all had expected, warm and enthusiastic. I want to express my thanks to Drs. Cummings, Franco, Mosier, Schneider and Stefanacci who have made commitments to this project. These physicians are but a few of the fifty fellows that trained with Dr. Warpeha over his 28 year tenure with the Department.  

Dr. Warpeha, as you will read in another article in this newsletter has had a rich and fulfilling career. He started the Burn Unit at Loyola that I now run. State of the art burn centers can today be found throughout the country, but in 1972, this was not the case and to create a burn center at that time was to create something unique. Clearly, everyone in the Chicago area benefited from having such a center. However, Dr. Warpeha’s true legacy will be always carried forward by those who knew him best and trained under him.  With the creation of this lectureship series we will continue the work Ray was so passionate about and continue his legacy of education and training.

Feature Articles
 

Founder of First Burn Unit Enjoying Retirement 

What does a plastic surgeon who pioneered in burn treatment do in retirement?  

If you’re Professor Emeritus Raymond Warpeha, M.D., Ph.D., D.D.S., you go back to nature. As Dr. Warpeha, a Minnesota native, explained it, “If you grew up in Minnesota and you don’t hunt or fish, people say there’s something wrong with you.” 

In the eight years since Dr. Warpeha retired as Loyola’s chief of the Division of Plastic and Reconstructive Surgery, he and his wife, Ivy, have fished a lot, mainly at their family retreat in Toronto, Canada. In the winter they fish in the Caribbean, he said. 

Juan Angelats, M.D., professor and current chief of the Division of Plastic and Reconstructive Surgery, said this about Ray Warpeha, whom he has known since 1968: “The loves of his life have been plastic surgery, hunting and fishing, and his wife, Ivy—not necessarily in that order!” 

Dr. Warpeha also enjoys living on several acres of wooded property in Oak Brook. Calling himself “an amateur botanist,” he said he has discovered more than 100 native plants on his land. 

Left his mark at Loyola 

Although retired, Dr. Warpeha has not entirely left Loyola. He still teaches anatomy in the Department of Surgery. For most of his 28-year tenure at Loyola, he held joint faculty appointments in surgery and anatomy. He trained more than 50 plastic surgeons.  

And, of course, he left a legacy at Loyola. 

“The Burn Center he built from scratch became one of the pillars of the Medical Center,” Dr. Angelats said. 

Dr. Warpeha was hired to start Loyola’s first burn unit in 1972, which he directed until 1990, when Richard Gamelli, M.D., arrived at Loyola.   “I’m really pleased to see how well Dr. Gamelli has done with the Burn Center,” Dr. Warpeha said. 

When asked what Dr. Warpeha accomplished that he is most proud of, he said the statewide triage system for burn injuries that he helped develop. He chaired both the Illinois and national groups that wrote the protocol in the 1970s for the transfer of burn patients. 

“That shed some positive light on Loyola and our Burn Center,” he said, crediting the late Robert Freeark, M.D., with the idea for the triage system. “The idea was to get burn patients to the appropriate center that had the proper expertise to treat them.” 

Other areas of burn care in which Dr. Warpeha pioneered are the early excision of facial burns, which he said has become the standard, and the use of homografts for temporary wound closure until wound closure is complete. “That has had a great deal to do with helping patients with very large burns survive,” he said. 

Besides burn reconstructive surgery, Dr. Warpeha performed all types of plastic and reconstructive surgery, especially in head and neck cancer. Dr. Angelats called him “one of the best head and neck surgeons and burn surgeons in the Midwest.” 

From dentist to surgeon 

It was being able to rebuild jaws that first attracted Dr. Warpeha to surgery, after he earned a dental degree. He practiced as a dentist part time during medical school. Then he did his general surgery residency at Cook County Hospital, training under Dr. Freeark. He said he was the first full-time Loyola faculty member that Dr. Freeark hired in 1972. 

The rest is history. 

A Changing Fiscal Environment

Over the past few years, our department, like many others has experienced an ever-increasing workload. We all understand that to succeed in today’s world requires hard work and working smart. So what is different today? The work presently seems to be undervalued and the measures we used in the past are no longer a good indicator of performance. This change is tied to the Center for Medicare and Medicaid Services (CMS) weighting of the work component of RVU’s (Relative Value Units.)  Each Current Procedural Terminology (CPT) code has an associated total RVU. The total RVU is made up of a number of components and the one that most of us have followed is the work component. The work RVU (wRVU) is a measure of complexity, time, and knowledge.  It represents how we, as physicians, can asses our work productivity. The utility of tracking wRVU’s has been a readily available performance measure. On the simplest level it allows wRVU’s to: measure work among surgeons; compare the performance of our faculty to national standards using the Faculty Practice Solution Center (FPSC) or the Medical Group Management Association (MGMA) annual survey; and measure changes in overall work level from one year to the next.                              

The use of wRVU’s can also assist in planning and financial analsis. We have found in the past that wRVU’s were a reasonable metric for: budgeting patient care revenue (income) for the next fiscal year; analyzing changes to reimbursement patterns such as collections/wRVU and payment for each unit of work: measuring the efficiency of our practice; and related business cost such as malpractice expense/wRVU and operating expense/wRVU. As a business in these financially challenging times we need to know if we can do more work without creating additional cost.                                         

The problem with using wRVU’s as we have in the past is twofold. First in 2007, CMS adjusted the value of a number of CPT codes. Most of these adjustments centered on Evaluation & Management (E & M) codes.  To understand the impact of the changes by CMS requires using historical data to reset the performance gauge. Using FY05 clinical volumes and applying wRVU values for CPT codes using 2005 values (blue bars) when compared to the FY05 activity using the 2007 wRVU’s (red bars) there is an inflated work estimate. This shift occurred without any additional activity at the department level. Typically, an increase in wRVU’s has translated into an increase in collections. As no additional reimbursement accompanied these changes the net was that the work was now being “undervalued” as per unit of work we had a decrease in collections.     

In the second half of FY07 the next change occurred. Faced with rising costs CMS put in place a mandatory reduction in reimbursements to hold costs flat. Using the same methodology as we did with wRVU’s only this time using reimbursement the net effect is a significant reduction in reimbursement to the level of $500,000.                       

Changes in clinical reimbursement can have a dramatic effect on our ability to carry out mission critical activities. Rethinking how we budget and use new metrics to support the planning for our future are absolutely necessary if we are to continue to be successful. There is much that many of us have had to learn since completing our surgical training that have little do with patient care. But in the end it is essential to know if we are able to do the real work that we are about. The practice of surgery requires we be the best we can at patient care and as an academic department improve each year in our educational programs and excel in our research. If the 16 percent cuts that are scheduled for Medicare physician payments over the next two years (a 10.6 percent cut on July 1st and a 5.4 percent cut in 2009) go through we will all be learning another lesson from the primer of academic life.

Surgery In the News

Virtual Pain Reality System

Dr. Richard L. Gamelli, chief of Loyola’s Burn Center, recently participated in a press conference attended by the major television stations in Chicago and various news organizations to demonstrate the Virtual Pain Reality System that was recently purchased by the Burn Unit.  The system helps manage pain felt by burn patients during wound care and physical therapy through a totally encompassing video game that distracts the patient's vision and hearing. Loyola is the first hospital in Illinois and only one of a handful across the nation that is employing this 21st century technology to help burn patients recover from their injuries.

Announcements
 

John L. Keeley, M.D. Traveling Fellowship Anniversary Reception 

Dr. Richard L. Gamelli and The Department of Surgery are hosting the Twentieth-Anniversary Celebration of the John L. Keeley, M.D. Traveling Fellowship, Friday, May 9, 2008.   The reception will be held in the Department of Surgery.    

Invitations have been sent to the Keeley Fellows from the past twenty years  - 1988  through 2008.   Also expected to attend the evening’s festivities are family members and friends of the late Dr. Keeley, first Chairman of the Department of Surgery. 

Visiting Professors 

March
Department of Surgery Grand Rounds

April
Department of Surgery Grand Rounds

May
The Puestow-Freeark Visiting Professor

The 2008 Puestow-Freeark Visiting Professor is Howard A. Reber, M.D. - Professor of Surgery, Department of Surgery - UCLA School of Medicine.    Dr. Reber is the 13th Puestow-Freeark Visiting Professor.  He is scheduled to lecture in the Department of Surgery on May 6-7, 2008

Juan Angelats, M.D. Service Award 

It is time again to call for nominations for “The Juan Angelats, MD Service Award.”   We will be announcing the recipient of this year’s award at our annual farewell and welcome dinner in June.   The published deadline of April 1^st has been extended to the end of  April.   

The nomination process and award are open to Department of Surgery faculty and staff; current and former fellows and residents; and emeritus faculty.  

Your nominee could be chosen to be the next recipient awarded this distinctive honor.   The first person to be honored with this award was Dr. David Calandra, a true humanitarian and stellar example of what this award represents.  The presentation ceremony was covered in detail in our summer 2007 electronic newsletter:  

http://www.stritch.luc.edu/depts/surgery/n_summer2007.htm 

For detailed information on the submission process, or should you have any questions, please feel free to contact Tim O’Hern, at (708)327-2707, or Karen Pyrz, at (708)327-2679.

Resident Service Project Award   

Last year was the inaugural year for the Resident Service Project Award.  Letters calling for proposals for this year’s award were mailed to all current residents and fellows in February.   The deadline for submission was April 1^st, however, it has been extended to the 15^th.    There is still time for you to submit a proposal.  This is a unique and exciting opportunity for you to develop a project that will enhance your clinical experience, and give back to the underserved social community.  Your only limitation is the scope of your vision.    The first person to receive this award was Dr. Luke Brewster.  The presentation was covered in detail in our summer 2007 electronic newsletter:   

http://www.stritch.luc.edu/depts/surgery/n_summer2007.htm 

• The award is open to all current Department of Surgery residents and fellows in good standing

For detailed criteria for submitting a proposal, or if you have any questions, please feel free to contact Kim Echert, at (708)327-2335.

Primary Care Reception 

A reception and dinner attended by many LUHS primary care physicians and Department of Surgery faculty members was held Wednesday, March 12, 2008 in the department’s conference room.  Dr. Steven De Jong, Dr. Elizabeth B. Frye, Dr. Richard L. Gamelli, and Mr. Dan Post welcomed the attendees.  The following Department of Surgery faculty gave presentations highlighting their areas of interest and expertise: 

Dr. Juan Angelats - Plastic surgery
Dr. Bernadette Aulivola - Peripheral Vascular surgery
Dr. John Brems - Hepatobiliary surgery and Liver transplantation
Dr. Loretto Glynn - Pediatric surgery
Dr. Sharfi Sarker - Minimally Invasive surgery
Dr. Margo Shoup - Surgical Oncology
Dr. Geoffrey Silver - General Surgery
Dr. Michelle Slogoff - Colorectal surgery 

Resident Corner

What I Do for a Living …
by Christine Gresik

 I recently attended my high school reunion and had the pleasure of reuniting with several old faces from my graduating class. During the night, most people obeyed the standard etiquette including asking about family, occupations and home. However, it came as no surprise to me when the former “class gossip” probed for more details on just about everyone in the class. Under normal circumstances I would have found this quite obnoxious, but I found her questions causing me to question things about myself as well. In particular her question, “what do you do for a living?” really triggered my mind. My answer was, “I’m a surgery resident” to which she immediately responded, "so you operate all day?" I stated, "No, not actually that often at all" to which she again asked, "So what do you do?" I thought that was a fascinating question... 

It is not all that often that I find myself at a loss for words, but this was definitely one instance that gave me something to think about. I guess that people always assume one's job description based on their title, but in most instances they probably assume at least a little incorrectly. I then thought to myself, how can I become a surgeon if I'm not really "acting" like one at work. I guess that what I am starting to learn during my course as a surgery resident is that operations are a part of what I do, but they truly are not the only way that I care for my patients. When all is said and done, the actual surgery consumes only a brief moment of the patient's hospital stay. So much goes into pre-operative preparation, clearance from the primary provider and not to mention often lengthy post-operative stays. This ends up becoming the main focus of my work.     

What I have really learned the most during my past two years is how to diagnose illness when someone presents to the emergency room or clinic and how to treat common illnesses and symptoms without a major surgery. I love what I do because I really get to interact and treat the patients, not just someone sleeping on the operating table. Don't get me wrong, I became a surgeon because I love the operating room, I've just realized along the way that I won't always spend a lot of time in there and that this is not necessarily a bad thing. I know I'll gain that operative technique and experience somewhere along the way, but I've also learned to enjoy the rest of the process along the way. And that is why I did not take the time to explain to my former classmate that night, I guess I really didn't have to as long as I understand it myself!   

So when all is said and done, I think I have a pretty interesting job, even though it might not be what everyone else in the world thinks that it is. Last night I went home and asked my husband if he knew what I did at work to which he promptly responded, "you operate of course!" I guess that I will live up to that reputation eventually, I'm just not quite there yet.

2008 John L. Keeley, M.D. Traveling Fellowship 

Congratulations to the 2008 Keeley Award Recipients:

Ankush Gosain, MD, PhD – General Surgery
Michael Mosier, MD – General Surgery
Gregory Surfield, MD – Plastic Surgery
 

Basic Laparoscopic Skills Training Sessions 

On January 18^th, the Residency Program launched an exciting training session utilizing the first of 23 modules of the American College of Surgeons / Association of Program Directors in Surgery Curriculum.  This first session, Basic Laparoscopic Skills, was directed toward PGY1 and PGY2 residents and included training at five separate stations.  The inaugural group was provided instruction from faculty facilitators, Dr. Raymond Joehl and Dr. Vinod Winston.    Dr. Luke Brewster, surgery resident, and Kim Echert, education coordinator, assisted with the planning and implementation of this session. 

Fundamentals of Laparoscopic Surgery (FLS) trainer boxes were used for each of the five exercises:  Running String, Block Move, Bean Drop, Checkerboard, and 0° Camera Navigation.  The residents were given proficiency targets and were asked to log an initial time for each task.  They are expected to continue to practice these skills and will be tested for proficiency at a later date.  In the meantime, the residents have round-the-clock access to these skills stations, located within the Golan Surgical Resident Resource Room, and may practice whenever convenient. 

The session was repeated two weeks later for the remaining PGY1 and PGY2 residents and was facilitated by Dr. Sharfi Sarker.  Feedback received from all who participated was very positive.  In addition to enhancing important laparoscopic skills in our trainees, the residents greatly enjoyed the friendly competition in learning who could best accomplish each task.   

Additional simulation training will be launched in the months to come.  The ACS/APDS Surgical Skills Curriculum may be reviewed at the following site: http://www.facs.org/education/surgicalskills.html.  Click on the link halfway down the page titled http://elearning.facs.org.  Access is free and all are invited to register to review these useful tools.  

Live Swine Anastomoses 

This winter and spring, the Department of Surgery will host mandatory live swine workshops for every PGY3 through PGY5 surgical resident with specific emphasis on hand-sewn bowel anastomoses. This is the latest exciting addition to the evolving surgical skills curriculum for promotion of sound surgical technique in our budding trainees. The first of the two workshops planned was held on Leap Day, February 29^th, 2008. Similar to the workshop held last year, the residents were given a lecture with lunch before the start of the day’s activities. This allowed participants to visualize and discuss the expectations for the workshop and the experience at-large. In an improvement from last year’s pilot experience, half the trainees participated in the February session, with the remainder scheduled to participate in April. This allows for three residents and one faculty member per large animal. 

At the conclusion of the didactic discussion, the course participants were escorted to the lower level animal laboratory, housed within the Division of Comparative Medicine at Loyola. Administration of general anesthesia with endotracheal intubation and ventilation was accomplished on each of three 60-70 kg swine. Three clinical intermediate and senior-level residents (a PGY-3, PGY-4 and PGY-5) were assigned to each animal and were given tasks in which to perform; these largely involved hand-sewn bowel anastomoses (i.e. gastrojejunostomy, jejunojejunostomy, and ileocolostomy), in single or double-layers, and using varying techniques (i.e. Lembert, Connell), similar to that required in real, clinical situations. Supplies were obtained and operative time extended to allow the interested medical students and PGY-1/PGY-2 level residents access to the pig workshop for practicing bedside techniques, including venous and arterial cutdown techniques, cricothyroidotomy, and tube thoracostomies. Essential basic technical considerations were emphasized by supervising attending surgeons, Dr. Joehl (program director), Dr. Santaniello (principal investigator/course supervisor), and Dr. Winston, who proctored the sessions for evaluation of proper technique and satisfactory results and outcomes. Prior to and at the conclusion of the workshop, a resident survey was utilized to evaluate the techniques mastered, the practitioner’s comfort level with certain techniques (including choice of suture, confidence in varying techniques, placement of sutures, knot-tying, etc), and overall assessment of economy of time and motion. 

It is important in our current climate for training young surgeons, to have a venue for the hands-on application of techniques that have fallen into relative disuse because of more efficient, reproducible, and easier alternatives, like stapling devices. Indeed, it is much simpler to surrender to the almighty stapler, with its efficient and reliable precision. However, in many a clinical scenario the stapling device is inappropriate, difficult to use because of spatial constraints, malfunctioning, or simply not available. The only remaining, relevant option all good surgeons should have in their armamentarium: the hand-sewn anastomosis, the “old-fashioned” way of doing things—a stitch and a knot. These techniques can be learned in a book, they can be taught on cadaveric tissue, they can be demonstrated in a 3-dimensional model; but there is no substitute for refining the art of surgical technique on living, bleeding – and often unforgiving – tissue. Judging from the feedback from the workshop thus far, our resident staff unanimously agrees. 

2008 Match Results 

Dr. Gamelli and Dr. Joehl are delighted to announce the names of our incoming residents to the General Surgery program for July 2008.  We are especially pleased to welcome four of our own SSOM students into our program.   

Research
 

Resident Research Information Day 

The Department of Surgery and The Burn & Shock Trauma Institute (BSTI) held a “Resident Research Information Day” on January 11, 2008. The goal was to provide information about the research opportunities and research expertise available to our residents who are considering research training following the first two years of surgical training. All categorical surgical residents in their intern year attended the research information day. 

Dr. Richard Gamelli, chairman of the Department of Surgery and director of BSTI, opened the proceedings with an introductory talk, which highlighted how research accomplishments would set a resident apart and pave the way for a career in academic surgery. He further emphasized that research training during residency would enhance the chances of securing a fellowship in any chosen field of surgery in a prestigious fellowship program.  

Dr. Elizabeth Kovacs who is the director for research at the BSTI emphasized the breadth of research opportunities available to residents and discussed the mechanisms of funding for the training. Dr. Kovacs pointed out that aside from clinically relevant basic science projects the program also offered the opportunity to engage in translational and clinical research projects. Residents are encouraged to obtain either a Masters degree in Clinical Research or Medical Bioethics or a PhD degree through Loyola University’s graduate program.  

The residents then had the opportunity to talk to the surgical residents who are currently in their research training. During a luncheon they gained a better perspective of the importance of productive research training and the merits of obtaining an additional degree. After the luncheon, the residents met with each faculty member individually to learn about the faculty’s research programs and initiatives to begin to think of the most suitable program for them.  

The day ended with a tour of the research laboratories and core facilities of BSTI to get an idea of the supportive research environment that would be a part of their experience during the research years.

Dr. Carol R. Schermer Appointed Director for Clinical Research 

We are pleased to announce that Dr. Carol Schermer has been appointed director for clinical research, effective March 1, 2008.  She will work with our clinical research nurses to enhance and expand the clinical research mission.  In addition, Dr. Schermer will facilitate the development of translational research projects within the Department of Surgery and the Burn & Shock Trauma Institute. 

 

Burn and Shock Trauma Institute

News from Dr. Kovacs' Lab

Eva L. Murdoch, PhD Candidate doing her dissertation research in the Kovacs laboratory is the Department of Cell Biology Neurobiology and Anatomy’s representative to the Graduate Student Council of the Stritch School of Medicine.  Eva is also a member of the Graduate Student Advisory Committee, Loyola University Chicago.  

John Karavitis, PhD Candidate in the Department of Cell Biology Neurobiology and Anatomy doing his dissertation research in the Kovacs laboratory was appointed as graduate student representative to the Medical Council, Stritch School of Medicine.   

Vanessa Nomellini, MD/PhD Candidate in the Program in Biochemistry is doing her dissertation research in the Kovacs laboratory is a member of the President of the Graduate Student Advisory Committee, Loyola University Chicago.

News from Dr. Callaci's Lab

• New Student:              Kristen Lauing (Cell Biology, Neurobiology & Anatomy)

• New Technician:         Elizabeth Favre (Ortho) 

• New Funding:             Blum Kovler Foundation 

Publications
 

Publications 

Abood, G.J., Bowen, M., Potkul, R.K., Aranha, G.V., and  Shoup, M.:    Hepatic Resection for Recurrent Metastic Ovarian Cancer.  Am J Surg 2008; 195:  370-373. 

Abood, G.J., Nickoloff, B.J., Gamelli, R.L.:  Treatment Strategies in Toxic Epidermal Necrolysis Syndrome:  Where are we at?  J Burn Care Res. 2008 Jan-Feb; 29(1):269-76. 

Aranha, G.V., Nimura, Y., Michelassi, F., and Farnell, M.:  The Rule of Extended Lympadenectomy for Adenocarcinoma of the Head of the Pancreas:  Strength of the Evidence.  J Gastrointest Surg (In Press) 

Baker, T.A., Aaron ,J.M., Borge, M., Pierce, K., Shoup, M., and Aranha, G.V.:    Role of the Interventional Radiologist in the Management of Complications after Pancreaticoduodenectomy.  Am J Surg 2008; 195:386-390. 

Bird, M.D., Karavitis, J., and Kovacs, E.J.: Sex differences and estrogen modulation of the cellular immune response after injury.  Cell. Immunol., Invited Review, in press 2008. 

Bird, M.D. and Kovacs, E.J.  Organ-specific inflammation following ethanol and burn injury.  J. Leukoc. Biol., Invited report, in press 2008. 

Brems, J.J.: Survival Analysis of Patients with Transplantable Recurrent Hepatocellular Carcinoma.  Archives of Surgery. 2008 Jan; 143(1): 74.  

Callaci, J.J., Himes, R.,  and Wezeman, F.H .:   Identification of Novel Bone-Specific Targets of Binge Alcohol and Ibandronate by Transcriptome Analysis. Alcohol Clin Exp Res in press 2008. 

Doren, E.. Hulvat, M., Norton, J.. Rajan ,P., Sarker, S., Aranha, G.V., and Yao K. :  Predicting Cancer on Excision of Atypical Ductal Hyperplasia.  Am J Surg 2008; 195: 358-362. 

Emanuele, N.V., LaPaglia, N., Kovacs, E.J., and Emanuele, M.A. Profound effects of burn and ethanol on proinflammatory cytokines of the reproductive axis in the male mouse.  J Burn Care Res. in press 2008.   

Endorf, F.W., Esposito, T.J., Reed ,R.L., Luchette, F.A., and  Gamelli, R.L.:  Broken Bones and orthopedist groans:  Can an Acute Care Surgeon fix Both? J Trauma. 2008 Mar; 64(3): 673-8. 

Farrell, R.T., Gamelli, R.L., Aleem, R.F., Sinacore, J.M.:  The Relationshp of Body mass Index and Functional Outcomes in Patients with Acute Burns.  J Burn Care Res. 2008 Jan-Feb; 29 (1):102-8. 

Foster, K., Greenhalgh, D., Gamelli, R.L., Mozingo, D., Gibran, N.,  and FS 4IU VH S/D Clinical Study Group:  Efficacy and Safety of a Fibrin Sealant for Adherence of Autologous Skin Grafts to Burn Wounds:  Results of a Phase 3 Clinical Study.  J Burn Care Res. 2008 Mar-Apr; 29(2): 293-303. 

Goral, J., Karavitis, J., and Kovacs, E.J.  Exposure - dependent effects of ethanol on the innate immune system. Alcohol, Invited Review, in press 2008. 

Jellish, W.S., Zhang, X., Langen, K., Spector, M.,  and White, F.A.:   Intrathecal Magnesium Sulfate Administration at the Time of Experimental Ischemia Improves Neurological Functioning by Reducing Acute and Delayed Loss of Motor Neurons in the Spinal Cord. Anesthesiology, Jan  2008:  108(1):78-86. 

Karavitis, J., Murdoch, E.L., Ramirez, L, Gomez, C.R., and Kovacs, E.J.:  Acute alcohol impairs macrophage phagocytosis.  J. Interferon Cytokine Res., in press 2008. 

Mosier, M.J., Gamelli, R.L., Halerz, M.M.,  and Silver, G.: Microbial Contamination in Burn Patients undergoing Urgent Intubation as Part of their Early Airway Management. J Burn Care Res. 2008 Mar-Apr; 29(2): 304-10. 

Murdoch, E.L., Brown, H.G., Gamelli, R.L., and Kovacs, E.J.:  Effects of Ethanol on Pulmonary Inflammation in Postburn Intratracheal Infection.  J Burn Care Res. 2008 Mar-April; 29 (2): 323-330. 

Muthu, K., He, L .K., Melstrom ,K., Szilagyi, A.. Gamelli, R.L., and Shankar, R.:  Perturbed bone marrow monocyte development following burn injury and sepsis promote hyporesponsive monocytes.  J Burn Care Res. 2008 Jan-Feb;29(1):12-21 

Nomellini, V., Faunce, D.E., Gomez, C.R., and Kovacs E.J.  Aging exacerbates pulmonary inflammation after injury.  J. Leukoc. Biol., in press 2008. 

Nomellini, V., Gomez, C., and Kovacs, E.J.:  Impairment of Innate Immunity: Hereditary and Age Related Alterations. In Contributions to Microbiology: Innate Immunity.  (eds., H. Herwald, A. Egesten, and A. Schmidt), Karger AG, Basel, Switzerland. In press 2008. 

Plackett, T.P. and Kovacs, E.J.:  Acute Models of Ethanol Exposure. (ed., L.E. Nagy)  In Alcohol Methods in Molecular Medicine. NY: Humana Press 2008: pp 3-9. 

Reed, R.L., Luchette, F.A., Esposito, T.J., Pyrz, K., Gamelli, R.L.:  Medicare’s “Global” Terrorism: Where is the Pay for Performance?  J Trauma. 2008 Feb; 64(2): 374-83. 

Silver, G.M., Albright, J.S., Schermer, C.R., Halerz, M., Conrad, P., Ackerman, P., Lau, L., Emanuele, M., Kovacs, E.J. and Gamelli, R.L.:   Adverse Clinical Outcomes Associated with Elevated Blood Alcohol Levels at the Time of Burn Injury (accepted for publication – Journal of Burn Care and Research) 

Waldschmidt, T.J., Cook, R.T., and Kovacs, E.J.  Alcohol and Inflammation & Immune Response: Summary of the 2006 Alcohol and Immunology Research Interest Group (AIRIG) meeting. Alcohol 2008: 137-142. 

Wezeman, F.H., Juknelis, D. and Callaci, J.J.:  Vitamin D and Ibandronate Prevent Tibail and Vertebral Cancellous Bone Loss Associated with Binge Alcohol Treatment in Male Rats. Bone 41 2007: 639-645.  

Presentations

Aranha, G.V.:  Pancreaticogastrostomy Master Video Symposium.  8^th Meeting of the International Hepato-Pancreato-Biliary Association, , Mumbai, India. February 27-March 2, 2008. 

Brems, J., and Brewster, L.:  Transplantation for Fulminant Liver Failure – The Proper Role of Physicians and Surrogate Decision Making .  Frontiers of Ethics in Transplantation – Chicago, IL.   

Gamelli, R.L.:  Critical Injury, Inflammation and Sepsis -Visiting Professor – Department of Surgery, University of Iowa- Iowa City, Iowa 

Gamelli, R.L.:  Departmental Mathematics Which Avoids Red Ink - EAST Leadership Work Shop.  21^st Annual Scientific Assembly-Eastern Association for the Surgery of Trauma - Amelia Island Plantation, Jacksonville, Florida 

Kovacs, E.J.:  Effects of Aging on the Pulmonary Inflammatory Response after Injury.  Society for Critical Care Medicine, Honolulu, HI, February 2008.  

Kovacs, E.J., Morgan, M. O., Ramirez, L., and Bird, M.D.:    Poster:  Pulmonary Inflammation after Ethanol and Burn Injury is Attenuated in TRIF Knockout Mice.  Keystone Symposium on Innate Immunity, Keystone, CO, February 2008.  

Schermer, C.R.:  “A Clustering of Injury Behaviors” – Western Trauma Association “Alcohol Withdrawal Syndrome in Trauma Patients – A Prospective Cohort Study”  - Brian Sharp MS4 – Senior Research Paper – Western Trauma Association 

Shoup, M., Oshima, K., Yong, S., and Aranha, G.:  Whipple Resections in patients without tumor:  What are potential mimickers?” – Poster Presentation – United States and Canadian Academy of Pathology Annual Meeting. 

Shoup, M., Vali, F., Nagda, S., Hong, R., Gao, M., Hall, W., Sinacore, J.,  Lee, S., and  E. Melian, E.:  Comparison of SUV-based PET and CT target volumes in esophageal cancer patients undergoing radiation therapy – Poster Presentation – ASCO-GI 

White, F.A.:  Symposium Speaker, Association of Anatomy, Cell Biology and Neurobiology      Chairpersons Annual Meeting, Los Playa, Costa Rica 

White, F.A.:  Invited Seminar, Pharmacology and Experimental TherapeuticsLoyola University, Chicago 

White, F.A.:  Invited Seminar, Immunology, Rush University, Chicago 

White, F.A.:  Symposium Speaker, Experimental Cell Biology 2008, San Diego, CA  

Yao, K. A.:  Histopathologic Features of the Primary Tumor in Breast Cancer Patients with Isolated Tumor Cells of the Sentinel Node.   Central Surgical Association – Cincinnati, OH. 

Abstracts  

Albright, J.A., Kovacs, E.J. Schermer, C.R., and Gamelli, R.L.:   Implications of formal alcohol screening in burn patients. Annual meeting of the American Burn Association, Chicago, IL, May 2008. 

Albright, J.A., Schermer, C.R., Halerz, M., Conrad, P., Ackerman, P., Yee, L., Emanuele, M.A., Kovacs, E.J., and Gamelli, R.L. Differences in clinical outcomes after alcohol intoxication at the time of burn injury.  Joint Meeting of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism, Washington, D.C., June 2008. 

Bird, M.D., Milligan, G.N., Albright, J.M. and Kovacs, E.J.  Differences in clearance of HSV-1 after acute ethanol exposure.  Annual meeting of the American Association of Immunologists, San Diego, CA April 2008.    

Kovacs, E.J., Morgan, M.I., Ramirez, L. and Bird, M.D.  Pulmonary inflammation after ethanol and burn injury is attenuated in TRIF knockout mice.  Keystone Symposium on Innate Immunity, Keystone, CO, February 2008. 

Kovacs, E.J., Ramirez, L., Morgan, M.O., Murdoch, E.L., and Bird, M.D. Organ-specific inflammatory responses following binge ethanol exposure and burn injury. Joint Meeting of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism, Washington, D.C., June 2008. 

Murdoch, E.L., Gamelli, R.L. and Kovacs, E.J.  Burn injury increases the susceptibility to pulmonary infection with Pseudomonas aeruginosa. Annual meeting of the American Burn Association, Chicago, IL, May 2008. 

Nomellini, V., Gomez, C.R., and Kovacs, E.J. Increased pulmonary inflammation in aged mice after burn correlates with increased neutrophil chemokines.  Annual meeting of the American Burn Association, Chicago, IL, May 2008. 

 Appointments 

Angelats, J.:   Committee on Applicants – American College of Surgeons. 

Cimino, V.G.:  Chairman of the Craniomaxillofacial Trauma Course – Spine Masters Institute- Burr Ridge, IL. 

Gamellli, R.L.:  Medical Advisory Board – Shriners Hospital for Children. 

Santaniello, J.:  Director, Fellowship Program for Surgical Critical Care. 

Shoup, M.:  Research Committee – American Hepatopancreaticobiliary Association 

Shoup, M.:  Program Committee – Central Surgical Association.

Awards 

Aranha, G.V.:  2008 Americas Top Surgeons – Consumers Research Council of America. 

Yao, K.A.:  Physician Spirit Magis Award. 

Grants 

Guttu, R.:  Educational equipment grant from BIOMET 3i for section of OMFS. 

Karavitis, J. and Kovacs, E.J.:  Alcohol and Impaired Macrophage Phagocytosis.   NIH, F31 AA017027-01 PhD, Predoctoral Trainee, Department of Cell Biology Neurobiology, & Anatomy) Period: 1/1/08 – 12/31/10. 

Murdoch, E., and Kovacs, E.J.:  Pulmonary Bacterial Clearance of Acute Ethanol and Burn Injury. NIH F31 AA017032-01 Period: 1/1/08 – 12/31/09.  

Shoup, M.:  $100,000 Grant from the Richard A. Perritt Charitable Foundation – A Pilot Study Evaluating Intratumoral Administration of Autologous KLH-pulsed Dendritic Cell Vaccine Following Standard Chemoradiation for Locally Advanced Pancreatice Adenocarcinoma. 

White, F.A.:  1 Year Grant Award for Neuroscience Translational Research, Dr. Ralph and Marian Falk Medical Research Trust  

Alumni Corner

Surgery Alumni Discuss Impact of Loyola Training on Their Career 

Surgeons who served their residency or fellowship with the Department of Surgery of Loyola University Chicago Stritch School of Medicine highlighted different reasons why their training at Loyola was crucial – even life-changing – as they developed their future careers. But high on the list were the mentoring of attending physicians, superb clinical training and the Jesuit spirit of caring for others as formative to their development.   

Margo Shoup, M.D., is associate professor of surgery in the Department of Surgery and chief of the Division of Surgical Oncology at Loyola. Serving her general surgical residency at Loyola from 1993-1999, and then as chief administrative resident from 1999-2000, she recalled the impact of her training on her career. 

“I think what stood out most was the excellent mentoring I received at the attending physician level,” explained Dr. Shoup, singling out Gerard Aranha, M.D., whom she succeeded as chief of the Division of Surgical Oncology, as well as Richard Gamelli, M.D., chairman of the Loyola Department of Surgery, and Jack Pickleman, M.D., now retired. “The clinical training was phenomenal in terms of the number of cases, and the appropriate autonomy I was given in providing patient care,” she added. 

Now engaged in National Institutes of Health-funded research, Dr. Shoup recalled early opportunities as a resident to present research results to such prestigious groups as the Eastern Association for the Surgery of Trauma, Shock Society and the Chicago Surgical Society, all of which recognized her research with awards. Mentors like Ravi Shankar, Ph.D., associate professor and research scientist in the Loyola Departments of Surgery and Cell Biology, Neurobiology and Anatomy, gave her research advice that she has never forgotten: “Work like a surgeon and think like a scientist.”  

Gerard Aranha, M.D., is professor of surgery in Loyola’s Division of Surgical Oncology and chief of General Surgery at Edward Hines Jr., Department of Veterans Affairs Hospital. A native of Bangalore, India, Dr. Aranha represents the third generation of physicians in his family.  Early on, he intended to follow in the footsteps of his namesake uncle and go into cardiovascular surgery. But after Dr. Aranha served a general surgical residency at Hines and Loyola from 1971-1975, he decided to focus on surgical oncology instead.  

Dr. Aranha joined the Hines surgical residency program in 1971, at the time run by Charles B. Puestow, M.D., internationally recognized surgeon and researcher who served as the chief of surgery at Hines. “Although I was already accepted at Albert Einstein College of Medicine in New York, Dr. Puestow gave me a position in the  surgical residency program at Hines,” explained Dr. Aranha. “He was a very impressive person.”   In 1973 the surgical residency programs at Hines VA and Loyola merged under the leadership of Dr. Robert Freeark.  

Following a fellowship in surgical oncology at the University of Minnesota, Dr. Aranha returned to Hines where he helped to grow the surgical oncology program and practiced at Loyola. Then in 1990, he was asked to develop the surgical oncology program at Loyola, where his leadership resulted in numerous innovations and improvements in surgical cancer care.   

Looking back, Dr. Aranha recognizes the Jesuit influence on his training. “I live by two mottos that have served me well. One is, ‘Faith and toil,’(Fide et Labore – Jesuit High School, Bangalore, India.)  The other is Loyola’s Jesuit motto ‘For the greater glory of God,’” explained Dr. Aranha. “I have been fortunate to have been given the opportunity to do work I find important and to do it without interference,” he added. 

Juan Angelats, M.D., served his residency in plastic surgery at Loyola University Medical Center from 1973-1976, and then joined the faculty. Now as professor of surgery and chief of the Division of Plastic and Reconstructive Surgery at Loyola, Dr. Angelats admitted he never intended to stay in the Chicago area following his residency. A native of Peru, he thought he would set up his surgical practice in Lima and return to his family and friends there. 

But Dr. Angelats said he found a sense of family at Loyola, one he never expected. He felt comfortable with the Jesuit philosophy, since he grew up with the influence of the Marist brothers and priests in Peru. But the sense of connection goes back further: to the former Cook County Hospital, where he served his general residency. There he met three surgeons critical to his future, all of whom later came to Loyola: Robert Freeark, M.D., former chairman of the Loyola Department of Surgery from 1975-1995; Raymond Warpeha, M.D, Ph.D., former chief of Loyola’s Division of Plastic and Reconstructive Surgery; and Sidney Blair, M.D., Ph.D., former chairman of the Loyola Department of Orthopaedic Surgery and Rehabilitation.  

After Dr. Angelats finished his Loyola plastic surgery residency, Orion Stuteville, M.D., then the chief of the Division of Plastic Surgery at Loyola who was retiring, asked him what he planned to do next. “I told him I was ready to get on a five-hour flight to Lima, to be with my parents and brothers and sisters,” said Dr. Angelats. “Dr. Stuteville thought I should stay at Loyola for a year, to help Dr. Warpeha, the new chief of plastic and reconstructive surgery, build the program. “Well, I’ll stay for a year,” Dr. Angelats told his mentor. “Now I’m still here, more than 35 years later.” 

Another faculty member whose training experience at Loyola made a deep and long-lasting impression is Steven A. De Jong, M.D., who began his association as a Stritch student in 1980. After graduation, he served his surgical internship and residency at Loyola University Medical Center from 1984-1989, followed by a fellowship in endocrine surgery there from 1989-1990. 

Today, Dr. De Jong is professor of surgery in Loyola’s Department of Surgery, where he serves as chief of the Section of Endocrine Surgery as well as chief of the Division of General Surgery. In addition, he is vice chairman for clinical affairs for the Department of Surgery.  

As a surgeon-in-training, Dr. De Jong was impressed by the attending faculty who served as strong mentors. “The dedication of the attendings was very evident, in the way they passed along important concepts, taught rounds each week and made issues clearer for us,” he said. “They just had a tremendous amount of enjoyment in taking care of patients, and this made us want to emulate them. You could see that their greatest achievement and joy was seeing their patients do well because of their intervention. 

 “The trust patients place in surgeons, who are totally in charge while patients are helpless under anesthesia, was something our mentors taught us to take very seriously,” Dr. De Jong stressed. “We learned that trust and stewardship were the most important things surgeons do. You could see that they learned this from their mentors and now we try to pass this on as well.”

Staff Corner

New Chapter Coordinator

Congratulations to Mary Kay Larson, MSN, nurse practitioner in the Department of Surgery, Division of Surgical Oncology, on recently being named as chapter coordinator-elect for the North Central chapter of the American Nephrology Nurses’ Association. This is part of a two-year obligation that places her in a key position with that organization on a regional and national level.

#1 Award 

Melissa Miller and Sandy Ransom shared the # 1 Award during the months of November and December.  They asked that the award be passed on to Gail Baron.  In their own words: 

Melissa:  “In my opinion, Gail is truly #1.  She has definitely been extremely helpful to me since I started working here at Loyola.  She is always more than willing to lend a helping hand and always seems to have a smile on her face.  She is truly a pleasure to work with!” 

Sandy: “Gail earned this month's #1 in my eyes because she was my #1 resource here in Surgery from my first day of work up until today.  She not only guided me through office procedures, like scheduling surgeries in EPIC, but also took it upon herself to help me familiarize myself with campus.  Months after I started she would remember some bit of knowledge she thought might be beneficial in the completion of my duties and she would send me a little "FYI" note about it.  As I mentioned in the meeting, she not only taught me what to do, she showed me how to handle things when I DIDN'T know exactly what to do.” 

Gail Baron who had the # 1 Award during the month of January asked that the award be passed on to Barb Reichardt.  In Gail’s words:

“I would like to pass on the #1 award on to someone who is always friendly and has a smile on her face.  She is busy, as we all are, but most times gets the wandering person from the lobby looking for someone here in our maze of cubicles.  She is always pleasant, stops what she is doing and walks them to their destination.  She is very approachable and willing to help, so I would like to pass this award on to Barb Reichardt.” 

Barb will keep the award until the next meeting, when she will pass it on to another deserving staff member.

The Last Word
 

Our Donor Wall Continues to Grow  

It has been two years since Department of Surgery Chair, Dr. Richard L. Gamelli announced the establishment of our Surgical Education & Research Endowment Fund and Donor Wall.    Since its inception, our Donor Wall has continued to grow with many generous donations.      

Over these past years the department of surgery has been blessed with friends, alumni, and faculty that have been willing to support our educational mission in the form of philanthropy.  Our donor wall serves multiple purposes.  It is a reminder of the responsibility we have to the future of medical education. It is a testament of the generosity of many people who in most cases may never know the full affect or implications of their generosity.    Finally, as it states, “Building on Success and for the Future of Surgery”  the donor wall is a call for future action.  

When donations are made to our endowment, they are translated into excellence, growth, and progress.  While the best reward is the knowledge that these gifts have helped in the advancement of our mission we also recognize our benefactors by displaying their names on a plaque on the Donor Wall.

As you see from the picture, the wall has no borders.  Such is the commitment to our mission and the future of surgical education … without boundaries

Donation levels include Chairman’s Circle ($10,000 +); Valued Donor ($5,000 - $9,999); Contributor ($1000 - $4,999); and Supporter (up to $999.)

If you would like more information on making a contribution, please contact Timothy O’Hern, director of administration, Department of Surgery (709)327-2707 or Peggy LaFleur,  director, Office of  Development (708)216-5197.