For the past 6 years, I’ve watched chief residents travel to faraway places, visiting some of the biggest names and places in surgery as part of the Keeley traveling fellowship, hoping that one day it would be my turn. This year – my chief year – I was fortunate enough to be awarded this unique opportunity to travel abroad and learn how things are done in the centers whose papers I’ve read for years.

I matched into a surgical oncology fellowship at Fox Chase Cancer Center in October, and shortly thereafter I began networking through Loyola as well as Fox Chase, to choose the best places for me to visit. I found the University of Pisa, in Pisa, Italy, and a Professor there named Dr. Hugo Boggi, who is good friends with one of the attendings at Fox Chase. He is an accomplished pancreatic surgeon in a tertiary referral center for pancreatic surgery and transplant. I also made arrangements to visit Hospital Paul Brousse, just outside of Paris, where the world-renowned Professor Rene Adam heads the Centre Hepato-Biliare. My husband was fortunate enough to be able to take 2 weeks off of work and join me on this European adventure.

We left Chicago Saturday April 23^rd, flying through Manchester, England to arrive in Pisa Sunday afternoon. We picked up our rental car and headed for Viareggio, a sea town just north of Pisa, where we stayed for the first week. Cisanello Hospital, on the outskirts of Pisa, is a beautiful hospital campus with a whole building devoted to general, transplant, and vascular surgery. In this building are wards, ICU’s, operating rooms, and an entire radiology suite including a surgeon-ultrasonographer and a surgeon-endoscopist. The nephrologists, endocrinologists and hepatologists also have their offices and patients there, so that all of the patients are cared for by a team of medical and surgical specialists skilled in the treatment of all aspects of hepatobiliary, pancreatic, and renal diseases. I learned a great deal about the very different system of training surgeons that Italy has developed. I was able to scrub and watch many procedures, including the technique of retroperitoneal pancreas transplant, which was developed by the team at Pisa. I spoke with several professors engaged in research pertaining to the pancreas, and visited their very impressive surgical skills lab.

On the side, my husband and I found time to drive around the Tuscany region, visiting several small towns and enjoying the fantastic Italian cuisine. After our week in Pisa, we traveled to Venice for the weekend, then caught an overnight train to Paris. The Centre Hepato-Biliare just outside of Paris functions as a well-oiled machine under the command of Professor Rene Adam. I attended several multi-disciplinary conferences where every new patient is presented to the team of faculty from all aspects of patient care – hepatologists, oncologists, surgeons, radiologists, and pathologists. I attended ICU rounds with an attending boarded in both hepatology and ICU care. I scrubbed or watched many procedures including a liver transplant, partial hepatectomy, repeat hepatectomy, cryoablation, RFA, and a TIPS. I discussed research ideas with some of the faculty, including Professor Adam, including the effects of pre-op chemotherapy on liver regeneration after resection and the use of cryo versus RFA in non-resectable, non-transplantable hepatocellular carcinoma.

The Keeley fellowship was an amazing learning experience for me, from watching different surgical techniques to learning about different systems of resident training, to experiencing different cultures. I’ve made professional contacts and personal friendships that I hope will continue throughout my career. Even since returning, I met up with several members of the Pisa team at the Pancreas Club meeting in Chicago. I would recommend every surgical resident apply for the Keeley traveling fellowship, as it is a truly once-in-a-lifetime opportunity.

As I look back at the last five years of my life, I compare it to a marathon.  When I first started my internship, I lost track of the marathon part and started sprinting.  I quickly ran out of breath.  It was hard making the transition from medical student to doctor.  Patients were now MY responsibility.  I was the person responsible for getting them to the OR, through their hospital course and safely discharging them.  All the notes, forms, meds, labs, pages, blood draws, dressing changes, line insertions, and TPN orders were solely my jurisdiction.  I needed to collect the films, organize them and present each patient coherently to the attending with a logical plan during attending rounds.   

Internship was “on the job” training.  The training part as an intern required that I pushed my book knowledge to the back of my head and started with the practical.  It meant learning how to apply what I had learned in theory and implement it in a dynamic, sometimes inefficient and vexing hospital environment.  It meant learning how to organize and prioritize.  Internship is akin to boot camp.  It’s meant to be difficult and stressful.  It exposed my foundation of personal and professional strengths and weaknesses.  Loyola provided the material to rebuild my weaknesses and augment my strengths.  

The following three years are a blur.  Where does the time go?  The early part of this period was spent learning who needed an operation and how to carry it out.  The latter part of this period was spent becoming more efficient and adept at those operations and adding in the more difficult decision of who WON ‘T benefit from an operation?  It is also a time of transition from worker bee to queen (or king) bee. 

Chief resident year is the best year.  The cases I had wanted to perform so badly for the last three years were now mine.  It has been a year to spread my surgical wings with the benefit of a safety net.  Job interviews and practice selection were exciting.  Deepening my knowledge has made the practice of general surgery more rewarding.  The finish line is now within sight.   

I am indebted to all of my attendings who took the time to share their personal and academic expertise for the benefit of my growth as a general surgeon.  I have been given a wonderful foundation upon which to build a surgical career.  

Congratulations to the graduates June 2005…..
By: Dr. Sheryl Gabram

This year we say goodbye to six graduating categorical general surgery chief residents.  For various reasons, this class was unique in that two started as 1^st year residents in July 2000 (Dr. Sean Barnett from Loyola Stritch School of Medicine and Dr. Olga Ivanov from Medical College of Toledo), one (Dr. Kim Brown spent two years as an NIH trauma training grant recipient with her main emphasis in the lab focusing on the effects of cholestasis and sepsis on hepatocyte apoptosis and regeneration), and three joined the program as 3^rd and 4^th year residents (Drs. Ata Mazaheri, Kara Kane Criswell, and Vinod Winston).  Due to their combined efforts, it was an outstanding academic year.  Dr. Kim Brown, the educational administrative chief resident, instituted the first internet based educational program with case studies, reading assignments and multiple choice questions available to residents on a weekly basis prior to the resident educational conference.  Dr. Sean Barnett, the administrative chief resident responsible for schedules and keeping the peace in the residency, kept the schedule running smoothly even with the new demands of the 80 hour work week and made sure all was well in the ranks.

I share an except from the welcome and fare well dinner on June 17^th when over 200 members of the Department, residents and guests (including parents and spouses of the graduates) joined us for an evening of recognition for all of our residents but in particular to the graduating chief residents in general surgery. 

For all of the graduates this year, I leave you with 3 final thoughts: 

Second, the world of surgery is a small circle.  Be cautious as you become a member of the surgical community whether it is in an academic or private practice setting.  You never know who you will run into years later in you career—which reminds me of a story.  Many of you have read about or personally know Dr. Grace Rozycki, distinguished trauma surgeon and known for her work in the FAST ultrasound exam.  What you probably don’t know is that, Grace and I were one year apart in training and I remember to this day confronting her in the stairwell at the Washington Hospital Center telling her to quit stealing my cases (she was a fellow and I was a chief resident at the time).  Now almost twenty years later we have formed a professional friendship, (and despite my outburst in that stairwell) she graciously agreed to be on a panel for me at the American College of Surgeons last Fall discussing academic careers in surgery—so try not to  burn any bridges that many of us probably did early on in our careers.

Third, as a leader in your surgical circle, make it meaningful.  Form the bonds of friendship with your surgical and non-surgical colleagues and try and understand where your patients are coming from.  For me this only took place in mid career and if I had to do it over again I would make it happen earlier.  It was through forming those bonds of friendship here with faculty and residents alike, as well as volunteering with the Y-Me organization when I had the opportunity to see the disease that I was treating every day through my patient’s eyes, that has really made an impact on my life as a practicing surgeon.  As surgeons we are taught to be decisively strong and maintain that professional barrier but I actually think that I am a better surgeon for occasionally crossing that barrier, forming those friendships and seeing life from a different perspective.

From the Bench

Good luck to Joanna Goral, Ph.D.  Dr. Goral completed her PhD training in the Department of Cell Biology, Neurobiology, and Anatomy and received her diploma at the graduation ceremony at the Loyola University Lake Shore Campus on May 19, 2005.  Dr Her dissertation research, performed in the laboratory of Dr Elizabeth Kovacs, was the entitled “Acute ethanol exposure inhibits Toll-like Receptor mediated inflammatory response in murine macrophages.”  On June 1, 2005, Dr Goral left Loyola to begin working as an Assistant Professor of Anatomy at Midwestern University School of Osteopathic Medicine, Downers Grove, IL. 

Eric D. Boehmer, MD/PhD student in the Department of Cell Biology, Neurobiology, and Anatomy completed the PhD portion of his training in the Dr. Elizabeth Kovacs’s laboratory.  Eric studied the effects of age on ability of murine macrophages to respond to inflammatory stimuli.  In July 2005 Eric will be returning to SSOM for the completion of his final two years of medical school. 

Congratulations to Daniel J. Fitzgerald.  Dan successfully defended his masters thesis on June 10, 2005 on a project designed to determine the mechanisms by which acute ethanol exposure impairs the early inflammatory response after dermal injury.  His work was conducted in the laboratory of Dr Elizabeth Kovacs through the Program in Cell and Molecular Biochemistry. 

The 10^th Annual Meeting of the Alcohol and Immunology Research Interest Group (AIRIG) will be held on Friday November 18, 2005 in the Department of Surgery at Loyola University Medical Center in Maywood, IL.  This will be the third such meeting organized by Dr Elizabeth Kovacs and the second held at the Medical Center.  The focus of the 2005 meeting will be “Alcohol and Inflammatory and Immune Responses.”  This year, the organizers elected to limit invited speakers to junior scientists and those new to the field of alcohol and immunology.  Additionally there will be short presentations, which will be selected from abstract submissions.  There will also be a poster session and ample time for discussion.  A National Institutes of Health R13 meetings grant was submitted by Dr Kovacs to cover a portion of costs of hosting the meeting.  Sponsors of the meeting include the Loyola’s Department of Surgery and the Alcohol Research Program (ARP).  For additional information about the ARP, visit our web site www.meddean.luc.edu/arp, and for additional information about the AIRIG meeting contact Dr. Kovacs or send an email to ARP@lumc.edu. 

Congratulations to Katherine A. Radek, a graduate student from the Program in Biochemistry, who completed the final defense of her doctoral dissertation on May 26, 2005.  Dr. Radek performed her thesis research in the Burn and Shock Trauma Institute in the laboratory of Dr. Luisa DiPietro, where she investigated how ethanol consumption affects the healing wound.  Kathy's studies showed that even a single dose of ethanol, if taken just prior to injury, substantially slows down the healing process.  In particular, Dr. Radek discovered that the growth of capillaries into the wound is significantly slowed by ethanol consumption.  Her findings may explain why trauma patients who have consumed ethanol are at greater risk for wound healing problems.  Now that she has completed her doctoral work, Dr. Radek will be moving to California, where she will take a position as a post-doctoral research fellow at the University of California at San Diego. 

Dr. Traci Wilgus, a post-doctoral fellow in the Burn and Shock Trauma Institute, is the 2005 winner of the prestigious 3M Young Investigator Fellowship.  The 3M Fellowship is awarded by the Wound Healing Foundation, an organization with the mission of improving the quality of wound care worldwide through the funding of research and education. The highly competitive fellowship will provide a $15,000 unrestricted grant to support Dr. Wilgus' research efforts.  Dr. Wilgus plans to study how particular growth factors influence scar formation by modulating fibroblast function.  Her work may eventually suggest therapeutic measures to reduce scar formation in patients with traumatic or surgical injuries.  

PUBLICATIONS and APPOINTMENTS

Gerard Aranha, M.D.
Top Doctor, Chicago Metroplitan Area - 2004 – Castle Connolly
Distinguished Physician Award – Indian American Medical Association – 2004
President – Chicago Surgical Society – May, 2005 

Shoup M, Aranha GV  “Non-Standard Pancreatic Resections for Unusual Lesions”.  Am J  Surg 2005; 189:223-228 

Brown K, Domin C, Aranha GV, Shoup M “Increased preoperative platelet count is associated with decreased survival following resection for Adenocarcinoma of the pancreas”.  Am J Surg 2005; 180:278-282

 John Brems, M.D.
America’s Top Doctors for Cancer – 2005 – Castle Connolly

Kimberly Davis, M.D.
Program Committee – Western Trauma Association
Subcommittee Chairperson – Education and Registry – Chicago Committee on Trauma

Davis KA,  Eckert MJ, Reed RL, Esposito TJ, Santaniello JM, Poulakidas S and Luchette FA “Ventilator-associated Pneumonia in the Injured Patient:  Do you trust your gram stain?”  J Trauma, 58(3), 462-467, 2005.

Steven DeJong, M.D.
President – Midwest Surgical Association
Editorial Board – American Journal of Surgery

Thomas J. Esposito, M.D.
Medical Director – Rural EMS and Trauma Technical Advisory Center, Bozeman, Montana

AAAST Liaison – American Brain Trauma Foundation

Co-author – “Future of Trauma Surgery” – Journal of Trauma

Richard L. Gamelli, M.D.
President – American Burn Association

Gosain A and Gamelli, RL: The Role of the Gastrointestinal Tract in Burn Sepsis.  J Burn Care Rehabil 2005 Jan-Feb; 26(1) 7-12.

Gosain A and Gamelli, RL: A Primer in Cytokines.  J Burn Care Rehabil 2005 Jan-Feb; 26(1) 85-91.

Brewster LP and Gamelli RL: Improving Clinical Outcomes in Trauma-Related Hemorrage: Cleaning up a Bloody Mess. Issues in Hemostatis Management 2005 Jan; 1(3).

Gamelli RL, ABA Board of Trustees, et al:  Disaster Management and the ABA Plan.  J of Burn Care & Rehabil 2005 Mar-Apr: 26(2) 102-6.

Endorf FW, Supple KG and Gamelli RL: The Evolving Characteristics and Care of Necrotizing Soft-Tissue Infections. BURNS 2005 May 31(3) 269-273.

Criswell KK and Gamelli RL: Establishing Transfusion Needs in Burn Patients:  One Institution’s Experience in Treating the Severely Burned.  Am J Surg. 2005 Mar; 189 (3):324-6.

Li X, Rana SN, Kovacs EJ, Gamelli RL,,Chaudry IH and Choudry MA:  Corticosterone suppresses Mesenteric lymph node T cell by inhibiting p-38/ERK pathway and promotes bacterial translocation following alcohol and burn injury.  Am J Physiol Regul Integr Comp Physiol. 2005 Feb 17;

Kavanaugh MJ, Clark C, Goto M, Kovacs EJ, Gamelli RL, Sayeed MM and Choudry MA:  Effect of Acute Alcohol Ingestion prior to Burn Injury on Intestinal Bacterial Growth and Barrier Function.  BURNS. 2005 May; 31(3):290-6.

Wang K, Brems JJ, Gamelli RL, Ding J:  Reversibility of caspase activation and its role during glycochenodeoxycholate-induced hepatocyte apoptosis.  J Biol Chem. 2005 Mar 14.

Davis KA, Luchette F, Santaniello J, Eckert M, Reed RL, Gamelli RL, Poulakidas S, and Esposito T: Ventilator-associated Pneumonia in Injured Patients:  Do you trust your Gram stain?  J Trauma. 2005  Mar; 58(3):462-6.

Howard J. Greisler, M.D.

President – International Society for Applied Cardiovascular Surgery
Chairman – VACO Surgery Merit Review Subcommittee for Surgery
Associate Editor – Cardiovascular Pathology

Brey E, Uriel S, Greisler HP,  Patrick C, McIntire L: Therapeutic neovascularization:  contributions from bioengineering.  Tissue Eng. 2005 Mar-Apr; 11 (3-4):567-84.

Fred Luchette, M.D.
Chair – Membership Advisory Committee – Central Surgical Association
Chair – Membership Committee – ACS COT
Secretary – Eastern Association for the Surgery of Trauma Foundation

Davis KA,  Eckert MJ, Reed RL, Esposito TJ, Santaniello JM, Poulakidas S and Luchette FA “Ventilator-associated Pneumonia in the Injured Patient:  Do you trust your gram stain?”  J Trauma, 58(3), 462-467, 2005.