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Newsletter
- Winter 2006
Welcome to the Department of Surgery Newsletter. We hope you find this information helpful.
From Where l Sit..
Richard L. Gamelli, MD, FACS
“The philanthropy of alumni, grateful patients and their families,
faculty and friends is critically important to our future. These gifts allow
us to offer surgical residents, fellows, and senior medical students going
into surgery a unique education and state-of-the-art training. Gifts to
fund research in our laboratories as well as at the bedside are used to
improve how we care for patients. It has been said the best way to predict
the future is to invent it. The donors that you see here have chosen to
shape that future.” The above statement will be the cornerstone of a donor
wall being erected within the department surgery. No longer can departments
of surgery solely fund the diverse aspects of senior medical student,
resident, and fellow education from operating revenue. One might raise the
argument that medical education and more specifically graduate medical
education is funded through Medicare reimbursement. I fully acknowledge
that without federal support our program and programs like it would not
exist. However, these funds do not support upon the breath of educational
programs that we must now provide.
In the past the department of surgery funded much of the cost of providing a
rich educational experience. It is unfortunate that clinical revenues can
no longer be stretched to the point where they meet all the educational
needs we see as appropriate for residents, fellows and students during their
surgical training. Additionally, unique programs such as our
Diversity Scholarship in Trauma, Burn Care and
Research which introduces senior minority medical students from across the
country to clinical care in trauma and burn, as well as research at Loyola
requires our ongoing support.
Over the 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 will
serve 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. The students and residents who participate in these
programs are enriched in their education. Further, they gain valuable skills
and knowledge that directly enhances their ability to care for patients
which will return a lifelong dividend to our donors. Finally, the donor wall
is also a call for future action. The department of surgery needs to go
beyond the generosity of a few and look toward the creation of a mechanism
that will be forever giving. As you see from the illustration our donor
wall has no borders. That is so since the commitment to our mission and the
future of surgical education cannot be one that is limited.
I plan to work with our development office in the creation
of a new endowment fund for the department of surgery specifically targeted to
the educational needs of our students, residents and fellows. My target for
such an endowment would be to raise $2 million over the next five years. Such
an endowment would create a secure revenue stream. As we move forward I hope
that you will keep in mind the many lives that will be touched by your gift.
This fund will not only provide an enhanced educational experience for our
students and residents but also will impact the patients they care for
throughout their professional career. For information on how you might
participate toward our future please contact the Denis O’Keefe, Director Major
Gifts Loyola University Development Office at (708) 216-5197 or the Department
of Surgery at (708) 327 2707.
Feature Article
Two Section
Chiefs Commemorate 25 Years with Loyola
Department of Surgery
Faculty members of Loyola University Chicago Stritch School
of Medicine (Stritch) are committed to academic excellence, scientific research
and ethical behavior. Two faculty members who exemplify these qualities are
celebrating their 25th anniversary with the Stritch Department of
Surgery: Juan Angelats, M.D., FACS, chief of the Division of Plastic and
Reconstructive Surgery, and Gerard V. Aranha, M.D., FRCS, chief of the Division
of Surgical Oncology.
Juan Angelats, M.D., served his residency in plastic
surgery at Loyola University Medical Center from 1973 to 1976, after which time
he joined the Department of Surgery faculty as an attending physician. Looking
back
 over his career of the last 25 years, the seasoned surgeon marvels at major
strides in overall patient care, as well as in plastic surgery. “The practice of
medicine has made terrific advances in the care of patients,” says the chief of
the Division of Plastic and Reconstructive Surgery, a role he has served since
2003. But he also noted some concerns, such as medical-legal issues, and the
growing influence of insurance companies and the government in patient care.
A native of Peru, Angelats first came to the United States
to gain more medical knowledge and training. “I wanted to become the best I
could be as a surgeon,” he explains. He went on to become a division chair and
professor within the Stritch Department of Surgery, where he has performed
research, taught numerous medical students and surgeons-in-training, and
provided excellent care to thousands of patients. Angelats also has authored or
co-authored 21 publications, seven abstracts, and four chapters. In addition, he
has made 136 presentations to regional, national and international audiences.
The plastic surgeon has been named one of the Top Doctors in Chicago by Castle
Connolly Guide and Consumers’ Research Council of America.
Although Angelats specialized in plastic surgery, he
developed competencies in a number of areas, such as breast reconstruction,
cardiomyplasty for heart patients, skin malignancies, and tissue expansion, as
well as cosmetic surgery and liposuction. “As a plastic surgeon, I like to say I
was trained to do everything,” Angelats notes, “from the top of the head to the
bottom of the feet.”
In the Jesuit tradition, he uses his numerous skills and
talents to help others. In particular, Angelats is very proud of his work with
the Peruvian American Medical Society (PAMS). Having conducted 13 medical
missions to different areas of Peru, the plastic surgeon has performed thousands
of procedures free of charge, trained Peruvian medical professionals and
arranged donations of medical equipment to hospitals in Peru.
Angelats hopes to continue to fulfill his life through this
type of service. “I am grateful to people who helped me,” he adds. “The Loyola
faculty members I have known for so many years have been excellent and very
congenial associates.”
Gerard V. Aranha, M.D., served his general surgery
residency at Loyola University Medical Center from 1971 to 1975. After he did a
surgical oncology fellowship at the
 University of Minnesota, he returned to
Loyola as an attending physician, eventually becoming chief of the Division of
Surgical Oncology in 1990. A professor of surgery, he also serves as the chief
of general surgery at the Edward Hines Jr., Department of Veterans Affairs
Hospital in Maywood.
When starting as a young attending physician 25 years ago,
Aranha says the practice of medicine had fewer regulations and malpractice
issues didn’t play as large a role as they do today. While today’s medical world
is more complex, it offers higher quality patient care and greater technological
advances, he adds.
The surgeon particularly values his focus on such disease
sites as esophageal, stomach, pancreatic and breast cancer, in addition to
melanoma and soft tissue sarcoma. One major accomplishment was serving as the
surgeon for the late Joseph Cardinal Bernardin, Archbishop of Chicago, who died
in 1995 from pancreatic cancer. Since this time, Aranha has assembled a large
database of nearly 600 cases of pancreatic cancer, which has spawned more than
60 publications and abstracts. As a result, he has served on several national
committees and promoted dialogue on improvements in the treatment of pancreatic
cancer. Aranha currently serves as associate director of the Cardinal Bernardin
Cancer Center.
In total, he has authored or co-authored 53 abstracts and
posters, as well as 108 articles, letters and book chapters on the subject of
surgical oncology. Aranha also has made 157 presentations to regional, national
and international audiences.
Currently, Aranha is serving as the president of the
Chicago Surgical Society, and is past president of the Illinois Surgical Society
and the Midwest Surgical Association. Named one of the Top Doctors in Chicago by
the Castle Connolly Guide, he also served on the board of directors of the
American Cancer Society from 1993-1996. The surgeon also has been recognized for
excellence in teaching by medical students and residents.
A native of India, Aranha received the Indian American
Medical Association of Illinois Distinguished Physician Award in 2004. He
decided to study in the U.S. because of its world-class surgical training. But
Aranha never forgot the example set by pre-eminent surgeons in India, who
treated patients in public hospitals in the morning, followed by clinics with
private patients in the afternoon. “Caring for patients, regardless of their
economic means, is very satisfying to me, even though it sometimes makes for a
hectic schedule as I care for patients at Hines and Loyola,” says Aranha. In
2003, he received the Association of Veterans Affairs Surgeons’ Distinguished
Service Award, an honor bestowed for excellence in patient care, research and
medical education.
In addition to
his medical activities, Aranha has volunteered at Visitation Grade School in
Elmhurst, Fenwick High School in Oak Park, and the Ray Graham Association for
People with Disabilities in Downers Grove, among other organizations.
Clinical
Spotlight
Division of Surgical Oncology
The Division
of Surgical Oncology was created within the department of general surgery to
organize a group of surgeons dedicated to the research, practice and
teaching of surgical oncology. The division intends to achieve these
objectives through three avenues: (1) a clinical program, (2) education,
and (3) research. The objective of the clinical program is to increase
market share of cancer cases and volume of operative cases. By this, the
Department of Surgery will gain recognition within the surgical community,
and Loyola as a whole, will be recognized for providing subspecialty care in
surgical oncology and subsequently will result in attracting more patients
into the Loyola system. Primary care physicians can refer their newly
diagnosed cancer patients to the Division of Surgical Oncology, and can be
assured they will be receiving specialized cancer care by experts trained
specifically within the field of oncology. The clinical programs within the
Division of Surgical Oncology include the Multidisciplinary Breast Oncology
Center and Cancer Risk Assessment and Prevention Clinic, the
Multidisciplinary GI Oncology Center, and the Multidisciplinary Center for
melanoma and soft tissue tumors. The above-mentioned clinical programs are
intended to attract patients with a variety of tumors, which will allow for
treatment as well as translational research. The division will allow the
Department of Surgery to build on an already strong tradition of surgical
excellence at Loyola.
Education:
The division
intends to instruct students in each of the four years on the basic concepts of
stage, prognosis and treatment of malignancies that are usually not formally
taught in the students' curricula. A new curriculum incorporating surgical
oncology principles will be added to the curriculum of students starting in the
first and second years of medical school. Additionally, exposure to the
Division of Surgical Oncology will enhance the surgical resident's knowledge of
surgical oncology by several mechanisms. The residents are exposed to surgical
cases of a complex nature; residents learn a multidisciplinary approach to
cancer patients through the multidisciplinary clinics and residents, through
multidisciplinary conferences and journal clubs, increase their core knowledge
of surgical oncology principles. Residents learn how to think like an
oncologist. This Division rotation will enhance their knowledge of chemotherapy
agents as well as their mechanisms of action, and it will give them a basic
understanding of radiation fields for the various types of radiation treatment.
Timing of surgical intervention will be discussed at length during the
multidisciplinary conferences and residents will learn that surgical resection
is part of the treatment of the disease, but is not always the right treatment
even when technically feasible. The goals are to increase residents knowledge in
the care of the cancer patient as a whole, to increase interest in surgical
oncology and to encourage residents to pursue surgical oncology fellowships.
Research:
The Division of Surgical Oncology intends to provide the opportunity to develop
a strong research program in surgical oncology. The division and members are
involved with several studies in basic and clinical research. This year,
Surgical Oncology research has been presented at the American Hepato-pancreatico-biliary
Association, the Central Surgical Society, the Midwest and Western Surgical
Associations, and upcoming presentations are scheduled for the Association of
Academic Surgeons/Society of University Surgeons annual meeting and the Society
of Surgical Oncology annual meeting. Presently, members of the division have
received grants to study breast cancer risk and notch signaling in breast cancer
and melanoma, and have a multimillion-dollar grant for a Phase I dendritic cell
vaccine trial for stage IV melanoma sponsored by the National Cancer Institute.
With the Cardinal Bernardin Cancer Center, the Division of Surgical Oncology has
several internal trials that will be accruing soon, including a
foundation-sponsored vaccine trial for adjuvant therapy for resected pancreatic
cancer and vaccine trials for unresectable pancreatic cancer and for recurrent
pediatric solid tumors. In addition, the members of the Division are Principal
Investigators of several multi-institutional clinical oncology trials. The
surgical oncologists work closely with basic scientists at the Cancer Center to
develop translational research, and work closely with other oncologists,
pathologist, radiologists, genetic counselors and nutritionists toward the
development of clinical trials. It is hoped that this well-rounded program will
lead to an endowed professorship in surgical oncology. The development of an
active translational research program, recruitment of a
research‑dedicated surgical oncologist, continued development of cancer clinical
trials, creation of databases and tissue banks of surgical oncology patients,
active resident involvement in surgical oncology research projects, high quality
presentations at national and regional meetings, and the creation of a website
that will list all clinical trials opened by the Division of Surgical Oncology
at Loyola are all goals of the Division of Surgical Oncology.
The three members
of the Division of Surgical Oncology are Dr. Gerard V. Aranha, chief of the
Division of Surgical Oncology; Dr. Margo Shoup, Director of the GI Oncology
Center and team leader for solid tumor translational research, and
Dr. Katharine Yao, Director of the Breast Oncology Center, and Associate
Director of the Cancer Risk Assessment and Prevention Clinic.
Resident Corner
Students from the Daniel Hale Williams Preparatory
School of Medicine’s Inspire Members of the Loyola Family
Daniel Hale Williams (1856-1931) was a surgeon and
national healthcare leader. After graduating from what became Northwestern
University School of Medicine (1883), he established the interracial Provident
hospital, where he performed one of the first successful repairs of a cardiac
stab wound (1893). Subsequently, he was Chief Surgeon at the Freedmen’s
Hospital in Washington, D.C., where
 he brought national acclaim for the quality
of care delivered by his highly qualified biracial staff. During his life he
helped establish the National Medical Association, was a charter member of the
American College of Surgeons and a member of the Chicago Surgical Society.
In recognition of his legacy, the Daniel Hale Williams
Preparatory School of Medicine (4934 South Wabash) was founded by the Chicago
Public Schools to help increase the number of underrepresented minority students
who pursue a career in the medical sciences. It opened its doors this August
inside of the famed halls of DuSable High School and is led by Dr. Delores L.
Bedar and her fabulous staff. Here, students (grades 7-12) are taught a
comprehensive curriculum that emphasizes scientific studies. In coordination
with the American Medical Association-Minority Affairs Consortium, the Daniel
Hale Williams’ school welcomed physicians from around Chicago to meet, teach,
and get to know these students this past September. Here, Loyola Alumni
Burnetta Herron MD, FACS (Department of Surgery 2003), and Allen I. Goldberg MD,
MBA, FAAP, FCCP, FACPE (Departments of Pediatrics and
Anesthesia), along with Luke Brewster MD (current resident in general surgery),
and many other local physicians were able to meet these students and discuss
with them the challenges and rewards attendant to being a physician.
The intellectual capacity and
energy that these students brought to this day was impressive to all in
attendance, and the participating physicians hope to continue to mentor these
young students through the arduous process of medical education. Hopefully,
these students will be as inspired by this opportunity as those of us who
participated as physicians. Collectively, we would like nothing more than to
hand the future of our profession to their capable young hands in the years to
come, where they can deliver the quality of care demonstrated by Daniel Hale
Williams in Chicago and around this country.
Education
Simulation Course in
Vascular Surgery
On Saturday, October 8th, the
Loyola Vascular Surgery division hosted a “hands-on” educational program specifically utilizing an endovascular
simulator and models to perfect vascular anastomotic techniques. During the workshop, vascular fellows,
general surgery residents and medical students had the opportunity to learn and practice
anastomotic techniques of traditional open surgery, as well as basic and advanced catheter and guidewire
skills for endovascular procedures.
Dr. Heron Rodriguez, Director of the workshop emphasized the importance of incorporating simulation
technology in the training of surgical residents: “advances in computer
technology and virtual reality allow trainees to develop skills in a controlled
and safe environment.
This is not unlike the simulator training that has long been employed in
perfecting aviation skills. Newer generation simulators provide
trainees with an experience that closely resembles real-life
situations. They are truly an invaluable tool for education,
skill assessment, research and have potential
applications in the credentialing process vascular surgery.”
During the course, participants performed a vascular anastomoses
under the supervision of Drs. Heron Rodriguez, Bernadette Aulivola and Peter Kalman. Using
a sophisticated endovascular simulator, they performed a variety of
catheter exercises emphasizing diagnostic and interventional procedures on the
carotid and renal arteries. Extremely important in this regard was to gain confidence in the utilization of
embolic protection devices for safe carotid angioplasty and stenting.
Dr. Peter Kalman, Chief of Vascular Surgery and Professor of Surgery and Radiology commented on the event: There
has been a notable paradigm shift in the day to day activities performed by
vascular surgeons today. It is imperative that we embrace new
technology for the training of future vascular specialists. The vascular
surgeons at Loyola possess the expertise to provide our trainees –as well as our
patients- with the entire spectrum of treatment modalities for
arterial and venous problems. This includes the latest, minim ally invasive
endovascular techniques as well as the traditional open
surgical procedures. Technology has really changed the face of our specialty.
With the addition of the latest endovascular techniques, we can now
individualize the management of each patient depending
upon the specific circumstances. This
versatility to choose and perform the different options available is how we can make a
tremendous impact in the care of our patients, as well as maximizing the
experience for our trainees”.
The event was supported by Abbot Endovascular, WL Gore,
LifeSystems and Mentice Inc. The 22 participants found the experience rewarding,
and the Vascular Surgery division is planning an annual workshop, and plans are being made to
extend invitations to trainees from other medical centers in the region.
Visiting Professor
Julie Freischlag, M.D., the William Stewart
Halsted Professor, Chair of the Department
of Surgery and Surgeon-in-Chief of The Johns Hopkins Hospital
in Baltimore, Maryland
will be a Visiting Professor here in the
Department of Surgery at Loyola on
February 21st and 22nd 2006.
Dr. Freischlag will present Department of Surgery
Grand Rounds
on Wednesday,
February 22nd at 7:30 am in the Stritch School of
Medicine Tobin
Hall, Classroom 190.
She will also observe
Vascular Case Conference on Tuesday afternoon, February
21st
at 4:30 pm in the Surgery Conference Room, EMS Building 110,
Room 3282. All
are welcome to attend these events featuring
Dr. Freischlag.
Dr. Freischlag came to Johns Hopkins from the
University of California in Los Angeles,
where she was Chief of the Vascular Surgery Division and Director of the Gonda
(Goldschmied) Vascular Center. She completed her surgical residency
and post residency
Vascular Fellowship at UCLA.
Before Dr. Freischlag returned to work at UCLA,
she was a Professor of Surgery
at the
Medical College of Wisconsin where she was also the Vice Chair of the
Vascular
Surgery Section and Chief of Surgery at Zablocki VA Medical Center.
Dr. Freischlag is recognized nationally and
internationally as an expert in the
diagnosis and treatment of thoracic outlet syndrome. She is presently
conducting a
quality of life study on all patients before and years after surgical
intervention for this
disease. She is the national principal investigator of the VA OVER trial (Open
Versus Endovascular Repair) of abdominal aortic aneurysms. The study is a
prospective randomized trial which has already randomized almost 500 patients
from 34 medical centers across the country. She is the Editor of the
Archives of Surgery
which is one of the major surgical journals. She also serves on several other
editorial
boards. She has published over 130 manuscripts, numerous abstracts and
book chapters.
We look forward to Dr. Freischlag’s
visit and hope many of you will make time to attend the Vascular Case Conference
on Tuesday afternoon as well as
her Grand Rounds presentation on Wednesday morning, February 22nd at
7:30 am.
Research
Alcohol and Immunology Research Interest Group Meeting
On November 18, 2005, the Department of Surgery and the
Alcohol Research Program hosted the 15th Annual Meeting of the Alcohol and
Immunology Research Interest Group (AIRIG). Like other scientific meetings, one
of the primary purposes of holding AIRIG meetings is to provide the opportunity
for investigators to discuss current and novel research in the field. Unlike
many meetings in which the same set of senior researchers give the majority of
the oral presentations, AIRIG meetings have an additional commitment to be
inclusive of junior scientists and those who are new to the field as speakers.
To accomplish this, for the 2005 meeting, the co-organizers (Drs. Elizabeth J.
Kovacs and Luisa A. DiPietro from the Department of Surgery, Loyola University,
along with Drs. Lou Ann Brown (Emory University), Robert Cook (University of
Iowa), and Thomas Jerrells (University of Nebraska)) chose to yield the podium.
We feel that giving oral presentations increases the exposure of new/junior
investigators to the other researchers in the field. Moreover, it avails the
speakers of the opportunity to receive critique from more senior scientists and
may foster collaboration which move the field forward at a faster rate. The
philosophy was, and continues to be, that in order to bring more investigators
into the field, we need to 1) provide a “user-friendly” environment for young
developing scientists and those who are new to the field and 2) invite speakers
from laboratories and institutions that have not previously participated in the
meetings.
The 2005 AIRIG meeting was supported by a scientific
meetings grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA)
of the National Institutes of Health (AA016057 awarded to Dr. Kovacs and
colleagues) and Loyola's Department of Surgery and Alcohol Research Program.
Over 55 clinical and basic science researchers attended the meeting including 19
postdoctoral fellows and students. Abstracts were published in November 2005
issue of Alcohol. There were 6 invited speakers, all of whom were either junior
faculty or more senior researchers who were new to the field of alcohol and
inflammation/immunology. Invited speakers included junior/research faculty, Drs.
Christine Metz (Long Island Jewish Hospital), Joanna Goral (Midwestern
University), and Pranoti Mandrekar (University of Massachusetts), and more
senior scientists who are new to the field and had not spoken at an AIRIG
meeting before, Drs. Luisa DiPietro (Loyola University), Tom Waldschmidt
(University of Iowa), and Annette Schlueter (University of Iowa). Additional
speakers were selected from submitted abstracts. This group had two Assistant
Professors (Pratibha Joshi from Emory University and John Callaci from Loyola
University) and two trainees at the pre- or post-doctoral level (Qun Dai from
Louisiana State University Shreveport and Audrey Lau from the University of
Pittsburgh), a technician (Betty Young from University of Iowa), and a scientist
who is new to alcohol & immunology (Dr. Martin Poenie from the University of
Texas). In addition, Denise Russo, PhD, NIAAA program officer attended the
meeting and spoke about NIH funding opportunities. Having Dr Russo spend the
day with the group allowed many of the junior investigators their first
one-on-one encounter with a representative from the NIH. This invaluable
experience of putting a face with the name was clearly beneficial for all. It
is hoped that additional NIH staff will be able to attend AIRIG meetings in the
future.
The overwhelming success of the meeting was trumpeted by
Dr. Russo and echoed in the responses to meeting evaluations distributed to all
participants. Because of the success, we plan to host the 2006 AIRIG meeting at
Loyola on November 17, 2006. Mark your calendars!
News from BSTI
Newly Awarded Extramural Grants in 2005
“Aging, macrophage mediators, and burn trauma.” NIH R01
AG18859-06-A1. $250,000/1,250,000 (direct costs). Period: September 9, 2005 –
September 8, 2006. P.I.: E.J. Kovacs, Investigator: D.E. Faunce and P.L. Witte.
“Alcohol and Immunology Research Interest Group Meeting.”
NIH R13 AA016057-01 (Scientific Meetings Grant Application) $16,250 (direct
costs). Period: November 10, 2005 – November 30, 2006. P.I.: E.J. Kovacs,
Collaborator: L.A. DiPietro.
Presentations
Elizabeth J. Kovacs, PhD “Estrogen modulation of
inflammatory and immune responses in a burn shock and ethanol model.” 2005 NIH
Integrative Neural Immune Program Workshop on Neural and Neuroendocrine Factors
in Shock and Immune Tissue Damage: Implications for Biodefense Treatment
Strategies, NIH Campus, Bethesda, MD, January 2005.
Elizabeth J. Kovacs, PhD. Estrogen replacement improves
cell-mediated immunity in aged mice after burn injury. NIA Workshop:
Endocrine-Immune Systems Interactions in Aging, Potomac, MD, April 2005.
Kovacs EJ, Plackett TP, Gamelli RL, and Witte PL. Aging and
cell-mediated immunity after injury: beneficial effects of estrogen. American
Burn Association, Chicago, IL, May 2005.
Kovacs EJ, Garretto R, Cutro BT, Ramirez L, and Gamelli RL.
Ethanol prior to burn injury increases susceptibility to pseudomonas infection
and upregulates pulmonary chemokine production. American Burn Association,
Chicago, IL, May 2005.
Elizabeth J. Kovacs, PhD “Pulmonary consequences of
combined insult of acute ethanol exposure and burn injury.” Annual Meeting of
the Research Society on Alcoholism, Santa Barbara, CA, June 2005.
Elizabeth J. Kovacs, PhD. “Aging impairs macrophage
function after injury.” NCI Frederick Cancer Research and Development Center,
Frederick, MD, October 2005.
Elizabeth J. Kovacs, PhD. “Aging, traumatic injury, and
immunity: improvement following estrogen treatment.” Plenary Session on Aging of
the Immune Response, Plenary Speaker, Austrian Society of Allergology and
Immunology Graz, Austria, December, 2005.
Recognition:
Joanna Goral, PhD student in the laboratory of Elizabeth J.
Kovacs completed her Dissertation research entitled: “Acute ethanol exposure
inhibits Toll-like Receptor mediated inflammatory response in murine
macrophages.” Dr Goral received an NIH NIAAA F31AA015019 NRSA Individual
Training Award entitled “Acute Ethanol and TLR-mediated Signaling in
Macrophages." Her present position is Assistant Professor, Department of
Anatomy, Midwestern University School of Osteopathic Medicine, Downers Grove, IL
where she is teaching histology and gross anatomy to first year medical
students.
Eric Boehmer is an MD/PhD student in the Dept. of Cell
Biology, Neurobiology & Anatomy, working under the supervisor of Elizabeth J.
Kovacs, PhD. Eric received a Schmitt Dissertation Fellowship recipient for his
final year of PhD training. His completed his PhD studies entitled “Effects of
age on mouse macrophage response to inflammatory stimul” in 2005 and returned to
medical school. He is currently a 3rd year medical student at SSOM.
Daniel Fitzgerald, Masters Student, in the Program in
Cellular and Molecular Biochemistry completed his Masters research entitled
“Acute ethanol exposure impairs the early inflammatory response during wound
healing” in the laboratory of Elizabeth J. Kovacs, PhD. Dan is currently
applying to medical school.
Eva Murdoch, PhD Student in the laboratory of Dr. Elizabeth
J. Kovacs, PhD received a Merit/Junior Investigator Award, Research Society on
Alcoholism Annual Meeting 2005, Santa Barbara, CA. (Award funded by the National
Institute on Alcohol Abuse and Alcoholism)
Christian Gomez, PhD, post-doctoral fellow in the Kovacs
laboratory, was given a Travel Award, Society for Leukocyte Biology Annual
Meeting to present his work in Oxford, UK in October 2005
Drs. Elizabeth J Kovacs and Luisa A DiPietro, along with
colleagues at the University of Iowa, University of Nebraska, and Emory
University served as the organizing committee for the Alcohol and immunology
research interest group (AIRIG) to organize a one day meeting. The meeting
covered research on Alcohol and Inflammatory/Immune Responses, and was held on
November 18th 2005 in the Department of Surgery at Loyola University. The
meeting was supported in part by the Department of Surgery, the Alcohol Research
Program and a scientific meetings grant from the National Institutes of Health
(NIH R13 AA015276) awarded to Elizabeth J. Kovacs, P.I.
Alumni Corner
To: Loyola Surgical News:
Thanks for the newsletter. It’s always a pleasure to read.
After practicing in St. Louis for eight years, I have relocated to the land of
Walmart, Tyson, JB Hunt,etc. in Northwest Arkansas. I founded the Arkansas Heart
and Vascular Institute which continues to grow rapidly. Our physicians and staff
offer adult cardiac, thoracic and vascular surgery, including traditional
cardiothoracic surgery as well as minimally invasive thoracic and cardiac
surgical techniques. Also, our vascular component offers Northwest Arkansas’
first certified vascular lab which services all of Northwest Arkansas. We offer
state of the art endovascular services including peripheral vascular stenting,
atherectomy, endovascular surgical procedures, as well as vascular screening
for all of Northwest Arkansas and post-operative surveillance. We have active
regional involvement with informative presentations on the prevention and
treatment of cardiac and vascular disease. We have an active research arm and
are currently one of twenty centers internationally studying the role of genetic
expression in the formation of atheroma and the progression of ASVD.
Thanks again for the newsletter.
John Ablan, M.D.
Arkansas Heart and Vascular Institute
Director Cardiothoracic and Vascular Surgery
St. Marys Hospital
Mercy Health Systems of Northwest Arkansas
Dr. Gamelli,
Greetings from Afghanistan! I hope all is well with you
and your family, as well as with the Department of Surgery.
I am again in Afghanistan, serving on a forward surgical
team, doing damage control surgery on injured U.S. and coalition troops, as well
as local Nationals. I have been very busy and had a wonderfully new coding
experience both personally and professionally. I’ve been here since July and
I’ll return to Fort Bragg in February 2006.
I finished my Fellowship at the University of Louisville in
Colorectal Surgery in 2004 and am now stationed at Fort Bragg, North Carolina
were I am a Staff Surgeon and the Chief of the Section of Colorectal Surgery.
My wife, Lynn, and I have four boys: Jack 6, Henry 4,
Tristan 3 and Maddox 3. Life is good and I can’t wait to get home.
Good luck and stay safe in the coming year. I hope to see
you all at one of the upcoming American College of Surgeons meetings soon.
Peter Deveaux
Greetings from northeast
Wisconsin or as we fondly refer to it as Loyola North. Surgical Associates of Neenah currently has three former chief residents from Loyola's general surgery
program, Ray Georgen MD (chief resident 1989-1990) , Jeff Burkett MD (chief
resident 1993-1994), and Pat Brennan MD (chief resident 2001-2002). Our surgical
group provides all of the surgical coverage, including thoracic, vascular and
endoscopy for Theda Clark Medical Center, a perennial top 100 hospital located
in Neenah, Wisconsin.
The members of our group have
been active an a wide array of medical activities both locally and at a state
level.
Dr. Georgen has been the
Trauma Director at Theda Clark since 1990 and helped develop the trauma system
at Theda Clark with the assistance of his partners. This effort led to the
verification of Theda Clark as the first and now longest verified Level 2 trauma
center in the state of Wisconsin. Dr. Georgen also has been an original member
of the State Trauma Advisory Committee since 2000. This group of health care
leaders was instrumental in writing and implementing the Wisconsin state trauma
plan which went into effect this year. Besides his trauma interests Dr. Georgen
serves as co-director of the Bariatric surgical program. This year the program
was recognized by the SRC in conjunction with the American Society of Bariatric
Surgeons as a national Center of Excellence. Dr. Georgen also was a board
member of Thedacare health system, Gold Cross Ambulance, and a council member of
the Wisconsin Surgical Society. He lives in Neenah with his wife Genie and
their two daughters Maria and Jill.
Dr Burkett has been active in
trauma pursuits as well. Jeff has been a member of the Wisconsin Chapter of the
American Trauma Society for over a decade the last several years as president.
He also has taken a lead role in the medical oversight committe of the Fox
Valley Regional Trauma Advisory Council. Despite serving on numerous hospital
committees, Jeff has also found the time to serve as president of Future Neenah,
a community organization which has revitalized the development of downtown
Neenah. Jeff lives in Neenah with his wife Denise and their children Dan, Nick,
Courtney, and Adam.
Dr. Brennan joined the group
in 2002 after his chief year at Loyola. Pat has served on the ICU committee and
the hospital trauma committee. Pat has given numerous trauma talks over the last
several years. Pat and Celeste welcomed a baby boy Gavin into their family in
July of 2004. The Brennans live an Neenah.
On the research front, Dr
Burkett and Dr. Georgen were awarded a U.S. patent for their development of a
percutaneous endoscopic neonatal feeding tube. It is hoped this technique will
be adopted as a less invasive means of delivering enteral nutrition to
neonates.
Along with our Loyola
contingent of surgeons Surgical Associates of Neenah has several Wisconsin
trained surgeons. Dr Kevin Wasco trained at University of Wisconsin and joined
the practice in 1999 and Dr. David Schults who trained at the Medical College of
Wisconsin and started his practice in 2004.
Goral J and Kovacs EJ. In vivo ethanol exposure
down-regulates TLR2-, TLR4-, and TLR9-mediated macrophage inflammatory response
by limiting p38 and ERK1/2 activation. J. Immunol. 2005; 174(1):456-463.
http://www.jimmunol.org
Acute ethanol exposure suppresses innate immune responses to inflammatory agents
including lipopolysaccaride. These include production of proinflammatory
cytokines via Toll-Like receptor signaling pathways, which involves activation
of mitogen-activated protein kinases. The present study reveals that the
alcohol-induced defects in signaling are not specific for the LPS mediated TLR4
pathway since activation of other TLR pathways reveal the same defect in
activation.
Emanuele NV, LaPaglia N, Kovacs EJ, and Emanuele MA. The
impact of burn injury and ethanol on the cytokine network of the mouse
hypothalamus: Reproductive implications. Cytokine. 2005; 30(3):109-115.
The combined insult of acute ethanol exposure and injury is associated with
greater mortality than injury. Immunoendocrine responses play a critical role in
survival after trauma. The present study examines production of proinflammatory
cytokines in the hypothalamus and other organs in the HPG axis.
Kavanaugh MJ, Clark C, Goto M, Kovacs EJ, Gamelli RL,
Sayeed MM, and Choudhry MA. Effect of acute alcohol ingestion prior to burn
injury on intestinal bacterial growth and barrier function. Burns. 2005;
31(3):290-296.
http://www.intl.elsevierhealth.com/journals/burn/
This study demonstrates that acute alcohol exposure exacerbates intestinal
inflammatory responses, including intestinal barrier function following a
moderate size burn injury relative to burn alone.
Kovacs E.J. Aging, traumatic injury, and estrogen
treatment. Exp Gerontol. 2005;
40(7):549-55.
http://www.elsevier.com/wps/find/journaldescription.cws_home/525468/description#description
This is a review article that describes the effects of estrogen replacement on
systemic and organ specific responses following tissue damage. The focus of the
studies includes dermal wound healing, burn injury and femur fracture.
Thiele GM, Mandrekar P, Zakhari S, Hoek J, Cook RT, Ray NB,
Happle KI, Kolls JK, Kovacs EJ, and Szabo G. RSA 2004: combined basic research
satellite symposium-mechanisms of alcohol-mediated organ and tissue damage:
inflammation and immunity and alcohol and mitochondrial metabolism: at the
crossroads of life and death session one: alcohol, cellular and organ damage.
Alcohol Clin Exp Res. 2005 29(9):1735-43.
http://www.alcoholism-cer.com
This is a meeting overview from a one-day symposium, which was a satellite
meeting the day before the 2004 meeting of the Research Society for Alcoholism.
Presentations ranged from studies examining the effects of acute alcohol
exposure on inflammation to chronic ethanol exposure on mitochrondrial
metabolism.
Li X, Rana SN, Kovacs EJ, Chaudry IH, and Choudhry 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 289(1):R37-R44.
http://ajpcon.physiology.org/
These studies explore the effects of acute ethanol exposure on mitogen-activated
protein kinase signaling and cytokine production by T lymphocytes obtained from
burn injuryed mice. Evidence presented herein reveals that aberrant activation
of these pathways is mediated by glucocorticoids.
Gomez C, Boehmer ED, and Kovacs EJ. The aging innate
immune system. Curr Opin Immunol. 2005. 17(5):457-462.
http://www.current-opinion.com/jimm/about.htm?jcode=jimm
This is an invited review article describing the effects of age on innate
immunity. The report pulls together data from multiple laboratories in the
field focusing on changes in the number and phenotype of innate immune cells in
young and aged subjects.
Emanuele NV, LaPaglia N, Kovacs EJ, and Emanuele MA.
Effects of chronic ethanol (EtOH) administration on pro-inflammatory cytokines
of the hypothalamic-pituitary-gonadal (HPG) axis in female rats. Endocr Res.
2005; 31(1):9-16.
http://www.tandf.co.uk/journals/titles/07435800.asp
Chronic alcohol exposure has well documented effects on the HPA effects on the
hypothalamic-pituitary-adrenal (HPA) axis, whereas there is only limited
information regarding the effect of chronic exposure on the
hypothalamic-pituitary-gonadal (HPG) axis. The study examines inflammatory
responses in the hypothalamus and pituitary gland in order to begin to examine
the mechanisms by which alcohol exposure affects these mediators.
Boehmer ED, Meehan MJ, Cutro BT, and Kovacs EJ. Aging
defects in macrophage signaling are limited to TLR-mediated MAPK pathways. Mech
Ageing Dev. 2005; 126(12):1305-1313.
http://authors.elsevier.com/JournalDetail.html?PubID=506026&index=D&Precis=KIND
The study describes signaling defects in macrophages from aged mice. The
defects include attenuated production of proinflammatory cytokines, IL-6 and TNFa,
and mitogen-activated protein kinases, p38 and jnk, in macrophages from aged vs.
young mice given lipopolysaccharide as an in vitro stimulant. In contrast, in
parallel studies, when macreophages were stimulated with interleukin-2 or
interferong failed to reveal
differences in cytokine production or signaling.
Ghosh S, Kahrilas PJ, Zaki
T, Pandilfino JE, Joehl RJ, Brasseur JG.Mechanical basis of impaired
esophageal emptying post fundoplication. Am J Physiol Gastrointest Liver
Physiol Jul 2005;289:G21-G35, 2005.
We aimed to contrast
quantitatively the mechanical balance between normal and post-fundoplication
esophageal emptying. Seven normal controls (NC) and 7 post fundoplication (FP)
patients underwent concurrent manometry and fluoroscopy. Temporal changes in
geometry of the distal bolus cavity and hiatal canal, and cavity driving
pressure were quantified during emptying. Mathematical models were developed to
couple cavity pressure to hiatal geometry and esophageal emptying, and to
determine cavity muscle tone. The average length of the hiatal canal post FP was
twice that of NC; reduction of hiatal radius was not significant. All esophageal
emptying events post FP were incomplete (51% retention), there was no
significant difference in the period of emptying between NC and FP, and average
emptying rates were 40% lower post FP. The model predicted three distinct phases
during esophageal emptying: hiatal opening (I), a quasi-steady period (II), and
final emptying (III). A rapid increase in muscle tone and driving pressure
forced normal hiatal opening. Post FP there was a severe impairment of cavity
muscle tone causing deficient hiatal opening and flow, and bolus retention.
Impaired esophageal emptying post-FP follows from the inability of distal
esophageal muscle to generate necessary tone rapidly. Immobilization of the
intrinsic sphincter by the surgical procedure may contribute to this deficiency,
to impaired emptying and, possibly, dysphagia.
Brewster LP, Risucci DA, Joehl
RJ, Littooy FN, Temeck BK, Blair PG, Sachdeva AK. Management of adverse events:
a structured education module for residents. Amer J Surgery 190:687-690, 2005
This pilot project developed a structured,
experiential, educational module using a bench model technical skills simulation
and standardized patients. It integrated teaching and assessment of clinical,
technical, and interpersonal skills, as well as professionalism within the
context of an adverse surgical event. General surgery residents (postgraduate
year [PGY] 2, 3) were asked to participate in the pre-, intra-, and
postoperative management of a patient with a retroperitoneal sarcoma. Residents'
performances during the module were assessed by standardized patients and
faculty, and residents were provided feedback during debriefing sessions.
Resident performance during the module was appropriate for the level of
training. Residents found this module to be a realistic, challenging, and
beneficial learning experience. Novel educational modules such as this one may
serve as a useful addition to resident education in surgery residency programs,
particularly in addressing patient safety and the core competencies. Reliability
of the model may be enhanced by modifications of the module.
Pandolfino JE, Curry JR, Shi G, Joehl RJ,
Brasseur JG, Kahrilas PJ.Restoration of normal distensive characteristics of the
esophagogastric junction after fundoplication. Ann Surg 242(1):43-48, 2005.
We aimed to study the mechanical characteristics
of esophagogastric junction (EGJ) of post-fundoplication patients and compare
them with previously reported data on normal subjects and GERD patients. Eight
normal subjects, 9 GERD patients, and 8 fundoplication patients were studied
with concurrent manometry, fluoroscopy, and stepwise controlled barostat
distention of the EGJ. EGJ opening diameter during deglutitive relaxation was on
average 0.5 cm greater in GERD patients compared with normal subjects and
fundoplication patients. EGJ opening pressure and opening diameter were
comparable between normal subjects and fundoplication patients; however, the EGJ
length was 32% longer in fundoplication patients. Fundoplication restores
distensibility of the EGJ to a level similar to normal subjects. Since trans-EGJ
flow is related to EGJ length and EGJ diameter, these findings suggest that
retrograde flow through the EGJ would be decreased by both a reduction in
diameter and an increase in length of the EGJ.
Samuel I, Chaudhary A, Fisher RA, Joehl RJ.
Exacerbation of acute pancreatitis by combined cholinergic stimulation and duct
obstruction. Amer J Surgery 190: 721-724, 2005 [PMID 16226947]
The role of cholinergic pathways in the
pathogenesis of bile-pancreatic duct ligation (BPDL)-induced acute pancreatitis
in rats remains controversial. We hypothesized that cholinergic stimulation
exacerbates acute pancreatic inflammation in the presence of duct obstruction.
We demonstrated in a rat model that cholinergic stimulation and duct obstruction
synergistically amplify acinar hyperstimulation and exacerbate acute
pancreatitis.
WE Longo, W Cheadle, A Fink, R Kozol, R DePalma,
R Rege, L Neumayer,J Tarpley, M Tarpley, R Joehl, TA Miller, D Rosendale, KItani.
The role of the Veterans Affairs Medical Centers in patient care, surgical
education, research and faculty development. Amer J Surgery 190:662-675, 2005 [PMID
16226937]
Over time, VA has evolved into a hospital system
that has had a major role in graduate medical education. The VA provides a venue
for the attending physician and resident to work in concert to allow the
resident to shoulder increasing accountability in decision-making and delivery
of care in the out-patient arena, the operating room, and the intensive care
unit. Numerous opportunities at the VA are available for novice and experienced
medical faculty members to develop and/or enhance skills and abilities in
patient care, medical education, and research. In addition, the VA offers unique
opportunities for academic physicians and other healthcare professionals to
administer its many programs,thereby developing leadership skills and experience
in the process. The VA will continue its leadership position in the healthcare
arena if it can successfully address the challenges facing it.
Presentations
Shoup M., Aaron J.M.,
Borge M., Anderson J., Brems J.J., Holt D.R. “A Role for Radiofrequency
Ablation of Unresectable Liver Malignancies”. Presented at the AHPBA
Congress, Ft. Lauderdale, Fl, April 14-17, 2005.
Michalski L.S., Burns C.J.,
Hatch D., Hou S., Norton J., Pakrasi A., Holt D.R. “Decreased Cost and Length
of Stay in Kidney Transplant Recipients Receiving Daclizumab Induction”.
Presented at the American Society of Nephrology meeting, Philadelphia, Pa,
November 8-13, 2005.
Kathpalia P., Ding D.,
Pakrasi A., Michalski L., Holt D.R., Hou S.H. “Substitution of Sirolimus (SIR)
for Calcineurin Inhibitors (CNI) in Renal Transplant (RT) Recipients with
Increased Creatinine (Cr)”. Presented at the American Society of
Nephrology meeting, Philadelphia, Pa, November 8-13, 2005. |
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