spring 1999 postop - stony brook medicine · 2020. 1. 7. · imagine a piano duet where one pianist...

DEPARTMENT OF SURGERY • UNIVERSITY HOSPITAL AND MEDICAL CENTER • UNIVERSITY AT STONY BROOK —1 —

POSTOpNews Update from the Department of Surgery

SPRING 1999Number 9

U N I V E R S I T Y . H O S P I T A L . A N D . M E D I C A L . C E N T E R . A T . S T O N Y . B R O O K

(Continued on Page 2)

INTRODUCINGDR. M. MARGARET KEMENY

Our New Chief OfSurgical Oncology

We are very pleased to intro-duce M. Margaret Kemeny, MD, whojoined our faculty last fall as chief ofthe Division of Surgical Oncology. Adistinguished academic surgeon andoncologist, Dr. Kemeny adds newstrength to our surgical oncology ser-vice, and it is expected that her clinicaland research expertise will make amajor contribution to Stony Brook’splanned cancer institute.

Dr. Kemeny comes to StonyBrook from North Shore UniversityHospital, in Manhasset, NY, whereshe was chief of surgical oncology.

Trained in surgical oncology atMemorial Sloan-Kettering and theNational Cancer Institute, Dr. Kemenyis an internationally recognizedleader in the treatment of primaryand secondary tumors of the liver.Her other interests include breastcancer, colon cancer, and melanoma.

As the new chief of surgical on-cology at Stony Brook, Dr. Kemenywill build our Division of SurgicalOncology into one which is at theforefront of cancer treatment and re-search. This will involve the surgicaltreatment of all types of tumors, andclose collaboration with Stony Brook’smedical and radiation oncologists tooffer the most advanced multimodal-ity therapy.

Dr. Kemeny’s research inter-ests include the use of gene therapyfor liver cancers and colon tumorsthat have spread to the liver. Shealso runs a laboratory which hasworked on using interleukin-2 (IL-2; a naturally-occurring hormonethat helps regulate the body’s im-mune system) as treatment forliver tumors as well as melanomaand kidney cancer.

With this focus, she has re-searched a new drug that blocksthe side effects of IL-2, allowingmore of it to be used so that it ismore effective. The new drug—called CNI-1493—has now gonefrom her lab into trials with patients.These clinical studies, which offer theonly access to this therapy availablein Suffolk County, will be opened topatients at Stony Brook this spring.

In addition to the research de-scribed above, Dr. Kemeny is currentlyinvolved in several clinical studiessponsored by the National Institutesof Health, Eastern Cooperative Oncol-ogy Group, and Southwest OncologyGroup.

One ECOG/SWOG trial, of whichDr. Kemeny is the principal investiga-tor, just closed. It is the largest trial todate of intra-arterial therapy after liverresection for colorectal cancer. ThisMay, she will present the results ofthis trial to the American Society ofClinical Oncology.

Dr. M. Margaret Kemeny

Our surgical oncologists providecomprehensive care for patientswith cancers of the gastro-intestinaltract, soft tissue, and breast, usinga fully integrated multidisciplinaryapproach to the treatment of cancer,and working closely with StonyBrook’s medical, gynecological, andradiation oncologists.

The other clinical study of which Dr.Kemeny is the principal investigator is amulti-group trial of adjuvant therapy forcolon cancer. With about 800 patients en-rolled at present, this trial will eventuallyenroll a total of more than 2,000 patients.

Dr. Kemeny is the author of numer-

—2 — DEPARTMENT OF SURGERY • UNIVERSITY HOSPITAL AND MEDICAL CENTER • UNIVERSITY AT STONY BROOK

ous journal articles and book chapters, and alsoserves on the editorial boards of three journals,namely, the American Journal of Surgery, CancerManagement, and HPB Surgery (a world journalof hepatic, pancreatic, and biliary surgery).

Originally published in 1992, Dr. Kemeny’spopular book, Breast Cancer and Ovarian Cancer:Beating the Odds (Perseus Books), is a guide forwomen who want practical advice on reducingtheir cancer risk, and also serves as a resourcefor those already diagnosed with cancer.

EDUCATION AND EXPERIENCEA graduate “cum laude” of Harvard

College, Dr. Kemeny received her MD fromColumbia University in 1972. Her surgical in-ternship and residency were completed at NewYork Presbyterian Hospital (1972-74), the Uni-versity of Colorado Medical Center (1974-75),and the Downstate Medical Center (nowSUNY-Brooklyn) where she did her senior yearsurgical residency and her chief residency,graduating from that program in 1979.

Her fellowship training in surgical on-cology was completed at two of the most dis-tinguished cancer centers in the nation. Shedid a one-year fellowship in tumor oncologyat Memorial Sloan-Kettering (1975); a one-year research fellowship in thoracic surgery(1976), also at Memorial Sloan-Kettering, in1976; and a two-year fellowship in surgical oncology at the National Cancer In-stitute (NCI; 1979-81).

From 1981 to 1986, Dr. Kemeny held the position of senior surgeon ingeneral and oncologic surgery at the City of Hope National Medical Center, anNCI-designated cancer center, in Duarte, CA.

She then returned to New York in order to serve as chief of surgical oncologyat St. Vincent’s Hospital and Medical Center, with an appointment as associateprofessor of surgery at New York Medical College. In 1993, she moved to NorthShore University Hospital as chief of its Division of Surgical Oncology.

Board certified in Surgery, Dr. Kemeny is a Fellow of the American Collegeof Surgeons. She is a member of the College’s Commission for Cancer, and forthree years served as the chair of its Committee on Approvals.

She is also a member of several FDA and NCI advisory panels, and recentlyserved as president of the Association of Women Surgeons and that of the NewYork Cancer Society.

Recognized as a top physician in surgical oncology, Dr. Kemeny—likeother members of our faculty—is one of the “Doctors of Excellence” featured inpast editions and the latest (1999) edition of the Castle Connolly Guide, How toFind the Best Doctors—New York Metro Area.

For consultations/appointments with Dr. Kemeny, please call (516) 444-1793.

So far, more than 9,000 copies ofDr. Kemeny’s popular book—nowin its third printing—have been soldworldwide.

Our participation in nationalclinical trials allows us touse the latest in therapeuticadvances for the care ofdifferent cancers—and thisgives our patients the onlyopportunity available inSuffolk County to benefitfrom such studies.

Dr. Kemeny(Continued)

Bringing ResearchTo LifePatients Needed

• Gene therapy for metastaticliver cancer

• Gene therapy for hepatomas• Adjuvant therapy for colon cancer• IL-2 therapy for metastatic

kidney cancer• IL-2 therapy for metastatic

melanoma

Patients interested in learning moreabout these clinical trials directedby Dr. Kemeny, and their possibleeligibility to enroll in them, shouldcall (516) 444-1793.

POST-OP is published by theDepartment of Surgery

University Hospital and Medical CenterState University of New York

at Stony BrookStony Brook, New York

Editor-in-ChiefJohn J. Ricotta, MD

Writer/EditorJonathan Cohen, PhD

Contributing EditorRichard Bogenshutz, MBA

Advisory BoardCollin E.M. Brathwaite, MD

Peter J. Garlick, PhDFabio Giron, MD, PhD

Arnold E. Katz, MDM. Margaret Kemeny, MDIrvin B. Krukenkamp, MD

Cedric J. Priebe, Jr., MDHarry S. Soroff, MD

All correspondence should be sent to:Dr. Jonathan Cohen

Writer/Editor, POST-OP

Department of Surgery/HSC T19University Hospital and Medical Center

Stony Brook, NY 11794-8191, USA



NEW PROGRAM IN SURGICALELECTROPHYSIOLOGY ESTABLISHEDPerforming the Maze Procedure ForAtrial Fibrillation

Imagine a piano duet where onepianist plays a march while theother plays a lullaby. Hard as theslower pianist tries to keep thetempo, the faster pianist makes theslower one speed up too. The resultis a song with no recognizablerhythm.

For more than 2 millionAmericans, their heart rates arelike the tempo of that piano duet.The upper chambers of theirhearts beat faster than the lowerchambers. The resulting rhythmis irregular and often fast.

We are very pleased to announcethe establishment of our new programin surgical electrophysiology madepossible by the recruitment of AdamE. Saltman, MD, PhD, who in Januaryjoined our Division of CardiothoracicSurgery.

Coming to Stony Brook from Har-vard University/Beth Israel DeaconessMedical Center, where he completedhis fellowship training in cardiothoracicsurgery, Dr. Saltman is skilled at per-form ing the latest surgical treatmentsof arrhythmias (abnormal heartrhythms), including the “maze” pro-cedure for atrial fibrillation, and will

serve as director of surgical electro-physiology at Stony Brook’s HeartHospital.

Dr. Saltman will also establish aresearch program in surgical electro-physiology. His current research inter-ests include the surgical treatment ofatrial fibrillation, the prevention ofpostoperative arrhythmias, and theelectrophysiological effects of intra-operative cardiac preconditioning.

WHAT IT ISSurgical electrophysiology is a

field of cardiac surgery that specializesin the treatment of arrhythmias bydestroying the responsible tissue(s)in the open heart.

The procedures used to treat thiscondition are performed in the operat-ing room with the patient on theheart-lung machine. Because of theirmagnitude, these operations are gen-erally reserved for those patients inwhom therapy with medication or lessinvasive techniques, such as catheterablation, fails to succeed.

The first applications of surgicalelectrophysiology date back to 1967,when two Dutch cardiologists, Drs.Dirk Durrer and Jan Roos, demon-strated and destroyed abnormal con-duction tissue in the heart of patientswith Wolff-Parkinson-White (W-P-W)syndrome.

Surgical electrophysiology grewrapidly in the 1970’s and 1980’s to in-clude the treatment for many forms ofarrhythmias, particularly the tachy-cardias (abnormally rapid heartbeats).Tachycardias in the atria (upperchambers of the heart) such as atrio-ventricular (AV) nodal reentry, ectopicatrial tachycardia, and atrial fibrilla-tion were all successfully treated byoperation.

In 1991, Dr. James Cox of St. Louisdescribed the maze procedure, whichwas the first procedure that effectivelytreated atrial fibrillation, an arrhythmiathat afflicts more than 2 million people inthe United States today.

Treatments for tachycardias origi-nating in the ventricle (lower chambersof the heart) have also been developedand refined over the past 20 years. Ven-tricular tachycardia occurring after amyocardial infarction, for example, hasbeen cured in over 50% of the patientsoperated on to date.

At the same time, with the recentdevelopment of less invasive approaches,much of surgical electrophysiology hasbeen taken over by cardiologists. W-P-W,AV nodal reentry, atrial flutter, and evensome ventricular tachycardias have beenhighly successfully treated with catheters,avoiding surgery.

Atrial fibrillation, however, remainsan elusive target. Although there has beensome modest success with a catheter-based approach, surgery remains the onlydefinitive cure.

At Stony Brook, under the directionof Dr. Saltman, we are investigating a hy-brid approach, using both catheters andminimally invasive surgical techniques inorder to recreate the maze operation andcure atrial fibrillation.

THE MAZE PROCEDUREAtrial fibrillation is the most com-

mon form of arrhythmia. In atrial fibril-lation, the tissue in the atria (upperchambers) of the heart beats chaoticallyand ineffectively, sometimes causing theformation of blood clots that can lead tolife-threatening stroke.

The newly developed maze proce-dure for atrial fibrillation involves care-fully placing a “maze” of incisions in theatrium to stop the electrical impulsescausing the atrial fibrillation from spread-ing. It is generally a treatment of lastresort; only after multiple medicationshave failed would most cardiologistsconsider it.

Dr. Adam E.Saltman


PERFORMING THE NEW OPCABMINIMALLY INVASIVEBYPASS SURGERYStony Brook SelectedAs National Training Site

Coronary artery bypass grafting (CABG) is the most commonly performedmajor operation in the United States, with about 600,000 patients undergoingthis procedure each year. Adverse side effects associated with use of the heart-lung machine—which, during conventional CABG, takes over the stoppedheart’s work—can now be avoided with the newly developed proceduresknown as “beating heart” or “off pump” bypass surgery.

Currently, there are two such procedures: MIDCAB [featured in issue no. 7]and the latest advance, OPCAB; that is, minimally invasive direct coronaryartery bypass and off-pump coronary artery bypass, respectively.

At Stony Brook, our use of these minimally invasive off-pump techniqueshas grown significantly. In 1997, less than 5% of all our bypass operationsperformed here were off-pump procedures, and in 1998 that percentage grewto nearly 25%.

We have developed minimally invasive bypass surgery to a level that istrue of only a few institutions in the country. Now, with OPCAB, we can offermulti-vessel—four- or five-vessel—bypass without the use of the heart-lungmachine. The benefit to the patient generally is a shorter time in the hospital,a quicker recovery at home, and an apparent reduction in associated risk ofcomplications.

Frank C. Seifert, MD, associateprofessor of surgery, who hasgained national recognition forhis skills in performing off-pump bypass procedures, leadsour Division of CardiothoracicSurgery in minimally invasiveheart surgery, including thenew OPCAB.

In August 1998, Stony Brook’s Heart Hospital was selected as a nationalpreceptor training site for teaching the operative techniques of off-pump multi-vessel CABG because of the high volume of this novel surgery performed hereby Dr. Seifert. We are one of only 15 sites nationwide, all of which are sponsoredby CardioThoracic Systems, a pioneering corporation in the development ofminimally invasive cardiac surgery treatments.

Practicing cardiac surgeons from all over the Northeast now visit StonyBrook once a month to observe Dr. Seifert perform OPCAB.

Off-pump techniques for multi-vessel bypass surgery have been used atStony Brook since September 1997, and have been evolving since then. Accord-

ing to Dr. Seifert, analysis of our experi-ence with them shows confirmed reduc-tion in blood utilization, confirmedshortening of hospital stay, an apparentreduction in stroke rate, and an apparentreduction in mortality.

WHAT IT ISWith regard to surgery, “minimally

invasive” can mean nothing more thanuse of a smaller incision. It can also meantreating a disease effectively with mini-mal disruption to a patient’s physiology,or vital processes.

Off-pump surgery is a techniquethat allows the surgeon to perform a by-pass procedure without the use of car-diopulmonary bypass (CPB) via theheart-lung machine. Consequently, pa-tients do not experience the inflammatoryresponse caused by CPB, which disruptsthe body’s physiologic balance.

Conventional open-heart proce-dures are performed after the heart isstopped and the patient is put on CPB.During both MIDCAB and OPCAB, thepatient’s heart continues beating, and thesurgeon uses a device to stabilize the por-tion of the heart where CABG is needed.

While the advent of CPB was a ma-jor breakthrough in the field of cardiacsurgery, there are serious issues associ-ated with its use. In addition to an in-creased risk of stroke, other potentialneurologic problems must be consideredas well, such as difficulties with memoryand understanding that can affect somepatients.

The potential benefits of having anoff-pump bypass procedure include re-duced trauma; reduced risk of bleeding,stroke and renal failure; reduced psycho-motor and cognitive problems; reducedhospital stay; and reduced postoperativecomplications.

Unlike the MIDCAB procedurewhich is performed through a thorac-otomy (an incision between the ribs), theOPCAB procedure is surgery that utilizesa traditional sternotomy (an incisionthrough the ribcage).

Dr. Frank C. Seifert



VascularHea

lthNew Screening Program ForStroke And Cardiovascular Risk Factors

In January, our Division of Vascular Surgeryestablished a new screening program for the detectionof risk factors for stroke and cardiovascular disease.This screening involves a non-invasive, 15-minuteultrasound test to detect build-up of plaque in thecarotid (neck) arteries.

Recommended for people aged 60 years andolder, the screening is offered every Tuesday after-noon (2 pm to 5 pm) and Friday morning (9 am to 12noon) at the Stony Brook Surgical Care Center atTech Park (37 Research Way, East Setauket). Thereis a nominal fee.

John J. Ricotta, MD, professor and chairman ofsurgery, says: “Stroke and cardiovascular disease arethe number one killers of older people in this country,and many of those deaths can be prevented. This testallows us to determine if an individual is at risk becauseof a plaque build-up and then to treat that individualto reduce the risk factor.”

To make an appointment, please call (516) 444-4393.

Free Blood Pressure and Vascular Screenings ForPeripheral Vascular Disease Risk Factors This May

Screenings for Vascular Disease

Checklist❑ Are you over age 55?❑ Do you have high blood pressure?❑ Are you a diabetic?❑ Do you smoke?❑ Is your cholesterol level high?❑ Are you overweight?❑ Do you have a family history of

heart disease?

If you can answer YES to any of thesequestions, you are at risk for periph-eral vascular disease—that is, block-age of blood flow in your legs. Earlydetection is key to avoiding loss oflimbs (amputation), as well as life-threatening cardiovascular disease.

UPDATE ON KIDNEYTRANSPLANTATIONLiving Donors GivingThe Gift of Life

Our transplantation program—theonly solid organ transplantation programon Long Island—has been responsible formore than 500 kidney transplants sinceits inception in 1981. We’re proud of thislife-saving work, but there continues tobe a critical shortage of donors to sup-ply the kidneys that could save manymore lives.

There are now about 50,000 peoplewaiting for a kidney transplant in theUnited States. Here at Stony Brook, wehave 240 patients waiting for a kidneytransplant.

Last year, we performed transplantsfor 56 members of the Long Island com-munity, 39 of whom received kidneysfrom cadaver donors and 17 from living-related or living-unrelated donors.

SAVING MORE LIVES WITHOUR LIVING DONATIONPROGRAM

Thanks to advances in medical tech-nology, the use of organs from livingdonors is increasing. This approach ispossible because a person actually needsonly one of their two kidneys, and canspare the other. Nationally, one third ofall donors are living.

At Stony Brook we have had a greatdeal of success with our living donationprogram—parents donating for their chil-dren, sisters donating for their brothers,husbands donating for their wives, andfriends donating for their friends.

Last year, we successfully trans-planted an “unrelated” kidney from ason-in-law to his mother-in-law, a firstfor our program.

Rates of both graft and patient sur-vival for the recipient of living donationsare very high. In fact, recent studies indi-cate that the graft survival rate in patients

The Division of Vascular Surgerywill provide free blood pressure andvascular screenings to detect risk fac-tors for potentially limb-threateningperipheral vascular disease:

WhenTuesdays, May 11 & May 18, 1999From 10:00 am to 2:00 pm

WhereStony Brook Surgical Care Center37 Research WayEast Setauket, NY(516) 444-4545

WhenWednesdays, May 12 & May 19, 1999From 12 Noon to 2:00 pm

WhereStony Brook Life Care Medical Center225 West Montauk HighwayHampton Bays, NY(516) 723-5000


Call us today for anappointment!


1999 RESEARCH CLASSICGOLF TOURNAMENT

To Benefit the Department’sBasic and Clinical ResearchOn Vascular Disease

On Monday, September 13, 1999, University Hospital and MedicalCenter’s 5th Annual Research Classic Golf Tournament will be held at St.George’s Golf and Country Club, in Stony Brook. The proceeds raised by thebenefit tournament this year will go toward funding the Department’s basicand clinical research on vascular disease, specifically atherosclerosis.

Atherosclerosis, also called hardening of the arteries, is the number onecause of death and disability in the United States today. It is of special concernto our aging population. This vascular disease, which is progressive throughoutlife, can result in stroke, heart attack, aneurysm, or limb loss.

Many factors are known to increase the risk of atherosclerosis, includingdiabetes, smoking, hypertension, and elevated cholesterol. A “cure” for thisdisease, however, is still far away.

The research to be funded by this year’s Research Classic will help us tobetter understand the basic processes which result in atherosclerosis, developscreening programs for high-risk persons, and develop new techniques oftreatment. This research program will be directed by Dr. John J. Ricotta,professor and chairman of surgery, who is a well-established investigator inthe field of vascular research.

Current efforts to treat atherosclerosis involve scientific investigationdirected at prevention of the disease and treatment of diseased vessels;development of screening programs to identify persons at high risk for stroke,heart attack, aneurysm, and limb loss, so that treatment can be institutedbefore complications arise; and development of new treatment strategies toprovide safer and longer-lasting therapy for patients.

Funds raised from previous tournaments have been dedicated to researchon heart disease, breast cancer, and prostate cancer/men’s health.

The official sponsor of this year’s tournament is TRITEC Real EstateCompany. The continued support of TRITEC, together with the support ofindividual community members, local businesses, and other corporate sponsors,has been key to the growing success of Stony Brook’s Research Classic.

Argotte AF, Giron F, Bilfinger TV. Bilateralsubclavian artery aneurysms withpseudocoarctation of the aorta: case reportand review of the literature. J Cardiovasc Surg1998;39;747-50.

Bark TH, McNurlan MA, Lang CH, Garlick PJ.Increased protein synthesis after acute IGF-I orinsulin infusion is localized to muscle in mice.Am J Physiol 1998;275(1 Pt 1):E118-23.

Bilfinger TV. Universität Zürich: ausgrenzung derschweizer in der chirurgie [University ofZurich: Expatriation of Swiss physicians insurgery]. Schweiz Aerztezeit 1998;79:1498.

Bilfinger TV, Fimiani C, Stefano GB. Morphine’simmunoregulatory actions are not shared byfentanyl. Int J Cardiol 1998;64(Suppl 1):S61-6.

Bilfinger TV, Petersen MJ, Ricotta JJ. Coronaryartery bypass grafting with carotid endarterec-tomy. In: Yao JS, Pearce WH, editors. PracticalVascular Surgery. Stamford, CT: Appleton &Lange, 1999: 147-60.

Bilfinger TV, Salzet M, Fimiani C, Deutsch DG,Tramu G, Stefano GB. Pharmacologicalevidence for anandamide amidase in humancardiac and vascular tissues. Int J Cardiol1998;64(Suppl 1):S15-22.

Bilfinger TV, Stefano GB. Downregulating thediffuse inflammatory potential followingsurgery - preface. Int J Cardiol 1998;64(Suppl 1):S1.

d’Audiffret A, Shenoy SS, Ricotta JJ, Dryjski M.The role of thrombolytic therapy in themanagement of paradoxical embolism.Cardiovasc Surg 1998;6:302-6.

Gamrin L, Berg HE, Essen P, Tesch PA, Hultman E,Garlick PJ, McNurlan MA, Wernerman J.The effect of unloading on protein synthesisin human skeletal muscle. Acta Physiol Scand1998;163:369-77.

Kemeny MM, Botchkina GI, Ochani M, BianchiM, Urmacher C, Tracey KJ. The tetravalentguanylhydrazone CNI-1493 blocks the toxiceffects of interleukin-2 without diminishingantitumor efficacy. Proc Natl Acad Sci U S A1998;95:4561-6.

Kemeny MM, Busch E, Stewart AK, Menck HR.Superior survival of young women withmalignant melanoma. Am J Surg1998;175:437-45.

Macallan DC, McNurlan MA, Kurpad AV, deSouza G, Shetty PS, Calder AG, Griffin GE.Whole body protein metabolism in humanpulmonary tuberculosis and undernutrition:evidence for anabolic block in tuberculosis.Clin Sci 1998;94:321-31.

McNurlan MA, Garlick PJ, Frost RA, DecristofaroKA, Lang CH, Steigbigel RT, Fuhrer J, GelatoM. Albumin synthesis and bone collagenformation in human immunodeficiency virus-positive subjects: differential effects of growthhormone administration. J Clin EndocrinolMetab 1998;83:3050-5.

Some Recent Publications*

* The names of faculty authors appearin boldface


For more information aboutthe Research Classic or forreservations, please call(516) 444-2899.


Research FocusUnderstanding KeloidsTo Find Better Therapy

Keloids are disorders of the healing process, characterized by abnormalaccumulations of collagen extending beyond original wound margins. Dark-skinned people are 15 to 20 times more likely to develop them than light-skinned people. Keloids are most likely to involve the ear, usually in responseto ear piercing, and often develop as shiny smooth growth on one or both sidesof the earlobe. However, keloids can involve any part of the body, with the no-table exception of palmar (palm of the hand) and plantar (sole of the foot) sites.

Symptoms include increasedpigmentation, itchiness, pain,and/or mild to severe disfigure-ment. Today’s increase in the inci-dence of keloids is probably dueto the more frequent puncturingof more parts of the body thanever before seen in our society.

Currently, keloids are treatedwith surgical excision, with orwithout the injection of corticoster-oids, the application of pressuredressings, or even the addition ofradiation therapy. Keloids may

recur regardless of treatment. Therefore, a better understanding of how theydevelop is needed. It is very possible that this new knowledge may lead to amore rational approach to the development of safer, more effective therapies.

What is the underlying cause of the growth of keloids?

Dr. Arnold E. Katz, professor of surgery and chief of otolaryngology-headand neck (ENT) surgery, was awarded the Bernstein Award in 1994 from theAmerican Academy of Facial Plastic and Reconstructive Surgery to study theetiology of keloid formation in collaboration with Dr. Marcia Simon, researchassociate professor of oral biology and pathology and scientific director of theLiving Skin Bank, and Dr. Daniel M. Siegel, associate professor of dermatologyand chief of dermatologic surgery at Stony Brook.

The study was carried out at the Living Skin Bank with Dr. ConstantinChipev, Gabriele Hatch, and Dr. Richard Simman.

Last July, at the Academy’s International Symposium on Facial Plastic Sur-gery held in Orlando, FL, Dr. Katz and colleagues reported the findings of theirstudy, in which fibroblasts (connective tissue cells) taken from both palmar andnon-palmar sites were cultured.

The palmar fibroblasts were found to be different from non-palmar andkeloid fibroblasts. Palmar fibroblasts expressed relatively low levels of collagenand low levels of alpha-smooth muscle actin, and were more sensitive to serumwithdrawal. All of these observations in the palmar fibroblasts were amelioratedby the addition of a protein called transforming growth factor beta-1, which is aregulator of cell growth and development.

Thus, the multidisciplinary team of researchers concluded that regulationof the healing process may decrease the incidence of keloid formation insusceptible individuals.

Pentyala SN, Whyard TC, Waltzer WC, Meek AG,Hod Y. Androgen induction of urokinase geneexpression in LNCaP cells is dependent ontheir interaction with the extracellular matrix.Cancer Lett 1998;130:121-6.

Rialas CM, Fimiani C, Bilfinger TV, Salzet M,Stefano GB. Endomorphin 1 and 2 inhibithuman vascular sympathetic norepinephrinerelease: lack of interaction with µ3 opiatereceptor subtype. Yao Hsueh Hsueh Pao [ActaPharm Sinica] 1998;19:403-7.

Ricotta JJ, Hargadon T, O’Brien-Irr M. Costmanagement strategies for carotid endarter-ectomy. Am J Surg 1998;176:188-92.

Salzet M, Salzet B, Sautiere P, Lesage J, BeauvillainJC, Bilfinger TV, Rialas C, Bjenning C,Stefano GB. Isolation and characterization ofa leech neuropeptide in rat brains: coupling tonitric oxide release in leech, rat and humantissues. Brain Res Mol Brain Res 1998;55:173-9.

Shao X, Tandon R, Samara G, Kanki H, Yano H,Close LG, Parsons R, Sato T. Mutationalanalysis of the PTEN gene in head and necksquamous cell carcinoma. Int J Cancer1998;77:684-8.

Smouha EE, Inouye M. Partial labyrinthectomywith hearing preservation: frequency-specificdata using tone-burst ABR. Otolaryngol HeadNeck Surg 1999;120:146.

Stefano GB, Salzet M, Bilfinger TV. Long-termexposure of human blood vessels to HIVgp120, morphine, and anandamide increasesendothelial adhesion of monocytes: uncou-pling of nitric oxide release. J CardiovascPharmacol 1998;31:862-8.

Stefano GB, Salzet M, Rialas CM, Mattocks D,Fimiani C, Bilfinger TV. Macrophagebehavior associated with acute and chronicexposure to HIV GP120, morphine andanandamide - endothelial implications. Int JCardiol 1998;64(Suppl 1):S3-13.

Stellman SD, Djordjevic MV, Muscat JE, Gong L,Bernstein D, Citron ML, White A, Kemeny M,Busch E, Nafziger AN. Relative abundance oforganochlorine pesticides and polychlorinatedbiphenyls in adipose tissue and serum ofwomen in Long Island, New York. CancerEpidemiol Biomarkers Prev 1998;7:489-96.

Talisman R, Lin JT, Soroff HS, Galanakis D.Gangrene of the back, buttocks, fingers, andtoes caused by transient cold agglutinemiainduced by a cooling blanket in a patient withsepsis. Surgery 1998;123:592-5.

Zhong F, Li XY, Yang SL, Stefano GB, Fimiani C,Bilfinger TV. Methionine-enkephalinstimulates interleukin-6 mRNA expression -human plasma levels in coronary artery bypassgrafting. Int J Cardiol 1998;64(Suppl 1):S53-9.

Recent Publications(Continued from Page 6)

Earlobe keloid before (left) and after (right)surgical removal.

Surgeons must be carefulWhen they take the knife!

Underneath their fine incisionsStirs the culprit—Life!

Emily Dickinson

Division Briefs


Burn CareLast November, at the Tenth

Quadrennial Congress of the Interna-tional Society for Burn Injuries held inJerusalem, Israel, Dr. Harry S. Soroff,professor of surgery and director ofStony Brook’s Burn Center, and col-leagues Dr. Marcia Simon (scientificdirector of the Center’s Living SkinBank), Dr. Richard Simman (recentburn fellow), and others presentedfour papers on the use of cultured epi-thelial grafts in the treatment of burns,and will detail their seven-year experi-ence with this novel technique.

Dr. Harry S. Soroff (left) congratulatedby Dr. Alfredo T. Ramirez.

Before traveling to Jerusalem,Dr. Soroff went to Manila, Philippines,to participate in the Philippine Cen-tennial International Trauma Forum,held in early November as part of thecountry’s celebration of its declarationof independence. There he wasawarded Honorary Membership inthe Philippine Society for the Sur-gery of Trauma.

At the gathering of trauma spe-cialists, Dr. Soroff also presented lec-tures on burn care, including hispioneering use of cultured epithelialgrafts in the treatment of burns.

Dr. Alfredo T. Ramirez, a promi-nent academic surgeon and burn spe-cialist in the Philippines, presidedover the Trauma Forum. Dr. Ramirez,

who is currently chairman of theboard of the Philippine Society for theSurgery of Trauma, is a former burnfellow of Dr. Soroff’s.

Cardiothoracic SurgeryDr. Frank C. Seifert, associate

professor of surgery, in February pre-sented his experience with OPCAB[see page 4] during the one-day courseon off-pump coronary artery bypasssponsored by CardioThoracic Systems,held in Phoenix.

General/GastrointestinalSurgery

Dr. Louis T. Merriam, assistantprofessor of surgery, in March pre-

sented his study titled ”GangrenousCholecystitis: Analysis of Risk Factorsand Experience with LaparoscopicCholecystectomy” at the CentralSurgical Society meeting held inSt. Louis.

Otolaryngology-Head andNeck Surgery

Dr. Arnold E. Katz, professorof surgery and chief of otolaryngol-ogy-head and neck surgery, hasbeen invited to serve as guest exam-

iner for the American Board of Oto-laryngology for 1999 (as he did lastyear).

In January, Dr. Katz served asone of two moderators of the plasticsand head/neck sections of the EasternSectional meeting of the AmericanLaryngological, Rhinological, and Oto-logical Society (The Triological Soci-ety), held in Providence, RI.

Last September, he gave two pre-sentations at the annual meeting of theAmerican Academy of Otolaryngol-ogy-Head and Neck Surgery, held inSan Antonio, TX: “Head and Neck Tu-mor Immunobiology” and “Recon-struction of Large Facial Defects afterMohs Surgery.”

Dr. Denise C. Monte, assistantprofessor of surgery, in January wasinvited to join the Audiocassette Pro-

gram Faculty of the American Academyof Otolaryngology-Head and NeckSurgery. She was nominated for thisprestigious appointment by theAcademy’s Continuing EducationAdvisory Committee, and will serveto help advance the Academy’s con-tinuing education goals for practicingphysicians.

Dr. Eric E. Smouha, recentlypromoted to the rank of associate pro-fessor of surgery, had the followingtwo articles selected for inclusion inthe Home Study Course of the AmericanAcademy of Otolaryngology-Head andNeck Surgery:• Smouha EE, Coyle PK, Shukri S. Facial nerve

palsy in Lyme disease: evaluation of clinicaldiagnostic criteria. Am J Otol 1997;18:257-61.

• Smouha EE, Karmody C. Non-osteiticcomplications of therapeutic radiation to thetemporal bone. Am J Otol 1995;16:1-5.

In addition, the following articleof his was cited in the February issue ofThe Journal of the American College ofSurgeons (“What’s New in Surgery?”):• Smouha EE. Time course of recovery after

Epley maneuvers for benign paroxymalpositional vertigo. Laryngoscope1997;107:187-91.

Trauma/Surgical Critical CareDr. Collin E.M. Brathwaite,

chief of trauma/surgical critical care,was selected as one of the recipients ofthe Presidential Citation Award foroutstanding contributions to the Soci-ety of Critical Care Medicine in 1998.In January, he was honored at a spe-cial awards ceremony at the 28th An-nual Educational and ScientificSymposium of the SCCM, held inSan Francisco.

Last November, Dr. Brathwaiteparticipated in the Philippine Centen-nial International Trauma Forum, heldin Manila, where he presented two lec-tures, “Liver Injuries” and “Nutritionin Trauma.”

Kathleen A. Clifford, ourtrauma-registry nurse since 1984and a 15-year veteran of the LakelandVolunteer Fire Department(Ronkonkoma), defeated two malechallengers in the December election


Alumni News


to fill the retiring commissioner’s seat,and in so doing became the district’sfirst woman fire commissioner.

Clifford says her medical back-ground was a major component ofwinning the campaign. The Lakelanddepartment serves 10,000 householdsand has combined fire and rescueservices.

“My interest in the departmentwas boosting ambulance rescue ser-vice,” Clifford says. “Our departmentresponds to over 1,000 rescue calls peryear. This places quite a demand onour rescue services, making it one ofour priorities.”

Emphasis on ambulance rescuecould mean more advancement for

women within Long Island’s districts,Clifford adds. “I think it’s just part of achange where people with a medicalbackground can offer more,” she says.“Nursing is a big part of that and mostnurses happen to be women.”

Clifford is certified by New YorkState as an emergency medical techni-cian (EMT), and certified by the SuffolkCounty Fire Academy in basic andadvanced firefighting, heavy rescue,hazardous materials awareness, andhazard materials operations.

She has received numerousawards and unit citations for excellentduty at fire and rescue operations. A1984 graduate of Stony Brook’s Schoolof Nursing where she earned her RN,she is a member of Sigma Theta TauInternational Nursing Honor Society.

Since the class of 1975 entered the profession of surgery, 134physicians have completed their residency training in generalsurgery at Stony Brook. The alumni of our residency programnow practice surgery throughout the United States, as well asin numerous other countries around the world.

Dr. Samuel Feldman (’79), ofCapital District Colon & Rectal Sur-gery Associates, has been appointedchief of surgery at St. Peter’s Hospitalin Albany, NY.

Dr. David Anaise (’81) is cur-rently in law school at the Universityof Arizona, and anticipates receivinghis JD in May.

Dr. Alejandro Callejas (’81) hasbeen in private practice since 1981in Port Charlotte/Punta Gorda, FL,essentially doing general surgery andendoscopy of the gastrointestinal tract.Since 1991, he frequently has beenassisting Dr. M. Andre Vasu (’77) invascular surgery and open heart sur-gery. A personal note: Dr. Callejas’older son, Alex Jr., now 27 years old,graduated from Boston University in1998, completing his education ingeneral dentistry.

Dr. Andreas G. Tzakis (’83) isprofessor of surgery at the Universityof Miami, and director of the liver/gastrointestinal transplant program atJackson Memorial Hospital, as well asco-director of the transplantation divi-sion. He has been involved in morethan 2,000 organ transplants in his 16-year career, and continues to contrib-ute to the latest clinical and scientificadvances in transplantation. His opera-tions keep making international news.

Last June, Dr. Tzakis treated a13-year-old boy from Maryland whosebody had rejected two quadruple-organ transplants in five weeks, andsucessfully transplanted a third set oforgans—a liver, a pancreas, a smallbowel, and a stomach. This patient wasthe first person ever to receive three

multiple-organ transplants. The last oper-ation took 19 hours to perform. At eightmonths post-op, the boy is doing well.

Commenting on how he relaxesthese days, Dr. Tzakis says: “My familyis my shelter, my wife [Dr. Pat Carroll]and my daughter Mariella. And bicy-cling. Key Biscayne is my favorite ride,watching the sunrise from CrandonPark. Miami is the most beautiful cityI’ve ever lived in.”

Dr. Robert H. Gotkin (’85), a spe-cialist in plastic and reconstructive sur-gery, has established a very successfulmultidisciplinary practice with his wife,Dr. Deborah S. Sarnoff, a dermatologist.Together, they offer the latest in cosmeticlaser surgery, plastic surgery, and der-matology. Dr. Gotkin has become well-known for his expertise in aestheticfacial surgery and liposculpture,including the use of lasers for facialrejuvenation.

Both Dr. Gotkin and Dr. Sarnoffare frequently featured in numerousmagazines, including Vogue, Glamour,Elle, Mademoiselle, Self, Marie Claire, andMirabella. They are often interviewedabout cosmetic and laser surgery by TheNew York Times and Newsday, and alsoserve as consultants for dermatologyand laser/plastic surgery to AnnLanders. They have demonstratedmany of their laser and surgical tech-niques on The Phil Donahue Show, ABC’sNightline, NBC’s Live at Five, CNN, andvarious other news broadcasts. Theyhave two offices called Cosmetique(with in-office operating rooms), one inManhattan and the other in Greenvaleon Long Island—visit their website athttp://www.cosmetiq.com.

Kathleen A.Clifford, RN


OUR ELECTRONICPHYSICIAN DIRECTORY

The Department has established a physician directory as part of its websiteon the Internet—please visit us at the address below for information about

our individual physicians (see sample below), as well as our programs inpatient care, education, research, and community service.

http://www.uhmc.sunysb.edu/surgeryMD: Cornell University (1955).Residency Training: General Surgery,Roosevelt Hospital, New York.Fellowship Training: Pediatric Surgery,Ohio State University.Board Certification: Pediatric Surgery; Surgery;Pediatrics.Specialties: Management of both congenital and ac-quired diseases of the neck, chest, abdomen, and softtissues in children (newborns to adolescents aged 17years); repair of inguinal hernias in infants less than1 year of age; repair of undescended testes in younginfants; newborn surgery related to alimentary tractobstruction and lung, diaphragm, abdominal or neckabnormalities; surgery for infant or childhood tumors;

and surgery for gastrointestinal disease.Additional: Chief of Pediatric Surgery; Fellow, American College of Surgeons(FACS); Fellow, American Academy of Pediatrics (FAAP).Honors: Inclusion as one of the “Doctors of Excellence” featured in past editionsand the latest edition (1999) of the Castle Connolly Guide, How to Find the BestDoctors—New York Metro Area.Languages Spoken: English.Consultations/Appointments: 516-444-4538.

Dr. Cedric J. Priebe, Jr.

Dr. Cliff P. Connery (’89) is as-sociate chief of the cardiothoracic sur-gery division and chief of the thoracicsurgery service at St. Luke’s-RooseveltHospital Center in New York, and as-sistant professor of clinical surgery atColumbia University College of Physi-cians and Surgeons. Two recent jour-nal publications are:• Gregory AK, Connery CP, Anagnostopoulos

CE. A late complication of tuberculouspericarditis after partial pericardial resection.Ann Thorac Surg 1998;65:542-4.

• Declerck C, Hillel Z, Shih H, Kuroda M,Connery CP, Thys DM. A comparison of leftventricular performance indices measured bytransesophageal echocardiography withautomated border detection. Anesthesiology1998;89:341-9.

Dr. Patricia R. Kennedy (’92),also a graduate of Stony Brook’sSchool of Medicine, continues to prac-tice as a breast surgeon at the FaulknerBreast Centre in Boston, where shejoined the full-time surgical staff in1993. She was admitted into Fellow-ship of the American College of Sur-geons in 1997. Although very busyclinically, she maintains an interest inresearch, and is currently studying theeffect of menstrual cycle timing onprognostic markers with breast sur-gery. A personal note: Dr. Kennedy isthe happy mother of a 2-year-old son.

Dr. Lance U. Jung (’95), who suc-cessfully completed his laparoscopicsurgery fellowship at the Institute forMinimally Invasive Surgery (NewYork Medical College) in White Plains,NY, now lives on Staten Island, NY,and practices general surgery as amember of the multi-specialty StatenIsland Medical Group.

For current mailing addressesof our alumni, please see theDepartment’s new AlumniDirectory on the Internet atwww.uhmc.sunysb.edu/surgery/alum-dir.html

Alumni News(Continued)

Residency UpdateFull and Unconditional Approval Received

A site visit of the residency programs in general surgery and in generalvascular surgery was conducted in May of last year. At the October 1998 meetingof the Residency Review Committee for Surgery (American Board of Surgery),both programs received full five-year accreditation, without any citations orareas of concern.

This accreditation is the highest given by the RRC, and is one measure of thequality of our programs, our staff, and the residents we attract to Stony Brook.The unconditional approval we received constitutes a major achievement—something we’re proud of!

Dr. John J. Ricotta, professor and chairman of surgery, is director of bothresidency programs. Commenting on their strength, he says: “We have assembleda faculty interested in resident education, clinical innovations, and advances inbasic and clinical research. In this way, we have assured that our resident traineesare not only exposed to the scientific basis of surgical practice, but interact withfaculty who are dedicated to the pursuit of new knowledge and the developmentof new technologies in surgical care.”


Maze Operation(Continued from Page 3)

Which procedure is used dependson the number and location of by-passes that need to be performed. Inboth the MIDCAB and OPCAB proce-dures, patients receive general anes-thesia, and a breathing tube is insertedso that a ventilator can provide oxygenand assist in breathing. During surgery,portions of the beating heart are stead-ied with a stabilizer foot.

The OPCAB approach, as notedabove, is utilized when there are mul-tiple vessels to be bypassed.

In 95% of patients referred to himfor CABG, Dr. Seifert has been able totreat them with off-pump procedures.Last year, he performed 200 OPCABand nearly 100 MIDCAB operations.

For more information about OPCAB andother minimally invasive heart surgery atStony Brook, please call (516) 444-1820to arrange for a consultation/appointmentwith one of our cardiothoracic surgeons.

The maze procedure requiresopen heart surgery and it is veryspecialized surgery, done at only afew medical centers. Some centers arenow experimenting with performingthe maze procedure with catheters(not requiring open heart surgery), butat present this is highly experimental.

The maze procedure performedas open heart surgery has a high suc-cess rate for sustaining normal heartrhythms, usually without the need fora pacemaker. Some patients, though,may still need to take medications afterthe procedure.

The most important thing for pa-tients to do is to make sure they haveexhausted all other medical and non-surgical options before having themaze operation. They should have anevaluation by a cardiac electrophysi-ologist—a cardiologist who specializesin atrial fibrillation.

With the surgical expertise of Dr.Saltman who performs the maze proce-dure, Stony Brook now provides the fullrange of the latest diagnostic and thera-peutic approaches to the care of patientswith atrial fibrillation and other electro-physiological heart problems.

BIO NOTEA graduate “magna cum laude” of Harvard College, Dr. Saltmanreceived his MD-PhD from Columbia University in 1990. He thenreturned to Cambridge to do his residency training in general surgeryat Harvard/Deaconess Hospital, which he completed in 1995. He spentthe following year at Harvard as a research fellow with a postdoctoralfellowship grant from the National Institutes of Health, studyingmechanisms of atrial flutter and fibrillation.

In 1996, he became board certified in surgery. That year he startedHarvard’s two-and-a-half-year residency in cardiothoracic surgery,which he completed in December 1998.

Dr. Saltman joined our faculty as an assistant professor of surgery.In addition to surgical electrophysiology, he performs general adultand pediatric cardiac procedures, as well as thoracic procedures,including videoscopic (minimally invasive) lung resection.

For consultations/appointments with Dr. Saltman, please call (516) 444-1820.

OPCAB(Continued from Page 4)

who receive kidneys from living-unrelated donors is nearly equal tothat of kidneys from living-relateddonors.

A recent reorganization of thetransplantation program has enabledus to improve the quality of patientcare and to increase the number ofpatients on the waiting list for kidneytransplants. In fact, we increased ourlist by over 100% to its present levelof 240 individuals.

We have decreased our lengthof stay in the hospital to sevendays, a decrease from 1997’s13-day length of stay, withoutany loss in the quality of carerendered.

This was done through a teameffort and the creation of a care mapfor the kidney recipient and donor. Infact, the living donor has a length ofstay of just five days in most cases.

Giving the gift of life is a tremen-dous gift that does not have to waitfor a person to die. At Stony Brook wecontinue to help families decide whatis right for them and their loved ones,and as our program expands, we aresaving more and more lives throughthe “miracle” of transplantation.

For more information about our kidneytransplantation program, please call(516) 444-2209.

Kidney Transplantation(Continued from Page 5)

STONY BROOK SURGICAL ASSOCIATES, PC

In this issue . . .

BREAST CAREJohn S. Brebbia, MDMartyn W. Burk, MD, PhDM. Margaret Kemeny, MDLouis T. Merriam, MDBrian J. O’Hea, MDVimala S. Sivaraman, MD

BURN CARECollin E.M. Brathwaite, MDJohn S. Brebbia, MDHarry S. Soroff, MD

CARDIOTHORACICSURGERYThomas V. Bilfinger, MD, ScDIrvin B. Krukenkamp, MDAllison J. McLarty, MDAdam E. Saltman, MD, PhDFrank C. Seifert, MD

GENERAL/GASTROINTESTINALSURGERYCollin E.M. Brathwaite, MDJohn S. Brebbia, MDMartyn W. Burk, MD, PhDLouis T. Merriam, MDVimala S. Sivaraman, MDThomas R. Smith, MD

OTOLARYNGOLOGY-HEADAND NECK SURGERY (ENT)Arnold E. Katz, MDDenise C. Monte, MDGhassan J. Samara, MDMaisie L. Shindo, MDEric E. Smouha, MD

PEDIATRIC SURGERYJane T. Kugaczewski, MDCedric J. Priebe, Jr., MD

PLASTIC AND RECON-STRUCTIVE SURGERYSteven M. Katz, MDSteven L. Shoen, MD

SURGICAL ONCOLOGYMartyn W. Burk, MD, PhDM. Margaret Kemeny, MDLouis T. Merriam, MDBrian J. O’Hea, MDVimala S. Sivaraman, MD

TRANSPLANTATIONFelix T. Rapaport, MDJohn J. Ricotta, MDWayne C. Waltzer, MD

TRAUMA/SURGICALCRITICAL CARECollin E.M. Brathwaite, MDJohn S. Brebbia, MDThomas R. Smith, MD

VASCULAR SURGERYFabio Giron, MD, PhDJohn J. Ricotta, MDPaul S. van Bemmelen, MD, PhD

For consultations/appointments with our physicians, please call• (516) 444-4550 for our specialists in breast care• (516) 444-1820 for our specialists in cardiothoracic surgery• (516) 444-4545 for our specialists in general/gastrointestinal surgery• (516) 444-4121 for our specialists in otolaryngology-head and neck surgery (ENT)• (516) 444-4538 for our specialists in pediatric surgery• (516) 444-4545 for our specialists in plastic and reconstructive surgery• (516) 444-1793 for our specialists in surgical oncology• (516) 444-2209 for our specialists in transplantation• (516) 444-1045 for our specialists in trauma/surgical critical care• (516) 444-2565 for our specialists in vascular surgery• (516) 723-5000 for our specialists also at the Life Care Center in Hampton Bays:

breast care - general/gastrointestinal surgery - pediatric surgery - vascular surgery

The State University of New York at Stony Brook is anequal opportunity/affirmative action educator and employer.This publication can be made available in alternative format.

________________________________________________________________________________________________________________

DEPARTMENT OF SURGERY

SCHOOL OF MEDICINE

STATE UNIVERSITY OF NEW YORK

AT STONY BROOK

Stony Brook, New York 11794-8191

■ Introducing Our New Chief ofSurgical Oncology

■ New Program in SurgicalElectrophysiology

■ Performing OPCAB MinimallyInvasive Heart Surgery

■ New Screening Program for Strokeand Cardiovascular Risk Factors

■ Update on Kidney Transplantation■ Research Focus on Keloids■ Residency Update/Alumni News■ Division Briefs—And More!

spring 1999 postop - stony brook medicine · 2020. 1. 7. · imagine a piano duet where one pianist...

Documents