Emory Surgery newsletter Department of Surgery of the Emory University School of Medicine

 

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RRC approves Soddo Christian Hospital to be a site for general surgery resident rotations

Dr. William Wood, who was visiting the site; Dr. Pollock (5th from left); and Soddo surgical trainees
Dr. William Wood (3rd from left, on his first visit to Soddo Hospital) with Dr. Pollock (5th from left) and Soddo surgical trainees

The centerpiece of the Department of Surgery's Global Surgery Program, Soddo Hospital in Soddo, Wolaita, Ethiopia, has been approved by the Residency Review Committee for a single six week rotation per year for one PGY3 and/or one PGY4 general surgery resident beginning in July 2013.

Born from the career interests of Dr. Jonathan Pollock, who joined our faculty in July 2010 after completing his general surgery residency at Emory, the Global Surgery Program will offer a variety of unique training opportunities. While retaining his Emory appointment, Dr. Pollock joined Soddo Hospital in July 2011 as assistant program director for its general surgery residency program, a position that will allow him to coordinate the Emory general surgery resident experience in Ethiopia.

The rotation will offer many stimulating prospects for research to residents interested in outcomes, public health, resource-poor surgical environments, and advanced and unusual disease states.

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Dr. Albert Losken
Dr. Losken
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Dr. William Hamm
Dr. Hamm (1902-1998)

Dr. Losken appointed to Hamm Chair

The Emory Board of Trustees recently confirmed the appointment of Dr. Albert Losken to the William G. Hamm, MD Chair in Plastic Surgery. "Dr. Losken is one of the bright young stars in academic plastic surgery," says Dr. Grant Carlson, chief of the Emory division of plastic surgery. "Emory is very proud of his accomplishments and his efforts to educate young surgeons and advance the specialty."

After completing his general surgery and plastic surgery residencies at Emory in 2002, Dr. Losken joined the plastic and reconstructive surgery faculty of the Department of Surgery. He was an early advocate and practitioner of breast oncoplastic surgery, a method for treating breast cancer involving surgical oncologists and plastic surgeons working together to remove the lesion and preserve and reconstruct breast tissue. He has also contributed much to the development and refinement of body contouring after weight loss surgery. Dr. Losken is a respected and sought after speaker at national meetings, published the books Acellular Dermal Matrices in Breast Surgery and Partial Breast Reconstruction: Techniques in Oncoplastic Surgery, is associate editor of the breast surgery section of Annals of Plastic Surgery and on the editorial board of Plastic Surgery International, has been named one of Atlanta's Top Doctors by Atlanta magazine, and is listed in the U.S. News Top Doctors online database, compiled by U.S. News and World Report and Castle Connolly Medical Ltd.

Dr. Hamm was one of the early pioneers of plastic surgery and is often credited with influencing the mandate that a general surgery residency precede the plastic surgery residency. After completing his general surgery residency at Barnes Hospital, Dr. Hamm embarked on his plastic surgery residency at the institution. He co-authored various influential articles with his mentor Dr. Vilray Blair, considered one of the prime movers in defining the specialty of plastic surgery. One of these was "The Early Care of Burns and the Repair of Their Defects," published in JAMA in 1932, which was one of the first studies to advocate the treatment of burns by gentle debridement and early grafting rather than by pretreatment with escharotics.

In 1935 Dr. Hamm moved to Atlanta and was the first fully trained plastic surgeon in the state. He opened a private practice clinic, worked at several hospitals, and initiated what became a 60-year relationship with Emory as a clinical professor. His specialties included treating adults with cancer of the face, mouth, and jaw, and caring for children with craniofacial deformities, particularly cleft lip and palate.

Dr. Hamm was a founding member of the American Board of Surgery and the American Board of Plastic Surgery, served as president of the latter as well as the American Society of Plastic and Reconstructive Surgeons, and was recognized as a distinguished fellow by the American Association of Plastic Surgeons. A member of the Naval Reserve, he retired with the rank of Rear Admiral.

Dr. Hamm passed away at age 96 in March 1998. His final act of generosity towards Emory was to donate $1.5 million to endow a chair in plastic surgery. Prior holders of the chair were the late Dr. John Bostwick and former plastic surgery chief Dr. T. Roderick Hester.

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Ashley Patton comforts Avery
Ashley Patton with Avery
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Alex Patton feeds Brantley
Alex Patton with Brantley

Dr. Lattouf helms precarious procedure: One blood clot, one mother, and twins

Dr. Lattouf's surgical team
Dr. Lattouf and his surgical team

When Emory cardiothoracic surgeon Dr. Omar Lattouf looked at Ashley Patton's echocardiogram for the first time, his own heart rate quickened as he saw the sheer size of the blood clot and where it was positioned.

"It was about three inches long, half of it on the right side, half on the left side, and it was wiggling back and forth with every heart beat," he says.

Dr. Lattouf knew that if the clot broke free and shot into Ashley's lungs, the young mother and her unborn twins would be lost, a fact that was clear to all of the seasoned Emory physicians gathered around Ashley at Emory University Hospital Midtown, a group that included pulmonologist and venous thromboembolism authority Dr. Kenneth Leeper, cardiologist and heart failure specialist Dr. Dan Sorescu, and Dr. Joel Zivot, medical director of the cardiothoracic ICU at EUHM.

"We all agreed that time was not on our side and that the risks of the clot breaking away or the babies being damaged were too high to attempt medical therapy or thrombolytic therapy," says Dr. Lattouf. "Immediate surgery was the only option."

The road to that point had already been rough for 21-year-old Ashley, who uses a wheelchair after being paralyzed from the waist down in a car accident at 14. Six months after she and her husband Alex learned that she was pregnant with twins, she started having chest pain and difficulty breathing. After receiving an emergency referral to EUHM, it was discovered that a large blood clot had broken away from her legs and lodged itself through the middle of her heart.

As the clock ticked, the staff at EUH Midtown rushed to clear two operating rooms and gathered together three surgical teams and two teams of adult and neonatal intensivists.

"We had one mom, three lives, three operations," says Dr. Lattouf.

In the first OR, Ashley underwent a caesarean section to deliver the twins. The delivery team worked quickly, being very aware that the general anesthesia going to Ashley was also going to the babies.

"They moved with the speed of light. They were in and out in probably less than 15 minutes," says Dr. Lattouf.

Avery and Brantley Patton, small, sedated, but stable, were born at one-pound-12-ounces and two-pounds-three-ounces.

Ashley was moved to the second OR and placed on a heart-lung machine. Dr. Lattouf and his team opened her chest and found one end of the clot dangling in her right atrium and the other in the left. Dr. Lattouf says he hadn't performed as complicated a surgery in almost 25 years, commenting that "it was like someone shoots a bullet and you have to go in and grab that bullet before it hits the target." He and his team were successful in removing the clot, after which Ashley underwent a third surgery to place a stent.

The twins spent several months in the special care neonatal and perinatal unit at EUHM and are now at home with Alex and Ashley. All are doing well.

"Everyone did an amazing job," says Dr. Lattouf. "It was as if it had been rehearsed a dozen times before!"

This story was originally reported on Fox News, Feb. 2, 2012. Watch it here.

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Dr. Buchman
Dr. Buchman
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Dr. Buchman named Master of Critical Care Medicine Fellow

Dr. Timothy Buchman, the founding director of the Emory Center for Critical Care (ECCC) and intrepid researcher in such areas as physiological dynamics and ICU end-of-life care, was one of 20 research physicians to be named among the American College of Critical Care Medicine's first class of Master of Critical Care Medicine (MCCM) Fellows during the Society of Critical Care Medicine's 41st Critical Care Congress in Houston.

The prestigious designation is awarded to an individual who has been a fellow of the American College of Critical Care Medicine (FCCM) for at least five years and has distinguished him or herself by achieving national and international professional prominence through personal character, leadership, eminence in clinical practice, outstanding contributions to research and education in critical care medicine, and years of exemplary service to the Society, the American College of Critical Care Medicine (ACCM), and the field of critical care medicine in its broadest sense.

The Society of Critical Care Medicine (SCCM) is the largest multi-professional organization dedicated to ensuring excellence and consistency in the practice of critical care. With nearly 16,000 members in more than 100 countries, SCCM is the only organization that represents all professional components of the critical care team. The society offers a variety of activities that promote excellence in patient care, education, research, and advocacy. Dr. Buchman was president of SCCM in 2003-2004.

Dr. Buchman will also be inducted into the Johns Hopkins Society of Scholars in April 2012. The society was established in 1967 to honor distinguished former Johns Hopkins postdoctoral fellows and junior or visiting faculty.

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Dr. Padala in the lab
Dr. Padala
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Dr. Padala receives OTT's Innovation of 2011 Award

The Emory Office of Technology Transfer (OTT) has selected Dr. Muralidhar Padala to receive Emory University's Innovation of 2011 award for his percutaneous mitral valve repair system. Dr. Padala, assistant professor in the division of cardiothoracic surgery, directs the Structural Heart Disease Research and Innovation Lab of Emory's Cardiothoracic Research Laboratory. Recipients of OTT awards are recognized for producing an invention that shows significant potential and are picked from a host of pioneering technologies by a panel of judges from both Emory and the Southeastern biotech community.

By implanting a biocompatible plug on the mitral valve leaflets at the site of valve regurgitation, Dr. Padala's invention enables repair of the mitral valve on a beating heart via the ventricular apex. The innovation also won first place in the 2011 Southeast BIO (SEBIO) Business Plan Competition, an annual event designed to foster the development of emerging life science opportunities across the Southeast, and has recently received seed funding from the Georgia Research Alliance (GRA) VentureLab program for prototype development and animal testing.

Dr. Padala will be presented with the award at OTT's 6th Annual Celebration of Technology and Innovation at the Emory Conference Center on March 8th, 2012.

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Dr. John Calvert
Dr. Calvert
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Dr. David Lefer
Dr. Lefer

Dr. Calvert and Dr. Lefer the 1st and senior authors of one of the ten most read articles of 2011 in Circulation Research

As recently reported by Circulation Research, "Exercise Protects Against Myocardial Ischemia-Reperfusion Injury via Stimulation of ß3-Adrenergic Receptors and Increased Nitric Oxide Signaling: Role of Nitrite and Nitrosothiols" was one the journal's ten most downloaded articles between January 2011-December 2011. The introduction to the listing states that the ten articles "represent paradigms of scientific excellence, particularly with respect to the three criteria that we value most: conceptual and/or mechanistic novelty, scientific impact, and methodological rigor."

Dr. David Lefer, director of the Cardiothoracic Research Laboratory, Dr. John Calvert, also affiliated with the lab, and their co-authors presented new evidence that the heart's ability to store the nitric oxide generated during exercise appeared to be an essential component to protecting the heart after a heart attack.

The researchers found that voluntary exercise boosted endothelial nitric oxide synthase (eNOS, an enzyme that produces nitric oxide), and that the level stayed high for a week after exercise ceased unlike other heart enzymes stimulated by exercise. Nitric oxide turns on chemical pathways that relax blood vessels to increase blood flow and activate survival pathways. The study found that both the chemical nitrite and nitrosothiols, nitric oxide attached to proteins via sulfur, appear to act as convertible reservoirs for nitric oxide in critical situations such as a lack of blood flow or oxygen.

In experiments with mice, the researchers showed that four weeks of being able to run on a wheel protected the mice from having a blocked coronary artery; the amount of heart muscle damaged by the blockage was less after the exercise period. Importantly, the mice were still protected a week after the wheel was taken away. However, the study found that the protective effects of exercise did not extend beyond four weeks after exercise ended, when nitrite and nitrosothiols in the heart returned to baseline.

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TAVR
Placement of the SAPIEN™ valve
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Dr. Thourani discusses TAVR with Emory HealthSource
Dr. Thourani discusses TAVR with Emory HealthSource (watch the video)

Dr. Thourani presents PARTNER 2 Results: TAVR also compares well with minimally invasive surgery

During transcatheter aortic valve replacement (TAVR), the SAPIEN™ transfemoral transcatheter heart valve—made of cow tissue—is mounted on a wire mesh, fed through a small incision in the chest wall or groin with a catheter, and placed where it is needed. Last year, the results of the multi-center Edwards LifeSciences PARTNER 1 SAPIEN™ trial, which established TAVR as a viable, non-surgical alternative to traditional, open-heart surgery or medication therapy in high-risk patients with aortic stenosis, influenced the FDA's approval of the new valve. In a new sub-analysis presented at the Society of Thoracic Surgeons (STS) annual meeting in Ft. Lauderdale, FL, researchers showed that TAVR is not only as effective as the alternative minimally invasive technique, but may also be safer in the short term. The results were presented by Emory cardiothoracic surgeon Dr. Vinod Thourani, who shared PI duties with Emory cardiologist Dr. Vasilis Babaliaros for the Emory University Hospital-based site of the national study.

The Emory team compared 341 TAVR patients with 250 patients receiving full-sternotomy surgery and 49 receiving either minimally invasive mini-thoracotomy or partial sternotomy to access the heart. Mean age (about 84 years) and Society of Thoracic Surgeons (STS)-predicted mortality risk (about 11%) were equivalent across groups.

While mortality was equivalent between TAVR and full-sternotomy at 30 days, minimally invasive surgery showed a higher death rate, though the difference was not statistically significant. Major vascular complications were higher with TAVR, while other endpoints such as rehospitalization and stroke were equivalent between all groups. On multivariable analysis adjusted for STS score, full-sternotomy surgery did not show increased mortality at 30 days compared with TAVR, though minimally invasive surgery did. At one year, however, neither full-sternotomy surgery nor minimally invasive surgery was associated with increased mortality compared with TAVR.

"Overall, both TAVR and surgical aortic valve replacement provide excellent results in high-risk patients," Dr. Thourani noted, "though early mortality is higher in those patients undergoing minimally invasive surgery. However, one-year mortality was not significantly different among groups, underscoring that in this high-risk patient population, careful preoperative consideration for operative strategy should be performed."

Dr. Thourani admitted that the study's scope didn't allow for conclusions as to why minimally invasive surgery patients did worse at 30 days. "We need to do more investigation on mini vs. full sternotomy," he says. "We've uncovered that something is going on between the two and a randomized study is needed to tease that out."

However, Dr. Thourani believes the similarity in one-year outcomes between the three methods once again vindicates the viability of TAVR. "It's what we found with the original PARTNER trial, in that most of the discrepancies equaled out after a year, and there are certain advantages with minimally invasive or endovascular-based therapy in high-risk patients, such as not having to open the chest and faster patient recovery."

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Upcoming events

EVENT DATE/TIME LOCATION
SURGICAL GRAND ROUNDS
Molecular Regulation of Neovascularization

Presented by Jeffrey M. Arbeit, MD
– Professor, Department of Surgery, Division of Urologic Surgery, Division of Biology and Biomedical Sciences, Washington University in St. Louis School of Medicine
7:00-8:00 AM, March 1, 2012 EUH Auditorium
SURGICAL GRAND ROUNDS
6th Annual Robert B. Smith, III, Visiting Professorship
Engineered Biomaterials for Repair and Regeneration

Presented by Elliot L. Chaikof, MD, PhD
– Surgeon-in-Chief, Chairman, Department of Surgery, Beth Israel Deaconess Medical Center (BIDMC)
– Johnson and Johnson Professor of Surgery, Harvard Medical School
7:00-8:00 AM, March 8, 2012 EUH Auditorium
6th Annual Celebration of Technology and Innovation
Sponsored by the Emory University Office of Technology Transfer
Keynote Speaker: Richard Cummings, PhD, Professor and Chair, Department of Biochemistry, Emory University School of Medicine
Topic: From Ideas to Opportunities — Making Money from Sugar

5:00-6:00PM, March 8, 2012 Emory Conference Center
SURGICAL GRAND ROUNDS
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignancies

Presented by Charles A. Staley, MD
– Professor of Surgery, Holland M. Ware Professor of Surgery and Chief, Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine
– Associate Director for Clinical Operations, Winship Cancer Institute of Emory University
7:00-8:00 AM, March 15, 2012 EUH Auditorium
EUH Surgical Services Performance Day
A quarterly review and analysis of surgical services performance among anesthesia, surgery, and OR Staff of Emory University Hospital
7:00-8:00 AM, March 22, 2012 EUH Auditorium
Surgery Division Chiefs Meeting 5:30-7:00 PM, March 27, 2012 J.B. Whitehead Room, EUH
SURGICAL GRAND ROUNDS
Current and Innovative Concepts in Renovascular Disease

Presented by Gabriela Velazquez, MD
– Chief Resident, Department of Surgery, Emory University School of Medicine
7:00-8:00 AM, March 29, 2012 EUH Auditorium
     
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