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




Dr. Jeffrey Nicholas
Dr. Nicholas
Dr. Dente teaching an ultrasound course
Dr. Dente
Dr. Jeffrey Salomone
Dr. Salomone
Dr. Grace Rozycki
Dr. Rozycki
Dr. Walter Ingram
Dr. Ingram
Dr. Gary Vercruysse
Dr. Vercruysse
Dr. Amy Wyrzykowski
Dr. Wyrzykowski
Dr. Ravi Rajani
Dr. Rajani

Trauma and surgical critical care at Grady: Transitions and status

Grady Memorial Hospital

The appointment of Dr. Jeffrey Nicholas to the first official Chief of Trauma for the Grady Health System is a significant development for the trauma and surgical critical care group at Grady Memorial Hospital. In this new position, Dr. Nicholas will oversee the entire program from pre-hospital care to rehabilitation and will implement changes throughout based on his background and training with the American College of Surgeon's Trauma Quality Improvement Program (TQIP). He will also direct Grady's effort to become an American College of Surgeons-verified Level I Trauma Center, an endeavor endorsed by the GHS leadership.

"He has the knowledge base, technical acumen, and collaborative skill set to lead this historical flagship program at Grady," says Dr. Sheryl Gabram, surgeon-in-chief of Grady. "I look forward to his leadership and taking the program to yet another level."

Before joining the Department of Surgery and Grady in 2000, Dr. Nicholas had already gained extensive experience at four public hospitals. Prior to Emory, he spent three years as an assistant professor of surgery at the University of South Florida and its clinical/academic affiliate Tampa General Hospital, one of the largest hospitals in the state serving western and central Florida. He did his general surgery residency at Wayne State University/Detroit Medical Center; his fellowship in trauma at Cook County Hospital, Chicago; and his fellowship in surgical critical care at Jackson Memorial Hospital/Ryder Trauma Center of the University of Miami.

Dr. Nicholas has engaged in various Grady-based initiatives since his arrival, including the introduction of a novel approach for jejunal feeding access in critically ill ICU patients, expanding the resident experience in upper GI endoscopy, establishing vacuum assisted fascial closure of patients with open abdomens, launching a laparoscopic colectomy program, and assisting Dr. Chris Dente and the Department of Transfusion Medicine with the development and execution of Grady's massive transfusion protocol. In 2011, Dr. Nicholas successfully initiated the Donation after Cardiac Death program at Grady, for which he received an Organ Donation Medal of Honor from the Department of Health and Human Services.

The ease of Dr. Nicholas's transition was influenced by Dr. Jeffrey Salomone's tenure as Emory's interim director of trauma at Grady. In addition to working with Dr. Grace Rozycki to maintain the equilibrium of the trauma service through the renovation of the trauma center's resuscitation section, which officially opened as the Marcus Trauma Center in October 2011, Dr. Salomone's leadership was essential to initiating and managing the peer review quality improvement meetings that are preparing the trauma service for its invitation to the state and ACS for Level I verification.

Among other roles, Dr. Salomone will continue his important position in prehospital Emergency Medical Services at Grady and is the official surgeon for the Atlanta Police Department, an appointment he has held since 1997.

The activities and endeavors of the rest of the trauma/surgical critical care group remain highly effective, forward-looking, and diverse.

For several years, Dr. Dente and Dr. Ken Wilson of Morehouse School of Medicine have been associate directors of the trauma program and recently collaborated on defining the roles of trauma team members during acute resuscitations in the Marcus Trauma Center. Dr. Dente was the driving force behind Grady's massive transfusion protocol, has made various national presentations and authored several publications related to it, and will be working with Dr. Nicholas to refine the protocol further based on patient outcomes.

Dr. Dente chairs the Committee on Trauma of the Georgia Chapter of the American College of Surgeons, has played a key role in developing the American Association of the Surgery of Trauma's (AAST) acute care surgery curriculum at Grady, and is a site surveyor of programs that have applied for AAST-approval of their acute care surgery fellowships. Dr. Dente also directs multiple ACS-sponsored, trauma-related courses for faculty, fellows, and residents, including ultrasound, advanced trauma life support, and advanced surgical skills for exposure in trauma (ASSET).

In addition to being vice chair of academic administration for the Department of Surgery, Dr. Rozycki continues as medical director of Grady's SICU and director of the trauma/surgical critical care fellowship, one of the most sought after and stellar programs of its type in the country. The two-year program currently trains three trauma fellows and three surgical critical care residents per year. Dr. Rozycki recently completed a presidential term for the Southeastern Surgical Congress.

Dr. Walt Ingram and Dr. Gary Vercruysse, director and co-director of the Grady Burn Center, recently participated in an American Burn Association site visit for verification. If granted, this is the highest recommendation a burn center can receive. As one of only two regional burn services in Georgia, the center continues to admit over 500 burn patients per year and to provide the vast majority of pediatric burn care in the state.

Dr. Amy Wyrzykowski's leadership has been crucial to the daily operation of the General Surgery A service and its response to the growth in general surgery and emergency general surgery case volumes. She assisted in the implementation of the EPIC electronic medical record at Grady in 2010 and remains Grady's EPIC physician champion, ensuring that the system continues to meet the needs of physicians, staff, and patients.

The most recent addition to the Grady group is vascular surgeon Dr. Ravi Rajani, also a former Emory trauma/surgical critical care fellow. Appointed director of vascular and endovascular surgery at Grady in August 2011, Dr. Rajani has expanded the endovascular capability of the trauma service to treat vascular trauma and blunt aortic injury. Recently Dr. Rajani initiated a multi-disciplinary monthly endovascular conference at the hospital to share best practices and to establish common treatment protocols regardless of specialty service.

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Dr. David Kooby
Dr. Kooby
Dr. Shishir Maithel
Dr. Maithel
Dr. S. Scott Davis
Dr. Davis

Hybrid treatment allows patients with upper GI cancer to avoid major surgery

"Human hybrid endoscopic and laparoscopic management of mass lesions of the foregut," a study published in the April 2012 issue of Gastrointestinal Endoscopy, describes the use of a minimally invasive approach combining endoscopy and laparoscopy to treat seven patients with tumors of the upper gastrointestinal tract. First author Dr. Field Willingham, a gastroenterologist and director of endoscopy at Emory University Hospital; senior author Dr. David Kooby, associate professor of surgery of the division of surgical oncology; and their co-authors report the results of this technique for patients who would have otherwise required major surgery encompassing removal of all or part of the esophagus, stomach, or intestine. These procedures, such as total gastrectomy or Whipple surgery, are intensive and impacting operations that include long recovery periods and can have lifelong quality-of-life effects.

The hybrid procedures were performed by a team of one attending surgeon—either Dr. Kooby or fellow Emory surgical oncologists and co-authors Dr. Shishir Maithel and Dr. Scott Davis—and one attending gastroenterologist—Dr. Willingham in these cases. After the surgeons mobilized the tumor from the outside, Dr. Willingham was able to remove the tumor from the inside without removing the organ from which the tumor originated. The procedure involves general anesthesia, several tiny laparoscopic or keyhole incisions, and an endoscopy (a long, flexible tube passed down the esophagus).

The technique was successful in five out of seven cases. In the two other cases, both patients had more extensive GI stromal tumors, necessitating the use of more conventional laparoscopic procedures to remove them. Follow-up treatment was variable because not all the tumors had the same level of malignancy; some patients received anti-cancer therapy afterwards.

For the seven patients, there were no immediate or late complications. The postprocedure hospital stays were short, approximately 2 days, compared to the two or three weeks that are typical of such surgeries as total gastrectomy.

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Dr. H. Kim Lyerly
Dr. Lyerly

Save the date: 11th Annual Emory Surgery Research Day

The 11th Annual Department of Surgery Research Day of the Emory University School of Medicine will commence at 7:00 a.m. on Thursday, May 3, 2012, with "Surgical Research: The Biology of Tissue Specific Immune Responses," a lecture by distinguished visiting professor H. Kim Lyerly, MD, George Barth Geller Professor of Research in Cancer; co-director of the Breast Cancer Research Program, Duke Comprehensive Cancer Center; and associate professor of pathology at Duke University School of Medicine. The lecture will be presented at surgical grand rounds in the EUH auditorium.

Dr. Lyerly is a pioneer in the development and testing of immunologic therapies and has consistently transferred immunotherapy from the bench to the bedside. He is nationally and internationally recognized for developing and leading novel clinical trials that evaluated the use of dendritic cells targeting HER2/neu, CEA, and RNA as a therapeutic vaccine to fight primary cancers as well as protect patients against recurrences. He serves on the Board of Directors, American Cancer Society, Southeast Division; chairs the Cancer Centers Subcommittee, National Cancer Advisory Board; co-chairs the Burroughs Wellcome Foundation Translational Research Advisory Board; is on the editorial boards of several peer-reviewed journals, including Annals of Surgery, Cancer Investigation, Journal of Clinical Oncology, and Cancer Gene Therapy; and has published over 180 papers, 75 book chapters, and edited or co-edited 11 books.

The symposium portion of the Annual Research Day will be in SOM Lecture Hall 120. The schdeule is as follows:

1:00-3:05 p.m.   Basic Science Session
3:05-4:25 p.m.   Poster Session, SOM Commons Lobby
4:30-6:30 p.m.   Clinical Session

The research of the Department of Surgery’s medical students, postdocs, residents, and fellows will be showcased. All presentations and posters were competitively reviewed and selected by a panel of distinguished faculty.

Dr. Lyerly will assist in ranking the posters and presentations, resulting in cash awards for the winners as well as dinner with the faculty immediately following the symposium.

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2012 faculty vs. residents softball game

faculty resident softball game 2012

An annual tradition, the 2012 faculty vs. residents softball game was held on Saturday, April 14 at WD Thompson Park. Thanks to PGY4 Dr. Andrew Page for filing the following report on the proceedings:

"The game began in beautiful weather, with the resident and faculty teams cordially expressing wishes for a constructive, educational competition. However, the friendly and lighthearted play quickly regressed and became a bloodbath. Fortunately, only minimal, self-induced physical injuries resulted. The game was close, with the final score being 12 to 11 in the residents favor, though we all won when Dr. Mansour hit the only homerun of the game."

faculty resident softball game 2012

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Upcoming events

Surgery Faculty Meeting 5:30-7:00 p.m., May 1, 2012 EUH Auditorium
7th Annual H. Harlan Stone, MD, Lecture in Trauma
The Trauma Laparotomy, 2000 – 2010: Lessons Learned in 25,000 Patients

Presented by John A. Morris, Jr., MD
– Professor of Surgery
– Director, Trauma, Burn & LifeFlight Patient Care Center, Vanderbilt University Medical Center
7:00-8:00 a.m., May 10, 2012 EUH Auditorium
12th Annual Gerald Zwiren Visiting Professor in Pediatric Surgery
Evidence Based Medicine and Level 1 Outcome Studies in Pediatric Surgery

Presented by George W. Holcomb, III, MD, MBA
– Surgeon-in-Chief;Director, Center for Minimally Invasive Surgery; Childrens Mercy Hospital, Kansas City
– Katharine B. Richardson Endowed Chair in Pediatric Surgery
– Professor of Surgery, University of Missouri-Kansas City School of Medicine
7:00-8:00 a.m., May 17, 2012 EUH Auditorium
National Kidney Foundation's 2012 Kidney Walk May 19, 2012 Learn more
Surgery Division Chiefs Meeting 5:30-7:00 p.m., May 29, 2012 Whitehead Room, EUH
Joesph B. Whitehead Lectureship
Ex vivo Repair and Regeneration of Organs for Transplantation

Presented by Shaf Keshavjee, MD, MSc
University of Toronto:
– Director, Toronto Lung Transplant Program
– Surgeon-in-Chief, University Health Network
– James Wallace McCutcheon Chair in Surgery
– Professor, Division of Thoracic Surgery and Institute of Biomaterials and Biomedical Engineering
7:00-8:00 a.m., May 31, 2012 EUH Auditorium
2011 Emory Surgery footer

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