FALL 1998 Number 8

POSTNews Update from the Department of Surgery Op UNIVERSITY.HOSPITAL.AND.MEDICAL.CENTER.AT.STONY.BROOK

INTRODUCING DR. COLLIN E.M. BRATHWAITE Our New Chief of Trauma/ Surgical Critical Care

e are very pleased to in- troduce Collin E.M. WBrathwaite, MD, who joined our faculty in August as chief of the Division of Trauma/Surgical Critical Care. He comes to Stony Brook from Allegheny University of the Health Sciences (formerly the Medical College of Pennsylvania and Hahnemann University) in Philadel- phia, PA, through which he served as chief of trauma and co-director of the intensive care unit of Crozer-Chester Medical Center. Dr. Collin E.M. Brathwaite attending to a As the new director of our Re- patient in the surgical intensive care unit. Dr. Brathwaite was recently gional (Level I) Trauma Center, Dr. recognized by Philadelphia Brathwaite will coordinate the contin- Magazine (1996) as one of the ued growth and development of our efficiency of our highly specialized “Top Docs” in trauma surgery program. University Hospital earned surgical intensive care unit (SICU), based on the preferences of its designation as a Level I Trauma which provides advanced tertiary Center in 1993, and has since as- physicians, and honored by medical care to critically ill adult sumed a vital leadership role in the the Pennsylvania Division patients. optimization of care given injured pa- of the American Trauma Society Our SICU offers ventilatory tients on Long Island. which bestowed on him its management using all modalities of Dr. Brathwaite is committed to 1997 Recognition Award respiratory support, including positive the multidisciplinary team approach for Trauma Prevention. to trauma management. At the top of end-respiratory pressure, high- his agenda at present is the imple- frequency ventilation, intermittent mentation of standardized protocols mandatory ventilation, pressure sup- Dr. Brathwaite’s SICU team man- and guidelines for our trauma pro- ported ventilation, and pressure con- ages the critical care of pre- and post- gram. trolled ventilation. It also offers operative patients from all of the As chief of our surgical critical cardiac monitoring and management, hospital’s surgical services, except for care program, Dr. Brathwaite will fo- including vasoactive drips, invasive the cardiovascular and pediatric monitoring, and continuous oximetry. (Continued on Page 2) DEPARTMENTcus on maximizing OF SURGERY • UNIVERSITY the capacity HOSPITAL and AND MEDICAL CENTER • UNIVERSITY AT STONY BROOK —1 — services which have their own ICU’s. EDUCATION AND Our critical care specialists are also EXPERIENCE available to provide consultation for Dr. Brathwaite received his MD all types of surgical patients, including from Howard University in 1983, and general surgery, trauma, orthopedics, completed his residency training in POST-OP is published by the neurosurgery, vascular, and trans- general surgery at St. Vincent’s Hospi- Department of Surgery plantation. tal and Medical Center in New York in University Hospital and Medical Center State University of New York 1988. He went on to complete a one- at Stony Brook year fellowship in traumatology/criti- Stony Brook, New York cal care at the prestigious Maryland Editor-in-Chief Institute for Emergency Medical Ser- John J. Ricotta, MD vices Systems of the University of Writer/Editor Maryland in Baltimore. Jonathan Cohen, PhD He then joined the faculty of Contributing Editor UMDNJ/Robert Wood Johnson Medi- Richard Bogenshutz, MBA cal School as an assistant professor of Advisory Board Collin E.M. Brathwaite, MD surgery. There, he co-directed the Peter J. Garlick, PhD trauma ICU, and rose to the rank of Fabio Giron, MD, PhD Arnold E. Katz, MD associate professor in 1995, having Irvin B. Krukenkamp, MD distinguished himself as a physician, Cedric J. Priebe, Jr., MD researcher, and educator. Harry S. Soroff, MD The following year, Dr. Brathwaite joined the faculty of Allegheny Univer- All correspondence should be sent to: Dr. Collin E.M. Brathwaite Dr. Jonathan Cohen sity of the Health Sciences, and as- Writer/Editor, POST-OP As a practicing general sumed leadership of the trauma Department of Surgery/HSC T19 University Hospital and Medical Center surgeon, Dr. Brathwaite’s program at Crozer, which houses Stony Brook, NY 11794-8191, USA clinical interests include all that region’s largest Burn Center. aspects of general surgery, Dr. Brathwaite’s research interests include post-traumatic sepsis and and he will be active on our nutritional support. He has published breast care and general/ more than 33 peer-reviewed journal gastrointestinal services, articles, 28 abstracts, and two book using both conventional chapters. and minimally invasive Board certified in Surgery and in approaches for the surgical Surgical Critical Care, Dr. Brathwaite LASER TREATMENT OF is a Fellow of the American College treatment of abdominal VASCULAR DISORDERS disease. of Surgeons (FACS) and a Fellow of the American College of Critical Care Our New Laserscope System Medicine (FCCM). Is State of the Art As part of his practice in general surgery, Dr. Brathwaite plans to For consultations/appointments with Dr. Varicose veins and telangiecta- establish a multidisciplinary obesity Brathwaite, please call (516) 444-4550 for sias (small spider-like veins) can be surgery program for the treatment of breast care and (516) 444-4545 for general/ painful and may lead to more serious morbid obesity—that state where gastrointestinal/obesity surgery. problems if not treated. Laser body weight exceeds ideal body For consultations concerning surgical critical therapy, alone or in conjunction with weight by 100 pounds or more, care, physicians should call (516) 444-1045. other therapeutic interventions, is a increasing the risk of early mortality new approach for treating these le- and other serious complications. sions. The laser procedure our vascu- lar specialists now perform—made possible by our newly acquired Laserscope system—is less painful than conventional surgery or injec- tions, and results in less bruising, swelling, and scarring.

—2 — DEPARTMENT OF SURGERY • UNIVERSITY HOSPITAL AND MEDICAL CENTER • UNIVERSITY AT STONY BROOK PERFORMING THE NEW BATISTA Some Recent Publications*

Barle H, Nyberg B, Andersson K, Essen P, OPERATION FOR FAILURE McNurlan MA, Wernerman J, Garlick PJ. The effects of short-term parenteral nutrition on human liver protein and amino acid As of September, Irvin B. Krukenkamp, MD, professor of metabolism during laparoscopic surgery. JPEN surgery and chief of cardiothoracic surgery, has successfully 1997;21:330-5. Bilfinger TV, Stefano GB, editors. performed six Batista operations. With no mortalities, his Downregulating the diffuse inflammatory results compare favorably to what has been achieved at other potential following surgery. Int J Cardiol heart centers nationwide. 1998;64(Suppl 1). Brathwaite CE, Rosko M, McDowell R, Gallagher J, Proenca J, Spott MA. A critical analysis of the effect of on-scene helicopter transport on The newly developed Batista operation—named after Brazilian surgeon survival in a statewide trauma system. J Dr. Randas Batista, who introduced the procedure in 1995—is a left ventricular Trauma 1998;45:140-6. remodeling operation for patients with end-stage heart failure, and it offers Brix-Christensen V, Tonnesen E, Sorensen IJ, them new hope as a potential bridge to transplantation. Bilfinger TV, Sanchez RG, Stefano GB. Effects of anaesthesia based on high versus In this innovative operation which is technically called partial left low doses of opioids on the cytokine and acute-phase protein responses in patients , or reduction left ventriculoplasty, a portion of heart muscle is undergoing . Acta Anaesthesiol removed and the geometry of the heart remodeled, thus improving the heart’s Scand 1998;42:63-70. ability to pump blood. Dilmanian FA, Wu XY, Ren B, Huang X, Thomlinson WC, Button TM, Petersen MJ, When the heart starts to fail, it increases in volume, occasionally to twice Chapman D. Xenon K edge imaging with a its original size. As a result, it loses its ability to pump blood effectively. Why monochromatic CT scanner to selectively image fat in rats: relevance to compositional this happens is not known. Typically, the only cure for patients with end-stage imaging of carotid atherosclerotic plaques. heart failure is a heart transplant. In the United States, these patients have about NSLS Proc 1997:112. a one in ten chance of receiving a donor heart. Eubanks PJ, Sawicki MP, Samara GJ, Wan YJ, Gatti RA, Hurwitz M, Passaro E Jr. Pancreatic Now the Batista operation may provide these patients with relief from endocrine tumors with loss of heterozygosity heart failure, and prolong their lives until a heart transplant can be performed. at the multiple endocrine neoplasia type I locus. Am J Surg 1997;173:518-20. The early experience with this new operation is encouraging. Not all patients Fricchione GL, Bilfinger TV, Stefano GB. Aspirin with end-stage heart failure can be candidates for it, but there are certain inhibits granulocyte and monocyte adherence patients who might particularly benefit from it, especially those with very to saphenous vein endothelia in a process not mediated by nitric oxide. Int J Cardiol dilated (enlarged) . 1998;64(Suppl 1):S29-33.

(Continued on Page 11) Garlick PJ, McNurlan MA, Caso G. Critical assessment of methods used to measure protein synthesis in human subjects. Yale J Biol Med 1998;70:65-76. Harris LM, Armstrong D, Browne R, Al-Jada A, This particular laser therapy, treatment using argon lasers, pulsed Peer R, Upson J, Pillai L, Curl GR, Ricotta JJ. moreover, provides results that are Premature peripheral vascular disease: clinical dye lasers, or filtered flashlamp sys- profile and abnormal lipid peroxidation. superior to what other laser systems tems. It enables our physicians to de- Cardiovasc Surg 1998;6:188-93. achieve. It is performed on an outpa- liver fully-variable bursts of laser Li YF, Wang JX, Shao L, Ding CF, Ottaviani E, tient basis at the Stony Brook Surgical energy at pulse widths in the 1 to 50 Stefano GB, Bilfinger TV, Fan SG. Naltrexone suppresses the rejection of cardiac Care Center in East Setauket, and pa- millisecond range. tissue transplantation. Int J Cardiol tients should be able to return to work This clinically-proven treatment 1998;64(Suppl 1):S23-7. immediately. range permits precise matching of the McLarty AJ, Phillips MR, Holmes DR, Schaff HV. Aortocoronary bypass grafting with expanded laser’s pulse width with the thermal polytetrafluoroethylene—12-year patency. WHAT CAN THE LASER TREAT? relaxation times of the targeted blood Ann Thor Surg 1998;65:1442-44. ■ SMALL LEG VEINS/ vessel. The pulse widths created by O’Hea BJ, Hill AD, El-Shirbiny AM, Yeh SD, Rosen PP, Coit DG, Borgen PI, Cody HS III. Sentinel TELANGIECTASIAS this system are long enough to pre- lymph node biopsy in breast cancer: initial ■ CHERRY ANGIOMAS vent bruising and short enough to experience at Memorial Sloan-Kettering Cancer Center. J Am Coll Surg ■ HEMANGIOMAS prevent scarring. 1998;186:423-7. ■ FACIAL SPIDER VEINS (Continued on Page 11) For more information, please call (516) 444-4545. * The names of faculty authors appear The new Laserscope system was in boldface created to minimize the undesirable side effects resulting from leg vein

DEPARTMENT OF SURGERY • UNIVERSITY HOSPITAL AND MEDICAL CENTER • UNIVERSITY AT STONY BROOK —3 — Research Focus AROTID NDARTERECTOMY C E Carotid Endarterectomy IN OPEN HEART SURGERY Well established as a measure to prevent stroke, carotid endarterectomy is troke is the most serious non-cardiac complication of coronary artery by- a vascular operation in which the surgeon Spass grafting (CABG) surgery. While the overall incidence of stroke is low removes an obstruction in the carotid after CABG, it may occur in 10% or more of patients with carotid stenosis. The (neck) artery caused by atherosclerosis, recent correlation of stroke risk with carotid artery disease has caused physi- commonly known as hardening of the ar- cians to consider the possibility of performing CABG and carotid endarterec- teries. tomy (CEA) during the same operation in selected patients. The problem corrected by this opera- A large series of cases from the Texas Heart Institute and our own series tion is due to arterial disease. As we age, from University Hospital show a decrease in stroke rates with synchronous our arteries narrow. They lose their flex- CEA/CABG’s compared with historic controls. Since other changes have oc- ibility and the linings crack. When the ar- curred over time, such as therapeutic and technical advances in the areas of teries in the neck begin to narrow, blood myocardial protection, patient monitoring, and medical management, these clots may develop. The carotid artery may findings warrant a prospective randomized study. become completely blocked or a piece of Our cardiovascular team, led by Dr. John J. Ricotta, professor and chair- clot may break off and travel to the brain. man of surgery, is now organizing such a study. In both cases a stroke may result. Risk of stroke increases as the artery Does prophylactic carotid endarterectomy reduce the risk becomes more and more narrow. The risk of stroke during or after coronary artery bypass surgery? is particularly high after the artery is blocked more than 70%. The amount of Strokes often occur two to five days after CABG. The incidence is high blockage may be determined by a simple enough that the New York State Cardiac Reporting System now distinguishes painless test called a “carotid Doppler” or between strokes occurring within the first 24 hours of surgery and strokes oc- “carotid ultrasound.” curring thereafter. People at greatest risk for carotid ar- At Stony Brook in 1992, a stroke rate of 4.3% was observed. This led to an tery narrowing are those over age 65 (par- institutional policy whereby all patients were screened for carotid obstructions ticularly smokers) and those who already and all patients with lesions in excess of 80% would undergo CEA, with the ex- have poor circulation in the legs or the ception of complete obstructions. heart. Patients who have temporary loss of This policy requiring prophylactic CEA, which we perform synchronously vision or speech and/or weakening of an with CABG, has lowered the overall stroke rate to 1.9% in the last five years. arm or leg may have had a “mini-stroke” These data suggest that the policy of combined surgery reduces stroke risk. and should see their doctor. Additional potential benefits of CEA performed synchronously with Carotid endarterectomy by an expe- CABG include decreased hospital stay and significant cost savings. rienced surgeon is a very effective way to According to Dr. Ricotta, “This new study will test our hypothesis that ca- reduce the risk of stroke. People who are rotid endarterectomy reduces the risk of perioperative stroke in at-risk patients considering carotid endarterectomy undergoing heart surgery. Our clinical experience strongly suggests that com- should ask their potential surgeon about bined surgery using state-of-the-art surgical and anesthetic techniques can be his/her experience and results. In general, performed safely with decreased risk of stroke and death.” the chance of complication occurring dur- ing surgery should be less than 4% in For consultations/appointments with our vascular specialists, please call (516) 444-2565. stable patients. Carotid disease is only one of several types of hardening of the arteries. Our sur- geons perform a broad range of operations including carotid endarterectomy to cor- rect arterial problems.

—4 — DEPARTMENT OF SURGERY • UNIVERSITY HOSPITAL AND MEDICAL CENTER • UNIVERSITY AT STONY BROOK RAPAPORT RECEIVES HIGH HONORS Awarded the Medawar Prize, Decorated with Argentina’s Order of May (From left to right) President Carlos S. Menem, Dr. Felix T. On July 15, Felix T. Rapaport, Rapaport, and Dr. MD, SUNY distinguished professor Thomas E. Starzl (surgery), was awarded the presti- gious Medawar Prize—the ultimate accolade of world transplantation—at the World Congress of the Transplan- tation Society, held in Montreal, Canada. The two other recipients of this year’s Prize are Dr. Fritz Bach, the Lewis Thomas professor of medicine, and Dr. Anthony Monaco, the Peter Medawar professor of transplantation surgery, of Harvard University. The The Prize was established in 1988 in countless as their works, need no qualifi- Prize itself includes a medal, a plaque, honor and memory of the Society’s first cation. Both men have made an out- and 100,000 Swiss francs. president, Sir Peter Medawar (1915- standing contribution to benefit our In his introduction of Dr. 1987), who is considered the founder of nation and the world at large. Their Rapaport at the award ceremony, Dr. transplantation immunology. work transcends the self, and that is Thomas Starzl, past-president of the why they set a double example for the Transplantation Society, celebrated his CELEBRATED IN next generation of physicians and re- colleague as a “peerless educator, sci- ARGENTINA searchers.” entist, and transplant surgeon.” High- On June 1, Dr. Rapaport was deco- The Order of May was established lighted were Dr. Rapaport’s diverse rated personally by the President of by Argentina in 1946. This decoration scientific contributions over the past Argentina, Carlos S. Menem, with the expresses the nation’s gratitude to those four decades that, according to Dr. Order of May at the rank of com- who, through their efforts, have contrib- Starzl, have had a “vast influence on mander. The Order of May, which is uted uniquely to its progress, well-being, transplantation,” starting with his re- Argentina’s highest civil decoration, culture, and international solidarity and ports of the first systematic study of was bestowed upon Dr. Rapaport to collaboration. It was originally named the skin allograft rejection in humans express the nation’s permanent grati- Order of Merit. Its name was formally which suggested the possible existence tude for his efforts to advance organ changed in 1957 to reaffirm the ideals of of tissue types. transplantation in Argentina. The cer- the leaders of the May Revolution (1810), This early work led to the discov- emony was held in the Presidential which launched Argentina’s long struggle ery made by Dr. Rapaport, together Palace, in Buenos Aires. for independence. with Dr. Jean Dausset, of the human Fellow transplant leader Dr. Tho- Argentina’s celebration of Drs. leukocyte antigen (HLA) system of hu- mas Starzl also received the Order of Rapaport and Starzl coincided with a man histocompatibility, which laid the May, as part of Argentina’s celebra- special two-day international festschrift scientific foundation for organ trans- tion of both physicians. Drs. Rapaport in honor of both physicians, held on June plantation. and Starzl are the first two physicians 1-2 in Buenos Aires. The festschrift, titled Funded by Sandoz Pharmaceuti- to ever receive this decoration in the “Present and Future Challenges in Trans- cals, the Medawar Prize is awarded bi- history of the Order. plantation,” was attended by more than ennially to one or more persons for a At the decoration ceremony, 400 participants. The 18 invited guest major scientific discovery or a focused President Menem said, “Drs. Rapaport speakers represented the cutting edge of body of work in immunobiology or ex- and Starzl are great medical figures transplantation research worldwide. perimental/clinical transplantation. whose achievements, which are as

DEPARTMENT OF SURGERY • UNIVERSITY HOSPITAL AND MEDICAL CENTER • UNIVERSITY AT STONY BROOK —5 — Residency Update Our fully accredited five-year nonpyramidal residency program in general surgery fulfills the standards for professional excellence adopted by the American Board of Surgery, and leads to Board eligibility. Our residents receive a broad-based surgical education, which includes not only the clinical but the biological aspects of surgery as well, and provides the foundation for a successful career in private practice, research, or academic surgery. Five surgical residents are selected each year through the National Resident Matching Program.

Drs. John Ricotta Our graduating (left) and Brian otolaryngology Pinard (right) with residents (left to 1998 graduating right), Drs. Joseph chief residents (from Abou-Mrad and left to right) Drs. Ahmed Soliman, James Wu, Michael with Dr. Arnold Ajemian, Mitchell Katz, chief of Chorost, Ravindra otolaryngology-head George, and Javad and neck surgery. Golzarian, at the graduation banquet Our graduating held on June 21. vascular surgery resident (center), Dr. Michael Sacca, with our senior vascular faculty, Drs. John Ricotta (left) and Dr. Fabio Giron (right).

1998 Graduating Chief Residents NAME MEDICAL SCHOOL (GRAD. YEAR) CAREER DIRECTION

Michael Ajemian, MD Eastern Virginia Medical School (’93) Staff, North Shore University Hospital

Mitchell Chorost, MD New Jersey Medical School (’93) Surgical Oncology Fellowship at SUNY-Buffalo Ravindra George, MD U of Madras (’78) Trauma Fellowship at SUNY- Stony Brook Javad Golzarian, MD Brussels Free U (’88) Colorectal Surgery Fellowship at Baylor College of Medicine James Wu, MD U of Chicago (’93) Cardiothoracic Surgery Fellowship at U of Chicago New Chief Residents Iman Karimpour, MD George Washington U (’94) James Lukan, MD SUNY-Stony Brook (’94) Tong Ma, MD U of Pennsylvania (’94) Dean Pappas, MD SUNY-Stony Brook (’94) Saad Shukri, MD U of Baghdad (’79) Incoming Residents/All Categorical PGY-1* Mary Fosu, MD U of Rochester (’98) Ariel Jurmann, MD SUNY-Stony Brook (’98) Tomasz Koslowski, MD U of Warsaw (’85) Paul Mancuso, MD St. George’s U (’98) Michael Mashaal, MD SUNY-Stony Brook (’98)

* As of July 1, 1998.

—6 — DEPARTMENT OF SURGERY • UNIVERSITY HOSPITAL AND MEDICAL CENTER • UNIVERSITY AT STONY BROOK Division Briefs Cardiothoracic Surgery Otolaryngology-Head and Plastic and Dr. Thomas Bilfinger, associate Neck Surgery Reconstructive Surgery professor of surgery, was appointed Dr. Ghassan Samara, assistant Dr. Steven Katz, assistant profes- Senior Research Scientist this July to professor of surgery, joined our fac- sor of surgery, joined us in August, Harvard Medical School’s Mind/ ulty in July. He comes to Stony Brook coming from the University of Texas Body Medical Institute. He will col- from Columbia M.D. Anderson laborate with Dr. George Stefano, the University (Co- Cancer Center in Institute’s Research Director for Basic lumbia-Presby- Houston. He re- Research (who has a faculty appoint- terian Medical ceived his MD ment as adjunct research professor of Center), where from the New surgery with us), to establish a joint he completed York Medical research strategy concerning the ex- his residency College in 1991. amination of neuroimmune and vas- training in oto- Before medical cular regulatory processes. Drs. laryngology- school, he had Bilfinger and Stefano gained interna- head and neck earned an MS in tional recognition for their pioneering surgery; prior physiology from work on the inflammatory response to this, he trained in general surgery Stanford University, and studied physi- during cardiopulmonary bypass, and at UCLA. He received his MD from ology and biophysics in the doctoral have collaborated on numerous inves- the University of Miami in 1989. His program at the University of California tigations since the early 1990s. clinical practice encompasses all as- at San Francisco. He completed his pects of general otolaryngology. Areas residency training in general/plastic General/Gastrointestinal of particular interest include the surgi- surgery at Montefiore Medical Center Surgery cal treatment of chronic sinusitis, ob- (Albert Einstein Medical College) in Dr. Louis Merriam, assistant structive sleep apnea, and tumors of 1997, where he was trained by Dr. professor of surgery, joined our fac- the head and neck. His research inter- Berish Strauch, a renowned leader in ulty in September. He received his MD ests currently focus on apoptosis in the field of microsurgery. At M.D. from Columbia head and neck cancer; that is, why Anderson he received fellowship train- University in damaged cells in cancer don’t die as ing in reconstructive microsurgery (post 1991, and this normal cells would. cancer). His special clinical interests in- year completed clude post-oncologic reconstruction of his residency Pediatric Surgery the breast, trunk, and extremities; post- training in gen- Dr. Jane Kugaczewski presented trauma reconstruction; foot-salvage sur- eral surgery at the first Aram Choudhury Memorial gery (see below); and the full range of Northwestern Trauma Lecture at Good Samaritan aesthetic surgery. His current research University. His Hospital Medical Center in West Islip interests focus on mandible reconstruc- clinical practice in February. She lectured on pediat- tion and peripheral nerve regeneration. at Stony Brook ric trauma with emphasis on splenic Dr. Steven Shoen has recently col- will focus on the management of dis- preservation. Because of her expertise laborated with Dr. Michael Petersen, of eases of the gastrointestinal system. in the surgical treatment of neonatal our vascular surgery service, in per- He has special expertise in minimally bowel obstruction and anorectal mal- forming successful foot-salvage surgery invasive (laparoscopic) surgery for the formations in children, she has also in a patient with severe peripheral vas- treatment of gastroesophageal reflux been invited by local hospitals to cular disease. Dr. Shoen performed a disease, common bile duct stones, present grand rounds on these topics. microvascular free-tissue transfer, while and inguinal hernia, as well as for Dr. Petersen performed distal bypass gallbladder and spleen removal. He surgery. This combined approach will also contribute to our breast care greatly benefits patients, as amputation service. His recent publications of the foot would commonly be re- address diseases of the pancreas and quired. In recent years, Dr. Shoen has laparoscopic splenectomy. teamed up with members of our vascu- (Continued on Page 8)

DEPARTMENT OF SURGERY • UNIVERSITY HOSPITAL AND MEDICAL CENTER • UNIVERSITY AT STONY BROOK —7 — Division Briefs (Continued)

lar surgery service in successfully pertaining to risks of vascular disease, Among his current research inter- performing six of these combined and has his/her blood pressure mea- ests are gene therapy for the treatment foot-salvage procedures. When ad- sured in the ankle and arm—a dis- of arterial disease, and the study of vanced ischemia is complicated by crepancy in these two readings may blood flow in arteries and veins and large areas of tissue loss, combined indicate a circulatory problem that re- capillaries. He is now conducting a distal bypass and microvascular quires medical attention. For more in- study on in vivo gene transfer and free-tissue transfer, performed simul- formation, please call (516) 444-7875. expression. taneously or in stages, is safe in care- Dr. Paul van Bemmelen, clinical fully selected patients, and can often assistant professor of surgery, joined save feet from amputation. For more our faculty in May. He received his information, please call Dr. Shoen at MD from the University of Leiden NEW WOUND CARE (516) 444-4545. (Netherlands) in 1978, and his PhD CENTER from the University of Amsterdam in Healing Chronic Wounds Trauma/Surgical 1985, for which he developed an ex- And Saving Limbs Critical Care perimental model of venous hyperten- Dr. John Brebbia, assistant pro- sion to study damage to vein valves. Any wound that doesn’t show im- After completing his general surgery fessor of surgery, joined our faculty provement in four weeks or is not healed residency at the University of in July, coming to us from SUNY- within eight weeks is considered a non- Buffalo, where Rotterdam in healing or chronic wound. Our new he just com- 1988, he went to Wound Care Center in East Setauket, led pleted his resi- the University of by Dr. Paul van Bemmelen, provides co- dency training Washington in ordinated multi-specialty care for pa- in general sur- Seattle for a one- tients with chronic ulcers (sores) on the gery. He re- year research leg, ankle, or foot. Among the causes of ceived his MD fellowship in such wounds are diabetes, poor circula- there in 1993. vascular surgery. tion, bad veins, and advanced age. For- tunately, limb salvage and prevention of His clinical He then returned disfigurement and disability are achiev- practice encom- to the Nether- able in the vast majority of patients. passes general surgery, laparoscopic lands for a two- year clinical fellowship in general surgery, trauma, and surgical critical The Center is dedicated to: care. Areas of particular interest in- vascular surgery. • Comprehensive patient care clude upper gastrointestinal, endo- In 1991, Dr. van Bemmelen re- • Early intervention crine, colorectal, and breast surgery. turned to the United States, going to • Improved healing rates Dr. Joseph Sorrento, assistant Southern Illinois University, where he • Reduced hospitalization completed his residency training in • Reduced amputations professor of surgery, received an • Reduced disability Award for Outstanding Teaching general vascular surgery. From there • Community outreach and follow-up presented by the Class of 1998 of he relocated to Long Island. Stony Brook’s graduating medical Dr. van Bemmelen specializes in Our wound care team consists of students—the third year in a row that wound care management, with exper- specialists in vascular surgery, dermatol- Dr. Sorrento has been so honored! tise in noninvasive vascular diagnosis ogy, and orthotics; when needed, special- with color-duplex in arterial and ists in podiatry, orthopedic surgery, Vascular Surgery venous disease; nonsurgical treatments plastic and reconstructive surgery, and for vascular disorders; and use of laser- physical medicine contribute their exper- Our Vascular Screening Pro- tise. In addition to its clinical mission, Doppler techniques to study changes gram is a free community service pro- the Center will direct research and educa- in the circulation of the skin in patho- gram designed for education about, tional programs designed to reduce the and early detection of, circulatory logical states (e.g., diabetes, arterial number of patients at risk for limb loss conditions that can block blood flow disease, and venous insufficiency) and associated with chronic wounds. to various parts of the body. Each their relationship with ulceration of participant completes a questionnaire the toes, feet, ankles, and legs. For more information, please call (516) 444-4545.

—8 — DEPARTMENT OF SURGERY • UNIVERSITY HOSPITAL AND MEDICAL CENTER • UNIVERSITY AT STONY BROOK Alumni News

Since the class of 1975 entered the profession of surgery, 129 physicians have completed their residency training in general surgery at Stony Brook. The alumni of our residency program now practice surgery throughout the United States, as well as in numerous other countries around the world.

Dr. Darlene J. Goldstein (’79) Since last June he has given 50 Several articles of which he is a has for the past decade been with Mid presentations at regional, national, and co-author are currently in press, to ap- Atlantic Surgical Associates, New international meetings, three of which pear in the Annals of Thoracic Surgery Jersey’s largest volume cardiovascular are: and the Journal of Thoracic and Cardio- • King WW. Laser surgery in Hong Kong [in- group, which performs more than vited lecture]. Asia-Pacific Conference on Cu- vascular Surgery. 1,600 open heart procedures annually; taneous Surgery and Laser Therapy, Hong He and colleagues have also Kong, December 1997. the group’s one- and three-year sur- • King WW. Association of squamous carci- given several presentations at national vival rates for bypass surgery (CABG) noma of the tongue with radiotherapy for na- and international meetings, a few of sopharyngeal carcinoma [oral presentation]. are among the best in the nation. She American Society for Head and Neck Surgery/ which are: Society of Head and Neck Surgeons, Palm • Thuys C, Mullaly RJ, Karl TR, et al. VAD in is an associate attending surgeon at Beach, FL, May 1998. children < 6 kg. European Association for Morristown Memorial Hospital in • King WW. Nasopharyngectomy and neck dis- Cardiothoracic Surgery, Copenhagen, section for recurrent NPC [invited lecture]. Na- Denmark, September 1997. Morristown, and Overlook Hospital in tional Head and Neck Congress, Hong Kong/ • Fulton J, Cochrane AD, Brizard CP, Karl TR. Summit, and currently is president of Beijing, June 1998. LVOTO does not influence outcome of neonatal IAA repair. Asian Congress on the Greater Morristown/Morris Thoracic and Cardiovascular Surgery, Sydney, We wish Dr. King the best of luck County Division of the American Australia, October 1997. in his new directorship! • Soto R, Brizard C, Cochrane A, Karl T. The Heart Association. intramural coronary artery in the transposition Dr. Tom R. Karl (’81) is director of the great arteries: results of arterial switch. Dr. Walter W.K. King (’80), who Chilean Congress on Cardiology and of the cardiac surgical unit at the Royal currently is professor of surgery and Cardiovascular Surgery, Santiago, Chile, Children’s Hospital in Melbourne, Aus- December 1997. chief of head and neck/plastic and re- • Brizard CP, Sohn YS, Mas C, Cochrane AD, tralia. Last October, his unit held a very Karl TR. Transatrial transpulmonary repair of constructive surgery at the Chinese successful international symposium; the tetralogy of Fallot with anomalous coronary University of Hong Kong, assumes a arteries. American Association for Thoracic proceedings were published in the Asia Surgery, Boston, May 1998. new position this September as direc- Pacific Journal of Cardiothoracic Surgery. tor of the Plastic and Reconstructive Recently, his unit visited Vien Tim Dr. Karl’s department was repre- Surgery Center, Hong Kong Sanato- Hospital in Ho Chi Minh City, as sented in the Melbourne 10-k inline rium and Hospital, in Hong Kong. guests of the Carpentier Foundation skate competition this year (one of his Since last June he has published 19 (Paris and Ho Chi Minh City). He and surgical colleagues and one of their journal articles so far. Among them his colleagues performed some sur- perfusionists, in addition to himself), are: though they didn’t win. He will cel- • Chow LT, Kumta SM, King WW. Extra-articu- gery and had a “fantastic educational lar pigmented villonodular synovitis of the experience” themselves, and they look ebrate his 50th birthday on January 22, temporomandibular joint. J Laryngol Otol 1998;112:182-5. forward to further visits. Since June of 1999, at the top of Chute 75, Squaw • Yeo W, Kwan WH, Teo PM, Leung WT, King Valley, CA, at noon—and says all are WW, Johnson PJ. Cosmetic outcome of last year, some of his publications are: breast-conservation therapy in Chinese pa- • Horton S, Karl TR. Extracorporeal membrane invited! tients with early breast cancer. Aust N Z J oxygenation using a centrifugal pump [letter]. Surg 1997;67:771-4. Ann Thorac Surg 1997;64:1528. Dr. Jean-Claude A. Bayle (’83) is • Yang WT, Lam WW, Cheung H, Suen M, • Duke T, Butt W, South M, Karl TR. Early working as a full-time house physician King WW, Metreweli C. Sonographic, mag- markers of major adverse events in children netic resonance imaging, and mammographic after cardiac operations. J Thorac Cardiovasc in surgery at Beth Israel North in Man- assessments of preoperative size of breast Surg 1997;114:1042-52. hattan, performing general, vascular, cancer. J Ultrasound Med 1997;16:791-7. • Cochrane AD, Brizard CP, Penny DJ, • Teo PM, Kwan WH, Chan AT, Lee WY, King Johansson S, Comas JV, Malm T, Karl TR. and plastic surgery. WW, Mok CO. How successful is high-dose Management of the univentricular connection: ≥60 Gy reirradiation using mainly external are we improving? Eur J Cardiothorac Surg Dr. Richard Nickerson (’84), beams in salvaging local failures of nasopha- 1997;12:107-15. who has a private practice in plastic ryngeal carcinoma? Int J Radiat Oncol Biol • Thuys CA, Mullaly RJ, Horton SB, O’Connor Phys 1998;40:897-913. EB, Cochrane AD, Brizard CP, Karl TR. Cen- and reconstructive surgery in Hun- trifugal ventricular assist in children under 6 kg. Eur J Cardiothorac Surg 1998;13:130-34. tington and Smithtown, was recently (Continued on Page 10)

DEPARTMENT OF SURGERY • UNIVERSITY HOSPITAL AND MEDICAL CENTER • UNIVERSITY AT STONY BROOK —9 — conjoined twins with comparative analysis of institutions dedicated to controlling Alumni News methods for abdominal wall closure and use (Continued) of the tripus limb. J Pediatr Surg cancer among children and adolescents. 1997;32:1761-6. • Horwitz JR, Chwals WJ, Doski JJ, Suescun Dr. Kelly M. James (’93), who elected president of the Suffolk EA, Cheu HW, Lally KP. Pediatric wound currently is in private practice (general County Medical Society. In addition, infections: a prospective multicenter study. Ann Surg 1998;227:553-8. surgery) in Independence, MO, re- he currently is director of the Cleft Lip • Doski JJ, Robertson FM, Cheu HW. Pediatric endocrine tumors. In: Andrassy RJ, editor. ceived his board certification in sur- and Palate Clinic at St. Charles Hospi- Pediatric Surgical Oncology. Philadelphia: gery in April. He has recently joined Saunders, 1997: 365-403. tal & Rehabilitation Center in Port the Kansas City Surgical Society. A Jefferson, and also serves as a member personal note: he and his wife are In April, at the spring meeting of of our voluntary teaching staff. awaiting the arrival of their fourth the Pediatric Oncology Group (POG) Dr. Richard W. Golub (’90), an child, due in October. held in St. Petersburg, FL, he pre- assistant professor of surgery at Dr. Mary D. Fogerty (’97) writes sented an update on the Surgeon’s SUNY-Brooklyn, this year was listed that she is now in private practice in Handbook for POG Surgical Protocols, in New York Magazine’s “Best Doctors Albuquerque, NM, doing general sur- the National Wilms Tumor Study 5 in New York,” as well as the Castle gery. And “twins Christian and and Intergroup Rhabdomyosarcoma Connolly Guide, How to Find the Best Carolyn are a year old [June] and do- Study 5. POG is a National Cancer In- Doctors—New York Metro Area (he’s in ing very well!” the 1997 edition, too). His clinical stitute-sponsored clinical trials coop- specialties are general surgery and erative group of individuals and colorectal surgery. Among his recent publications are: • Golub RW, Wise WE, Kerner BA, Khanduja KS, Aguilar PS. Endorectal mucosal advance- EW LECTRONIC ment flap: the preferred method for complex N E cryptoglandular fistula-in-ano. J Gastrointest Surg 1997;1:487-91. HYSICIAN IRECTORY • Shin CK, Golub RW, Golub R, El-Tamer M, P D Wait RB. Colorectal cancer in a young urban population [abstract]. Am J Gastroenterol 1997;92:1676. he Department has established a physician directory as part of its website Ton the Internet—please visit us at the address below for information about His two most recent presenta- our individual physicians (see sample below), as well as our programs in pa- tions are: tient care, education, research, and community service. • Golub RW. Malignant colorectal obstruction: palliation with self-expanding metal stents. Society of American Gastrointestinal http://www.uhmc.sunysb.edu/surgery Endoscopic Surgeons, Seattle, April 1998. • West MW, Golub RW. Self-expanding metal stents for palliation of malignant colorectal MD: McGill University Faculty of Medicine (1981). obstruction. New York Society of Colon and Rectal Surgeons, New York, March 1998. Residency Training: General Surgery, St. Vincent’s Hospital and Medical Center of New Forthcoming are three book York; Otolaryngology, Manhattan Eye, Ear and chapters he has co-authored on gall- Throat Hospital. bladder cancer, esophageal cancer, Fellowship Training: Otology-Neurotology, Ear and gastric cancer, to be published Research Foundation (Sarasota, FL). this November by Lippincott-Raven Board Certification: Otolaryngology. in a text titled Primary Care. Specialties: Chronic ear disease and cholesteatoma; Dr. John J. Doski (’93) currently hearing loss and tinnitus, including otosclerosis is senior pediatric surgical fellow at (stapedectomy surgery), congenital ear malforma- the Children’s Medical Center of Dal- tions, and profound deafness (cochlear implant las and University of Texas South- surgery); vertigo and balance disorders; acoustic western Medical Center, in Dallas. neuroma and skull base tumors. Since last June, he has published three Dr. Eric E. Smouha Additional: Director of Otology-Neurotology; articles and a book chapter: Fellow, American College of Surgeons (FACS); see selected recent publications. • Doski JJ, Butler TJ, Louder DS, Dickey LA, Cheu HW. Outcome of infants requiring Honors: One of the “Doctors of Excellence” featured in past and future (1999) cardiopulmonary resuscitation before editions of the Castle Connolly Guide, How to Find the Best Doctors—New York extracorporeal membrane oxygenation. J Pediatr Surg 1997;32:1318-21. Metro Area. • Doski JJ, Heiman HS, Solenberger RI, et al. Language Spoken: English. Successful separation of ischiopagus tripus Consultations/Appointments: 516-444-4121.

—10 — DEPARTMENT OF SURGERY • UNIVERSITY HOSPITAL AND MEDICAL CENTER • UNIVERSITY AT STONY BROOK Batista Operation much muscle can weaken the heart and Recent Publications (Continued from Page 3) hasten death. It perhaps has the most (Continued from Page 3) potential benefit for patients with ter- THE PROCEDURE ITSELF minal heart failure caused by a disease Ricotta JJ, O’Brien-Irr MS. Cost concerns in carotid surgery. In: Calligaro KD, DeLaurentis DA, Baker The Batista operation is an open of the heart muscle (cardiomyopathy) WH, editors. Management of Extracranial heart operation performed with the Cerebrovascular Disease. New York: Lippincott- and with a dilated left , who Raven Publishers, 1997: 3-13. aid of a heart-lung machine to main- are not adequately helped by medica- Samara GJ, Krespi YP. Endoscopic treatment of tain circulation while the heart is tion and are awaiting a heart transplant. nasopharyngeal lesions. In: Blitzer A, Pilsbury H, stopped. The essence of the procedure Jahn A, Binder W, editors. Office Based Surgery of the Head and Neck. Philadelphia: Lippincott- is to remove a wedge of left ventricle BRIDGE TO TRANSPLANTATION Raven, 1997: 349-52. muscle (weighing about 40 to as much The Batista operation is not an al- Smouha EE, Davis RP, Shapiro A, Shindo M, Sobol as 250 grams, or 1.5 to 9 ounces) and ternative to . It L. Image-guided surgery of the skull base using a novel miniature position/orientation sensor. stitch together the two edges of the certainly helps most patients for some Skull Base Surg 1998;8(Suppl 1):35. ventricle. In this manner the size of time. In a potential heart transplant Spevetz A, Afessa B, Bekes CE, Brathwaite CE, et the left ventricle is reduced, and the candidate, the Batista operation buys al. Guidelines for advanced training for physicians in critical care. American College of ventricle is remodelled as well. some time to allow a more suitable Critical Care Medicine of the Society of Critical In addition, sometimes the mi- and better matched donor heart to be Care Medicine. Crit Care Med 1997;25:1601-7. tral valve (which lies between the left found. Thus, it may serve as a useful Stefano GB, Salzet M, Hughes TK, Bilfinger TV. ventricle and left , and often Delta2 opioid receptor subtype on human bridge to transplantation. vascular endothelium uncouples morphine leaks in end-stage heart failure) may Today, the only other alternative stimulated nitric oxide release. Int J Cardiol 1998;64(Suppl 1):S43-51. need to be either repaired or removed bridges to transplantation are the use and replaced with an artificial valve. Stefano GB, Salzet M, Magazine HI, Bilfinger TV. of a ventricular assist device (VAD) Antagonism of LPS and IFN-gamma induction of In two of Dr. Krukenkamp’s patients, and another new operation called dy- iNOS in human saphenous vein endothelium by morphine and anandamide by nitric oxide was done, render- namic , in which inhibition of adenylate cyclase. J Cardiovasc ing the valves completely competent. muscle taken from the patient’s back is Pharmacol 1998;31:813-20. In patients who have heart wrapped around the heart and syn- Suh H, Peresleni T, Wadhwa N, McNurlan M, rhythm disturbances as well, an artifi- Garlick P, Goligorsky MS. Amino acid profile chronized with a special pacemaker and nitric oxide pathway in patients on cial implantable defibrillator device (cardiomyostimulator) to make it func- continuous ambulatory peritoneal dialysis: L-arginine depletion in acute peritonitis. may be implanted. If the coronary ar- tion like heart muscle. Am J Kidney Dis 1997;29:712-9. teries are diseased, they may be VAD implantation is an extremely Sumner DS, van Bemmelen PS. Hemodynamics of grafted, too (CABG operation). expensive option, and has a lot of com- the venous system: calf pump and valve function. In: Raju S, Villavicencio JL, editors. In left ventricular failure, the plications and morbidity. Dynamic Surgical Management of Venous Disease. muscle cells in the wall of the left ven- cardiomyoplasty is currently being Baltimore: Williams & Wilkins, 1997: 16-59. tricle have been stretched beyond studied in clinical trials, and its efficacy van Bemmelen PS. Functional duplex evaluation of physiologic limits. The Batista opera- chronic venous obstruction and incompetence. has not yet been established; possible In: Raju S, Villavicencio JL, editors. Surgical tion, by removing a wedge of the ven- side effects of this operation include Management of Venous Disease. Baltimore: Williams & Wilkins, 1997: 77-85. tricular wall, reduces the circumference body rejection phenomena/local tissue of the ventricle, and the size of the Vlay SC, Bilfinger TV, Levy M, Chitkara V. reaction, muscle and nerve stimulation, Alternative locations for internal defibrillator ventricle cavity. It changes the relation- infection, erosion of the cardiomyo- electrodes. Pace-Pacing Clin Electrophysiol 1998;21:1309-12. ships of pressure and stress on the wall. stimulator/leads through the skin, Consequently, the individual transvenous lead-related thrombosis, muscle fibers are restored to their nor- embolism, and cardiac tamponade. mal length, and now come within the The Batista operation may there- normal physiologic limit. They thus fore be a good option for treating different factors, the ultimate place of function more effectively in pumping end-stage heart failure. Ultimate heart the Batista procedure in the manage- blood, and in this way, heart failure is transplantation, however, still remains ment of heart failure cannot be deter- relieved. an eventuality to be faced. mined. But with the extensive use of In such a paradoxical manner, The future role of the Batista this new option for different stages removal of heart muscle tissue actu- operation is not yet known. Scientific and types of heart failure, such data ally helps the heart pump more effec- analysis of data from patients who have will soon be available. tively. The operation, as described undergone this procedure is still in a above, is a radical departure from con- very early stage. Without long-term For consultations/appointments with ventional thinking. Removal of too follow-up and extensive analyses of Dr. Krukenkamp, please call (516) 444-1095.

DEPARTMENT OF SURGERY • UNIVERSITY HOSPITAL AND MEDICAL CENTER • UNIVERSITY AT STONY BROOK —11 — STONY BROOK SURGICAL ASSOCIATES, PC

BREAST CARE OTOLARYNGOLOGY-HEAD TRAUMA/SURGICAL VASCULAR SURGERY Collin E.M. Brathwaite, MD AND NECK SURGERY (ENT) CRITICAL CARE Fabio Giron, MD, PhD John S. Brebbia, MD Arnold E. Katz, MD Collin E.M. Brathwaite, MD Kara H.V. Kvilekval, MD Martyn W. Burk, MD, PhD Denise C. Monte, MD John S. Brebbia, MD Michael J. Petersen, MD Jean M. Ferber, MD Ghassan J. Samara, MD Jean M. Ferber, MD John J. Ricotta, MD Louis T. Merriam, MD Maisie L. Shindo, MD Thomas R. Smith, MD Paul S. van Bemmelen, MD, PhD Brian J. O’Hea, MD Eric E. Smouha, MD Vimala S. Sivaraman, MD PEDIATRIC SURGERY BURN CARE Jane T. Kugaczewski, MD Collin E.M. Brathwaite, MD Cedric J. Priebe, Jr., MD John S. Brebbia, MD Harry S. Soroff, MD PLASTIC AND RECON- STRUCTIVE SURGERY CARDIOTHORACIC Steven M. Katz, MD SURGERY Steven L. Shoen, MD Thomas V. Bilfinger, MD, ScD Irvin B. Krukenkamp, MD SURGICAL ONCOLOGY For consultations/appointments with our physicians, please call Allison J. McLarty, MD Collin E.M. Brathwaite, MD • (516) 444-4550 for our specialists in breast care Frank C. Seifert, MD John S. Brebbia, MD • (516) 444-1820 for our specialists in cardiothoracic surgery Martyn W. Burk, MD, PhD • (516) 444-4545 for our specialists in general/gastrointestinal surgery GENERAL/ Jean M. Ferber, MD • (516) 444-4121 for our specialists in otolaryngology-head and neck surgery (ENT) GASTROINTESTINAL Louis T. Merriam, MD • (516) 444-4538 for our specialists in pediatric surgery SURGERY Brian J. O’Hea, MD • (516) 444-4545 for our specialists in plastic and reconstructive surgery Collin E.M. Brathwaite, MD Vimala S. Sivaraman, MD • (516) 444-4545 for our specialists in surgical oncology John S. Brebbia, MD • (516) 444-2209 for our specialists in transplantation Martyn W. Burk, MD, PhD TRANSPLANTATION • (516) 444-1045 for our specialists in trauma/surgical critical care Jean M. Ferber, MD Felix T. Rapaport, MD • (516) 444-2565 for our specialists in vascular surgery Louis T. Merriam, MD John J. Ricotta, MD • (516) 723-5000 for our specialists also at the Life Care Center in Hampton Bays: Vimala S. Sivaraman, MD Wayne C. Waltzer, MD breast care - general/gastrointestinal surgery - pediatric surgery - vascular surgery Thomas R. Smith, MD The State University of New York at Stony Brook is an equal 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

In this issue . . . ■ Introducing Our New Chief of Trauma/Surgical Critical Care ■ More New Faculty/Services ■ Laser Therapy for Vascular Disorders ■ Our New Wound Care Center ■ Performing the New Batista Operation ■ Research to Improve Heart Surgery ■ New Electronic Physician Directory ■ Rapaport’s Most Recent Honors ■ Residency Update/Alumni News ■ Division Briefs