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 HEART 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 ventriculectomy, or reduction left ventriculoplasty, a portion of heart muscle is undergoing cardiac surgery. 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) hearts. 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.