Winter 2012
/ COVER STORY /
Emily’s New Kidney: A Transplant Story From Start to Finish / F E AT U R E /
Antibiotics and the Sinus Infection
Predicting Response to Breast Cancer Treatment / Investigational Catheter Device / New PET Scan / Treating Pituitary Tumors I N T H I S IS SU E
WINTER 2012
In this issue BY THE NUMBERS
3 5
NEWS >
Our Bodies, Our Microbes
>
P redicting Response to Breast Cancer Treatment
BREAKTHROUGHS >
Zuum App
>
Investigational Catheter Device
>
New PET Scan
COVER STORY Emily’s New Kidney: A Transplant Story From Start to Finish
16 I N N O VAT E |
2 4
13 14
SIDE BY SIDE When Everything Changes: A Patient’s Story
FEATURE STORY Antibiotics and the Sinus Infection
FYI >
Treating Pituitary Tumors
>
New President of Neurosurgery Society
WINTER 2012
|
17
AT A GLANCE Against the Odds
BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
A LETTER FROM RICHARD LIEKWEG B A R N E S - J E W I S H H O S P I TA L ,
a nonprofit academic institution, is the largest hospital in Missouri and is consistently ranked among the Honor Roll of America’s best hospitals by U.S. News & World Report. The adult teaching hospital of Washington University School of Medicine, Barnes-Jewish was the first adult hospital in Missouri to be certified as a Magnet hospital for its nursing excellence.
Barnes-Jewish Hospital is a member of BJC HealthCare, one of the largest nonprofit health care organizations in the United States. The Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine is the only cancer center within a 240-mile radius of St. Louis to hold the Comprehensive Cancer Center designation from the National Cancer Institute and membership in the National Comprehensive Cancer Network. WA S H I N G TO N U N I V E R S I T Y P H YS I C I A N S
are the medical staff of Barnes-Jewish Hospital and the Siteman Cancer Center.
For more information or to make an appointment, call 314-TOP-DOCS (314-867-3627) or 866-867-3627 (toll free). Innovate is published quarterly by Barnes-Jewish Hospital.
One of the many privileges of working at Barnes-Jewish Hospital and with our physician partners at Washington University is serving our patients and fulfilling our mission: taking exceptional care of people. And one of the benefits of doing that is being able to hear stories of victory and celebration. The kidney transplant story on Page 5 is one of the hundreds of such experiences that take place here every day. We at Barnes-Jewish are grateful to be a part of Emily’s triumph over kidney failure. Our mission has prompted us to plan for the transformation of our physical campus over the next 10 years. And it is causing us to look at the ways we can improve ourselves. This more personal transformation is based on our values: integrity, compassion, accountability, respect and excellence, or ICARE. We want these qualities to define us as a hospital and as a body of individuals bound together by our shared vision to be national leaders in medicine and to provide an outstanding patient experience. Though new walls and refurbished buildings are easier to see, the goal at Barnes-Jewish is for our ICARE values to be no less visible. With sincere regards,
Editor Anne Makeever Contributing editors Mary Lee, Juli Leistner, Jackie Stack Contributing writers Caroline Arbanas, Anne Bassett, Pam McGrath, Michael Purdy, Gaia Remerowski, Julia Strait
Richard Liekweg President, Barnes-Jewish Hospital and Barnes-Jewish West County Hospital
Want to send a message to Richard Liekweg? Have questions or comments? Email innovate@bjc.org.
Address Changes: Innovate Circulation Mailstop 90-75-585 | 4901 Forest Park Ave. | Suite 1221 | St. Louis, MO 63108 Visit BarnesJewish.org/e-news to manage your Innovate subscription, sign up for e-newsletters and request additional information.
WWW.BARNESJEWISH.ORG
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W I N T E R 2012
| INNOVATE
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BY THE NUMBERS
FUNDS RAISED FOR CANCER RESEARCH AT THE ALVIN J. SITEMAN CANCER CENTER
$42,987
raised for cancer research by the St. Louis Cardinals and Papa John’s and through a jersey raffle and pizza sales during the 2012 baseball season
49,349 Pink Ribbon Bagels sold in 48 local Saint Louis Bread Co. cafes to benefit Siteman’s breast health outreach program
200
KIDNEY TRANSPLANT PROGRAM
TRANSPLANTS at Barnes-Jewish Hospital
TOTAL TRANSPLANTS
AT BARNES-JEWISH IN 2011
since the program began in 1963
Patient Survival Rate* at Barnes-Jewish:
98.82%
Patient Survival Rate* Nationally:
96.87% OR
*One year after surgery
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BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
54% OF TOTAL
MISSOURI TRANSPLANTS
Image courtesy of U.S. Department of Agriculture
News Our Bodies, Our Microbes
provided the most comprehensive census to date of the microbial makeup of healthy humans.
Trillions of single-cell organisms known as microbes inhabit the human body, occupying virtually every nook and cranny. And most of the time, this relationship is a friendly one, with microbes helping to digest food, strengthen the immune system and ward off dangerous pathogens.
“You can think of our ecosystems like you do rain forests and oceans— very different environments with communities of organisms that possess incredible, rich diversity,” says Weinstock, who also is a Washington University professor of genetics and microbiology. In fact, the human genome includes some 22,000 genes, a mere fraction of the eight million genes that make up the human microbiome.
Scientists want to know why some pathogens can suddenly turn deadly, an endeavor that will refine current thinking on how microorganisms cause disease. “It’s not possible to understand human health and disease without exploring the massive community of microorganisms we carry around,” says George Weinstock, PhD, associate
The bacterium Enterococcus faecalis, which lives in the human gut, is just one type of microbe studied as part of the Human Microbiome Project.
director of The Genome Institute at Washington University and one of the principal investigators in the Human Microbiome Project research study. Now complete, with results reported in the journal Nature, the study has
“The future of microbiome research is exciting,” Weinstock says. “Research in this area will open doors in many other areas of medicine to improve our understanding of good health and the treatment and prevention of disease.” – C. ARBANAS
Predicting Response to Breast Cancer Treatment
Image courtesy of The Genome Institute, Washington University
Decoding the DNA of patients with advanced breast cancer has allowed scientists to identify distinct cancer signatures that could help predict which women are most likely to benefit from estrogen-lowering
therapy while sparing others from unnecessary treatment.
patients who have breast cancer,” says lead author Matthew Ellis, MD, PhD, a Washington University oncologist who treats patients at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine.
“This is one of the first cancer genomics studies to move beyond cataloging mutations involved in cancer to finding those that link to treatment response,” says senior author Elaine Mardis, PhD, codirector of The Genome Institute at Washington University.
had tumors that were genomically more unstable,
Ellis and Mardis will soon begin a new trial that will base treatment decisions on the genomic signatures of each patient’s breast cancer tumor. Women likely to benefit from estrogen-lowering therapy will receive it, but those unlikely to respond will be treated with surgery followed by chemotherapy and drugs that target specific mutations in their tumors.
with higher rates of mutations and other changes.
– C. ARBANAS
“As a medical oncologist, I’m looking for clues for how to best treat my A Circos plot shows tumor DNA from a breast-cancer patient who didn’t respond to estrogen-lowering drugs, which are often prescribed to shrink large tumors before surgery. Women who didn’t respond
WWW.BARNESJEWISH.ORG
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atest The L ical d in Me s and urce Reso nology Tech
BREAKTHROUGHS NEW PET SCAN
H E A LT H Y L I V I N G
H I G H B LO O D P R E S S U R E
ALZHEIMER’S DISEASE
Washington University prevention experts at
In people with uncontrollable high blood
Washington University physicians at Barnes-
the Siteman Cancer Center have developed a
pressure, the nerves in the kidney’s arteries
Jewish Hospital are the first in Missouri
free iPad app that calculates disease risk and
often fire at abnormally high rates. To treat
to offer a new type of positron emission
offers a customized plan for living a healthier
this condition, doctors are inserting a new
tomography (PET) scanning for patients
life. Called Zuum, the app quickly estimates a
catheterization device into the kidney’s
with memory disorders and other forms of
person’s risk of heart disease, diabetes, stroke
arteries, where they apply radiofrequency
cognitive impairment. This new imaging test
and different cancers, including lung, colon,
energy to interrupt signals from overactive
is now available because the U.S. Food and
breast and prostate. Zuum then provides
nerves. Because the rate at which the nerves
Drug Administration (FDA) recently approved
tailor-made tips to help prevent these illnesses
fire has been changed, the kidneys may
the clinical use of the necessary radioactive
and boost overall health. For example, the app
be less active in secreting chemicals
diagnostic agent. This agent causes neuritic
shows users how diet, TV-viewing habits and
that lead to blood pressure elevation.
plaques, a hallmark of Alzheimer’s disease,
other factors could affect future health.
to light up during a PET scan. For information about who may qualify to
Zuum is available on iTunes at itunes.apple.com/us/app; search for it by name.
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participate in the study, call 314-362-1962 or email mpalazzo@dom.wustl.edu.
BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
courtesy of Mallinckrodt Institute of Radiology
INVESTIGATIONAL CATHETER DEVICE
Left and center images © istock.com. Right image
ZUUM APP
From left to right, images courtesy of Washington University School of Medicine, Medtronic and Mallinckrodt Institute of Radiology
at Barnes-Jewish Hospital and Washington University School of Medicine
THE LIVING-DONOR KIDNEY TRANSPLANT PROGRAM
EMILY’S NEW KIDNEY:
A Transplant Story From Start to Finish
to organ rejection. In addition to cleansing blood by the removal of waste, kidneys also produce erythropoietin, a hormone that stimulates production of red blood cells in the bone marrow. When kidneys fail, transfusions are used to stimulate blood marrow production. “Every transfusion exposes the patient to an antigen that can produce the antibodies that trigger organ rejection. The longer a patient in kidney failure is on the wait list for a kidney, the more sensitized that patient becomes and the greater the risk of organ rejection once a kidney is transplanted,” says Shenoy.
THE LIVING-DONOR
KIDNEY TRANSPLANT PROGRAM and director of the living-donor transplant program, says, Emily received her new kidney from a living donor “In general, patients who receive a kidney from a living through a paired-kidney exchange. This novel approach donor have a better chance of the kidney lasting up to 20 allows patients with kidney failure who have a suitable, years. A kidney from a deceased donor may last 10 to 12 but mismatched potential kidney donor to exchange years.” Patients who receive a kidney from a living donor donors. Each donor gives a kidney to a different recipient usually spend less time in the hospital after the surgery than he or she originally intended, and each recipient is and experience fewer complications. able to receive a living-donor kidney, rather than remain on the waiting list. The availability of a living-donor DONOR RECIPIENT kidney also can ensure a patient A patient in need of a kidney transMISMATCH A A doesn’t remain on the waiting list for plant reaps a number of benefits when an extended period of time. The longer the donated kidney comes from a living the wait-list time, the more diminished MATCH donor rather than a deceased donor. a patient’s quality of life becomes. Surendra Shenoy, MD, PhD, a MISMATCH Wait-list time, which may last as Washington University transplant B B long as five years, can contribute surgeon at Barnes-Jewish Hospital
WWW.BARNESJEWISH.ORG
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W I N T E R 2012
| INNOVATE
“ In general, patients who receive a kidney from a living donor have a better chance of the kidney lasting up to 20 years. A kidney from a deceased donor may last 10 to 12 years.”
New techniques used to remove a kidney from a living donor have reduced postoperative pain and recovery time.
Surendra Shenoy, MD, PhD
EMILY’S NEW KIDNEY: A Transplant Story From Start to Finish
I
RE I TNT E H OTO GA RA DALLLL H HY YM A N W R IW TT BN Y BAYN A NN E NMEAMKAEKEEVEEVRE R > > P HPOTO GR PP HH E EDDBBYYRRAANNDA
To learn more about the living-donor kidney transplant program at Barnes-Jewish Hospital, visit barnesjewish.org/kidneydonor or call 314-TOP-DOCS (314-867-3627) or 866-867-3627 (toll free).
BACKGROUND
When Emily arrived at Barnes-Jewish Hospital on the morning of June 14 for her kidney
transplant, she was in end-stage renal failure. The kidney that had been doing important work—
n the weeks and months leading up to her
Emily arrives at Barnes-Jewish Hospital with her
transplant, Emily is rigorously evaluated by the
parents, in-laws, two girlfriends (who keep Emily’s
kidney transplant team. Transplant candidates are
many well-wishers updated via Facebook and Twitter
assessed for physical, anatomic and psychosocial
throughout the day) and her husband. Her new kidney,
fitness. They undergo a series of blood and
from a living donor, is on an airplane, flying in from
radiology tests. They also meet with dietitians,
New York.
social workers and finance specialists who are experts
removing excess water and waste from her blood, transforming poisonous waste products into
in helping patients access available resources. The goal
urine and returning cleansed blood for use throughout her body—was no longer functioning. A
in all this is to ensure a patient has the medical support
dialysis machine performed this role for her before she and a team of specialists determined a
and the demanding postoperative regimen.
and determination to withstand both transplant surgery
kidney transplant would restore a better quality of health and life.
11
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BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
WWW.BARNESJEWISH.ORG
Surendra Shenoy, MD, PhD, a Washington University transplant surgeon at Barnes-Jewish Hospital and director of the living-donor transplant program, is Emily’s surgeon.
The following is a timeline of Emily’s surgery.
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BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
THE LIVING-DONOR KIDNEY TRANSPLANT PROGRAM
EMILY’S NEW KIDNEY:
A Transplant Story From Start to Finish
to organ rejection. In addition to cleansing blood by the removal of waste, kidneys also produce erythropoietin, a hormone that stimulates production of red blood cells in the bone marrow. When kidneys fail, transfusions are used to stimulate blood marrow production. “Every transfusion exposes the patient to an antigen that can produce the antibodies that trigger organ rejection. The longer a patient in kidney failure is on the wait list for a kidney, the more sensitized that patient becomes and the greater the risk of organ rejection once a kidney is transplanted,” says Shenoy.
THE LIVING-DONOR
KIDNEY TRANSPLANT PROGRAM and director of the living-donor transplant program, says, Emily received her new kidney from a living donor “In general, patients who receive a kidney from a living through a paired-kidney exchange. This novel approach donor have a better chance of the kidney lasting up to 20 allows patients with kidney failure who have a suitable, years. A kidney from a deceased donor may last 10 to 12 but mismatched potential kidney donor to exchange years.” Patients who receive a kidney from a living donor donors. Each donor gives a kidney to a different recipient usually spend less time in the hospital after the surgery than he or she originally intended, and each recipient is and experience fewer complications. able to receive a living-donor kidney, rather than remain on the waiting list. The availability of a living-donor DONOR RECIPIENT kidney also can ensure a patient A patient in need of a kidney transMISMATCH A A doesn’t remain on the waiting list for plant reaps a number of benefits when an extended period of time. The longer the donated kidney comes from a living the wait-list time, the more diminished MATCH donor rather than a deceased donor. a patient’s quality of life becomes. Surendra Shenoy, MD, PhD, a MISMATCH Wait-list time, which may last as Washington University transplant B B long as five years, can contribute surgeon at Barnes-Jewish Hospital
WWW.BARNESJEWISH.ORG
|
W I N T E R 2012
| INNOVATE
“ In general, patients who receive a kidney from a living donor have a better chance of the kidney lasting up to 20 years. A kidney from a deceased donor may last 10 to 12 years.”
New techniques used to remove a kidney from a living donor have reduced postoperative pain and recovery time.
Surendra Shenoy, MD, PhD
EMILY’S NEW KIDNEY: A Transplant Story From Start to Finish
I
RE I TNT E H OTO GA RA DALLLL H HY YM A N W R IW TT BN Y BAYN A NN E NMEAMKAEKEEVEEVRE R > > P HPOTO GR PP HH E EDDBBYYRRAANNDA
To learn more about the living-donor kidney transplant program at Barnes-Jewish Hospital, visit barnesjewish.org/kidneydonor or call 314-TOP-DOCS (314-867-3627) or 866-867-3627 (toll free).
BACKGROUND
When Emily arrived at Barnes-Jewish Hospital on the morning of June 14 for her kidney
transplant, she was in end-stage renal failure. The kidney that had been doing important work—
n the weeks and months leading up to her
Emily arrives at Barnes-Jewish Hospital with her
transplant, Emily is rigorously evaluated by the
parents, in-laws, two girlfriends (who keep Emily’s
kidney transplant team. Transplant candidates are
many well-wishers updated via Facebook and Twitter
assessed for physical, anatomic and psychosocial
throughout the day) and her husband. Her new kidney,
fitness. They undergo a series of blood and
from a living donor, is on an airplane, flying in from
radiology tests. They also meet with dietitians,
New York.
social workers and finance specialists who are experts
removing excess water and waste from her blood, transforming poisonous waste products into
in helping patients access available resources. The goal
urine and returning cleansed blood for use throughout her body—was no longer functioning. A
in all this is to ensure a patient has the medical support
dialysis machine performed this role for her before she and a team of specialists determined a
and the demanding postoperative regimen.
and determination to withstand both transplant surgery
kidney transplant would restore a better quality of health and life.
11
12
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BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
WWW.BARNESJEWISH.ORG
Surendra Shenoy, MD, PhD, a Washington University transplant surgeon at Barnes-Jewish Hospital and director of the living-donor transplant program, is Emily’s surgeon.
The following is a timeline of Emily’s surgery.
|
W I N T E R 2012
| INNOVATE
5
6
I N N OVAT E |
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BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
EMILY’S NEW KIDNEY: A Transplant Story From Start to Finish
The Transplant Surgery 19:07:35 19:54:38 Now placed within the abdominal
15:11:47
15:07:38
The donor kidney is removed from its packing materials to an area within the
called benching the kidney. It is this process
kidney arrives in the operating
that ensures the kidney remains healthy
room and unpacking begins. Prior
and viable up to the moment it is sutured in
to the kidney’s arrival, the surgeon
place in the recipient.
The kidney is removed from the preservative
When first placed in the body,
orientation.
arteries are connected and blood
cavity, checking several times for optimal
“In this case, the kidney has two arteries, one
becomes a more vivid color.
placement. Once the best orientation
of which is situated in an unusual position.”
15:35:27
nurses and anesthesiologists who keep
any anomalies that could affect
17:11:56
once it’s removed from the body, it is
implantation to the anatomy of the donor
her and her family informed.
transplantation and other relevant
kept cool in a slush of ice to preserve
organ and the recipient,” says Shenoy.
With the kidney in place, Shenoy and his
infection or high blood pressure, they are left in place. The new kidney will be located in a space created for it within the abdominal cavity.
BARNESApproximately 40 percent of JEWISH
kidney transplants 53at Barnes27.7 MONTHS
MONTHS
Jewish come from living donors.
- 80% viable for 2450to 48 hours.
53 27.7 At Barnes-Jewish, MONTHS MONTHS
10 - 15%
“A kidney from a live donor is more likely to endure this preservation
availability is greater, and living-donor
process than one from a deceased
kidneys may last almost twice as long.
donor,” says Shenoy.
50 - 80%
BARNESJEWISH
U.S. BARNESJEWISH 27.7 MONTHS
median time to
transplant is 27.7 53 MONTHS
of the work of two functioning kidneys, while
50 - 80%
months vs. 53
dialysis can only perform 10 to 15 percent of
10 - 15%
months nationally.
53 MONTHS
are no kinks or twists in the connections
A transplanted kidney can do 50 to 80 percent
that same work.
200+
50 - 80% medications to suppress her immune 53 MONTHS
10 - 15%
200+
Since the kidney-
and friends.
10 - 15%
18:22:00
system. After recovery, Emily is enjoying life with her husband, family
50 - 80%
“The kidney must be situated so that there that may impact its function.”
10 - 15%
27.7 MONTHS
U.S.
27.7 MONTHS
BARNESJEWISH
against organ rejection, Emily takes
BARNESJEWISH
U.S.
In this manner, a kidney can be kept
of the new kidney. To ensure
U.S.
and the ureter to the patient’s bladder.
alive despite the lack of blood flow.
With a living-donor transplant organ,
monitor the function and efficiency
and arteries to the patient’s blood vessels
preservatives designed to keep cells U.S.
Blood is drawn at specified times to
team begin to connect the organ’s veins
with injections of a cold solution of
prepared to receive the donated kidney. Unless the failed kidneys are causing
abdominal cavity is further prepared.
the exterior. The interior is maintained
operating room, her abdominal cavity is
Emily is a patient at Barnes-Jewish
urine output is closely monitored.
“A transplant surgeon must tailor the
of this kind are not unusual.
connected to a functioning kidney,
This happens over a period of time.
five to 10 minutes without blood flow
anesthesiology team.
After Surgery
is returned to its bath of slush, and the
Because a kidney can survive for just
Upon the patient’s arrival in the
process called atrophy. Once
produce urine, it may shrink, a
surgery. Once home, her new kidney’s
Shenoy the condition of the kidney,
arteries instead of one. Differences
transplant is complete.
until it is able to function normally.
preoperative room. She meets with
wheeled to the operating room by the
sutures are made, and the kidney
up to one-half liter of urine at a
for six days following her transplant
the living donor discussed with
kidney Emily receives has two
information is confirmed, the last
can hold 300 to 400 milliliters—
the bladder will begin to stretch
nears the airport, Emily is assigned a
Finally, sedation is started and Emily is
is functioning properly. When that
kidney makes urine, the bladder
for placement is determined, the kidney
who removed the kidney from
15:11:45
for evidence that Emily’s new kidney
begins to work. When a healthy
to a failed kidney that does not
begins to flow into the kidney, it
Once the plane carrying the donor kidney
information. For instance, the donor
Shenoy and the surgical team look
arteries connected, the kidney
time. If a bladder is connected
the kidney is pale pink. Once the
the kidney in the prepared abdominal
transplantation. The preparation process is
way across the country, the donor
17:45:37
and placed in the abdominal cavity in proper
Shenoy and his surgical team arrange
operating room where it will be prepared for
Tracked by GPS as it makes its
14:09:51
15:45:27
16:37:10
cavity with the ureter, veins and
“Once the new kidney begins to The transplant team 200+
at Barnes-Jewish
transplant program began in 1963,
“It’s a delicate job to join a tube that is 3
3,000 kidney transplant surgeries
to 4 millimeters in diameter to another
200 kidney transplant surgeries
have been performed at Barnes-
of similar size. The sutures are made
annually, which is more than half of
Jewish Hospital.
with thread as thin as a hair.”
all kidney transplants in Missouri.
averages more than
function normally, the patient can return to a normal life, free of dialysis,” says Shenoy.
Learn more about kidney transplant by visiting barnesjewish.org/kidneytransplant.
200+
200+
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WWW.BARNESJEWISH.ORG
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BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
WWW.BARNESJEWISH.ORG
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| INNOVATE
10
EMILY’S NEW KIDNEY: A Transplant Story From Start to Finish
The Transplant Surgery 19:07:35 19:54:38 Now placed within the abdominal
15:11:47
15:07:38
The donor kidney is removed from its packing materials to an area within the
called benching the kidney. It is this process
kidney arrives in the operating
that ensures the kidney remains healthy
room and unpacking begins. Prior
and viable up to the moment it is sutured in
to the kidney’s arrival, the surgeon
place in the recipient.
The kidney is removed from the preservative
When first placed in the body,
orientation.
arteries are connected and blood
cavity, checking several times for optimal
“In this case, the kidney has two arteries, one
becomes a more vivid color.
placement. Once the best orientation
of which is situated in an unusual position.”
15:35:27
nurses and anesthesiologists who keep
any anomalies that could affect
17:11:56
once it’s removed from the body, it is
implantation to the anatomy of the donor
her and her family informed.
transplantation and other relevant
kept cool in a slush of ice to preserve
organ and the recipient,” says Shenoy.
With the kidney in place, Shenoy and his
infection or high blood pressure, they are left in place. The new kidney will be located in a space created for it within the abdominal cavity.
BARNESApproximately 40 percent of JEWISH
kidney transplants 53at Barnes27.7 MONTHS
MONTHS
Jewish come from living donors.
- 80% viable for 2450to 48 hours.
53 27.7 At Barnes-Jewish, MONTHS MONTHS
10 - 15%
“A kidney from a live donor is more likely to endure this preservation
availability is greater, and living-donor
process than one from a deceased
kidneys may last almost twice as long.
donor,” says Shenoy.
50 - 80%
BARNESJEWISH
U.S. BARNESJEWISH 27.7 MONTHS
median time to
transplant is 27.7 53 MONTHS
of the work of two functioning kidneys, while
50 - 80%
months vs. 53
dialysis can only perform 10 to 15 percent of
10 - 15%
months nationally.
53 MONTHS
are no kinks or twists in the connections
A transplanted kidney can do 50 to 80 percent
that same work.
200+
50 - 80% medications to suppress her immune 53 MONTHS
10 - 15%
200+
Since the kidney-
and friends.
10 - 15%
18:22:00
system. After recovery, Emily is enjoying life with her husband, family
50 - 80%
“The kidney must be situated so that there that may impact its function.”
10 - 15%
27.7 MONTHS
U.S.
27.7 MONTHS
BARNESJEWISH
against organ rejection, Emily takes
BARNESJEWISH
U.S.
In this manner, a kidney can be kept
of the new kidney. To ensure
U.S.
and the ureter to the patient’s bladder.
alive despite the lack of blood flow.
With a living-donor transplant organ,
monitor the function and efficiency
and arteries to the patient’s blood vessels
preservatives designed to keep cells U.S.
Blood is drawn at specified times to
team begin to connect the organ’s veins
with injections of a cold solution of
prepared to receive the donated kidney. Unless the failed kidneys are causing
abdominal cavity is further prepared.
the exterior. The interior is maintained
operating room, her abdominal cavity is
Emily is a patient at Barnes-Jewish
urine output is closely monitored.
“A transplant surgeon must tailor the
of this kind are not unusual.
connected to a functioning kidney,
This happens over a period of time.
five to 10 minutes without blood flow
anesthesiology team.
After Surgery
is returned to its bath of slush, and the
Because a kidney can survive for just
Upon the patient’s arrival in the
process called atrophy. Once
produce urine, it may shrink, a
surgery. Once home, her new kidney’s
Shenoy the condition of the kidney,
arteries instead of one. Differences
transplant is complete.
until it is able to function normally.
preoperative room. She meets with
wheeled to the operating room by the
sutures are made, and the kidney
up to one-half liter of urine at a
for six days following her transplant
the living donor discussed with
kidney Emily receives has two
information is confirmed, the last
can hold 300 to 400 milliliters—
the bladder will begin to stretch
nears the airport, Emily is assigned a
Finally, sedation is started and Emily is
is functioning properly. When that
kidney makes urine, the bladder
for placement is determined, the kidney
who removed the kidney from
15:11:45
for evidence that Emily’s new kidney
begins to work. When a healthy
to a failed kidney that does not
begins to flow into the kidney, it
Once the plane carrying the donor kidney
information. For instance, the donor
Shenoy and the surgical team look
arteries connected, the kidney
time. If a bladder is connected
the kidney is pale pink. Once the
the kidney in the prepared abdominal
transplantation. The preparation process is
way across the country, the donor
17:45:37
and placed in the abdominal cavity in proper
Shenoy and his surgical team arrange
operating room where it will be prepared for
Tracked by GPS as it makes its
14:09:51
15:45:27
16:37:10
cavity with the ureter, veins and
“Once the new kidney begins to The transplant team 200+
at Barnes-Jewish
transplant program began in 1963,
“It’s a delicate job to join a tube that is 3
3,000 kidney transplant surgeries
to 4 millimeters in diameter to another
200 kidney transplant surgeries
have been performed at Barnes-
of similar size. The sutures are made
annually, which is more than half of
Jewish Hospital.
with thread as thin as a hair.”
all kidney transplants in Missouri.
averages more than
function normally, the patient can return to a normal life, free of dialysis,” says Shenoy.
Learn more about kidney transplant by visiting barnesjewish.org/kidneytransplant.
200+
200+
7
I N N OVAT E |
WINTER 2012
|
BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
WWW.BARNESJEWISH.ORG
|
W I N T E R 2012
| INNOVATE
8
9
I N N OVAT E |
WINTER 2012
|
BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
WWW.BARNESJEWISH.ORG
|
W I N T E R 2012
| INNOVATE
10
EMILY’S NEW KIDNEY: A Transplant Story From Start to Finish
The Transplant Surgery 19:07:35 19:54:38 Now placed within the abdominal
15:11:47
15:07:38
The donor kidney is removed from its packing materials to an area within the
called benching the kidney. It is this process
kidney arrives in the operating
that ensures the kidney remains healthy
room and unpacking begins. Prior
and viable up to the moment it is sutured in
to the kidney’s arrival, the surgeon
place in the recipient.
The kidney is removed from the preservative
When first placed in the body,
orientation.
arteries are connected and blood
cavity, checking several times for optimal
“In this case, the kidney has two arteries, one
becomes a more vivid color.
placement. Once the best orientation
of which is situated in an unusual position.”
15:35:27
nurses and anesthesiologists who keep
any anomalies that could affect
17:11:56
once it’s removed from the body, it is
implantation to the anatomy of the donor
her and her family informed.
transplantation and other relevant
kept cool in a slush of ice to preserve
organ and the recipient,” says Shenoy.
With the kidney in place, Shenoy and his
infection or high blood pressure, they are left in place. The new kidney will be located in a space created for it within the abdominal cavity.
BARNESApproximately 40 percent of JEWISH
kidney transplants 53at Barnes27.7 MONTHS
MONTHS
Jewish come from living donors.
- 80% viable for 2450to 48 hours.
53 27.7 At Barnes-Jewish, MONTHS MONTHS
10 - 15%
“A kidney from a live donor is more likely to endure this preservation
availability is greater, and living-donor
process than one from a deceased
kidneys may last almost twice as long.
donor,” says Shenoy.
50 - 80%
BARNESJEWISH
U.S. BARNESJEWISH 27.7 MONTHS
median time to
transplant is 27.7 53 MONTHS
of the work of two functioning kidneys, while
50 - 80%
months vs. 53
dialysis can only perform 10 to 15 percent of
10 - 15%
months nationally.
53 MONTHS
are no kinks or twists in the connections
A transplanted kidney can do 50 to 80 percent
that same work.
200+
50 - 80% medications to suppress her immune 53 MONTHS
10 - 15%
200+
Since the kidney-
and friends.
10 - 15%
18:22:00
system. After recovery, Emily is enjoying life with her husband, family
50 - 80%
“The kidney must be situated so that there that may impact its function.”
10 - 15%
27.7 MONTHS
U.S.
27.7 MONTHS
BARNESJEWISH
against organ rejection, Emily takes
BARNESJEWISH
U.S.
In this manner, a kidney can be kept
of the new kidney. To ensure
U.S.
and the ureter to the patient’s bladder.
alive despite the lack of blood flow.
With a living-donor transplant organ,
monitor the function and efficiency
and arteries to the patient’s blood vessels
preservatives designed to keep cells U.S.
Blood is drawn at specified times to
team begin to connect the organ’s veins
with injections of a cold solution of
prepared to receive the donated kidney. Unless the failed kidneys are causing
abdominal cavity is further prepared.
the exterior. The interior is maintained
operating room, her abdominal cavity is
Emily is a patient at Barnes-Jewish
urine output is closely monitored.
“A transplant surgeon must tailor the
of this kind are not unusual.
connected to a functioning kidney,
This happens over a period of time.
five to 10 minutes without blood flow
anesthesiology team.
After Surgery
is returned to its bath of slush, and the
Because a kidney can survive for just
Upon the patient’s arrival in the
process called atrophy. Once
produce urine, it may shrink, a
surgery. Once home, her new kidney’s
Shenoy the condition of the kidney,
arteries instead of one. Differences
transplant is complete.
until it is able to function normally.
preoperative room. She meets with
wheeled to the operating room by the
sutures are made, and the kidney
up to one-half liter of urine at a
for six days following her transplant
the living donor discussed with
kidney Emily receives has two
information is confirmed, the last
can hold 300 to 400 milliliters—
the bladder will begin to stretch
nears the airport, Emily is assigned a
Finally, sedation is started and Emily is
is functioning properly. When that
kidney makes urine, the bladder
for placement is determined, the kidney
who removed the kidney from
15:11:45
for evidence that Emily’s new kidney
begins to work. When a healthy
to a failed kidney that does not
begins to flow into the kidney, it
Once the plane carrying the donor kidney
information. For instance, the donor
Shenoy and the surgical team look
arteries connected, the kidney
time. If a bladder is connected
the kidney is pale pink. Once the
the kidney in the prepared abdominal
transplantation. The preparation process is
way across the country, the donor
17:45:37
and placed in the abdominal cavity in proper
Shenoy and his surgical team arrange
operating room where it will be prepared for
Tracked by GPS as it makes its
14:09:51
15:45:27
16:37:10
cavity with the ureter, veins and
“Once the new kidney begins to The transplant team 200+
at Barnes-Jewish
transplant program began in 1963,
“It’s a delicate job to join a tube that is 3
3,000 kidney transplant surgeries
to 4 millimeters in diameter to another
200 kidney transplant surgeries
have been performed at Barnes-
of similar size. The sutures are made
annually, which is more than half of
Jewish Hospital.
with thread as thin as a hair.”
all kidney transplants in Missouri.
averages more than
function normally, the patient can return to a normal life, free of dialysis,” says Shenoy.
Learn more about kidney transplant by visiting barnesjewish.org/kidneytransplant.
200+
200+
7
I N N OVAT E |
WINTER 2012
|
BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
WWW.BARNESJEWISH.ORG
|
W I N T E R 2012
| INNOVATE
8
9
I N N OVAT E |
WINTER 2012
|
BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
WWW.BARNESJEWISH.ORG
|
W I N T E R 2012
| INNOVATE
10
EMILY’S NEW KIDNEY: A Transplant Story From Start to Finish
The Transplant Surgery 19:07:35 19:54:38 Now placed within the abdominal
15:11:47
15:07:38
The donor kidney is removed from its packing materials to an area within the
called benching the kidney. It is this process
kidney arrives in the operating
that ensures the kidney remains healthy
room and unpacking begins. Prior
and viable up to the moment it is sutured in
to the kidney’s arrival, the surgeon
place in the recipient.
The kidney is removed from the preservative
When first placed in the body,
orientation.
arteries are connected and blood
cavity, checking several times for optimal
“In this case, the kidney has two arteries, one
becomes a more vivid color.
placement. Once the best orientation
of which is situated in an unusual position.”
15:35:27
nurses and anesthesiologists who keep
any anomalies that could affect
17:11:56
once it’s removed from the body, it is
implantation to the anatomy of the donor
her and her family informed.
transplantation and other relevant
kept cool in a slush of ice to preserve
organ and the recipient,” says Shenoy.
With the kidney in place, Shenoy and his
infection or high blood pressure, they are left in place. The new kidney will be located in a space created for it within the abdominal cavity.
BARNESApproximately 40 percent of JEWISH
kidney transplants 53at Barnes27.7 MONTHS
MONTHS
Jewish come from living donors.
- 80% viable for 2450to 48 hours.
53 27.7 At Barnes-Jewish, MONTHS MONTHS
10 - 15%
“A kidney from a live donor is more likely to endure this preservation
availability is greater, and living-donor
process than one from a deceased
kidneys may last almost twice as long.
donor,” says Shenoy.
50 - 80%
BARNESJEWISH
U.S. BARNESJEWISH 27.7 MONTHS
median time to
transplant is 27.7 53 MONTHS
of the work of two functioning kidneys, while
50 - 80%
months vs. 53
dialysis can only perform 10 to 15 percent of
10 - 15%
months nationally.
53 MONTHS
are no kinks or twists in the connections
A transplanted kidney can do 50 to 80 percent
that same work.
200+
50 - 80% medications to suppress her immune 53 MONTHS
10 - 15%
200+
Since the kidney-
and friends.
10 - 15%
18:22:00
system. After recovery, Emily is enjoying life with her husband, family
50 - 80%
“The kidney must be situated so that there that may impact its function.”
10 - 15%
27.7 MONTHS
U.S.
27.7 MONTHS
BARNESJEWISH
against organ rejection, Emily takes
BARNESJEWISH
U.S.
In this manner, a kidney can be kept
of the new kidney. To ensure
U.S.
and the ureter to the patient’s bladder.
alive despite the lack of blood flow.
With a living-donor transplant organ,
monitor the function and efficiency
and arteries to the patient’s blood vessels
preservatives designed to keep cells U.S.
Blood is drawn at specified times to
team begin to connect the organ’s veins
with injections of a cold solution of
prepared to receive the donated kidney. Unless the failed kidneys are causing
abdominal cavity is further prepared.
the exterior. The interior is maintained
operating room, her abdominal cavity is
Emily is a patient at Barnes-Jewish
urine output is closely monitored.
“A transplant surgeon must tailor the
of this kind are not unusual.
connected to a functioning kidney,
This happens over a period of time.
five to 10 minutes without blood flow
anesthesiology team.
After Surgery
is returned to its bath of slush, and the
Because a kidney can survive for just
Upon the patient’s arrival in the
process called atrophy. Once
produce urine, it may shrink, a
surgery. Once home, her new kidney’s
Shenoy the condition of the kidney,
arteries instead of one. Differences
transplant is complete.
until it is able to function normally.
preoperative room. She meets with
wheeled to the operating room by the
sutures are made, and the kidney
up to one-half liter of urine at a
for six days following her transplant
the living donor discussed with
kidney Emily receives has two
information is confirmed, the last
can hold 300 to 400 milliliters—
the bladder will begin to stretch
nears the airport, Emily is assigned a
Finally, sedation is started and Emily is
is functioning properly. When that
kidney makes urine, the bladder
for placement is determined, the kidney
who removed the kidney from
15:11:45
for evidence that Emily’s new kidney
begins to work. When a healthy
to a failed kidney that does not
begins to flow into the kidney, it
Once the plane carrying the donor kidney
information. For instance, the donor
Shenoy and the surgical team look
arteries connected, the kidney
time. If a bladder is connected
the kidney is pale pink. Once the
the kidney in the prepared abdominal
transplantation. The preparation process is
way across the country, the donor
17:45:37
and placed in the abdominal cavity in proper
Shenoy and his surgical team arrange
operating room where it will be prepared for
Tracked by GPS as it makes its
14:09:51
15:45:27
16:37:10
cavity with the ureter, veins and
“Once the new kidney begins to The transplant team 200+
at Barnes-Jewish
transplant program began in 1963,
“It’s a delicate job to join a tube that is 3
3,000 kidney transplant surgeries
to 4 millimeters in diameter to another
200 kidney transplant surgeries
have been performed at Barnes-
of similar size. The sutures are made
annually, which is more than half of
Jewish Hospital.
with thread as thin as a hair.”
all kidney transplants in Missouri.
averages more than
function normally, the patient can return to a normal life, free of dialysis,” says Shenoy.
Learn more about kidney transplant by visiting barnesjewish.org/kidneytransplant.
200+
200+
7
I N N OVAT E |
WINTER 2012
|
BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
WWW.BARNESJEWISH.ORG
|
W I N T E R 2012
| INNOVATE
8
9
I N N OVAT E |
WINTER 2012
|
BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
WWW.BARNESJEWISH.ORG
|
W I N T E R 2012
| INNOVATE
10
THE LIVING-DONOR KIDNEY TRANSPLANT PROGRAM
EMILY’S NEW KIDNEY:
A Transplant Story From Start to Finish
to organ rejection. In addition to cleansing blood by the removal of waste, kidneys also produce erythropoietin, a hormone that stimulates production of red blood cells in the bone marrow. When kidneys fail, transfusions are used to stimulate blood marrow production. “Every transfusion exposes the patient to an antigen that can produce the antibodies that trigger organ rejection. The longer a patient in kidney failure is on the wait list for a kidney, the more sensitized that patient becomes and the greater the risk of organ rejection once a kidney is transplanted,” says Shenoy.
THE LIVING-DONOR
KIDNEY TRANSPLANT PROGRAM and director of the living-donor transplant program, says, Emily received her new kidney from a living donor “In general, patients who receive a kidney from a living through a paired-kidney exchange. This novel approach donor have a better chance of the kidney lasting up to 20 allows patients with kidney failure who have a suitable, years. A kidney from a deceased donor may last 10 to 12 but mismatched potential kidney donor to exchange years.” Patients who receive a kidney from a living donor donors. Each donor gives a kidney to a different recipient usually spend less time in the hospital after the surgery than he or she originally intended, and each recipient is and experience fewer complications. able to receive a living-donor kidney, rather than remain on the waiting list. The availability of a living-donor DONOR RECIPIENT kidney also can ensure a patient A patient in need of a kidney transMISMATCH A A doesn’t remain on the waiting list for plant reaps a number of benefits when an extended period of time. The longer the donated kidney comes from a living the wait-list time, the more diminished MATCH donor rather than a deceased donor. a patient’s quality of life becomes. Surendra Shenoy, MD, PhD, a MISMATCH Wait-list time, which may last as Washington University transplant B B long as five years, can contribute surgeon at Barnes-Jewish Hospital
WWW.BARNESJEWISH.ORG
|
W I N T E R 2012
| INNOVATE
“ In general, patients who receive a kidney from a living donor have a better chance of the kidney lasting up to 20 years. A kidney from a deceased donor may last 10 to 12 years.”
New techniques used to remove a kidney from a living donor have reduced postoperative pain and recovery time.
Surendra Shenoy, MD, PhD
EMILY’S NEW KIDNEY: A Transplant Story From Start to Finish
I
RE I TNT E H OTO GA RA DALLLL H HY YM A N W R IW TT BN Y BAYN A NN E NMEAMKAEKEEVEEVRE R > > P HPOTO GR PP HH E EDDBBYYRRAANNDA
To learn more about the living-donor kidney transplant program at Barnes-Jewish Hospital, visit barnesjewish.org/kidneydonor or call 314-TOP-DOCS (314-867-3627) or 866-867-3627 (toll free).
BACKGROUND
When Emily arrived at Barnes-Jewish Hospital on the morning of June 14 for her kidney
transplant, she was in end-stage renal failure. The kidney that had been doing important work—
n the weeks and months leading up to her
Emily arrives at Barnes-Jewish Hospital with her
transplant, Emily is rigorously evaluated by the
parents, in-laws, two girlfriends (who keep Emily’s
kidney transplant team. Transplant candidates are
many well-wishers updated via Facebook and Twitter
assessed for physical, anatomic and psychosocial
throughout the day) and her husband. Her new kidney,
fitness. They undergo a series of blood and
from a living donor, is on an airplane, flying in from
radiology tests. They also meet with dietitians,
New York.
social workers and finance specialists who are experts
removing excess water and waste from her blood, transforming poisonous waste products into
in helping patients access available resources. The goal
urine and returning cleansed blood for use throughout her body—was no longer functioning. A
in all this is to ensure a patient has the medical support
dialysis machine performed this role for her before she and a team of specialists determined a
and the demanding postoperative regimen.
and determination to withstand both transplant surgery
kidney transplant would restore a better quality of health and life.
11
12
I N N O VAT E |
WINTER 2012
|
BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
WWW.BARNESJEWISH.ORG
Surendra Shenoy, MD, PhD, a Washington University transplant surgeon at Barnes-Jewish Hospital and director of the living-donor transplant program, is Emily’s surgeon.
The following is a timeline of Emily’s surgery.
|
W I N T E R 2012
| INNOVATE
5
6
I N N OVAT E |
WINTER 2012
|
BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
THE LIVING-DONOR KIDNEY TRANSPLANT PROGRAM
EMILY’S NEW KIDNEY:
A Transplant Story From Start to Finish
to organ rejection. In addition to cleansing blood by the removal of waste, kidneys also produce erythropoietin, a hormone that stimulates production of red blood cells in the bone marrow. When kidneys fail, transfusions are used to stimulate blood marrow production. “Every transfusion exposes the patient to an antigen that can produce the antibodies that trigger organ rejection. The longer a patient in kidney failure is on the wait list for a kidney, the more sensitized that patient becomes and the greater the risk of organ rejection once a kidney is transplanted,” says Shenoy.
THE LIVING-DONOR
KIDNEY TRANSPLANT PROGRAM and director of the living-donor transplant program, says, Emily received her new kidney from a living donor “In general, patients who receive a kidney from a living through a paired-kidney exchange. This novel approach donor have a better chance of the kidney lasting up to 20 allows patients with kidney failure who have a suitable, years. A kidney from a deceased donor may last 10 to 12 but mismatched potential kidney donor to exchange years.” Patients who receive a kidney from a living donor donors. Each donor gives a kidney to a different recipient usually spend less time in the hospital after the surgery than he or she originally intended, and each recipient is and experience fewer complications. able to receive a living-donor kidney, rather than remain on the waiting list. The availability of a living-donor DONOR RECIPIENT kidney also can ensure a patient A patient in need of a kidney transMISMATCH A A doesn’t remain on the waiting list for plant reaps a number of benefits when an extended period of time. The longer the donated kidney comes from a living the wait-list time, the more diminished MATCH donor rather than a deceased donor. a patient’s quality of life becomes. Surendra Shenoy, MD, PhD, a MISMATCH Wait-list time, which may last as Washington University transplant B B long as five years, can contribute surgeon at Barnes-Jewish Hospital
WWW.BARNESJEWISH.ORG
|
W I N T E R 2012
| INNOVATE
“ In general, patients who receive a kidney from a living donor have a better chance of the kidney lasting up to 20 years. A kidney from a deceased donor may last 10 to 12 years.”
New techniques used to remove a kidney from a living donor have reduced postoperative pain and recovery time.
Surendra Shenoy, MD, PhD
EMILY’S NEW KIDNEY: A Transplant Story From Start to Finish
I
RE I TNT E H OTO GA RA DALLLL H HY YM A N W R IW TT BN Y BAYN A NN E NMEAMKAEKEEVEEVRE R > > P HPOTO GR PP HH E EDDBBYYRRAANNDA
To learn more about the living-donor kidney transplant program at Barnes-Jewish Hospital, visit barnesjewish.org/kidneydonor or call 314-TOP-DOCS (314-867-3627) or 866-867-3627 (toll free).
BACKGROUND
When Emily arrived at Barnes-Jewish Hospital on the morning of June 14 for her kidney
transplant, she was in end-stage renal failure. The kidney that had been doing important work—
n the weeks and months leading up to her
Emily arrives at Barnes-Jewish Hospital with her
transplant, Emily is rigorously evaluated by the
parents, in-laws, two girlfriends (who keep Emily’s
kidney transplant team. Transplant candidates are
many well-wishers updated via Facebook and Twitter
assessed for physical, anatomic and psychosocial
throughout the day) and her husband. Her new kidney,
fitness. They undergo a series of blood and
from a living donor, is on an airplane, flying in from
radiology tests. They also meet with dietitians,
New York.
social workers and finance specialists who are experts
removing excess water and waste from her blood, transforming poisonous waste products into
in helping patients access available resources. The goal
urine and returning cleansed blood for use throughout her body—was no longer functioning. A
in all this is to ensure a patient has the medical support
dialysis machine performed this role for her before she and a team of specialists determined a
and the demanding postoperative regimen.
and determination to withstand both transplant surgery
kidney transplant would restore a better quality of health and life.
11
12
I N N O VAT E |
WINTER 2012
|
BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
WWW.BARNESJEWISH.ORG
Surendra Shenoy, MD, PhD, a Washington University transplant surgeon at Barnes-Jewish Hospital and director of the living-donor transplant program, is Emily’s surgeon.
The following is a timeline of Emily’s surgery.
|
W I N T E R 2012
| INNOVATE
5
6
I N N OVAT E |
WINTER 2012
|
BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
SIDE BY SIDE
WHEN EVERYTHING CHANGES In the last months of 2010, 20-year-old Danny Strobbe was enjoying the life of a college student when he experienced the most excruciating pain he’d ever had. In high school he’d suffered from severe headaches, but this was different. A trip to Barnes-Jewish Hospital ultimately revealed that Strobbe’s brain had hemorrhaged. In January 2011, Michael Chicoine, MD, Washington University neurosurgeon at Barnes-Jewish, performed a craniotomy on Strobbe to stop the bleeding; a second surgery to reduce pressure followed. Another
Danny Strobbe Survivor of multiple brain hemorrhages ON HIS INITIAL DIAGNOSIS
I was taking college algebra and some other classes, just going along in my daily life. Everything was great. And then the next thing you know, I’m in the hospital, and everything changed.
Michael Chicoine, MD Washington University neurosurgeon ON STROBBE’S CONDITION
Danny Strobbe’s multiple hemorrhages were caused by a cavernous malformation, a type of vascular irregularity in the brain. Because this abnormality was located in deep-seated and critical areas of the brain, an aggressive attempt to remove it entirely was not pursued
hemorrhage in September 2011 led to additional surgery, during which Chicoine used a new technology called intraoperative magnetic resonance imaging (iMRI)—performed with a device that is in use at only a small number of institutions worldwide. The iMRI gave Strobbe’s surgical team a view of their progress in real time in the operating room. As a result, they could more precisely remove the source of Strobbe’s brain abnormality while minimizing both the risk of damaging healthy tissue and the need for additional surgery.
Danny Strobbe and Mandi Freeman
ON HIS TREATMENT
I can barely remember October and November 2011, to be honest, except some things involving my family. I can recall my dad saying, though, that I was one of the first people to be operated on using the iMRI. It’s pretty amazing. I feel like it saved my life. ON HOW HE IS NOW
I’m doing great. I had my six-month
during the first surgeries. The concern was that complete removal might cause disabling side effects, including paralysis, coma or even death. ON THE USE OF iMRI
Using this technology during the third surgery allowed for nearly complete and safe removal of the abnormality. This strategy has allowed Danny to resume a normal lifestyle and to avoid consequences that these deep-seated cavernous malformations can cause.
check in April, and everything looked good. I celebrated the year anniversary of my surgery with the iMRI in September. I’m thankful for Dr. Chicoine and the iMRI. I’m also truly thankful for my family and my girlfriend and her family for helping me through everything. Right now, I’m taking it easy and enjoying life, and I’m looking forward to what’s ahead. ON THE FUTURE OF TREATMENT
To date we have just scratched the surface of the advantages that iMRI may provide in treating complex conditions of the brain. And it’s only because of the collaboration and generosity of the many people involved that we are among the first to adopt and use this technology. – A. BASSETT To view a video about iMRI, visit bjhne.ws/du.
WWW.BARNESJEWISH.ORG
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W I N T E R 2012
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13
ANTIBIOTICS AND THE SINUS INFECTION
Images © istockphoto.com
WRITTEN BY JULIA STRAIT
Mounting evidence continues to indicate that adults and children suffering with sinus infection will not be helped by taking an antibiotic. In fact, a recent study from Washington University shows that antibiotics typically prescribed for sinus infections do not reduce symptoms any better or help patients recover any faster than a placebo, or sugar pill. Most people get better on their own.
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“We think that antibiotics are overused in the primary-care setting,” says Jane Garbutt, MD, a Washington University clinical investigator. “There is a movement afoot, led by the Centers for Disease Control and Prevention, to try to improve the judicious use of antibiotics. We hope
BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
this study provides the scientific evidence doctors can use to explain to their patients that an antibiotic is not likely to help an acute sinus infection.” Garbutt and her colleagues say that it is important to know whether antibiotics are effective for sinus infections because they are so frequently prescribed for that purpose and because bacterial resistance to antibiotics is rising. In practice, instead of giving antibiotics such as amoxicillin, research suggests a combination of treating the symptoms—pain, cough and congestion—and
watchful waiting to see whether further treatment is necessary is the best approach. Garbutt’s study, published in the Journal of the American Medical Association, included 166 adults whose symptoms fit the criteria for acute sinus infection recommended by an expert panel convened by the Centers for Disease Control and Prevention. To participate, patients’ symptoms had to be classified as moderate, severe or very severe. Specifically, they had to report pain or tenderness in the face and sinuses, and infected nasal discharge that lasted between seven and 28 days that was not improving. Patients with chronic sinus infections, serious complications from the condition or a simultaneous ear or chest infection that might require antibiotic treatment were not included in the study. Participants were recruited at their primary-care physicians’ offices in St. Louis and were randomly assigned to receive a 10-day course of either amoxicillin or a placebo. All patients also got medications for relieving pain, fever, congestion and cough.
Researchers assessed patients’ symptoms at the start of treatment and then three, seven, 10 and 28 days afterward. At each time point, patients answered a questionnaire assessing quality-of-life measurements related to the disease. The study also compared recurrence of symptoms and the number of days missed from work. At day three, there was no difference between the antibiotic and placebo groups in any of these measures. At day seven, the study revealed a small improvement in the antibiotic group’s questionnaire scores. However, Garbutt says this small change was unlikely to represent a noticeable relief from symptoms. Furthermore, this modest statistical improvement disappeared by day 10, when about 80 percent of patients in both groups reported their symptoms were very much improved or cured. They also found no difference between the antibiotic and placebo groups in the amount of over-thecounter medications patients used to alleviate pain, fever, congestion and cough. “It’s a nasty disease,” Garbutt says. “People have significant symptoms. They feel miserable and miss time from work. If an antibiotic is not going to be of any benefit, then what is? That’s a question we haven’t answered yet. But we are working on it.” Garbutt says upcoming studies will examine whether nasal irrigation with saline solution, such as that used with a neti pot, will help alleviate symptoms and clear the infection more quickly.
Prevention & Treatment A few lifestyle changes may help prevent sinus infections or ease symptoms. WAS H H A N D S
Sinus infections often follow the common cold. Reducing the risk of upper respiratory tract infections may help prevent colds and their progression to sinus infections. DRINK FLUIDS
Fluids can thin mucous and help the sinuses drain. GET PLENTY OF SLEEP
A well-rested body is better able to fight infection. SLEEP WITH HEAD E L E VAT E D
This position can help with sinus drainage. USE A HUMIDIFIER
Moist air can also help thin mucous. Keep the humidifier clean and mold free. R I N S E O U T N ASA L PA S SA G E S
This home remedy may help clear sinus congestion. Use water that is sterile, distilled, boiled first then cooled, or filtered (pore size 1 micron or smaller). Whether using a squeeze bottle, bulb syringe or neti pot, clean and air dry it between uses.
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Treating Pituitary Tumors
endoscope into the patient’s nose. Once at the tumor site, a neurosurgeon removes the growth.
The acorn-sized pituitary gland, located beneath the brain, is prone to developing slow-growing, benign tumors. Although many of them don’t produce symptoms, some may increase or decrease production of pituitary hormones. And, depending on location, they also may cause symptoms like headaches and vision loss.
“We use an innovative surgical navigation system—much like GPS— to guide us to the tumor,” says Michael Chicoine, MD, a Washington University neurosurgeon at Barnes-Jewish Hospital. This system, called intraoperative MRI (iMRI), allows neurosurgeons and radiologists to immediately determine whether the entire pituitary tumor has been removed.
“Many patients with pituitary tumors don’t require treatment but simply need regular follow-up. Others need neurosurgery, while some need both surgery and radiation treatments. There also are certain types of pituitary tumors that respond well to medication,” says Julie Silverstein, MD, a Washington University endocrinologist at BarnesJewish Hospital. “Determining the most effective course of treatment takes a cooperative effort among multiple specialists.” The Washington University and Barnes-Jewish Comprehensive
New President of Neurosurgery Society Ralph Dacey Jr., MD, neurosurgeon in chief at Barnes-Jewish Hospital and the head of the Department of Neurosurgery at Washington University School of Medicine, became president of the Society of Neurological Surgeons (SNS) in May. His term will last one year.
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Pituitary Center is the region’s only clinic to offer a convenient, multidisciplinary approach to treating patients with pituitary tumors. The center provides patients with access to specialists as well as the latest and best technology for treating pituitary tumors. Most patients needing surgery undergo a minimally invasive procedure during which an ear, nose and throat (ENT) surgeon inserts an
Dacey, who also is the Henry G. and Edith R. Schwartz Professor of Neurological Surgery, joins an exclusive group of neurosurgical leaders that includes Harvey Cushing, MD, who is regarded as the father of modern neurosurgery and served as the first SNS president in 1920. Dacey’s predecessors as head of the Department of Neurosurgery also served terms as president of the SNS. The society’s goals include promoting improvements in education and
BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS
“If a fragment remains, we can perform immediate follow-up surgery. This is especially important when treating hormone-secreting tumors, since any small piece left behind will continue producing that hormone,” says Chicoine. In cases where the tumor has invaded areas containing vital nerves or arteries, Gamma Knife radiosurgery may be used to target the tumor with a beam of radiation. – P. McGRATH
training for neurosurgical students and postgraduates, recognizing outstanding neurosurgical care, instruction and research, and Ralph Dacey Jr., MD encouraging the highest standards of care for patients with neurological diseases. – M. PURDY
Image © shutterstock.com
FYI
AT A G L A N C E
AGAINST THE ODDS When Lukas Wartman, MD, began medical school at
Participants in gene-sequencing research studies do not
Washington University, he knew he wanted to study cancer
usually experience a change in treatment based on study
and treat patients. What he didn’t know was that by his fourth
findings. However, in sequencing Wartman’s genes, scientists
year of school, he would end up battling the disease he was
found a normal gene that was producing massive amounts
studying. In 2003, he was diagnosed with acute lymphoblastic
of a certain protein that might be contributing to Wartman’s
leukemia (ALL), a cancer of the blood that is treatable in
cancer growth. And they identified an existing drug that
children but often fatal in adults.
could target the hyperactive gene. Once again, Wartman
Two years of chemotherapy put the cancer into remission, and Wartman finished his clinical training. In 2008, he relapsed and was treated with chemotherapy and a stem cell
had defied the odds. After treatment, his cancer is again in remission and, though he has since had another stem cell transplant with some adverse side effects, he is doing well.
transplant from his younger brother. Again in remission, he
The ability to sequence the genome and RNA of an individual
began fellowship work in the lab of Washington University and
with cancer did not exist when Wartman’s leukemia was
Siteman Cancer Center researcher Timothy Ley, MD, chief of
diagnosed. And while this approach to treatment is not yet
the Section of Stem Cell Biology in the Division of Oncology.
generally available, researchers envision a future when
In 2011, Wartman relapsed again. While the chances of an adult with ALL surviving one relapse are slim, there are no statistics to suggest surviving a second. Another round of chemotherapy did not induce another remission, and time was running out. In an attempt to beat the clock, Ley proposed sequencing
it becomes routine. Malachi Griffin, MD, the Washington University researcher who analyzed Wartman’s RNA, says, “We want to be able to take the tumor of every patient that comes into the clinic, sequence the genome and produce a clinical report, just like when a physician orders a blood test.” – G. REMEROWSKI
the genes of Wartman’s cancer cells and normal cells. Researchers also analyzed his RNA, the cellular material
For story details, visit siteman.wustl.edu/wartman.
that works with genes to orchestrate protein production.
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