Innovate: Issue 16, Fall 2012

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

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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.

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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

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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

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“ 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.

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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

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W I N T E R 2012

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“ 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

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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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

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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

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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 |

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

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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

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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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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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