Alumni Bulletin
J e ff e r s o n M e d i ca l C o l l e g e • T h o ma s J e ff e r s o n U n i v e r s i t y • SU M M ER 2 013
Zapping Epilepsy with Laser Surgery
Stephen K. Klasko, MD, MBA,
joins Jefferson as new campus leader See story page 6.
Calling all ’3s and ’8s!
A l u m n i w e e k e n d 2 013 • O c t o b e r 4 – 6
This year’s Friday, highlights: October 4 Evening Welcome Reception: “A Night in Venice” Join fellow JMC alumni on campus for a complimentary evening of food and fun that will transport you to La Serenissima, the beautiful city of Venice. Mingle with special guests and friends and faculty under the stars — it’s a great way to kick off alumni weekend or get together with alumni from the Philadelphia area.
Saturday, October 5
Sunday, October 6
Morning/Afternoon •L egacy admissions workshop • Tours of the Rector Clinical Skills Center and the new anatomy lab • “My 27 Years with the Phillies” with Phil Marone, MD ’57 • “ Taste of Philadelphia” luncheon, hosted by Dean Mark L. Tykocinski, MD •N ew this year: Alumni Association recognizes Peter Amadio, MD ’73, this year’s Alumni Achievement Awardee.
Morning “Pearls at Work” Alumnae Brunch Wrap up Alumni Weekend with brunch hosted by JMC Alumni Association President, Marianne Ritchie, MD ’80. Help local women transition into the professional workplace by donating new or nearly new and cleaned suits, blazers or jackets.
Evening Ritz-Carlton, Philadelphia • Reunion Photos •C lass Reunion Receptions
Inn at the Union League 215-587-5570
•A lumni Dinner: Enjoy a sumptuous sit-down dinner in one of the most elegant ballrooms in Philadelphia. Our special guest for the evening is entertainer Joe Conklin, a constant in Philadelphia radio for more than 20 years. He’s known for his spot-on impressions of celebrities and politicians, and provides an evening of fun you will long remember.
Holiday Inn Express Midtown 215-735-9300
For more information: Call 215-955-9100
•
Discounted hotel rate at these locations:
Ritz-Carlton Philadelphia 1-800-241-3333
Email events@jefferson.edu
register online: connect.jefferson.edu/AlumniWeekend2013
Contents Features
10 Laser Ablation Puts the Heat on Epilepsy 14 Breathing More Easily: ECMO Advances Extend Life Support 18 Surprising Ties Between the Titanic and Hematology Research at Jefferson
Departments 2 DEAN’S COLUMN 6 SPOTLIGHT Stephen K. Klasko, MD, MBA, Named President of Thomas Jefferson University and President and CEO of TJUH System 8 FINDINGS Amplification of Stat5 Gene Locus Over-Produces Protein That Drives Prostate Cancer Spread
21 ON CAMPUS 22 FACULTY PROFILE Roger B. Daniels, MD: 11th Annual Jefferson Awards Gala Honoree
24 CLASS NOTES 25 Alumnus Profile
10 Questions with… Nicholas Ruggiero II, MD ’01
26 IN MEMORIAM 27 Alumni Association President’s Message 29 BY THE NUMBERS Jefferson Alumni Bulletin Summer 2013 Volume 62, Number 3 Senior Vice President, Jefferson Foundation: Frederick Ruccius Vice President for Development and COO, Jefferson Foundation: Stephen T. Smith Editor: Gail Luciani Associate Editor: Karen L. Brooks Design: JeffGraphics Bulletin Committee William V. Harrer, MD ’62 Chair James Harrop, MD ’95 Cynthia Hill, MD ’87 Larry Kim, MD ’91 Phillip J. Marone, MD ’57, MS ’07 Joseph Sokolowski, MD ’62
Quarterly magazine published continuously since 1922. Address correspondence to: Editor, Alumni Bulletin Jefferson Medical College of Thomas Jefferson University 925 Chestnut Street, Suite 110 Philadelphia, PA 19107-4216 215-955-7920 Fax: 215-503-5084 connect.jefferson.edu Alumni Relations: 215-955-7751 The Jefferson community and supporters are welcome to receive the Alumni Bulletin on a regular basis; please contact the address above. Postmaster: send address changes to the address above. ISSN-0021-5821 Copyright© Thomas Jefferson University. All Rights Reserved. JG 13-1984
THOMAS JEFFERSON UNIVERSITY
On the Cover: A color-enhanced cross-sectional MRI scan indicates mesial temporal sclerosis, a type of epilepsy treatable with laser ablation. The abnormal right hippocampus (in red) is the seizure generator. Image by Neil M. Borden.
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The Dean’s Column On May 30, 2013, Dean Mark Tykocinski, MD, shared the following comments with JMC graduates at Jefferson’s 189th commencement ceremony. His remarks appear here, adapted, in lieu of his usual column. A video of his address is available on our website at connect.jefferson. edu/2013commencementaddress. Today, you carry with you your hopes and dreams, as well as those of the families who support you and the faculty who have vested so much in you. Your futures hold opportunities to provide compassionate care, discover cures and educate the next generation of caregivers. Class of 2013 — as each of you now heads off to blaze your own trail, my parting message to you speaks to personal expectations in a relentlessly changing world — what others will expect of you, and what you will expect of yourselves — the unreasonable and the reasonable. April’s horrific Boston Marathon bombing is still vivid in our minds. Transfixed by video loops of the explosions and their immediate aftermath, I found myself fixated on the runners themselves. One moment pressing forward on a beautiful New England spring day, the next a world ripped apart. Each runner reacted differently — a few stumbled; some seemed
to ignore the deafening explosions, unable or unwilling to flip the switch from finish line mode; others registered the changed reality virtually instantaneously, with some even reincarnated into first-responders. David King, a Mass General trauma surgeon and veteran of Afghanistan, charged past the finish line and just kept tacking on miles, beelining to his home hospital to receive the wounded. The spectrum of human response to catastrophe was on vivid display — and a few, like Dr. King, revealed a seemingly hard-wired ability to internally recalibrate. This past year, we had an example of this much closer to home; Donald Liu, MD ’90, chief of pediatric surgery at University of Chicago Comer Children’s Hospital — unwinding on a Sunday, on a small Lake Michigan beach, with his wife and three children. In the distance he spots two 12-year-old boys toppled from their canoe by the lake’s riptide current. In a flash, Dr. Liu flips into rescue mood, diving in to save them. Tragedy unfolds — he manages to help the boys make it to shore, but is himself pulled down by the undertow — with this dramatic act of pure selflessness playing out before his family. Pediatric surgeon saving children — work life and personal life blurring together. Donald Liu’s heroism touched the heart of so many, but
none more than us here at Jefferson — after all, he was one of our children. A David King, a Donald Liu — remarkable human beings, each displaying a superhuman ability to react to a suddenly shattered reality. Tempting for us in the Jefferson faculty to imagine we had something to do with this. Who knows — intense clinical drilling combined with incessant drumming of professionalism and empathy values — a magical potion for subliminal reprogramming that in a rare moment can transform one of our medical students into a heroic Liu — capable of lightning reaction, and self-sacrifice as a reflex. Yes, we are proud of our physician heroes — they instantiate our most profound aspirations. Yet, on reflection, there is a paradoxical dimension lurking behind their heroism. Might there be a slippery slope here between aspiration and expectation? As society demands ever more of its physicians, does the heroic selfsacrifice of a Donald Liu subliminally inflate society’s expectations of its physicians? Are we all supposed to be godlike, ascending to some mythical standard of selflessness — doing incredible things, settling for nothing less than perfect? Last year, the question of professional expectations rocked the world of science. An Italian court convicted seven scientists and experts on manslaughter charges for failing to predict the 2009 6.3-magnitude earthquake in central Italy, which killed 308 people in the medieval town of L’Aquila, and
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devastated its historic center. Six-year prison sentences were handed down to the defendants — among them some of Italy’s most prominent and internationally respected seismologists and geological experts. The accusation — monumental negligence — for giving “inexact, incomplete and contradictory information” about whether small tremors felt by L’Aquila residents in the months before the quake should have constituted grounds for a quake warning. The conviction sent shock waves through the international science community. The American Association for the Advancement of Science condemned the verdict as a complete misunderstanding of the science behind earthquakes, which are nearly impossible to predict and can only be forecasted with low probability. But the Italian court saw it differently — the experts must be all-knowing and non-erring. Imperfection in professionals and experts will simply not be tolerated. In this new ethereal realm, reflected in that courtroom theatre of the absurd, professionals must not only react to catastrophe — they are now expected to predict it! What is true in the “court” for geologists is also true in the “court” for physicians. Here in Philadelphia, we deliver health care in the backdrop of one of the nation’s most unforgiving malpractice insurance court systems. Every delivery, every neurosurgical procedure, must be perfect. Every heroic effort to save a patient at death’s doorstep — even a patient whom others
have abandoned as hopeless and Jefferson has embraced — is insidiously recast as a routine care encounter, with no allowance for error. Through society’s increasingly distorted lens, the heroic morphs into the expected. Nothing less than absolute perfection is tolerated. Needless to say, this has a chilling effect on how we practice medicine. Delivering a baby becomes an act of defiance, as does performing a brain operation to mitigate suffering. One almost becomes afraid to do anything. In his lyrical book, Intoxicated by My Illness, Anatole Broyard waxes poetic about patients’ expectations of their physicians: “Every patient invites the doctor to combine the role of the priest, the philosopher, the poet, the lover. He expects the doctor to evaluate his entire life, like a biographer.” But on a parallel track, I’d hasten to tack on some things that should not be expected — heroism, omniscience, perfection. Yes, on rare occasion such lofty qualities miraculously unfold before our eyes, the actions of the David Kings and Donald Lius at defining moments commanding our admiration and awe — but this simply cannot be transformed into the normative. Expectations of physicians must be kept in check, confined to the realm of the reasonable. This slippery slope of aspiration-toexpectation extends to our research mission as well. Senators grill NIH leaders as to why more diseases have not been cured. Where is our nation’s return-on-investment,
they mock. Many politicians cultivate a perception of a disappointing lag in the translation of discovery into therapeutic application. Their view of the glass as half-empty is ironic, given the astounding leap forward in biomedical sciences of the past decades — unraveling the genome, designing whole new categories of personalized medicines and procedures, deciphering mechanisms of human pathophysiology that stretch the imagination. No matter, this triumph of biomedical discovery is discounted, impatience dominates, unrealistic directives are formulated, and bad policy ensues. Loss of faith in invention triggers a premature emphasis on technical implementation. An inexorable case for “clinical translation” — the catchword of the day — has gained lemming-like momentum, with our scientific leaders themselves succumbing to the narrative and joining the bandwagon. Discovery, the very heart of the academy’s role in our society, has in some sectors become the villain, as the plug is progressively pulled on extramural funding, just when a doubling-down of our biomedical investment is needed to capture the crescendo of biomedical insight. Ironically, as our nation barely reaches the finish line, other countries are racing forward, availing themselves of our multi-decade, post-World War II investment into biomedical science. This is what happens when unrealistic expectations go unchallenged, and false narratives are allowed to gain traction.
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So Class of 2013, my first message: take on the mantle of this fight. As you strive for perfection and aspire to elevate yourselves, through a relentless focus on service, quality and outcomes, you must at the same time resist, individually and collectively, the expectation for perfection and instant outcome. And as you pitch in to extend the limits of biomedical knowledge and pioneer new diagnostics and therapeutics, push back against those who throw darts and cynically question the rate of practical application. Do not tolerate unrealistic expectations from others, and by no means impose them upon yourselves. As the saying goes, “the perfect is the enemy of the good.” It will interfere with bringing hope to the hopeless, it will impede scientific discovery, just as we probe the boundaries of human knowledge. An Orwellian quote comes to mind: “During times of universal deceit, telling the truth becomes a revolutionary act.” Be revolutionaries. And another Orwellian quote: “To see what is in front of one’s nose needs a constant struggle.” Too many refuse to look beyond their noses. A second message to you, moving from the unreasonable to the reasonable. What should you reasonably expect of yourselves? What is indeed reasonable when it comes to facing change? Well, you can’t be expected to shine, let alone predict, when catastrophic change will befall. However, it is reasonable to challenge yourselves to recognize and adapt to gradual change. Real-life change
rarely has the drama of terrorist bombs or over-turned canoes. More often than not, change is so gradual that one practically misses it entirely. Such change surrounds us in medicine — changes in disciplines and practice norms, changes in business-ofmedicine models that constrain us. What each of you must continuously cultivate is what they call at Wharton peripheral vision, scanning for change that could be disruptive — you need to detect it, forecast it and respond to it. Psychological flexibility will enhance your ability to perceive emergent realities in real time. In an ever-changing world, cultivate an agility for mental recalibration. Failure to assimilate changes that envelop you will ultimately derail you. I am fascinated by theories of the mind that speak to how we process reality and detect change. Both individually and collectively, we create our own realities and narratives. To wax poetic, our realities are our own self-enacted theatres. At the entrance to an exhibition of the art and videography of William Kentridge, a wall inscription describes the artist’s conception of the world as a theatre of memory. And in Soul Dust, a book on emerging notions of human consciousness, the author offers the intriguing metaphor of mind as theatre. Our minds are synthetic and elastic, and within our personal theatres of the mind, we each set the expectations that dictate how we perceive and respond to changing realities. Simply put, we ourselves constrain or empower our responses to
change. We calibrate that which is possible and that which can be reasonably expected. One last thought and third message to you, moving from performance-related expectations to those surrounding your career goals. On this landmark day, it is certainly appropriate to think about how the theatre of your mind frames your ambition. What do you dream of for yourselves? What are your threshold, as well as your fantasy, career expectations? My advice: liberate yourselves from the onus of perfection. Allow yourselves satisfaction in incremental accomplishments, and importantly, allow for intermittent setbacks and failures along the way. The 19th century Greek poet Constantine Cavafy, reflects in his poem, The First Step, on the challenge of realizing one’s professional ambitions and dreams: Just to be on the first step should make you happy and proud. Even this first step is a long way above the ordinary world … To have come this far is no small achievement: what you have done already is a glorious thing. So, set your career goals high, but do not demand the unrealistic. Today, as you take stock of yourselves, if there’s a haunting feeling deep down that notwithstanding it all, you haven’t quite gotten to where you could be, temper this feeling. There is no world-standard scale for measuring career accomplishment. You set your own scale — it too is enacted in the theatre of your minds. This unsettled feeling is natural for many
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of us overachievers, but understand that it will deflate you and even dissuade you from taking the first steps. You are better off internalizing Cavafy’s wisdom: Even this first step is a long way above the ordinary world. Knowing the value of first steps should motivate you to seek out and embrace them, fearlessly, aggressively, but realistically. In an ever-changing world, fear of failure, framed by over-expectation, can be crippling. A few moments ago, you heard from our honorary degree recipient, a pioneer of ECMO on this 60th anniversary year of its progenitor technology, Jefferson’s heart-lung machine. A few weeks ago, Herb Cohn, one of our distinguished senior surgeons, shared an insider’s view of the development of the heart-lung machine. It turns out that the machine’s pioneer, John H. Gibbon, the surgical giant, had a deep-seated fear of failing his patients. In the year after his 1953 landmark operation, Gibbon performed two additional cases with the heart-lung machine; both patients died. He responded by closing the heart-lung program for a year, and when the shop reopened, he turned it over to John Templeton. From that day on, Gibbon, though only 50 years of age, never did another heart operation, confining
himself to his thoracic surgical practice. Ironically, the patients’ deaths had nothing to do with the heart-lung machine per se, but rather with the simple fact that these patients, unlike the first, were undergoing a far more treacherous procedure — pulmonary embolectomy via the Trendelenberg procedure — one unavoidably associated with dismal survival. No matter, Gibbon abandoned the heart-lung machine, notwithstanding his 27-year experimental quest and his 1953 surgical triumph. A fear of failure can lead even giants to abandon their craft in their prime. Fortunately, Gibbon had already made it to the first step. When questioned about the collapse of her assistance enterprise in Africa in the wake of the Yom Kippur War, Prime Minister Golda Meir smartly retorted: A setback is not a failure. A disappointment is not a ruin. A frustration is not a catastrophe. Not every enterprise can give immediate returns. Nothing ever goes to waste. Time will tell. So in closing, my messages to you: 1. W hile celebrating the extraordinary among yourselves, do not think it is the expected. Aspire for that which is realistically attainable, and diligently
recalibrate your mindsets from the unrealistic to the real — remember, you write the script for the theatre of your mind. 2. Y es, aspire for the most, but do not let others turn that aspiration into an expectation. Reach out to resist the unreasonable when it is being forced upon you, and do not tire of telling your story, or in demanding that others have realistic views of us. 3. A nd last, what you should expect of yourselves is meaningful first steps, defining first steps that are attainable for you. Derive satisfaction from their attainment — understanding that even at your best, you can’t accomplish it all at once — even the first step will be worth it. We salute all those that brought you to this point in life — your parents and family who nurtured and supported your passion for service and inquiry. It is indeed the dreams of all of us here today that go with you. You enter a long tradition that dates from Hippocrates, to McClellan and Gross, through Gibbon, and now to you. It is your turn to join, to continue and to enhance Jefferson’s legacy of service, and to perpetuate that desire to make a difference that brought you to Jefferson four years ago.
Watch a video of Dean Tykocinski’s remarks at: connect.jefferson.edu/2013commencementaddress See more photos from this year’s commencement ceremony at: connect.jefferson.edu/2013commencementphotos
Mark L. Tykocinski, MD Anthony F. and Gertrude M. DePalma Dean Jefferson Medical College
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Spotlight
Stephen K. Klasko, MD, MBA, Named President of Thomas Jefferson University and President and CEO of TJUH System Transformative Leader for USF Health System Returns to Philadelphia to Oversee New Structure
Stephen K. Klasko, MD, MBA, dean of the Morsani College of Medicine at the University of South Florida and chief executive officer of the University of South Florida Health System, has been appointed to the new position of president of Thomas Jefferson University and president and chief executive officer of TJUH System. Klasko will begin his tenure in early September. In June 2012, Richard C. Gozon, a member of the University board, took on the role of Thomas Jefferson University president, while the position of president and CEO of TJUH System remained unfilled. Gozon will resume his role as a trustee when Klasko joins Jefferson. Klasko, 59, returns to his hometown with more than 30 years of academic leadership experience and business management expertise developed while holding a variety of executive positions at USF and Drexel University College of Medicine. “I am truly honored to be leading one of the finest academic health centers in the nation, with a rich medical history and stellar reputation for academic excellence, innovative research and compassionate patient care,” says Klasko. “This is by far one of the greatest opportunities to come along in a decade, to forge Thomas
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“ I am truly honored to be leading one of the finest academic health centers in the nation, with a rich medical history and stellar reputation for academic excellence, innovative research and compassionate patient care.”
Jefferson University, TJUH System and Jefferson University Physicians into the model for healthcare revolution.” Klasko joined the University of South Florida as dean of the College of Medicine and vice president of the USF Health Sciences Center (HSC) in 2004. He reorganized the HSC as USF Health, including the colleges and the USF Physicians Group, and was named its CEO. While at USF Health, Klasko was responsible for a series of program changes in medical education. He created the SELECT (scholarly excellence, leadership education, collaborative training) Program, by which students are chosen on quantitative emotional intelligence parameters, and reformed the medical education curriculum, which is now based on the science, business, teamwork and communication skills needed for the physicians of tomorrow. Klasko also created the USF Center for Advanced Medical Learning and Simulation (CAMLS), the world’s largest center for the assessment of technical and teamwork competencies. At USF Health, Klasko created patient care and academic partnerships through a series of local and state-wide initiatives. He planned and secured funding for the development of more than $300 million in new construction, including a college of
nursing, faculty and research facilities and the Morsani Center for Advanced Healthcare, built around the concept of continuity of care. NIH funding doubled under his leadership. At the Villages, one of the largest retirement communities in the United States with 90,000 residents, Klasko oversaw the largest single-site public health study for seniors, leading to the formation of a primary-care driven, community-based accountable care organization. And USF Health teamed up with HCA to form a trauma network, creating five new centers across Florida and a new data analysis center, thus allowing more residents access to trauma care and a broader research base for trauma. Prior to joining USF, Klasko served in a series of leadership positions at Drexel University College of Medicine from 2000 to 2004, including dean of the College of Medicine, professor of ob-gyn and CEO of Drexel University Physicians. He also served as president and CEO of the Lehigh Valley Physician Group from 1996 to 1999. Klasko received his BS in chemistry and biology from Lehigh University; his MD from Hahnemann University; and his MBA from the Wharton Executive Program of the University of Pennsylvania. He is board certified in obstetrics and gynecology.
Watch for an interview with Dr. Klasko in an upcoming issue of the Bulletin.
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Findings
Amplification of Stat5 Gene Locus Over-Produces Protein That Drives Prostate Cancer Spread
Led by researchers at Jefferson’s Kimmel Cancer Center, an international group of investigators has solved the mystery of why a substantial percentage of castrate-resistant metastatic prostate cancer cells contain abnormally high levels of the pro-growth protein Stat5. They discovered that the gene that makes the protein is amplified in these cancer cells, which allows them to produce excess amounts of the oncogenic protein. The study — whose senior author was Marja Nevalainen, MD, PhD, associate professor of cancer biology, medical oncology and urology at Jefferson — found a direct association between the number of Stat5 genes in human prostate cancer cells and Stat5 protein levels and also revealed that gene amplification and protein levels increased as prostate cancer metastasized and became resistant to castration (anti-androgen) therapy. Nevalainen’s laboratory provided the initial proof-of-concept and validation that Stat5 is a therapeutic target protein for advanced prostate cancer. The current finding of Stat5 gene locus amplification in advanced prostate cancer is important since agents that inhibit the Stat5 pathway are currently entering clinical trials, Nevalainen says. “Our latest findings on Stat5 provide further support for the idea that targeting Stat5 protein pharmacologically
might provide powerful therapy for advanced prostate cancer. Our hope is that a successful agent might prevent some prostate tumors from spreading and might be able to contain metastasis that has already occurred and become castrate-resistant.” The discovery also suggests that testing Stat5 gene amplification in patients could provide a biomarker that identifies those patients most likely to respond to Stat5 inhibition, she says. Not only is Nevalainen testing Stat5 inhibitors developed by AstraZeneca and Novartis in preclinical studies, her lab has also developed its own inhibitor, which is also being tested. Nevalainen has long studied Stat5 in prostate cancer and with her colleagues has authored several studies demonstrating the impact the gene and its protein can have on prostate cancer progression. “Stat5 isn’t the only protein that drives prostate cancer, but it is a very important one,” she says. Contributors to the study included investigators from Georgetown University, the University of Helsinki in Finland, the University of Basel in Switzerland and the University of Tampere in Finland. The work was supported by grants from the National Institutes of Health and the Academy of Finland.
Amino Acids
Amplified Stat5 gene in the nucleus of a castrate-resistant metastatic prostate cell.
Once free from the nucleus the RNA combines with amino acids using ribosomes, which act like protein factories churning out protein strands.
Ribosome
RNA exits the nucleus.
Completed Protein
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This prostate cancer cell contains an abnormal amount of the Stat5 protein. The protein levels in prostate cancer cells have shown to increase as the cancer metastasizes and becomes resistant to androgen deprivation.
Research has found that the Stat5 protein may respond to drugs that inhibit the protein’s function and provide a targeted therapy for advanced prostate cancer.
The research also indicates that Stat5 gene locus amplification may provide a genetic biomarker to identify patients most likely to respond to Stat5 inhibitors.
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* **
Photo by Ed Cunicelli.
James Evans, MD, (left) and Ashwini Sharan, MD, fit a patient with a stereotactic head frame. A coordinate system on the frame will guide them in drilling an approximately 3-millimeter hole in the skull, toward the lesion responsible for seizures. They will then thread a fiber-optic laser probe through the hole. Photo by Ed Cunicelli.
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Laser Ablation Puts the Heat on Epilepsy By Karen L. Brooks
Story Summary Physicians have begun using MRI-guided laser ablation to treat patients with focal epilepsy. Ablation is minimally invasive and helps reduce side effects and recovery time following temporal lobectomy, the traditional surgery for epilepsy. Jefferson faculty are leading the effort to study ablation’s efficacy, fine-tune indications and develop formal protocols for use with epileptic patients.
Last November, Ashwini D. Sharan, MD, and James J. Evans, MD, drilled a hole the size of a pen tip in 43-year-old Nancy’s skull. They threaded a fiber-optic laser probe through the hole and then, guided by real-time magnetic resonance thermal imaging, safely burned out part of the hippocampus from her brain. Satisfied with what their monitor was showing, they removed the probe and closed the wound with a single staple. Nancy, who experienced seizures throughout her life but only received an epilepsy diagnosis at age 27, went home the day after her procedure and hasn’t had a seizure since. Physicians have treated certain cancers with laser ablation, a technology that uses light energy to destroy tumors or other damaged tissue, for several years, but its use with epilepsy is a newer application. Jefferson began offering the procedure in fall 2011, and results have been promising. “We have done eight ablations to date. All of the patients have seen improvement, and so far, several have stopped having seizures altogether,” says Sharan, director of the Division of Functional Neurosurgery. “Until recently, we thought surgical treatment for epilepsy meant we had to open up the skull. But you know what? We don’t.”
Who’s a Candidate?
Nancy is one of approximately 2.5 million Americans with epilepsy, which affects about one out of every 100 people. But not all of them qualify for laser ablation. Candidates must have tried, without success, a combination of medications. They must also have focal epilepsy, meaning their seizures come from a single, isolated area in the brain. “That’s the million-dollar question: Can we identify an exact target to ablate?” Sharan says. Michael R. Sperling, MD, director of the Jefferson Comprehensive Epilepsy Center, says that while physicians are still learning how effective ablation is and how best to use it, he is most hopeful about the procedure for people who have seizures that start deep in the temporal lobe, in the hippocampus. “I’m also enthusiastic about ablation for patients whose seizures are triggered by heterotopic lesions next to the ventricles,” Sperling says. “You really can’t do open surgery on these individuals, as you’d have to dig too far through healthy tissue. The laser presents an elegant way of fixing that problem.”
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A series of MRI scans from an ablation procedure. The first set confirms proper placement of the laser probe. The second set shows the brain before, during and after the procedure; you can see that the shape of the ablation on the right conforms to the shape of the lesion shown in the center (in orange). Scans courtesy of Visualase, Inc.
A ‘Symphony’ of Personnel “The beauty of ablation is the teamwork it requires — and that Jefferson excels in coordinating,” Ashwini D. Sharan, MD, says. In addition to standard nursing staff, ablation technology experts attend each procedure to assist with the equipment. Because images are interpreted in real time and information from multiple scans is combined to construct the brain three dimensionally, both MRI technicians and neuroradiologists also participate. A dedicated anesthesia team is always present, and to date, two neurosurgeons have collaborated on every case. “This procedure is still so new and rare, it would be impossible to remember each detail and reproduce each one the same way every time, so we double up to retain as many of the nuances as possible,” says James J. Evans, MD, who has worked side-by-side with Sharan during each ablation at Jefferson. Not every institution can assemble the requisite “symphony of personnel,” Sharan says. “Ablation is an amazing tool, but it could be slow to catch on because many hospitals simply don’t have the resources.”
Then vs. Now
Temporal lobectomy, the standard surgery for focal epilepsy, requires a major incision, removal of a large piece of skull and disruption of substantial normal tissue to reach the lesion that generates seizures. The procedure is highly successful, but recovery takes about two months, and consequences can include memory loss, mood swings and personality changes. “We accepted these side effects because a lobectomy was the best option we had,” says Evans, associate professor of neurosurgery. Ablation, with its combination of stereotactic laser surgery and MRI techniques, is not risk free but reduces these concerns. Produced by a company called Visualase, the technology is exceptionally precise, destroying targeted tissue while leaving surrounding tissues untouched. First, MRI scans pinpoint a lesion’s location, with electroencephalography and other studies helping to confirm that the lesion is causing seizures. In the operating room, a surgeon attaches a stereotactic frame to the patient’s skull with four pins, then uses the frame’s coordinate system to drill a hole and insert a probe. This takes about half an hour, after which the patient is wheeled back to the MRI suite. A surgical and technical team sits in a nearby control room, using real-time images to confirm placement of the probe and operate the laser, watching onscreen as its heat ablates the lesion.
“Through the MRI, you can see thermography. As brain tissue heats up, you get automatic warnings when areas reach certain temperatures. You keep signaling the laser until you see that all the tissue you want burned is burned, and then you’re done,” Sharan says. Ablation decreases the chance of complications such as bleeding, pain and infections and may reduce the possibility of memory loss from surgery. There are cost advantages, too, with less time in the operating room, minimal time in intensive care and shorter overall hospital stays. All of Jefferson’s patients have been discharged the day after their procedure; one was back at work within three days, as opposed to the usual six to eight weeks off following a lobectomy. “This is so much less invasive — it’s the difference between a 3-millimeter drill hole and opening the entire scalp,” Evans says. “Patients barely even experience discomfort, let alone problems with speech, vision or memory.” And if ablation doesn’t halt a patient’s seizures, surgeons can always perform a subsequent lobectomy. “With the laser, if you win, you win big. If you lose, you aren’t really losing anything,” Sharan says.
Going Forward
To measure just how effective ablation is, Jefferson is leading the effort to establish a national consortium of epilepsy surgery
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“ Until recently, we thought surgical treatment for epilepsy meant we had to open up the skull. But you know what? We don’t.” — Ashwini Sharan, MD
centers to study the technique in a systematic way and formalize procedure guidelines. “Not everyone is capturing images the same way. We need to standardize this, or when we compare results, it’s not apples to apples,” Sharan says. “The protocols are still fluid, and we can only draw true conclusions from our own cases.” He and his colleagues are working with the technology’s manufacturers to obtain MRI files from other centers and analyze techniques and outcomes. And even in these early stages, they are pondering expanded applications for ablation. “For years, it was thought that the hippocampus was the primary part of the brain that caused temporal lobe epilepsy, but now we believe other areas can be part of a seizure network,” Sharan says. “Maybe we should be targeting more than one laser probe and taking out multiple areas. It’s too soon to tell, though. I could stick six probes in at once, but we need to fully understand the technology before getting creative.” Although a lobectomy has been the recourse thus far when ablation hasn’t eliminated a patient’s seizures, surgeons are also looking to assess performing a second ablation instead. “I’m hoping a second laser would prevent any need for a lobectomy, but this hasn’t been explored enough yet,” Sharan says. “At this time, there is no solid data that can tell us whether ablation would be just as good as — or better than — a lobectomy.”
Evans says he is also interested in using ablation as a follow-up when a standard lobectomy doesn’t put an end to seizures. “Ablation doesn’t always have to be the first approach. Say someone has had a resection but continues to experience seizures and perhaps had undesirable side effects from surgery. If we could figure out exactly where an ablation needs to be, we could certainly do it and spare further complications.” Sperling calls it “heartbreaking” when patients improve after ablation but still continue to experience some seizures, then do not want to pursue additional procedures. “One of my patients went from 15 or 20 seizures per month to about one per month, and she’s happy to stop there,” he says. “Some patients settle for ‘good enough,’ but I think it’s worth it to go for a perfect outcome with lobectomy or possibly another ablation if the first procedure does not completely stop seizures.” While further research is needed to evaluate ablation and its advantages, laser technology has already significantly changed the treatment of epilepsy. “We are questioning all of our old paradigms. Look where we have come from and where we are going,” Sharan says, noting that although ablation patients currently remain in the hospital overnight, the procedure is so innocuous that sameday release is likely in the future. “Can you imagine that? Outpatient brain surgery — it’s going to happen,” he says.
How Hot is Hot Enough? Heat has long been known to damage tissue, and laser thermal ablation involves the destruction of tissue through its elevation to lethal temperatures. The “magic number” for ensuring cellular death within seconds is 60°C.
Above 100°C Intra- and extra-cellular water vaporizes; cell membranes rupture. 60°-100°C Proteins and cellular components instantly become denatured; tissue coagulates. 44°-59°C Damage depends on exposure time; critical enzymes can become denatured, and cell death can occur. Below 44°C Thermal damage does not occur regardless of exposure time.
14 Jefferson Medical College Alumni Bulletin
Breathing More Easily: ECMO Advances Extend Life Support By Gail Luciani
A few years ago, there was a craze of smoking wet cigarettes, which is marijuana dipped in PCP (phencyclidine), then formaldehyde. It gives you an LSD response. A couple of people who did this burned their lungs out from inhaling such a high level of formaldehyde. They were ventilated and put on ECMO at Jefferson. One patient, a 22-year-old woman, eventually recovered after 40 days on ECMO. That was a record. — Harrison Pitcher, MD, assistant professor of cardiothoracic surgery
Story summary Based on the heart-lung machine, ECMO technology has evolved in recent years. Advanced technology and a multidisciplinary approach to standardized patient management have improved outcomes. ECMO patients range from people who have had massive heart attacks to extreme cases of influenza. ECMO keeps patients alive, allowing organs to repair themselves or be replaced with transplantation.
Physicians know that extracorporeal membrane oxygenation, or ECMO, provides prolonged respiratory and cardiac support to patients whose lungs and heart are so severely diseased or damaged that they cannot function on their own. “But the first thing most of them think of when they hear ECMO is that it’s a death sentence,” says
SUMMER 2013 15
Left: Members of the Jefferson ECMO transport team include, from left: Gary Thompson; Jing Yang, MD; Hitoshi Hirose, MD, PhD; Kevin Kady; Ted Hesson; Brian Glynn; Amy Tropea; Nicholas Cavarocchi, MD; Bryan Nagle; Linda Reid; Steve Rosito; Raymond Birkmire; and John Roussis. Below: Robert Bartlett, MD, received an honorary degree at this year’s commencement ceremony in recognition of his lifelong work on ECMO.
Nicholas Cavarocchi, MD, director of the cardiac critical care unit and professor of surgery. “However, the ECMO of yesterday is gone and has nothing to do with presentday patient care management.” So what changed? ECMO technology had been the same since the launch of the heart-lung machine, developed at Jefferson 60 years ago by John Gibbon, Jr., MD ’27. It was a bypass device that took a patient’s blood, gave it oxygen, warmed it and returned it to the patient. ECMO was no different from the heart-lung machine in the OR. Big, cumbersome and costly, it tended to break down blood products, resulting in death from infection or bleeding for most patients. “Today’s ECMO machine, with its miniaturized circuitry, improved membrane oxygenator and centrifugal pump, is a completely different machine with the same concept. It helps avoid serious complications such as bleeding and hemolysis,” says Cavarocchi. “With current technology, we
can run patients on these external devices with minimal risk of infection, allowing the heart and/or lungs to recover.” At Jefferson, patients are placed on ECMO early, ideally before they have organ failure. This improves their chances of being successfully weaned from the device or having surgery with fewer complications. “Another thing that’s different is our multidisciplinary approach to patient management,” says Cavarocchi. “Our model combines the best ECMO technology with a team of cardiac physicians, nurses and mid-level providers all trained in complex critical care. Our standardized management of patient care uses established protocols that were built with evidence-based medicine. By standardizing patient management, we have improved overall results.” And those results are impressive. The program boasts survival rates that far exceed reported national rates — 60 to 70 percent for patients with life-threatening conditions, up from a previous zero-based
survival rate. “If patients die, it’s of their primary disease,” Cavarocchi adds. “ECMO can hold them for a period of time and can extend life, allowing organs to repair themselves or be replaced with transplantation.” The service is currently the only one in the nation led by cardiothoracic surgeons, rather than anesthesiologists or other medical doctors. Managing patients requires a massive amount of work, but that’s why the team is successful. “We’ve taken the randomness out of it, because we do the same thing every time,” says Harrison Pitcher, MD. “When you do the same thing every time, you learn and continuously improve.”
ECMO can begin with patient transport
ECMO patients range from people who have had massive heart attacks to extreme cases of influenza. “We had a patient who had been shot twice and was rushed to our ER, where the trauma team resuscitated him. He was doing well until he had a
16 Jefferson Medical College Alumni Bulletin
Photo by Lisa Godfrey.
“ Our model combines the best ECMO technology with a team of cardiac physicians, nurses and mid-level providers all trained in complex critical care.” — Nicholas Cavarocchi, MD
pulmonary embolism here on the floor and almost died,” says Pitcher. “We put him on ECMO and we saved his life.” Patients from other hospitals who transfer to Jefferson can start ECMO treatment as early as when they are being transported. A team of physicians and mid-level providers in the cardiovascular intensive care unit, JeffSTAT medical transportation and respiratory therapists use two devices — the SERVO-I ventilator and the CARDIOHELP (portable) ECMO machine — to place critically ill patients on ECMO for transport to Jefferson. “We have specially trained personnel and dedicated space in our CVICU, so we encourage physicians who think they have a patient for ECMO to contact us.
In fact, we currently have a collaborative relationship with area hospitals, including Aria Health System, St. Mary’s Medical Center, Chester-Crozer Health System, Atlantic Care and Geisinger Health System,” says Cavarocchi. Jefferson also serves as a medical partner with local chemical companies in the event of a chemical disaster. For example, the hospital has an exclusive contract with DuPont
Chemical for treating potential chemical burns that result in respiratory disease. DuPont Chemical manufactures phosgene, a nerve gas that can kill people within six hours if they are exposed to it. In May, DuPont Chemical conducted a mock disaster drill to practice handling just such an exposure. The JeffSTAT helicopter was dispatched, and the ECMO team transferred a mock patient to test coordination between the two organizations.
Online REsourCes For information about ECMO at Thomas Jefferson University Hospital, please visit jeffersonhospital.org/ecmo. To learn more about the 60th anniversary of the heart-lung machine, visit connect.jefferson.edu/heartlungmachine. Visit the transfer center online at jeffersonhospital.org/transfer.
SUMMER 2013 17
Extracorporeal life support
“Extracorporeal membrane oxygenation is not really an accurate description of what it has evolved to,” says Robert Bartlett, MD, professor emeritus at the University of Michigan Health Systems. “It’s really ‘extracorporeal life support’ because there is a lot more involved than membrane oxygenation. There is CO2 removal and improved blood flow. ECMO doesn’t treat anything — it just keeps people alive.” Bartlett received an honorary degree from JMC at this year’s commencement ceremony for his lifelong work on ECMO. He retired from active surgery six years ago but runs a lab that is working on new devices, such as implantable artificial lungs for children and an artificial placenta — a variation of ECMO that may be used for premature infants. “A lot of problems are caused by trying to make immature lungs breathe when they aren’t ready to. This device would take over the function of the placenta,” he says. Bartlett is also working on variations of the ECMO device to simplify the system and make it easier to use. As for the future, Cavarocchi sees devices becoming more miniaturized and microcircuit driven. “The artificial heart is now part of the Jeff system,” he says. “A patient could come off ECMO and have his heart replaced with artificial heart. We may see mechanical lungs in future. Currently, mechanical circulatory support devices all have some form of external connection, like energy. In the future, the energy source will be percutaneous; it might have a lithium battery or be nuclear or solar powered. There are even prototype percutaneous devices that work on ultrasound beam being tested.” Bartlett agrees that the device he is known for will continue to improve. “Like Dr. Gibbon’s experiments with the heartlung machine, what seems like a grand plan in fact started out as a single patient problem and a simple idea,” says Bartlett. “It’s still a work in progress.”
If you think you have a patient who is a good candidate for ECMO, call the Jefferson Transfer Center at 1-800-JEFF-121 (1-800-533-3121) and ask for one of the ECMO consultants. Together, you can plan your patient’s next steps.
You asked for it: Patient transfer made easy Call 1-800-JEFF-121 Sometimes you just have to ask. “A couple of years ago, several Jefferson alumni told us they would send more patients to the hospital if the process weren’t so difficult,” says John Roussis, physician liaison. “We took that advice to heart and created a center where dispatchers work side by side with the transport team and hospital coordinators.” The result is a centralized patient transfer system that handles details from the initial dispatch call to the hospital bed assignment. Transferring patients start receiving clinical care immediately, whether they are in an ambulance or a helicopter. Once the patient arrives, team members circle back to update the referring physician. Attending physicians in the Department of Emergency Medicine provide medical direction. “We have been using the transfer center since it opened in 2008,” says Kevin Bristowe, MD ’95, medical director of Emergency Services, Beebe Medical Center in Lewes, Del. “We are very happy with the level of the communication — calls are answered promptly, and our critical patients get to Jefferson quickly. We see a lot of cervical injuries from the surf in the summer due to our proximity to the Delaware shore, so Jeff’s transport team is important to our patients.” Physicians calling the transfer center can: •
Speak directly with an attending Jefferson physician — just ask.
•
Get the patient accepted for transfer to Jefferson. The center can facilitate transfer to the Surgical Cardiac Care Unit, Cardiac Catheterization Lab, Acute Stroke Center, Spinal Cord Injury Center, Level 1 Regional Resource Trauma Center and any other inpatient area at Jefferson.
•
Get a JeffSTAT ambulance or helicopter dispatched to pick up the patient stat. JeffSTAT has dedicated critical care transport nurses, paramedics and emergency medical technicians on duty 24 hours a day, seven days a week, supplying everything from basic life support, advanced life support and critical care ambulance services to air medical transport via a helicopter.
John Roussis of the Jefferson Transfer Center.
18 Jefferson Medical College Alumni Bulletin
Surprising Ties Between the
Titanic and Hematology Research at Jefferson By Elizabeth Seasholtz
On the infamous day of April 15, 1912 ,
the RMS Titanic hit an iceberg on its maiden voyage across the North Atlantic Ocean. Aboard the ship in one of the most expensive suites (featuring two bedrooms, a sitting room and a private 50-foot promenade) were Charlotte Drake Martinez Cardeza and her 35-year-old son, Thomas. Charlotte, Thomas and their two staff members all survived the night by escaping on one of the Titanic’s too-few lifeboats. Charlotte, the daughter of a British textile manufacturer and divorced widow of a successful lawyer, was a prominent
Philadelphia socialite with a colorful personality. She lived lavishly and was a frequent traveler, art buyer, yachtswoman and big game hunter. Prior to boarding the Titanic, she and Thomas were on safari in Africa, then hunting game on Thomas’s reserve in Hungary. The Cardezas boarded the Titanic with 14 steamer trunks, three crates of baggage and four suitcases. After the ship sank, Charlotte’s loss of property claim was the largest of any passenger, valued at $177,352 (a value of more than $4 million today). Her staggering loss of personal
possessions included a seven-carat diamond valued at $20,000 in 1912. Returning to her home in Germantown, Pa., Charlotte was known to be generous — in her will she even provided funds for the future funeral arrangements of her servants and their relatives. Her son inherited her generous spirit. Years later, Thomas’s wife, Mary Racine, was treated by a Jefferson physician for blood disease. This sparked a lasting relationship between the Cardezas and Jefferson, establishing a research foundation. Upon Thomas’s death in 1952, the family fortune of $5.5 million went to the
SUMMER 2013 19
Top: Charlotte and son Thomas Cardeza aboard their steam yacht Eleanor, ca. 1900. (TJU Archives & Special Collections) Middle: Charlotte Drake Cardeza Foundation lab, ca. 1961. (TJU Archives & Special Collections) Bottom: Cardeza Hemophilia Center today.
Popperfoto/Getty Images
Department of Medicine in Jefferson Medical College to establish the Charlotte Drake Cardeza Foundation for Hematologic Research. Today, the Cardeza Foundation supports faculty salaries, research programs, education programs and administration. “The Cardeza investment has allowed the department to thrive,” says Paul Bray, MD, director of the Foundation. “General hematology is not a high-paying discipline, so the Cardeza trust allows us to provide clinical care to patients at Jefferson and continue our research enterprise.”
The Foundation has a strong history in transfusion medicine, and currently the faculty has NIH grants that support platelet biology, including research on bleeding and clotting. The Cardeza faculty also focuses on genetic work, trying to identify genes that dictate a patient’s risk for bleeding and clotting. “The Cardezas’ generosity helps all major missions of the institution — research, education and clinical care,” says Bray. “Plus, what other academic enterprise can link its mission to an iceberg in the North Atlantic?”
Left: Charlotte Drake Martinez Cardeza. Image courtesy of the TJU Archives & Special Collections, Scott Memorial Library.
20 Jefferson Medical College Alumni Bulletin
Charitable Gift Ann u i t y P r o g r a m
A charitable gift annuity can provide you with payments for life while supporting the mission of Jefferson. The income from a charitable gift annuity is fixed at the time of the gift and will not vary over your lifetime. With the volatility of the economy and interest rates, this type of gift assures you an annual income that will not change.
For more information, please contact Fritz Ruccius at the Jefferson Foundation at 215-955-8733.
Jefferson Foundation recommends that you consult with your financial adviser on the best way to take advantage of this giving opportunity. THOMAS JEFFERSON UNIVERSITY AND HOSPITALS
SUMMER 2013 21
Jefferson Faculty Recognized
In April, three Jefferson physicians received prestigious awards. Howard Weitz, MD ’78, director of the Jefferson Heart Institute and the Bernard L. Segal Professor of Cardiology, and Geno Merli, MD ’75, senior vice president, chief medical officer and co-director of the Jefferson Vascular Center, were recognized as Masters of the American College of Physicians, a designation given to physicians who are among the most outstanding internists and teachers of their day. Randall Culp, MD, a surgeon with the Philadelphia Hand Center at Jefferson, received the 2013 Golden Apple Award from Health Volunteers Overseas, an organization committed to improving global health through education. Culp volunteers with the Honduras Hand Surgery program, performing surgeries and sharing his expertise in upper extremity surgery techniques.
Former Jefferson Surgeon Elected Mayor of Rome
Ignazio Marino, MD, former professor of surgery at Jefferson renowned for his work involving transplants, was recently
elected mayor of Rome, Italy. Marino left Philadelphia in 2006 to become a senator in Italy.
VEGF May Not Be Relevant Biomarker
The protein VEGF (vascular endothelial growth factor) does not appear to have prognostic or predictive value for men with locally advanced prostate cancer, researchers from Jefferson and other institutions found in a retrospective study published online in BMC Radiation Oncology. VEGF induces blood vessel growth, a key element in solid tumor growth and metastasis. It is overexpressed in various cancers and has been shown to help predict response to certain drugs. However, conflicting data has left its role in prostate cancer unclear. In one of the largest studies of VEGF expression in prostate cancer, Adam P. Dicker, MD, PhD, chair of the Department of Radiation Oncology, and colleagues found no statistically significant difference in pre-treatment characteristics among men with varying VEGF levels and no correlation between VEGF expression and overall survival, distant metastasis, local progression, diseasefree survival or biochemical failure.
“ What Every Healthcare Professional Should Know: A General Medical Update.” February 2 – 6, 2014 New Location! The Ritz-Carlton, Lake Tahoe Spend a week with Jefferson faculty at the Annual Alumni Winter CME Meeting. Renowned experts from several specialties will present. SELECTED TOPICS INCLUDE: • Raft Debate: Obesity • Clinical Pathologic Conference • Moving from Bench to Bedside • Healthcare Reform: Evolution or Revolution • International Medicine • Up in the Air: Travel Medicine Emergencies REGISTRATION FEE: Beginning at $595 (see website for details) includes: • All education sessions and CME Credit • Welcome Reception (Feb. 2) • Breakfast and afternoon snacks (Feb. 3 – 6) • One dinner ticket (Feb. 5) Guests welcome with additional ticket purchase • Access to additional area discounts See the full schedule, including additional topics, and registration information online: http://jeffline.jefferson.edu/jeffcme/AlumniCME
Questions? Contact the JMC Office of CME at 1- 888 - JEFF-CME or jeffersoncme@jefferson.edu The Ritz-Carlton, Lake Tahoe Room rates range from $259 to $489. To reserve a room book online at: www.ritzcarlton.com/en/Properties/LakeTahoe and use code “JFC.” Make your room reservations before December 17 to access special Jefferson rates.
Kane Invested as Korman Professor On May 9, 2013, Gregory Kane, MD ’87, became the Jane and Leonard Korman Professor of Pulmonary Medicine. Pictured are Richard Gozon, president of Thomas Jefferson University; Jane and Leonard Korman; Dr. Kane, and Mark Tykocinski, MD, dean of Jefferson Medical College.
Jefferson Medical College of Thomas Jefferson University is accredited by the ACCME to provide continuing medical education for physicians. Jefferson Medical College designates this live activity for a maximum of 16.0 AMA PRA Category 1 Credit(s).™ Physicians should claim only the credit commensurate with the extent of their participation in the activity. (Subject to change)
22 Jefferson Medical College Alumni Bulletin
Jefferson Faculty Roger B. Daniels, MD:
11th Annual Jefferson Awards Gala Honoree A practicing physician for 45 years, Roger Daniels is often asked when he’s going to retire. The question puzzles him. “Why would I retire? The same reasons I wanted to be a physician are the reasons I want to continue working now. As long as I can help patients, I want to continue practicing,” he says. Daniels has been treating patients at Jefferson since 1997, when then-JMC Dean Joseph Gonnella, MD, successfully brought him from his longtime position as an internist at Pennsylvania Hospital. Essential to his practice is a concern for his patients’ emotional health in addition to their physical well-being; he feels that trying to understand both is important.
Daniels’ skill in medicine has brought him many honors, including the 2008 Clinical Practice Award from the Pennsylvania Chapter of the American College of Physicians. In 2011, a group of his colleagues and patients at Jefferson joined to establish an associate deanship in professionalism in his name, and this October, he will receive the Achievement Award in Medicine at the 11th Annual Jefferson Awards Gala. Q: What is the best part of your job? A: W hat keeps me going is the opportunity to do something meaningful and significant for people every day. I’ve never
Photo by Sabina Pierce.
SUMMER 2013 23
really loved science — in fact, I love the arts more — but medicine’s human appeal drew me to my field.
laboratory, with its sophisticated measures, now tends too much to reduce the significance of the history and exam.
Q: What is your teaching philosophy? A: I want our interns and residents to learn primarily from our patients. House officers are often surprised by how much time I spend talking to patients, but we as physicians need to be good listeners because of the importance of their histories.
Q: What are some of your proudest moments at Jefferson? A: Having an associate deanship in professionalism named for me was a very proud moment. In medicine, my goal has always been to do the best I can and never to forget the seriousness of my responsibilities. Being recognized for that meant a lot to me.
Q: How has the practice of medicine changed throughout your career? A: At an earlier time, the most important part of a patient evaluation was the history and the physical examination. Laboratory testing helped to confirm or change diagnoses. Perhaps the
I am certainly extremely proud and surprised to be selected as honoree for this year’s gala, but I consider the event as much a tribute to Jefferson as well. I love being here and want to help secure support for a team that works hard to achieve its goals in education, research and clinical care.
Save the Date 11th Annual Jefferson Awards Gala October 30, 2013 5:30 p.m. Reception 6:30 p.m. Dinner and program
Honorees: Award of Merit: Leonard and Jane Korman Achievement Award in Medicine: Roger B. Daniels, MD Grand Ballroom Hyatt at the Bellevue 200 S. Broad Street, Philadelphia For more information or to sponsor the event, contact Phyllis Nangle at phyllis.nangle@jefferson.edu or 215-955-9136.
24 Jefferson Medical College Alumni Bulletin
ClassNotes ’51
Victor F. Greco, who collaborated with John Gibbon, MD ’27, on the development of the heart-lung machine and participated in the first surgery using the device, was recently featured in the alumni publication of his undergraduate alma mater, the University of Scranton. At 86, Greco remains active, continuing to teach and lecture. He lives in Drums, Pa.
’54
Donald Dubrow retired from private internal medicine practice 10 years ago and remains active reaping crops from the garden. He lives in Dallas and says he looks forward to seeing everyone during reunion weekend in October.
’56
Owen Chang writes that he recently had back surgery performed by James Harrop, MD ’95, director of the Division of Adult Reconstructive Spine at Jefferson. Chang says he has been pain free since the procedure, which took place just weeks before his 83rd birthday. He lives in Pennsauken, N.J.
’59
L. Reed Altemus spent the winter in Jekyll Island, Ga., to escape the cold weather in his home city of North Yarmouth, Maine. Lewis C. Druffner recently was awarded the annual Pittston Sunday Dispatch “Joseph F. Saporito Lifetime of Service Award.” Druffner has been retired for 13 years and for the past four years has been working at the Care and Concern Free Health Clinic at the University of Scranton.
’61
David K. Subin reports that he is enjoying semi-retirement, working half time evaluating eligibility for Social Security benefits. He lives in San Diego.
’65
Earl J. Fleegler says he plans to spend more time fly fishing in trout streams and salmon rivers. He lives in Ambler, Pa., and recently became engaged.
’66
Robert G. Timmons lives in Portales, N.M., and is working part time, primarily in outpatient clinic and hospital consults.
’67
Scott C. Stein has been the anesthesiology director at the Rand Eye Institute in Deerfield Beach, Fla., since 1991. He lives in Boynton Beach, Fla., and sends his regards to all of his classmates.
’69
Alan S. Bricklin reports that he is getting closer to complete retirement and is now working only six hours a week, signing out GI biopsies. Bricklin lives in Calabasas, Calif., and enjoys writing and spending time with his two grandchildren. Paul M. Weinberg, a pediatric cardiologist at the Children’s Hospital of Philadelphia, received the 2013 Distinguished Teacher Award from the American College of Cardiology (ACC) at its national conference in San Francisco in March. The award recognizes a fellow of the ACC for “innovative, outstanding teaching characteristics and compassionate qualities” resulting in “major contributions to the field of cardiovascular medicine at the national and/or international level.” Weinberg lives in Cherry Hill, N.J., and has been director of the fellowship training program in pediatric cardiology at CHOP for 22 years.
’74
Albert L. Blumberg was elected president of the American College of Radiology during
the recent ACR 90th Annual Meeting and Chapter Leadership Conference in Washington, D.C. Blumberg is vice chair of radiation oncology at the Greater Baltimore Medical Center and a practicing radiation oncologist with Radiation Oncology HealthCare, PA, in Baltimore.
D. David Dershaw has been awarded the gold medal of the Society of Breast Imaging (SBI). The medal is given once every other year to recognize outstanding contributions to breast imaging. Dershaw is a former president of SBI and emeritus director of the Breast Imaging Section at Memorial Sloan-Kettering Cancer Center. He has lectured worldwide and is frequently consulted by television, radio and print media. As an advocate for the breast imaging community, he has testified before Congress and advised the FDA, Veterans’ Administration and other government agencies. He lives in New York, N.Y.
’89
Raj K. Sinha has been practicing in Palm Springs, Calif., for the last 10 years. Sinha is the founder of S.T.A.R. Orthopaedics, Inc., and the Joint Replacement Hospital of America.
’90
Brian L. Schwam was recently named chief medical officer and worldwide vice president for regulatory affairs for Johnson & Johnson Vision Care. Schwam, an ophthalmologist and cornea and external disease specialist, joined Johnson & Johnson five years ago after practicing at the Mayo Clinic Jacksonville and in private practice. He lives in Jacksonville, Fla.
’97
Michelle Pelle is a dermatologist in San Diego and has two children, Michael and Sienna.
’78
Ira U. Smith recently earned board certification in hospice and palliative medicine from the American Board of Internal Medicine. Smith lives in Cherry Hill, N.J., and specializes in pulmonary and critical care with Samaritan Healthcare & Hospice in Marlton, N.J.
’84
Evan Y. Liu practices personal injury law and was named a 2013 Pennsylvania Rising Star by Super Lawyers, an attorney rating service. Rising Stars are attorneys who are 40 or under, or who have been practicing for 10 years or less, and are nominated by their colleagues for outstanding service. Liu lives in Media, Pa.
Send us your personal and professional updates for the Bulletin’s Class Notes! Contact Toni Agnes at 215-955-7751 or antoinette.agnes@jefferson.edu. Mail to: Toni Agnes The Jefferson Foundation 925 Chestnut St., Suite 110 Philadelphia, PA 19107
Alumnus Profile
SUMMER 2013 25
10 Questions with…
Nicholas Ruggiero II, MD ’01
Photo by Lisa Godfrey.
From a young age, Nick Ruggiero remembers making house calls with his father, a cardiologist, who told him the best part of being a physician was forming relationships with your patients. “We’d go see a patient, give them a shot of Lasix if they were in heart failure, and then sit and have coffee with the family at the kitchen table while waiting to see how the patient did,” Ruggiero recalls. “I loved it.” When it came time to choose a medical school, Jefferson was a natural choice — his father, Nicholas, is a 1966 graduate, along with his uncle Richard Soricelli, MD ’60, and cousin Aimee Soricelli, MD ’96. After initially thinking he wanted to specialize in orthopaedics, Ruggiero decided to follow in his father’s footsteps and pursue cardiology. He completed an internal medicine residency, chief medical residency and a three-year general cardiology fellowship at Jefferson then went on to complete two fellowships at Massachusetts General Hospital in Boston in vascular interventions and structural heart disease. Coming back to Jefferson after his fellowships, Ruggiero joined the catheterization laboratory. Now the director of structural heart disease and non-coronary interventions, he works to expand the scope of the lab, predominantly treating
peripheral vascular disease, valvular heart disease and structural heart disease, specifically valve implantations. “The big thing I’ve been working on for past two years is getting the percutaneous valve program up and running,” he says. “Instead of opening the chest to do valve implantation, we can now do it through a catheter in the groin.” Although his consultations are not happening around the kitchen table like his father’s, Ruggiero says patient interactions are “hands down” the best part of his job. “Patients come in and tell you their entire life stories, and they bring cute things for you, like rosary beads, tiny plates from places they’ve visited, cards, notes,” he says. “Those things, along with watching them get better, are worth all that we do.”
Ruggiero answers 10 questions about his career:
1. If you could work for a year in any location in the world, where would you do it? I would love to give a year back to my hometown: Wilkes-Barre, Pa. Growing up there made me who I am today. 2. If you weren’t a physician, what would you be? Wine-maker/grape-grower/ farmer. Our family has been making wine for more than 20 years.
3. Describe your time as a JMC student in one sentence. Some of the best years of my life. 4. What was the most fun you ever had in your career? My intern year, everything in medicine was new. Even little things like writing an order in the chart seemed like a major accomplishment. 5. W hat is your biggest pet peeve? A loss of dedication to patients and quality in medicine predominantly due to time constraints. 6. What do you daydream about? New inventions and procedures — and owning a winery someday! 7. If you had a theme song, what would it be? “Thunderstruck” by AC/DC. I wake up to it every morning. 8. What gets you out of bed in the morning? The challenge of the job, the chance to help others and the curiosity of what will happen every day. 9. What don’t people know about your field that you wish they did know? Interventional cardiology is rapidly expanding. We no longer treat only coronary lesions — we are performing valve implantations, fixing congenital defects and complex peripheral vascular interventions. 10. Who’s your personal hero? My dad. He started from impoverished beginnings, worked his way through school and honorably served his country. He loves his patients and his profession, but still has time to be a loving husband and great father. That’s a hero in my book.
26 Jefferson Medical College Alumni Bulletin
InMemoriam ’50
Frank McElree Jr., 87, of Greenville, Pa., died March 8, 2013. McElree completed his training at the University of Pittsburgh Medical Center and was chief surgical resident at West Penn Hospital from 1954 to 1955. He moved to Greenville to practice surgery and became the first medical director of emergency services for UPMC-Horizon. He later worked as a consultant for Diversified Family Services in Hermitage, Pa., and also served as deputy coroner in Mercer County, Pa., for more than 35 years.
McElree was a member of the American College of Surgeons, the American College of Emergency Medicine and the Mercer County Medical Society, of which he was also past president. He served as vice chairman for the Mercer County United Way; board member of the former Mercer County Crippled Children’s Society; and board member for the American Cancer Society. He is survived by his wife of 58 years, Geraldine; four children; one great-grandson; one nephew, and three nieces.
’53
Richard F. Robinson, 90, died Sept. 19, 2012, at Misericordia Nursing and Rehabilitation Center in York, Pa. Robinson was a U.S. Army veteran who served in World War II, taking part in the landing on Omaha Beach on D-Day. He fought in the Battle of the Bulge and was awarded the French Jubilee of Liberty Medal and the European African Middle Eastern Service Medal with five bronze stars. He interned at York Hospital and worked as a general practitioner in New Freedom, Pa., from 1954 to 1988. He is survived by his wife of 58 years, Marjorie, and two daughters.
’55
John O. Hewlett, 87, died Feb. 15, 2013, in Camp Hill, Pa. Following his internship and residency, Hewlett joined the Hershey Chocolate Company as the company physician. He also served as physician for the Milton Hershey School as well as Hershey Estates, the Hershey Bears Hockey Club and visiting teams. He practiced private family medicine until 1972, then spent a decade as the emergency room director at Holy Spirit Hospital in Camp Hill. He later worked as a staff physician at the Masonic Health Care Center in Elizabethtown, Pa., until his retirement in 1992. Hewlett is survived by three sons. His wife, Betty, preceded him in death.
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Franc Brodar, 87, of Tucson, Ariz., died Nov. 16, 2012. Brodar completed an internal medicine residency at Tucson Medical Center and worked for the public health service on the White Mountain Apache Indian Reservation until 1960. He opened a private practice in 1971, where he served his patients and community until 1997. He loved his family, gardening and trout fishing and spoke seven languages. He is survived by four of his five children, 14 grandchildren and four great-grandchildren. William Darling Inglis, 81, of Marblehead, Ohio, died Jan. 1, 2013, in Sandusky, Ohio, at Stein Hospice Care Center, where he was senior medical director. Inglis was the recipient of several honors including a U.S. Army commendation medal; the Annual House Staff Award for Teaching at Riverside Methodist Hospitals; the Prism Award for the Diversity Committee at OhioHealth; the Distinguished Educator Award from College of Medicine and Public Health at Ohio State University, and the Governor’s Community Service
Award from the American College of Chest Physicians CHEST Foundation. In 2012, he was named Person of the Year by the Midwest Care Alliance.
Inglis was a member of many professional societies including the American Academy of Hospice and Palliative Medicine; the American College of Chest Physicians; the American College of Physicians; the American and Ohio Thoracic Societies; the American Medical Association; the American Society of Internal Medicine; the Society of Critical Care Medicine; the Council of Hospice Professionals of the National Hospice Organization, and the American Academy of Home Care Physicians. He is survived by his wife, Suzanne, and three children. James C. Newton, 83, died suddenly Feb. 25, 2013, at his home in West Palm Beach, Fla. Newton was an ophthalmologist with a practice based in Manhattan, where he also served as professor and chairman of the Department of Ophthalmology at Columbia-St. Luke’s Roosevelt Hospital. He co-authored a number of scientific papers on retina and anterior segments. He was a Knight of the Order of St. John Hospital in Jerusalem, a member of the Certified American Board of Ophthalmology, a member of the Retina Society, a fellow of the American College of Surgeons and a fellow of the New York Academy of Medicine. He was also instrumental in the foundation of the American Society of Retina Specialists. He is survived by his wife of 56 years, Mary, and four children.
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Rudolph W. Bee, 77, of New Britain, Conn., died at home Nov. 8, 2012. Bee served in the U.S. Army Medical Corps and was a renowned eye surgeon
with a private practice in New Britain for 40 years. He was a diplomate of the National Board of Medical Examiners and a fellow with the American Academy of Opthalmology and the Royal College of Surgeons in Canada. He was a member of the Hartford County Medical Society, Connecticut State Medical Society, American Medical Association and the Connecticut Society of Eye Physicians. Throughout his career, his professional appointments included: clinical assistant professor of surgery, University of Connecticut Health Center; chief of ophthalmology, Castle Point Medical Center and VA Hospital; attending eye surgeon, New Britain General Hospital; consultant, State of Connecticut Veterans Home and Hospital; and attending eye surgeon, Bristol Hospital. He is survived by a daughter and seven cousins.
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William A. Browne died of cancer April 13, 2013. After completing his medical training, Browne returned to his hometown of Greenville, Ohio, to establish a family practice. In 1966, he was drafted as a physician and served as a captain in the U.S. Army. He returned to Greenville in 1968 and continued to practice there until 1985, when he became medical director of Miami University’s Student Health Service. During his time at Miami, he was instrumental in the design of a new student medical facility. Following his retirement, Browne gave full attention to his home in Ohio and to his beloved summer residence on Manitoulin Island in Canada. He loved fishing, reading and animals and cared for many stray dogs and cats. He is survived by his wife, Cornelia; three sons, Bill, Michael and Stewart; and five grandchildren. continued on page 28
SUMMER 2013 27
Marianne Ritchie, MD ’80, far right, with sisters Ellen Smith, Judy Freind and Toni Grosso.
Alumni Association President’s Message
Being a ‘Family Doctor’ As the youngest of four girls, I was a limb in a cohesive body known as the Ritchie sisters. When each of us married, we left the nest to see the world, but eventually we came home to roost. The Ritchie compound extended over a five-mile diameter with our parents in the center. The final grandchild tally reached 16. The oldest sisters were identical twins, mirror twins; one left-handed, the other right-handed. One had a natural left part and the other, a right part. When one lost her left eye tooth … you guessed it, her sister lost her right. Last summer, both twins were diagnosed with breast cancer within days of each other. True to form, Judy had an 8-millimeter growth in her left breast and Toni had an 8-millimeter lesion in the right. Twins to the end. In any crisis, the four sisters join forces and provide an infinite supply of love and support. But when there’s a medical issue, I morph into “go” mode. I am the medical lingo filter, the air-traffic controller, the
“family doctor,” especially when the word “cancer” is in the sentence. When I heard the diagnoses, I felt this compulsion to make the plans for each sister … my big sisters. They taught me how to ride a bike, make cupcakes, braid my hair and apply lipstick inside the lines! I could not, would not, let cancer take them. After all, I trained at Sloan Kettering. I had a plan. “Judy, don’t you want me to take you to Sloan Kettering for a second opinion?” “Toni, are you sure you’ve chosen the right surgeon?” My sisters were seasoned consumers … Judy had two sons with melanoma. Toni’s daughter has been ravaged by juvenile diabetes for more than 20 years. They had made medical decisions without me before. Was I interceding or interfering? As physicians, most of us will stand at this crossroad at some point in our lives. When a family member or friend faces critical medical decisions, we feel an obligation to maximize the opportunities for proper care and minimize the distress. But it is a tight rope that we walk.
I may question a decision made by the doctor in charge, but if my sister has faith in the physician, who am I to shake her confidence or disrupt their relationship? When several siblings gather around a parent’s bedside, who makes the final decision? Just because I’m a physician, should my opinion carry more weight? What we hope to learn with age and experience is that sometimes it is our job to be good listeners. My sister Ellen has inspired me to appreciate the value of this lesson. Imbued with a spirit of wisdom and generosity, she has an innate ability to soothe in the most difficult of situations. With guidance from the attending physician, patients have to feel as though they are making decisions for themselves. As the “family doctor,” I do the research, present the information completely and wait for an invitation to opine. I am always honored when any of my sisters requests my help. In the end, my sister Toni recuperated fully, and her focal cancer is cured. Judy, however, was overwhelmed by an aggressive form of the disease and slipped away in November. We gathered for Thanksgiving on Nov. 3, while she was still strong enough to enjoy one last family celebration. We knew there were so many reasons to give thanks. We prayed together, laughed together and wept together. Most importantly, we had the chance to say goodbye. In her final days, Judy thanked me for helping her fight an uphill battle. I wasn’t her doctor; I was her little sister. Every day is a gift.
Marianne T. Ritchie, MD ’80 President, JMC Alumni Association
28 Jefferson Medical College Alumni Bulletin
continued from page 26
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Benjamin P. Houser Jr., 75, of Lehighton, Pa., died Feb. 24, 2013. Houser completed an internship at Geisinger Medical Center in 1964 before joining the U.S. Air Force. He attained the rank of captain and was stationed in Cheyenne, Wyo., where he served as a flight surgeon during the conflict in Vietnam. He then completed a residency in ophthalmology at Wills Eye Hospital in Philadelphia in 1969, serving as chief resident during his final year. He took over his father’s practice in Tamaqua, Pa., and practiced ophthalmology in the area until retiring in 1998. He was on the teaching staff at Wills. Houser is survived by his wife and four children.
FACULTY
Stephanie Schulz, PhD, assistant professor in the Department of Pharmacology and Experimental Therapeutics, died March 9, 2013. Schulz earned a PhD in zoology from the University of Vermont in 1987. Her career included postdoctoral fellowships at Vanderbilt University and the University of Texas Southwestern Medical Center, where she was a Howard Hughes Fellow. She was a postdoctoral fellow with David Garbers, a member of the National Academy of Sciences and a Howard Hughes Investigator who was a leader in the field of membrane-bound guanylyl cyclase signaling. While working in Garbers’ laboratory,
Schulz identified and cloned guanylyl cyclase C, the intestinal receptor for the heat-stable enterotoxins, a global cause of bacterial diarrheal disease. She created essential tools, including a genetic mouse model, for those studies. Schulz joined Jefferson’s faculty in 1994 and became a leader of the team that discovered the importance of guanylyl cyclase C as a key biomarker that predicts risk of recurrence and response to chemotherapy in patients with colorectal cancer; as a target for chemoprevention of colorectal cancer; as a vaccine target for the secondary prevention of
colorectal cancer, and as a novel target for appetite suppression to treat obesity. This seminal work produced more than 60 peerreviewed publications and more than 50 patents. A cancer survivor from age 25, Schulz overcame the long-term physical debilities resulting from treatment. She was an animal lover, a birdwatcher and a supporter of animal protection groups. She is survived by her parents, Carol and Robert; her brother, Eric, and his wife, Amy; her sister, Alexandra, and her husband, Steven; three nephews, and two nieces.
Art
Medicine How Art Can Make Better Doctors
November 2 + 3, 2013 Philadelphia, PA
A two-day symposium sponsored by Elsevier, publisher of Frank H. Netter’s landmark Atlas of Human Anatomy and Jefferson Medical College will coincide with the annual meeting of the American Association of Medical Colleges, November 1 – 6. The symposium will invite physicians, artists, writers, educators and students to discover the role that the arts can play in medical education, patient care and professional development through lectures, discussions and exploration of issues of empathy and patient interaction. Guest Speakers + Panel Discussion 10 a.m. – 12:30 p.m. Saturday, November 2, 2013 Connelly Auditorium/Hamilton Building Walnut and Locust Streets
Museum Experience 5 p.m. – 7 p.m. Sunday, November 3, 2013 Pennsylvania Academy of the Fine Arts 118 North Broad Street
For more information, please contact Salvatore Mangione, MD, at Salvatore.Mangione@jefferson.edu.
The
By Numbers
Sources: The American Red Cross and the Jefferson Blood Donor Center.
Summer 2013 29
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