GrandRounds

Spring 2013

Saint Louis University School of Medicine

Pediatric Cardiologys Growth Spurt

Adult Cardiology Teams Combine

Learning by Doing

From the Dean | Saint Louis Universitys School of

Medicine has had a rich tradition of leadership in the diagnosis and treatment of cardiovascular diseases. Doctors Hanlon, Willman and others continue to be celebrated for their achievements at SLU, even though most of their accomplishments occurred decades ago. Its heartening to see the banner of cardiovascular leadership begin to rise again at SLU. This issue of Grand Rounds introduces SLUs new cardiovascular leaders and their programs to you with the focus on the patients and students who will benefit from their skills. These new SLU ventures at the forefront of cardiovascular medicine help to reassure us that real progress and leadership can be achieved even during challenging times in the field of health care. As our nations health care costs continue to rise and a national spending sequester is being enforced, most experts predict that cost cutting is the future focus for the medical community. Progress is more difficult in such times because program building requires front-end investments and risks. The rewards of such investments, however, can be substantial. SLUs new cardiovascular programs, the pediatricians who have reacquired NIH grants after periods of local bridge funding and the new simulation training facilities at SLU all highlighted in this issue of Grand Rounds are just a few such examples. So we will continue to invest and look to our alumni, our grateful patients and other friends to help support a future that is aligned with the priorities of a new and more cost-effective American health care system. The programmatic and fiscal approaches that worked in the eras of Hanlon and Willman no longer guarantee success, but the fundamental goals are the same, i.e., to educate and mold great physicians of tomorrow, to provide outstanding health care through leadership, investigation and innovation, and to always do more to serve the underserved. This issue of Grand Rounds reminds us that SLU remains committed to achieving and sustaining these missions.

Grand Rounds is published biannually by Saint Louis University Medical Center Development and Alumni Relations. Grand Rounds is mailed to alumni and friends of the School of Medicine. Philip O. Alderson, M.D. Dean|Saint Louis University School of Medicine Vice President|Medical Affairs Schwitalla Hall M268 1402 S. Grand Blvd. St. Louis, MO 63104-1028
Grand Rounds Editorial Board

Keeping the Beat

Pediatric cardiology expands to meet demands and exceed expectations.| page 6

Taking the Lead

page 10

New Comprehensive Cardiac Care Center breaks tradition and benefits patients.|

Learning by Doing
page 14

Philip O. Alderson, M.D. Edward J. OBrien Jr., M.D. 67 Cheryl Byrd Coordinator and Writer|Marie Dilg|SW 94 Designer|Dana Hinterleitner Laura Geiser|A&S 90|Grad 92 Nancy Solomon Carrie Bebermeyer|Grad 06 Riya V. Anandwala Steve Dolan|front cover, 1, 6-9, 12, 14-17 Riya V. Anandwala|4, 18-19 Carrie Bebermeyer|Grad 06|2 Cardinal Glennon Public Relations|4, 8-9, 10, 19 President| Edward J. OBrien Jr., M.D. 67| St. Louis Emil DiFilippo, M.D. 66| St. Charles, Mo. James T. Merenda, M.D. 82| St. Louis Leroy F. Ortmeyer, M.D. 55| St. Louis Joan M. Pernoud, M.D. 74| St. Louis Keith M. Starke, M.D. 81| St. Louis Thomas F. Lieb, M.D. 82| St. Louis Anne T. Christopher, M.D. 94| St. Louis
Photo and illustration Credits magazine Contributors

Expanded Clinical Skills Center allows students to develop diagnostic competencies.|

Pediatric Researchers Rise to the Challenges

Using NIH dollars, SLU researchers tackle childhood diseases.| page 16

Match Day

Alumni Executive Board

Fourth-year students celebrated Match Day 2013 at the St. Louis Cardinals Redbird Club at Busch Stadium.| page 18

Ellen M. Nicastro, M.D. 04| Chesterfield, Mo.

GrandRounds
Saint Louis University School of Medicine Vol. 11 No.1

Terrence A. Tyrrell, M.D. 73| Belleville, Ill.

Jane Willman Turner, M.D. 92| St. Louis

Spring 2013

Peter Kong-Woo Yoon, M.D. 81| St. Louis 2013, Saint Louis University All rights reserved

Vital Signs | page 2 Alumni Pulse | page 20

On the cover

I Give Because | back

Philip O. Alderson, M.D. Dean | Saint Louis University School of Medicine Vice President | Medical Affairs

For more information about the magazine or to submit story suggestions, please contact 314 | 977-8335 or grandrounds@slu.edu.

Five-year-old Orion Smithey energetically tackles the obstacles on his favorite playground, which is amazing given the obstacles Orion faced as an infant. Born with several congenital heart defects, Orions mother, Julie Smithey, said the cardiologists and cardiac surgeons at SLU saved her son.|page 6

VitalSigns
Saint Louis University investigators with collaborators from the University of Missouri and the University of Pittsburgh have reported a breakthrough in the pursuit of new hepatitis B drugs that could help cure the virus. The researchers were able to measure and then block a previously unstudied enzyme to stop the virus from replicating, taking advantage of known similarities with another major pathogen, HIV. John Tavis, Ph.D., study author and professor of molecular microbiology and Tavis immunology at SLU, said the finding may lead to drugs which, in combination with existing medications, could suppress the virus far enough to cure patients. Hepatitis B is the major cause of liver failure and liver cancer worldwide, Tavis said. This would have an extremely positive effect on liver disease and liver cancer rates. World health experts estimate that more than 350 million people are chronically infected with the hepatitis B virus. Several drugs are able to treat symptoms successfully, though they are not able to cure many patients. Of those infected with hepatitis B virus, up to 1.2 million die from liver failure and liver cancer each year.

Hepatitis B Breakthrough Could Reduce Liver Cancer Worldwide

While existing medications are powerful, they cannot quite deliver the knockout punch to hepatitis B. The drugs we have are very good drugs, Tavis said. They push the virus down, but they cant quite kill it. Theyll still do the heavy lifting in the future, but with an additional drug I hope well be able to mop up the rest. Together, they may be able to do it. We dont have a big distance we need to travel to reach that point. Like HIV, the hepatitis B virus replicates by reverse transcription. Viral DNA is converted to RNA and then converted back to DNA by two viral enzymes, both of which are vital to the viruss replication. The first of these enzymes, a DNA polymerase, has been well studied but the second enzyme, ribonuclease H (RNAseh) has eluded investigators. After years of work, Tavis and his team were able to develop an assay for RNAseh, allowing him to study the enzyme and test promising theories as to how to block it. Using techniques that stopped HIV, including inhibitors of HIV RNAseh, researchers found they could also inhibit the hepatitis B virus RNAseh. With these promising advances, Tavis said the search an anti-hepatitis B RNAseh drugs is now feasible. And using similar anti-HIV compounds as a guide is likely to lead to success. Their research is published in the Jan. 24 edition of PLOS Pathogens.

Vitamin D Holds Promise Against Deadly Breast Cancer

SLU researchers have discovered a molecular pathway that contributes to triple-negative breast cancer, an often deadly and treatment resistant form of cancer that tends to strike younger women. Their results were published in the Jan. 17 issue of The Journal of Cell Biology. In addition, Susana Gonzalo, Ph.D., assistant professor of biochemistry and molecular biology, and her team identified vitamin D and some protease inhibitors as possible new therapies and discovered a set of three biomarkers that can help identify patients who could benefit from the treatment. In the recent breakthrough, which was funded in part by a $500,000 Department of Defense grant, Gonzalos lab identified one pathway that is activated in breast cancers with the poorest prognosis, such as those classified as triplenegative. These cancers often strike younger women and are harder to treat than any other type of breast cancer. Women who are born with BRCA1 gene mutations are at increased risk for developing breast and ovarian cancers within their lifetime, and the tumors that arise are frequently the triplenegative type. Although chemotherapy is the most effective treatment for triplenegative breast cancer, it has profound secondary effects. Understanding the biology of triple-negative breast cancers will help develop less toxic therapeutic strategies. Experiments performed in Gonzalos laboratory showed that activation of a novel pathway not only allows tumor cells to grow unchecked, but

also explains the reduced sensitivity of these types of tumors to current therapeutic strategies. Importantly, vitamin D plays a role in turning off the pathway, which may provide a safe and costeffective strategy to fight these types of tumors.

Giving Thanks for the Final Gift

Ritalin May Help Patients with Alzheimers Disease

Researchers at SLU are studying methylphenidate, more commonly known as Ritalin, as a therapy for apathy and fall risk in those who suffer from Alzheimers disease. The only site for the study, SLU received a $183,540 grant from Noven Pharmaceuticals, Inc. to conduct the pilot investigation. Apathy is a common problem for those with Alzheimers disease, affecting approximately 70 percent or more of patients. Apathy can be frustrating for loved ones, said George Grossberg, M.D., director of geriatric psychiatry and principal investigator for the study. Its late afternoon, and their parent or spouse has zero motivation to do anything. There is, however, some evidence that stimulants like methylphenidate may be able to help. Co-study investigator at SLU, Ahmed Baig, M.D., said apathy also is connected to the risk of falling. He says that although extensive research has been conducted to try to understand the factors involved in falls, the number of falls and fall-related injuries in the elderly continue to rise, creating a need for additional treatment options to more effectively reduce risk.

The first Gift Body Memorial Service in 1994 was held inside the hospital chapel.

In 1994, soon after being named associate director of the School of Medicines Gift Body Donor program, Margaret Cooper, Ph.D., professor in the department of surgery, searched for a way to reflect the deep appreciation that students and faculty have for donors. These donors do something very special, she said. They give their bodies so others can learn, and I felt we needed some way to honor them. She arranged for what she thought would be a small thanksgiving service in the Saint Louis University Hospital chapel for students and medical center faculty. It was standing room only. The following year, the Gift Body Memorial Service moved outside to Caroline Mall and she invited family members and friends of the donors. More than 600 people attended that year, the same year the school dedicated a memorial stone on the mall in honor of the donors. Over the years, the service and the number of guests has continued to grow. Approximately 1,500 students, faculty, and donor families and friends gathered last fall at St. Francis Xavier College Church the new location for the service to honor the more than 400 people who had donated their bodies to the school in 2012. While Cooper initiated the service, she gives credit for its continued significance to the medical students. They are responsible for the program, prayers, flowers, reflections and music. First-year medical student Tyler Zahrli, who was an undergraduate theology major at SLU, took a philosophical approach in his reflection at the service. This piece was really for the family members, Zahrli said. Because we are the only connection to their loved ones, it was an opportunity for them to see what we will be getting out of this

program academically as well as personally. Cooper said the service also represents closure for many family members. Sometimes its hard for family members to grasp why their husband or mother or sister made this contribution, she said, But the family members come to the service and see how caring, respectful and grateful our students are, and they understand. Saint Louis University School of Medicine has the largest body donor program in the state. Daniel Tolbert, Ph.D., professor and director of the Center for Anatomical Science and Education, said he believes the service has something to do with that. People put their trust in institutions that are faith-based, he said. People trust us because were Catholic, and they know well do the right thing. This service is the right thing. Cooper is retiring this year, and while she has been the force behind the memorial service, she expects it will carry on long after she leaves. Students value the memorial service, she said. Even if preparations cut into their study time they know what it means to donor families and what those donors have done to advance their education. Years from now when they look back on their medical school years, I guarantee the students will remember the service because its so beautiful.

 These donors do something very special. They give their bodies so others can learn, and I felt we needed some way to honor them.
Margaret Cooper, Ph.D. Professor, Department of Surgery

Grand Rounds Saint Louis University School of Medicine

Outcomes for Obese Kidney Transplant Recipients

In a research review article published in the American Journal of Nephrology, SLU investigators examined data from multiple studies to better understand the impact of obesity on kidney transplant patients. The authors report that, even as some connections between weight and health outcomes are unknown or contradictory, there is evidence that obese kidney transplant patients do not do as well after surgery. They experience more adverse outcomes, including wound infections, delayed graft function, graft failure, cardiac disease and increased costs. Led by Krista Lentine, M.D., associate professor of internal medicine in nephrology, and Betsy TuttleNewhall, M.D., director of abdominal transplantation at SLU, the authors examined multiple studies and concluded that the health outcomes of

patients with higher body mass indices (BMI) are not as good. In addition, they found several areas where more study is needed to make clear and consistent recommendations about kidney transplants for heavier patients. Lifestyle alterations that seem reasonable to improve health outcomes should be encouraged, Tuttle-Newhall said. Just as we require patients with alcoholic liver disease to stop drinking prior to transplant, it is reasonable to ask kidney transplant candidates to lose excess body fat and attempt to increase lean muscle mass by becoming more physically active and modifying their diet. The authors say future investigations should seek to determine the upper BMI limit at which point kidney transplantation should not be recommended for obese patients. In addition, researchers note the limitations of BMI alone as a measure of body fat and suggest further research using more refined measures.

Dr. Thomas Westfall Steps Down as Chair

Tuttle-Newhall and Lentine

Chair of the department of pharmacological and physiological science for more than 33 years, Thomas C. Westfall, Ph.D., stepped down in January. During his nearly 50 years with Saint Louis University, Westfall has served as a researcher, educator and leader in the field of pharmacology. He will remain on staff with the department as a faculty member. His dedication to graduate training and to medical education was the foundation of his career, said Mark Knuepfer, Ph.D., professor of pharmacological and physiological science. Despite making several important observations in his research and becoming an international expert in the role of catecholamines and neuropeptide Y in vascular function and hypertension, he cherished his graduate program and sent every student from the department with the same exhortation: Do great research and make us proud. For former student T. Vivian Ishimaru-Tseng, M.D., Westfall was the most influential professor throughout her medical career. At one point during my medical training, I felt so overwhelmed that I began looking at the option of leaving medical school and not becoming a physician, said Ishimaru-Tseng, who is now the medical director at Hawaii Medical Center East in Honolulu. However, Dr. Westfall and his team believed that I could succeed in spite of some of my struggles. We moved forward in faith, and not only

did I go as far as winning second place in a research contest, I graduated from medical school as scheduled and even had a baby during my third year, making me and my husband the happiest and busiest couple in the class of 92. Throughout his career, Westfall also has secured more than 28 NIH grants, which totaled 103 years of support with more than $12 million in funding. He also authored more than 200 peer-reviewed papers, articles and book chapters. In honor of Westfalls years of service, former graduate students and faculty created the Thomas C. Westfall Graduate Student Fellowship, which assists students in their future research endeavors. It is expected to further Westfalls mission of training scientists to elucidate the causes of human diseases using physiological and pharmacological techniques. To give to the Thomas C. Westfall Graduate Student Fellowship, visit giving.slu.
edu/med.

New Members Appointed to SLUCares Executive Leadership Team

Following a national search, SLUCare named Gary Van House as its new chief executive officer. Van House has worked in the health care industry for more than three decades, specializing in physician practice management. He has served a wide range of health care organizations, including large multi-specialty physician groups, community hospitals, multi-facility hospital systems,

a health plan with more than a million members and national health care systems. He is Van House experienced in finance, governance, strategic planning and operations. Most recently, Van House had been a managing director at Huron Consulting Group in Chicago, guiding hospital systems and their medical groups in performance improvement initiatives. Kathleen Merlo, director of Saint Louis Universitys compliance department, has been selected as SLUCares chief operating officer. Merlo oversees and coordinates all practice operations for the 500-plus physician practice group. Merlo has extensive experience creating and executing new programs that are more efficient, save money and increase revenues. As director of the Universitys compliance department since 1999, Merlo developed and implemented many initiatives including: University Medical Group physician Merlo and provider documentation and billing practices; programs protecting patient privacy; and compliance education programs.

Researchers at SLU will use a three-year, $460,000 grant from the Maternal Child and Family Health Coalition (MCHFC) and St. Louis Mental Health Board to expand efforts to detect and treat postpartum depression in new mothers. Currently, SLUCare pediatricians and pediatric nurse practitioners at SSM Cardinal Glennon Childrens Medical Center screen new mothers for postpartum depression during routine well baby visits for the first two months of the childs life. The new project, Happy Mothers, Healthy Families, expands the program to include screenings during the first six months of well baby visits. The new expanded program also will offer on-site counseling and case-management services to help ensure moms get the treatment they need. Postpartum depression affects the whole family, said Matthew Broom, M.D. (03), assistant professor of pediatrics and project team leader. Children of depressed mothers are more likely to have developmental delays and attachment issues, and are at greater risk for behavior problems down the road. As pediatricians, our No. 1 goal is to have healthy children, and healthy mothers raise healthy children.

Grant Supports Study of Postpartum Depression

Sophia Chung, M.D., has been named the Dr. Walter F. and Sharon Ryan Davisson Endowed Chair in Ophthalmology. Chung came to the University in 1990, joining the department of ophthalmology and neurology, where she has continued to serve as a fulltime faculty member for the last 23 years. Chung, a current member of the American Board of Ophthalmology, has served on numerous Chung boards and committees, has been a principal investigator for NEI-sponsored studies, and recently was honored as a recipient of the Senior Achievement Award last November. Chung has received five teaching awards, three best lecturer awards and was among the first recipients of the Distinguished Teacher Award for the School of Medicine. The Dr. Walter F. and Sharon Ryan Davisson Endowed Chair in Ophthalmology was established in 1993. When we created the Davisson Chair of Ophthalmology 20 years ago, our aim was to advance the mission of the University, namely to educate and improve the students who study here, Walter Davisson, M.D., said. We cannot emphasize enough give back for your education; its what made you who you are and put you where you are today. For more information about giving to the School of Medicine, visit giving.slu.
edu/med.

Ophthalmology Professor Named to Endowed Chair

Beyond VitalSigns
To read more about the research and events at the Medical Center, click on the Beyond Vital Signs link at medschool. slu.edu/alumni or check out SLU Health News on Facebook. Once you like SLU Health News, you can get updates in your Facebook news feed and participate in discussions. Some of the stories youll find:

SLU Researchers receive a $1.8 million grant to study lupus Pilot TB study could accelerate vaccine discovery Regions first outpatient bone marrow transplant program opens Faculty Honors

VitalSigns

Grand Rounds Saint Louis University School of Medicine

The School of Medicines pediatric divisions of cardiology and cardiothoracic surgery are in the midst of a dramatic growth spurt. The number of cardiac surgeries almost doubled between 2011 and 2012. Cardiac catheterizations are up 20 percent. The number of echocardiograms exceeded 7,000 in 2012, and outpatient visits climbed to more than 4,300. Impressive statistics to be sure, but the number Julie Smithey finds most remarkable is 90. Her five-year-old son Orions blood oxygen saturation level exceeded 90 percent after undergoing a transcatheter interventional procedure last December. Orion was at 84 percent before the catheterization, Smithey said. He was used

to having blue toes and blue lips, but after the catheterization his toes pinked up. Hed never had pink toes before. He couldnt wait to take off his shoes and show everybody. Smithey was 21 weeks pregnant with Orion when she learned he had a form of heterotaxy syndrome, a rare congenital condition associat-

ed with multiple heart defects involving the systemic and pulmonary veins, the pulmonary arteries, and in Orions case, significant underdevelopment of the left ventricle. Orion was just 24 hours old when he had his first of six cardiac catheterizations. He was seven months old when he had the first of two openheart surgeries. Orion is now an active pre-schooler who runs rings around his classmates, loves animals and is looking forward to kindergarten. He has completed all three stages of the surgery required to repair his defect and is seen for follow-up every four months. He has amazed me, Smithey said. It was touchand-go so many times, and yet, here he is, going strong.

ABOVE Orion showing off his pink toes.

race around the playground would know he was born with severe heart defects.

LEFT No one watching five-year-old Orion

Keeping the Beat

Pediatric Cardiology Expands to Meet Demands and

Exceed Expectations

Grand Rounds 7

Al-Jureidini

Huddleston

Fiore

Schowengerdt

1. Saar Danon M.D., assistant professor pediatrics, Al-Jureidini, M.D., professor of pediatrics, and Andrew C. Fiore, M.D., professor of cardiothoracic surgery, perform procedures concurrently in the hybrid catheterization lab. 2. Orion at play 3.Schowengerdt listens to Orions heart.

Beyond Bricks and Mortar Less Is More

SLUs interventional cardiologists also are helping children avoid major surgery to repair holes in the heart by using catheters to guide placement of a device to close holes between heart chambers. They are utilizing catheters to insert coils and vascular plugs to occlude abnormal vessels, and also to insert stents to enlarge necessary vessels that have become abnormally narrowed. In selected instances, some ventricular septal defects even may be closed by catheter-based techniques. Last year they also began using the Medtronic Melody Transcatheter Pulmonary Valve and Ensemble Delivery System, which involves passing a folded valve mounted within a stent through a catheter and expanding it in the appropriate position within the childs heart to replace a diseased and/or leaking pulmonary valve. Interventional procedures lessen trauma, shorten duration of hospital stays, and our results are excellent, said Saadeh Al-Jureidini, M.D., a professor of pediatrics who performed all but one of Orions six catheterization procedures. Jureidini has practiced interventional techniques at Cardinal Glennon since 1984, when the specialty was emerging. The hybrid suite takes us beyond anything weve been able to do in the catheterization lab before.
2 Perhaps the most significant expansion to the cardiology programs relates to personnel. Since Schowengerdt became director of cardiology in 2006, the number of faculty has increased from four to 10 cardiologists, with another cardiologist scheduled to join the group this summer. Schowengerdt is continuing to recruit to deal with patient volume. He also revived the cardiology fellowship program, and the first fellow arrives in July. A key faculty recruit in 2011 was Charles B. Huddleston, M.D., professor of surgery. Huddleston is a highly respected cardiothoracic surgeon in the St. Louis region and a recognized expert in pediatric heart surgery, heart transplantation and congenital heart disease. He joined the School of Medicine from St. Louis Childrens Hospital, where he spent two decades of his career. I was drawn to Cardinal Glennon by the opportunity to work in a family-oriented environment where parents are welcome to participate in our care of their children, Huddleston said. I also can work with the latest diagnostic tools and therapeutic technologies to benefit our patients. Huddleston and fellow cardiothoracic surgeon, Andrew C. Fiore, M.D. (77), professor of cardiothoracic surgery in the School of Medicine and director of pediatric cardiac surgery at Cardinal Glennon, comprise the most experienced pediatric cardiothoracic surgery team in the region. A key to our success is having a group of physicians, physician assistants and nurses who work in a collegial and completely unselfish manner with the goal of achieving excellence in caring for children with complex congenital heart disease, said Fiore, who has been the with the School of Medicine since 1989. We are growing because we have that. We also are growing because the administrations at Cardinal Glennon Hospital and at the School of Medicine are totally committed to our mission. Another key to achieving excellence is that no one is preoccupied about who should receive credit for our success, he said. We dont focus on ourselves; we help each other and focus on our patients. Which brings us back to the numbers. For the combined years of 2011 and 2012, Cardinal Glennon Hospital had a greater than 99 percent survival rate for patients who received treatment for congenital heart defects.

Risk Reduction

Orions cardiac surgeries were performed at SSM Cardinal Glennon Childrens Medical Center, now home to the only pediatric hybrid cardiac catheterization suite in the St. Louis metro area. The suite, opened in 2011, enables interventional cardiologists and cardiovascular surgeons to work together simultaneously to repair heart defects in the most minimally invasive manner possible. For example, initial treatment for infants with hypoplastic left heart syndrome, a condition in which the left side of the heart and aorta are severely underdeveloped, usually requires an open-heart procedure that can last up to six hours while the infant or child is connected to a heartlung machine. Infants who are particularly small or have other conditions that make them high-risk candidates for the surgery, however, can undergo a hybrid procedure in the lab that takes only 60 to 90 minutes. During the hybrid procedure, an interventional cardiologist inserts a stent to keep a vascular structure open, thereby ensuring a stable source of blood flow to the body, while a surgeon opens the chest and places partial ligatures on the artery to each lung to limit pulmonary blood flow. While the surgeon still has to open the chest, we avoid having to place the baby on cardiopulmonary bypass, or the heart-lung machine, and stop the heart, said Kenneth O. Schowengerdt Jr., M.D. (84), Wieck-Sullivan Professor of Pediatrics, director pediatric cardiology and medical director of the Dorothy and Larry Dallas Heart Center at Cardinal Glennon Hospital. This decreases the risk of the procedure significantly.

Picture This

 He has amazed me. It was touch-and-go so many times, and yet, here he is, going strong.
Julie Smithey mother of Orion

The suite is only one of the highly specialized services Cardinal Glennon has developed during the last few years to treat children with congenital heart defects, the number-one birth defect worldwide. The hospitals Dallas Heart Center opened in 2009 with nine exam rooms, four echocardiography suites, a fetal echocardiography lab to find heart problems in babies still in the womb, and an exercise stress testing lab. Doctors have access to the latest digital technology, including a cardiac ultrasound machine that allows physicians a real-time, 3-D view of a childs heart. In 2013, Cardinal Glennon Hospital opened a new $8.7 million Imaging Center that offers the lowest radiation dose available for high resolution pediatric CT scans in St. Louis. It also includes an interactive MRI suite that enables children to control the color of the lighting and the theme of their MRI experience through an iPad. The Imaging Center allows another means of evaluating our patients in a non-invasive way, Schowengerdt said, And sometimes we can get the cardiac information we need from an MRI rather than a catheterization. Schowengerdt said phase two of cardiologys expansion in 2014 will add more exam and echocardiography rooms to the Dallas Heart Center.

8 Grand Rounds

Taking the Lead

New Comprehensive Cardiac Care Center breaks tradition and benefits patients
When you fuse two historically separate and sometimes competitive specialties cardiology and cardiac surgery into one unique comprehensive care center, there are bound to be skeptics. Michael Lim, M.D., associate professor, director of the division of cardiology and co-director of the new center, is determined to erase their doubts. Instead of working at cross purposes, were working together to offer to our patients a full array of heart care options, Lim said. We must be on the right track because our patient volume is up significantly. Thats what happens when you put patients first.

Surgeries have increased significantly since Richard Lee, M.D. returned to Saint Louis University Hospital last fall.

Grand Rounds 11

Michael Lim, M.D. and Richard Lee, M.D. direct the C4 with a shared vision that offers patients more treatment options and better outcomes.

From catheterization, to open surgery, to thoracoscopic surgery, to medical therapy and ablation, we collaborate to make care decisions with the patient, Lim said. The C4 also is working to build bridges with other departments, including the department of neurology and psychiatrys Souers Stroke Institute at SLUCare. Knowing that a significant number of strokes are cryptogenic in nature, the C4 has partnered with the stroke team to utilize implantable cardiac loop recorders to detect arrhythmias, such as atrial fibrillation often found in patients at high risk of stroke. Lee and his C4 team believe that using these Reveal implantable loop recorders, thin devices implanted just beneath the skin, will provide patients and their neurologists with more accurate data for identifying patients at risk. Patients arent the only ones who benefit from the team approach. Medical students, residents and cardiac fellows are being taught in this new paradigm. A huge part of our mission is education, Lim said. Our students will see something not seen at many institutions. They will see leading-edge procedures. They will see a surgeon and cardiologist with offices right next to each other taking care of the same patient at the same time and bringing care back to the bedside, where it should be.

Measure of Success
Fewer than three months after the University took the lead, Lee said he began receiving calls from colleagues interested in visiting SLU to see how the C4 functions. He has plenty to show. Since October 2012, patient volume has increased significantly, and Lee is on track to triple the number of cardiac procedures he performs in 2013. He hopes to hire more surgeons to help absorb the workload and expand the center. We had a very thoughtful plan going in but had no idea wed be this far this fast, Lee said. Weve already reached our three-to-five year mark. Lim and Lee said patient volume is just one aspect of building a sustainable C4. We recognize its important for us to be fiscally responsible but to be truly innovative we need to be at the forefront of research, Lee said. To get that edge, the C4 is creating a board of community business leaders charged with securing research funding for all aspects of cardiovascular care, including prevention. Lim and Lee said getting people to buy in shouldnt be difficult when they consider that heart disease is the nations leading killer and that C4 is breaking new ground in the battle against it.

Putting patients first is the driving force behind the Center for Comprehensive Cardiovascular Care or C4. The operational home for the center being developed within Saint Louis University Hospital includes a new echocardiographic lab, renovated cardiac catheterization and electrophysiology suites, as well as a new hybrid catheterization lab. The hospital is investing $5 million in the center, which offers patients a sort of one-stop shop. Rather than bouncing from specialist to specialist, patients are offered a menu of treatment options from a team of experts. If youre a patient and youre referred to a cardiologist and his expertise is catheterization and stenting, then thats probably what youll get, Lim said. If his expertise is surgery, then thats the route youll probably take. Were removing that physician bias and leveraging the strength of a team to determine whats best for our patients.

This is not the first time Lim and Lee have teamed up. The two joined the medical school in the same year and began collaborating on patient care in 2003 to determine whether surgery, medicine or interventional cardiology was indicated. In 2005, both appeared on the St. Louis Business Journals 40 Under 40, a list that honors professionals for achievements in their careers, leadership, ability and dedication to community. I came back to SLU because Dr. Lim and I are like-minded and were committed to this new algorithm, said Lee, professor and co-chair of the C4. I also wanted the opportunity to work at an institution that valued a multidisciplinary approach to traditional cardiac procedures while creating opportunities for new treatment options.

Right Time, Right Place

Although fusing the two specialties is not an entirely new concept Vallee L. Willman, M.D., former chair of the department of surgery, floated the idea more than 20 years ago Lee said his return isnt the only reason the C4 got off the ground. Lee said with the increased specialization in the fields of cardiology and cardiac surgery, the two disciplines have grown closer together while becoming more isolated from their traditional fields of internal medicine and surgery. For example, he noted the new percutaneous aortic valve placement guidelines recommend collaboration between cardiologists and cardiac surgeons. He sits on a committee writing guidelines for implantable cardioverter defibrillators that also will recommend collaboration between the two disciplines. In addition, Lim said SLU Hospital, the University and the School of Medicine administrations support the plan and are invested in seeing cardiology lead the way with this transformational change in care delivery. When youve been an innovator for so long the first cardiac catheterization lab west of the Mississippi, the first open heart surgery in St. Louis, the first prosthetic valve implant in St. Louis, the first pacemaker, the first coronary bypass, the first heart transplant in the Midwest you have an obligation to carry that innovation through, Lim said. We are trying to deliver the next, most obvious first to the St. Louis region and in the nation.

Getting Creative
One of the new treatment options made possible by Lees return and the centers team approach is designed to cure atrial fibrillation (AFIB). Lim, Lee and Ali Mehdirad, M.D., F.A.C.C., professor of internal medicine and director of electrophysiology, are working together to offer the full spectrum of procedures and therapies customized to a patients circumstances. While at Northwestern, Lee pioneered the hybrid maze procedure for AFIB, a minimally invasive option performed in two stages. In the first stage, Lee creates a maze or scar on a beating heart without opening a patients chest. In the second stage, Mehdirad performs catheter ablation to create more scars inside the heart. This cures a patients AFIB by putting the heart back into rhythm, all without a sternotomy and with a quicker recovery.

Homecoming
Lim said the idea of leveraging a team to treat heart conditions has been percolating for years, but he wasnt able to execute the plan until October 2012 when the School of Medicine secured the return of one of St. Louis most prominent cardiac surgeons, Richard Lee, M.D. Lee was an assistant professor of surgery at SLU from 2003 to 2007. He returned to co-direct the C4 after spending five years as an attending cardiac surgeon at Northwestern Memorial Hospital and surgical director of the Center for Heart Rhythm Disorders at the Bluhm Cardiovascular Institute.

Grand Rounds 13

T he Pat i ent Pat i ents

What would motivate someone to strip down to their underwear in front of an audience? Be poked and palpated by dozens of inexperienced medical students? Repeatedly answer personal health questions in front of a group of strangers? Its not the fame. Nobodys asking for autographs. Its not the money. The average pay for a standardized patient, also known as a teaching associate (TA), is about $15 an hour. So what is it? Grand Rounds decided to ask two of the medical schools most experienced TAs: Whats your motivation? 53-year old Ken Konchel is an artist who has been a TA for 17 years. 70-year-old Jim Conway is a retired high school English teacher with 18 years of experience in the skills center. KK: Ive found that one of the most fulfilling aspects of being a TA is the feedback we get from students who are so grateful for what we do. They say they can learn so much more from interacting with us in the exam room than they can from a lecture in the classroom. JC: Were real, live people. Not mannequins. We help guide the students and make suggestions, which they really seem to appreciate. Its our privilege to help bring them along in their professional training. GR: Is there any lab you enjoy more than the others? KK: My favorite is the complete physical exam, top to bottom, because of the amount of feedback we can give students. We offer constructive criticism and point out what theyre doing right. Its an opportunity to instill in students a sense of empathy with their patients and to help them develop a good bedside manner. GR: How do you go about instilling good bedside manner? JC: When we lie down on the exam table and they forget to pull out the extender, for example, Ill say Whoa. Didnt you forget something? Or, sometimes they have to examine us in the groin area and theyll start to remove my clothing and Ill say, Are you just going to jump into my drawers? No, of course not. I tell the students they need to slow down, explain what they need to do and ask our permission, maybe even let us participate by holding our underpants to the side. Simple, but 5 important stuff. GR: What impact has playing a patient had on your interactions with your own physician? 6 JC: The funny thing is my personal physician is a teaching doctor here at SLU so when I go in he gives me a smile and says, Lets see if I can get it right this time. KK: It does make things interesting when I go to my physicians office. Hell be examining me and Ill think, Oh, I know what youre doing now. Youre palpating my abdomen and I know why. GR: What do you think it takes to be a good teaching associate? KK: Good communication skills and a good memory. JC: I agree. Were doing the complete exams next week and we have 134 things to remember and check off. Sometimes were allowed to guide the students and sometimes we have to stick to a script, like when we play the role of a patient with emphysema or urinary tract infection. Faculty will tell us if we get it wrong. KK: I also think you have to be patient and have the desire to help someone learn. JC: I agree with that, too. I almost always ask students if theres something they want to do over again. Theyve made a big investment in their education and they should get their moneys worth.

by Doing
It s F r i da y afte r noon
and every exam room in the Clinical Skills Center is occupied. Second-year medical students are flexing, extending and rotating the joints of standardized patients to learn how to detect osteoarthritis and bicipital tendonitis. Fourth-year medical students wander from room to room answering questions the students might have. Every two hours, a new group of approximately 30 students listens to a brief lecture about a particular aspect of a physical exam today its the joints of the appendicular skeleton before going into a room with their standardized patient. Medical students are the primary users of the center but nursing and allied health students are regular users as well, and they will be more engaged as the medical campus expands its interprofessional education programs. The skills center has the room to accommodate this collaborative philosophy. When it moved two years ago from the basement of the Learning Resources Center to the Health Sciences Education Union (HSEU), the center nearly doubled in square footage and went from seven exam rooms to 11. The center has more than 130 standardized patients to help students develop their communication, assessment and evaluation skills.
right Both students and TAs receive checklists before beginning their clinical skills exercise the students to make sure they dont forget to cover everything during the exam and the TAs to make sure the students dont miss anything. As part of their preparation, TAs also attend the same skills lecture as students before going into the exam rooms, which are fully equipped to simulate a true medical office experience. Each room has two cameras for observing and recording student/TA interactions. above right 1. Second-year student Cameron Rice practices his skills at identifying joint abnormalities with standardized patient, Ken Konchel. Fellow second-year student Mitchell Stotland looks on. 2. Fourth-year medical student Max Palatnik guides secondyear students Tierney Shanon and Jeff Ko through a proper exam of the lower joints. 3. Second year student Kevin Smith tests
range of motion with Jim Conway, one of the SOMs most experienced teaching assistants.

L ea r n i n g

1 2

Students develop diagnostic competencies at expanded Clinical Skills Center

 With the expansion of the exam rooms and the state-of-the-art technology, were moving forward in the evolution of utilizing standardized patients in teaching, assessment and clinical simulation.
Denise Townsend program director of the Clinical Skills Center

Grand Rounds 15

Rise to the challenge

The challenge to secure National Institutes of Health grants is more competitive than ever as federal funds are limited and more researchers vie for the awards especially the coveted RO1, the gold standard grant mechanism for investigators. Five basic science researchers within the School of Medicines department of pediatrics are managing not only to succeed in this competitive environment but thrive as they endeavor to turn their discoveries into health care.

Pediatric Researchers

Barenkamp

Sick or premature babies often have underdeveloped lungs and require the use of ventilators. In fact, Noah H. Hillman, M.D., notes that one in 10 babies needs some assistance with breathing at birth.

Breathing Easy

Ear infections caused by Haemophilus influenzae bacteria are common among children throughout the world, and there are no preventative measures. However, a $1.2 million NIH grant awarded to Stephen Barenkamp, M.D., professor of pediatrics, will further efforts to develop a potential vaccine against the infections. Barenkamp and his team have discovered two bacterial proteins that have surfaced as possible vaccine candidates. In his study, these two proteins will be tested for their ability to protect against ear infections in animals when delivered by either the intramuscular or intranasal route. We also have collected serum samples from children and adults, and want to determine how well the antibodies from these samples can kill the bacteria,

Alleviating Ear Infections

Barenkamp said. If the naturally produced antibodies in the samples are capable of killing the bacteria, that would mean the proteins could be important components of a protective vaccine. This research is targeting otitis media, a common type of infection found in children. Barenkamp will prepare a vaccine model using a weakened form of common respiratory virus known as adenovirus that will be tested on the chinchilla model. We want to decrease the use of antibiotics and use a vaccination instead to prevent this disease, he said.

Hillman

The delivery of oxygen under pressure, however, can damage fragile air sacs and lead to injury and long-term lung diseases, such as asthma and bronchopulmonary dysplasia. The goal of our research is to minimize ventilator-induced injury, said Hillman, associate professor of pediatrics and a neonatologist. Were exploring not only what type of lung injury occurs in preterm babies but the progress of that injury over time. Hillman conducts his NIH-funded research in collaboration with colleagues at the University of Western Australia in Perth and the Cincinnati Childrens Hospital Medical Center, where he was on faculty for six years before joining SLU. Using

a pre-term sheep model, they are testing resuscitation equipment and procedures, and examining lung tissue to look for the molecular pathways of injury. Once the researchers find the safest, most effective way of resuscitating preterm babies Hillman said the findings will be incorporated into resuscitation guidelines used throughout the world. Forty percent of babies born under 28 weeks develop chronic lung disease, he said. Any small change we make in how we ventilate these newborns could have a dramatic impact.

Iron
With a $1.8 million NIH grant, Robert Fleming, M.D., is examining the mechanisms by which transferrin, an iron binding protein, regulates iron Fleming metabolism and red blood cells. This will develop transferrin as a possible treatment for hereditary hemochromatosis and beta thalassemia. His prior work had demonstrated that transferrin serves as an iron delivery molecule and also a signaling molecule affecting production of hepcidin, which is the bodys iron regulatory hormone. Fleming, professor of pediatrics, discovered that the production of hepcidin is abnormally low in hemochromatosis.

Man

In this project, Flemings collaborators have determined that hepcidin levels are low not only in hemochromatosis, but also in beta thalassemias. We know that giving extra transferrin to the beta thalassemic mice is able to offset the hepcidin abnormality. The question we are asking is what mechanisms bring that about, Fleming said. They will study three possible mechanisms that allow transferrin to serve as a therapeutic agent in beta thalassemia: by directly signaling to hepcidin through a specialized transferrin receptor cloned in Flemings laboratory; by removing toxic free iron from the circulation; or by limiting iron uptake into erythrocyte progenitor cells.

Adriana M. Montao, Ph.D., is conducting research that could revolutionize the way doctors diagnose and treat patients with rare but serious genetic disorders. Together with Shunji Tomatsu, M.D, at the Nemours/ Alfred I. duPont Hospital for Children, Montao received a $2.5 million NIH grant to evaluate a screening method, developed by SLU researchers, that uses dried blood samples routinely taken at birth to test for Mucopolysaccharidoses (MPS) disorders. This group of chronic and progressive disorders occurs approximately 1 in 25,000 births and includes Morquio, Hunter and Sly Syndromes. Bone deformities, enlarged abdominal organs, hearing loss, vision impairment, valvular heart disease and mental retardation are common in people with MPS disorders. According to Montao, associate research professor in the department of pediatrics, the department of biochemistry and molecular biology and principal investigator of the SLU study, one challenge in treating patients with MPS disorders is diagnosing the disease before it has progressed too far. Most MPS patients are asymptomatic at birth, and do not receive a diagnosis until they are 4 to 5 years old. If we were able to identify newborns with MPS disorders and begin treatment immediately, we could slow or even stop the progression of the disease, greatly improving their quality of life and possibly prolonging it, she said.

Catching Rare Disorders Early

Deciphering Babys First Responders

Joyce Marie Koenig, M.D., is an expert in both neonates and neutrophils. A practicing neonatologist, Koenig became interested in neutrophils when she was a fellow working in the lab of renowned researcher Robert Christensen, M.D., at the University of Utah. Neutrophils are white blood cells important in fighting infection because they are the first to respond to the site, but they also can contribute to chronic inflammation in premature infants. Inflammation in the lungs, brain and intestines can lead to debilitating disorders such as chronic lung disease, cerebral palsy and necrotizing enterocolitis. Koenig has studied key regulatory factors involved in neutrophil production and function in fetuses and neonates. She also studied neutropenia in neonates born to mothers with pregnancies complicated by pre-eclampsia. When she joined SLU in 2006, Koenig brought with her a $1.8 million NIH grant to study the role of neutrophil

Koenig

apoptosis in neonatal inflammation. With her most recent $412,500 NIH grant, she is collaborating with Guangyong Peng, M.D., Ph.D., in the division of infectious diseases, allergy and immunology, to study novel interactions between neutrophils and T regulatory cells in newborn inflammation. Koenig brought more than her expertise in neutrophils to the School of Medicine. She brings a passion for research. During her tenure as associate chair for research in pediatrics, she instituted a monthly research seminar and created Pediatric Science Days, an annual symposium that brings in visiting professors and highlights multidisciplinary pediatric research across SLUs campus.

16 GrandRounds

Montao

Dermatology

Niraj Butala

Alex Fox

Cooper University Hospital-N.J.

University of Utah Affiliated Hospitals

Andrew Chen Philip Clerc

Loyola University Medical Center-Ill. Keesler Air Force Base-Miss.

Joban Vaishnav Subeer Wadia

Johns Hopkins Hospital-M.D. Rush University Medical Center-Ill. Internal Medicine/Pediatrics

Otolaryngology

Eric Appelbaum

Garrett Searcy Stacy Stieren

Maulik Dhandha Megan Rogge

Anthony Hoff

Virginia Commonwealth University Health System

Indiana University School of Medicine University of Colorado School of Medicine-Denver

Surgery-General

Lauren Cass

Vanderbilt University Medical Center-Tenn.

Saint Louis University School of Medicine Icahn School of Medicine at Mount Sinai-N.Y.

University of Minnesota Medical School

Nicholas Crews Mary Ehlman

Scott Montgomery Johnathan Yoon Rishi Zaveri

Garrett Huck

Nellis Air Force Base-Nev.

Mayo School of Graduate Medical Education-Minn. Mercy Hospital St. Louis

Sonalee Ravi

M at c h D ay

Cassandra Simonetta Reena Varade Lindsey Yeh

Abigail Ironside Charity Kaiser Neil Kalsi

Saint Louis University School of Medicine Internal Medicine/Psychiatry

Southern Illinois University School of Medicine and Affiliated Hospitals University of Nebraska Affiliated Hospitals University of Illinois College of Medicine-Chicago Pathology-Anatomic and Clinical

Robert Dickason Andrew Huffman Erin Ibler

Mark Woolley

New York Hospital Medical Center Queens Rush University Medical Center-Ill. St. Lukes-Roosevelt-N.Y.

Childrens Mercy Hospital-UMKCMo. Physical Medicine and Rehabilitation

Texas A&M-Scott & White Northwestern McGaw/NMH/ VA-Ill. Northwestern McGaw/NMH/ VA-Ill.

Saint Louis University School of Medicine Saint Louis University School of Medicine St. Lukes Roosevelt-N.Y.

Nimah Jamaluddin Ramzy Jandali

UCLA Medical Center-Calif. Cedars-Sinai Medical Center-Calif.

Aaron Hand

Sushma Jonna Stefan Law Sonia Lin Jane Ma

University of Kansas School of Medicine-Kansas City Neurological Surgery

Jeffrey Derbas

Marianjoy Rehabilitation Hospital-Ill.

Brian Kilmartin Juliet Kim

Jeremy Hartman

Barnes-Jewish Hospital University of Colorado School of Medicine-Denver University of Southern California Olive View-UCLA Medical CenterCalif.

David Kim

George Hanna James Smith

Joanna Chaffin Stephen Olsen Daniel Rowan Sherry Tang

Pediatrics

Barnes-Jewish Hospital Plastic Surgery (Integrated)

University of Texas Southwestern Medical School-Dallas UCLA Medical Center-Calif.

Springfield, Ill. native Aaron Meyer holds up the match letter for his parents. Meyer is headed to University of California San Diegos family medicine and psychiatry program.

Emergency Medicine

Methodist Hospital Sacramento-Calif.

Loma Linda University-Calif. West Virginia University School of Medicine Neurology

Medical College of Georgia Barnes-Jewish Hospital Medical College of Wisconsin Affiliated Hospitals Duke University Medical Center-N.C.

Brandon Richland

Tripurari Mishra David Myers

Nicholas Busch

William Kim

Henry Ford Health Sciences CenterMich.

Kaiser Permanente Orange CountyCalif.

University of California Irvine Medical Center Psychiatry

UIC/Metro Group Hospitals-Ill. Keesler Air Force Base-Miss.

Caroline Dowers Matthew Fellin Anne Godbout

James Kirkpatrick Melissa Lao

Henry Ford Health Sciences CenterMich. Anesthesiology

University of Missouri Kansas City Programs Mercy Hospital St. Louis

Eric Kim

Christine Charles Chris Chen

Steven Nguyen

Rahul Malireddy

Kaiser Permanente-Los Angeles

North Shore-LIJ Health System-N.Y. University of Southern California

Saint Louis University Medical Center

Neeti Arora

Eastern Virginia Medical School Harbor-UCLA Medical Center-Calif.

New York Presbyterian HospitalWeill Cornell Medical Center

Sri Nimmagadda Jackson Pugh

New York Hospital Medical Center Queens

Matthew Preston Jason Weller

Bethany Nyland

Community Hospitals-Ind. Saint Louis University School of Medicine

Rajeev Malireddy

University of Washington Affiliated Hospitals Boston University Medical CenterMass. Obstetrics and Gynecology

Central Iowa Health System

Alyson Baker Ryan Brady Erin Davis

Jacob Wilson

Sowmya Kantamneni Eric Lee

University of Arizona Affiliated Hospitals Stanford University Programs-Calif.

Lucas Haapapuro Clinton Holaday Yinjiang Huang

Alameda County Medical CenterCalif.

University of Connecticut School of Medicine Loyola University Medical Center-Ill. Saint Louis University School of Medicine

Mayo School of Graduate Medical Education-Minn. Psychiatry/Family Medicine

Jacinta Robenstine Xiaoming Shi

West Virginia University School of Medicine San Antonio Uniformed Services Health Education Consortium-Texas

Western Michigan University School of Medicine Madigan Army Medical Center-Wash. Harbor-UCLA Medical Center-Calif.

Conor McCartney Aaron Miller

Karl Szafranski

Matthew Lyman Akshay Menon

Greenville Hospital System/ University of South Carolina

Saint Louis University School of Medicine Saint Louis University School of Medicine

Aaron Meyer

Thomas Ganz Emily Mills

University of Colorado School of Medicine Ochsner Clinic Foundation-La.

Vincent Tichenor

Saint Louis University School of Medicine University of Connecticut School of Medicine

University of California San Diego Medical Center

Michael Willman

Jonathan Hintze Peter Jung

Amy Nuismer

Andrew Krieger Sarah Kuehnle

Scott Air Force Base-Ill.

Shoeb Mohiuddin Christian Oliver Andrew Oster

Saint Louis University School of Medicine Maricopa Medical Center-Ariz.

Christopher Wedell Broc White Doyle Witt

Guilford Parsons Akshar Patel Niral Patel

Saint Louis University School of Medicine Utah Valley Regional Medical Center University of Missouri Kansas City Programs

Virginia Mason Medical CenterWash. University of Michigan HospitalsAnn Arbor Henry Ford Health Sciences CenterMich.

Saint Louis University School of Medicine Loma Linda University-Calf.

University of California Davis Medical Center Radiation Oncology

Saint Louis University School of Medicine Transitional Year

Stuart Conner

Logan Peterson

Madigan Army Medical Center-Wash.

Margaret Lau

Anupama Chundury

University of Illinois College of Medicine-Chicago University Hospitals-Jackson-Miss. University of Missouri Kansas City Programs

Kristina Pontarelli

Daren Mahoney Tian Mi

University of Nevada Affiliated Hospitals-Las Vegas Allegheny General Hospital-Pa.

University of Illinois College of Medicine-Chicago Ophthalmology

University of California Irvine Medical Center

Barnes-Jewish Hospital Radiology-Diagnostic

San Antonio Uniformed Services Health Education ConsortiumBrooke Army Medical Center-Texas

Andrew Krispinsky
Urology

Brian Madden

Kevin Bui

Navy Medical Center Portsmouth-Va.

Christopher Young Jonathan Yun

Rina Parmeshwar Saumil Patel Suman Rao Sina Samie

Astha Mor

Mercy Hospital St. Louis Ohio State University Medical Center Internal Medicine

Ann Perrin

Oregon Health & Science University

Kelly Laurenti Kevin Miller

Wright State University Boonshoft School of Medicine-Ohio

University of California Medical Center

University of California Davis Medical Center Hospital of the University of Pennsylvania Northwestern McGaw/NMH/ VA-Ill. University of Southern California

Saint Louis University School of Medicine

Melissa Reimers

Medical College of Wisconsin Stony Brook Teaching Hospitals-N.Y.

Kaitlyn Murphy

Mariam Malik

Patricia Heller David Song

Max Palatnik

University of North Carolina Hospitals

Case Western/University Hospitals Case Medical Center-Ohio

Loyola University Medical Center-Ill.

University Hospitals Columbia-Mo. Barnes-Jewish Hospital Vascular Surgery

Vanderbilt University Medical Center-Tenn.

Abdullah Abdussalam Justin Adams

Matthew Reisinger Rae Rohlfsen

Ramsudha Narala Ryan Vogel

Lauren Pommert Karen Pugh

Daniel Marion

Christopher Styles William Terrin

Saint Louis University School of Medicine Medical College Wisconsin Affiliated Hospitals

University of Colorado School of Medicine-Denver University of Nebraska Affiliated Hospitals

Loyola University/Hines VA Hospital-Ill. Medical College of Wisconsin Orthopaedic Surgery

Saint Louis University School of Medicine Saint Louis University School of Medicine

Saint Louis University School of Medicine

Benjamin McDowell Jordan Nepute Samuel Nyon

University of Illinois College of Medicine Saint Louis University School of Medicine Loma Linda University-Calif.

Christopher McAninch

University of Wisconsin Hospital and Clinics

Morristown Memorial Hospital-N.J. Brooklyn Hospital Center-N.Y. Family Medicine

Kavya Reddy

Matthew Akin

Shahed Shams Jeremy Sharp Justin Sheehy Eric Shelley Gurjit Sivia

Schirin Tang Lei Tian

University of Arizona Affiliated Hospitals Case Western/University Hospitals Case Medical Center-Ohio

Kristin Bendert Katelyn Bezek

Oregon Health & Science University Allina Family Residency ProgramMinn.

Indiana University Health Ball Memorial Hospital

St. Lukes Hospital-St. Louis Kaiser Permanente San Francisco Barnes-Jewish Hospital University of Iowa Hospitals and Clinics Loma Linda University-Calif.

Thomas Acott

Saint Louis Childrens Hospital

University of Tennessee College of Medicine-Memphis

Ram Rohatgi

Tracey Bertram

Ashley Haegele

Mayo School of Graduate Medical Education-Minn.

Mercy Hospital St. Louis

Richard Bloomingdale William Bzdawka Amanda Cartee

University of South Florida College of Medicine-Tampa

Laura Schalembier Michael Schildz

Andrew Schreiner Tisha Singer

Cleveland Clinic Foundation Rhode Island Hospital/Brown University

Navy Medical Center San Diego Saint Louis University School of Medicine

Leon Vorobeichik

Andrew Bryant Sarah Buller

University of Toronto Child Neurology

Mercy Hospital St. Louis Brown Medical School/Memorial Hospital-R.I.

Wayne State University Detroit Medical Center-Mich. University of Wisconsin Hospital and Clinics Mayo School of Graduate Medical Education-Minn.

Timothy Lonergan

University of Tennessee College of Medicine-Memphis

Good news for internal medicine. Among the students nationwide who participated in the match this year, more than 3-thousand were matched to a training program that focuses on some aspect of internal medicine. According to the National Resident Matching Program, thats a 6.6 percent increase over last year and a 19 percent increase from 2009, a recent low.
3
1. Jordan Nepute will be staying in St. Louis as he matched the SLU radiology program. 2. Shoeb Mohiuddin was excited to know that he matched the University of Illinois Chicagos anesthesiology program. 3. Stefan Law jumps with joy and is joined by his friends. Law will be going to University of Colorado for internal medicine.

Stacey Stubblefield Brandon Szeto

Joshua Kim

North Shore-LIJ Health System-N.Y.

Stephanie Du

Scripps Clinic/Green Hospital-Calif. Case Western/University Hospitals Case Medical Center-Ohio

Shiney Koshy

UCLA Medical Center-Calif.

Kaiser Permanente Orange CountyCalif.

Joseph Eckelkamp

Cory Cheatham

Mercy Hospital St. Louis

Saint Louis University School of Medicine

Theodore Tollivoro Jesse Tran

Kaiser Permanente San Francisco University of California Irvine Medical Center

18 GrandRounds

Grand Rounds 13

AlumniPulse
A mother brought her daughter to see Mann for treatement of a cerebromeningeal protrusion.

Living the Mission Talking Turkey

After more than 50 years of practicing medicine outside Chicago, Lester Mann, M.D. (62), retired several years ago, but isnt ready to give up his second job meatpacking. Every year for the past 61 years, Mann, his family and their church friends have spent a week canning thousands of pounds of meat for local, national and international relief agencies. This year, Mann and the team packed 25,000 pounds of turkey into 13,000 cans that were shipped to the Mennonite Central Committee warehouse in Pennsylvania for distribution.

We do everything from grinding the meat, to filling, sealing, labeling and boxing the cans, he said. After more than 60 years, I think Ive gotten pretty good at it. The son of a Mennonite pastor, Mann grew up with a strong sense of commitment to peace, community and service. You dont say no to those in need, he said. Manns commitment to service expanded in the early 1980s. He took breaks from his pediatric practice in Freeport, Ill. to volunteer in Haiti and in 1986 a friend asked him to travel to Zambia, where the Macha Mission Hospital in the southern province needed a pediatrician.

The 208-bed, acute-care for months at a time, spendhospital run by the Brethren ing a total of about 8.5 years in Christ Church, includes a helping adult and pediatric comprehensive community patients. health program, outpatient It became our second services, and HIV and TB home, he said. clinics that serve an estimated The Manns often timed 60,000 people, half under the their trips to arrive in Zambia age of 12. during the rainy season, when I had an immediate conmalaria outbreaks were so bad nection with the patients, that pediatric patients had to he said. And I enjoyed the share beds or sleep on floors. variety of medical problems Mann contracted malaria durthat came through the door ing one of his stays and had every day. to lie down on the operating Mann outlined a typical day room floor in the midst of at the hospital in a diary he performing a C-section. Ankept: In the morning I saw a other physician took over. premature infant It wasnt with respiratory always the most distress, a 4-yearideal circumstancold boy with a es, but we did the fever, a pregnant best we could with woman, a 50-yearwhat we had, and old woman with the people were so osteomylitis of grateful and trustthe mandible with ing, he said. puss running from Mann and Mann with Gift Hansumo, a her jaw. I went his wife stopped farmer and friend who worked back to pediatrics, going to Zambia the fields near the medical clinic in Zambia. where 68 critically a couple of years ill children were ago for personal waiting for me. health reasons, but they conBecause he wanted to tinue to sponsor doctors and commit more fully to serving medical students who serve at the people of Zambia, Mann the Macha Mission Hospital. gave up his pediatric practice I consider it a privilege and worked in emergency to have served in the name of medicine to allow him greater Christ, he said. And I apflexibility for travel. During preciate Saint Louis University the next 20 years, Mann and School of Medicine for makhis wife, Leota, volunteered ing my life work possible.

From Your Alumni Association President Edward J. OBrien Jr., M.D. (67)

MARK YOUR CALENDAR

School of Medicine Alumni Events
For information:

314-977-8335 medschool.slu.edu/alumni/

May 2 May 17 Aug. 4

John H. Gladney, M.D., Diversity Award Reception School of Medicine Precommencement White Coat Ceremony

Reunion Weekend 2012

School of Medicine Honors a Pioneer in the Field of Neuroradiology

Michael Huckman, M.D. (62), received the 2012 School of Medicine Alumni Merit award during Reunion Weekend in October. In this photo he is congratulated by Philip O. Alderson, M.D., dean of the School of Medicine, and Edward J. OBrien Jr., M.D. (67), president of the School of Medicine Alumni Association. A leader in neuroradiology education, Huckman organized a post-graduate course on Computed Tomography of the Brain the oldest course of its kind in the United States. Before retiring with the rank of professor-emeritus in September 2012, Huckman spent 42 years as director of neuroradiology at Rush University Medical Center and Rush Medical College. To view more photos from the 2012 Medical Alumni Reunion Weekend, visit the Image Galleries section of the School of Medicine alumni website at medschool.lu.edu/alumni.

Dont forget Reunion 2013: Oct. 17-19

celebrating the classes of: 2008, 2003, 1998, 1993, 1988, 1983, 1978, 1973, 1968, 1963, 1958, 1953 and earlier.

Oct. 17-18 Reunion Weekend This spring we shared the excitement with our fourthContinuing Medical Education Programs year medical students as they For information: celebrated Match June 11-12 24th Annual Summer Geriatric Institute Day and learned 314-977-7401 medschool.slu.edu/cme/ June 21 3rd Annual JMF Conference CME Course of Primary Immunodeficiency Diseases where they will continue their July 19-21 Cosmetic Blepharoplasty and Fundamentals of Face Lift education and July 22-26 Masters Conference for Advanced Death Investigation specialty training. July 29-30 ER Skills We offer these OBrien students our best Aug. 1-3 The 20th Advanced Techniques in Cervical Spine Decompression and Stabilization wishes and welcome them into Aug. 24 Innovations in Glaucoma Surgery the Alumni Association. In May, the University will formally celebrate the 25th Show your school colors www.clubcolors.com/slu Anniversary of the presidency of Lawrence Biondi, Deceased alumni Corinne Walentik, M.D. (74), S.J. Under his leadership the 1949-2012 Owen Eisele, M.D. (38) University has been transCorinne Walentik, M.D., Christopher Vournas, M.D. (38) Casimir Casey Firlit, formed significantly both M.P.H., professor of pediatrics M.D., Ph.D., 1939-2012 Edward Laskowski, M.D. (42) academically and aesthetically in the division of neonatology Casimir Casey Firlit, M.D., Louis Browning, M.D. (43) and it continues to grow died in December at the age adjunct Charles Sherwin, M.D. (43) both physically and financially. of 63. professor in Edward Kinsella, M.D. (44) The acquisitions and construcColleagues and members of the School of James OMalley, M.D. (46) tion projects since 1987 are the community often described Medicine and W. Howard Lewin, M.D. (44) numerous and exceptional. As her as a passionate advocate director of James Bellomo, M.D. (47) for the once lonely medical for babies and families. reconstructive Richard Munger, M.D. (47) school, the east side of Grand She was a brave woman urology, neuroJack Starrett, M.D. (47) Boulevard from Choteau to FIRLIT with tremendous unmatched urology and Ismael Vilar, M.D. (47) Lafayette avenues has become knowledge of community fetal urology at SSM Cardinal John Malone, M.D. (51) a health science city. We conneeds and reGlennon Medical Center, died John Tisserand, M.D. (51) gratulate Father Biondi on his sources regardin December at the age of 73. Curtis Flanagan, M.D. (52) insightful initiatives, continuing childrens Dr. Firlit was a wonderful Donald Mehan, M.D. (52) ing leadership and stewardship health care, said physician, teacher and mentor David Steigmeyer, M.D. (52) in the Jesuit tradition. William Keenan, to many clinicians throughRichard Strassburger, M.D. (53) As for our Alumni AssociaM.D., professor out the years, said Sherlyn Carl Hertzman, M.D. (55) tion, we urge members of the of neonatology Hailstone, president of SSM WALENTIK John King, M.D. (55) classes with years ending in at SLU and Cardinal Glennon. His kind3 and 8 to consider leadWilliam McKnelly, M.D. (55) Dr. Walentiks colleague for 32 ness, compassion and ability to ership roles for the Medical James Ransdell, M.D. (55) years. She was a champion for relate to the children he served School Reunion in October. Richard Hahn, M.D. (56) children. were legendary. Follow us electronically and Joseph Des Rosiers, M.D. (57) During her 36 years at His love of children and watch for announcements and John McNally, M.D. (57) SLU, Dr. Walentik held several helping improve their lives invitations in the mail. Feel Marion Jabczenski, M.D. (58) academic positions. Most reinfluenced Dr. Firlit every day. free to contact the alumni David McKenna, M.D. (59) cently, she was the professor In a 2011 profile in St. Louis office for any information or Daniel Semenoff, M.D. (63) of pediatrics in the division of Magazine, Dr. Firlit put his pasguidance. Jerome Goldschmidt, M.D. (69) neonatal-perinatal medicine sion into words: I found that Peter Litzow, M.D. (78) and physician executive for kids, in spite of the adversity, Michael Malon, M.D. (85) managed care and public policy [children] have the resilience to at SSM Cardinal Glennon go through this and come out Childrens Medical Center. very positive. Its what just lit my fire.

In Memoriam

21 Grand Rounds Saint Louis University School of Medicine

Non-Profit Org. U.S. Postage St. Louis, MO Permit No. 134

PAID

1 N. Grand Blvd., Salus 609 St. Louis, MO 63103 Address Service Requested

Giving really does change lives.

I hope others may experience similar opportunities at Saint Louis University. It was at SLU that I matured, obtained a degree in a noble profession and made lifelong friends.
Though the amounts and the reasons may vary, theres one thing all gifts have in common: Together they make a world of difference to Saint Louis University. Make your gift by using the envelope enclosed in this issue of Grand Rounds or online by visiting giving.slu.edu. If youve already made a gift to SLU, thank you. Please visit giving.slu.edu/igive and tell us your reason for giving.

Paul J. R eiling, M.D. (62)