Spring 2013 Saint Louis University School of Medicine

GrandRounds

Pediatric Cardiology’s Growth Spurt Adult Cardiology Teams Combine Learning by Doing

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grandrounds@slu.edu.

Vol. 11 No.1Saint Louis University School of Medicine SpriNg 2013

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 Philip O. Alderson, M.D.

Edward J. O’Brien Jr., M.D. ’67 Cheryl Byrd

maGazinE ContriButors 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

Photo and illustration CrEdits 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

alumni ExECutivE Board

President|Edward J. O’Brien Jr., M.D. ’67|St. Louis

Anne T. Christopher, M.D. ’94|St. Louis

Emil DiFilippo, M.D. ’66|St. Charles, Mo.

Thomas F. Lieb, M.D. ’82|St. Louis

James T. Merenda, M.D. ’82|St. Louis

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

Leroy F. Ortmeyer, M.D. ’55|St. Louis

Joan M. Pernoud, M.D. ’74|St. Louis

Keith M. Starke, M.D. ’81|St. Louis

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

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

Peter Kong-Woo Yoon, M.D. ’81|St. Louis

© 2013, Saint Louis University All rights reserved

From the Dean | Saint Louis University’s School of Medicine has had a rich tradition of leadership in the diag-nosis 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. It’s heartening to see the banner of cardiovascular leadership begin to rise again at SLU. This issue of Grand Rounds introduces SLU’s 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 cardiovas-cular 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 nation’s health care costs continue to rise and a national spending sequester is be-ing 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 sub-stantial. SLU’s new cardiovascular programs, the pediatri-cians 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, investiga-tion 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.

Vital Signs | page 2

Alumni pulse | page 20

i give Because | back

Keeping the BeatPediatric cardiology expands to meet demands and exceed expectations.| page 6

Taking the LeadNew Comprehensive Cardiac Care Center breaks tradition and benefits patients.| page 10

Learning by DoingExpanded Clinical Skills Center allows students to develop diagnostic competencies.| page 14

pediatric researchers rise to the ChallengesUsing NIH dollars, SLU researchers tackle childhood diseases.| page 16

Match DayFourth-year students celebrat-ed Match Day 2013 at the St. Louis Cardinals Redbird Club at Busch Stadium.| page 18

grandrounds

Philip o. alderson, m.d.Dean | Saint Louis University School of Medicine

Vice President | Medical Affairs

On the cover Five-year-old Orion Smithey energetically

tackles the obstacles on his favorite play-ground, which is amazing given the obstacles

Orion faced as an infant. Born with several congenital heart defects, Orion’s mother, Julie

Smithey, said the cardiologists and cardiac surgeons at SLU saved her son.|page 6

VitalSignsHepatitis B Breakthrough Could reduce Liver Cancer WorldwideSaint 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 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.

In 1994, soon after being named associate director of the School of Medicine’s Gift Body Do-nor 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 Uni-versity 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 do-nors. 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 mem-bers,” Zahrli said. “Because we are the only con-nection 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 clo-

sure for many family members.“Sometimes it’s 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 car-ing, 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 we’re Catholic, and they know we’ll 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 it’s so beautiful.”

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 cost-effective strategy to fight these types of tumors.

ritalin May Help patients with Alzheimer’s DiseaseResearchers at SLU are studying methylphenidate, more commonly known as Ritalin, as a therapy for apathy and fall risk in those who suffer from Alzheimer’s 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 Alzheimer’s 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. “It’s 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.

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 can’t quite kill it. They’ll still do the heavy lifting in the future, but with an additional drug I hope we’ll be able to mop up the rest. Together, they may be able to do it. We don’t 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 virus’s 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 discover-ed 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, Gonzalo’s lab identified one pathway that is activated in breast cancers with the poorest prognosis, such as those classified as triple-negative. 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 triple-negative type. Although chemotherapy is the most effective treatment for triple-negative 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 Gonzalo’s laboratory showed that activation of a novel pathway not only allows tumor cells to grow unchecked, but

3 Grand Rounds Saint Louis University School of Medicine

giving Thanks for the Final gift

The first Gift Body Memorial

Service in 1994 was held inside

the hospital chapel.

“ 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

tavis

a health plan with more than a million members and national health care systems. He is 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 University’s compliance department, has been selected as SLUCare’s 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 University’s compliance department since 1999, Merlo developed and implemented

many initiatives including: University Medical Group physician and provider

documentation and billing practices; programs protecting patient privacy; and compliance education programs.

VitalSigns

grant Supports Study of postpartum DepressionResearchers 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 Children’s Medical Center screen new mothers for postpartum depression during routine well baby visits for the first two months of the child’s 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.”

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 Westfall’s 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 Westfall’s 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 SLUCare’s Executive Leadership TeamFollowing 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,

Dr. Thomas Westfall Steps Down as ChairChair 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

Ophthalmology professor Named to Endowed ChairSophia 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 full-time faculty member for the last 23 years.

Chung, a current member of the American Board of Ophthalmology, has served on numerous 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 Ophthal-mology 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’; it’s 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.

Outcomes for Obese Kidney Transplant recipientsIn 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 Tuttle-Newhall, 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.

tuttle-newhall and lentine

merlo

van house

Chung

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 discus-sions.

Some of the stories you’ll find:

SLU Researchers receive a $1.8 million grant to study lupus

Pilot TB study could accelerate vaccine discovery

Region’s first outpatient bone marrow transplant program opens

Faculty Honors

5 Grand Rounds Saint Louis University School of Medicine

Beyond VitalSigns

Grand Rounds 7

to having blue toes and blue lips, but after the catheteriza-tion his toes pinked up. He’d never had pink toes before. He couldn’t wait to take off his shoes and show every-body.”

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 pulmo-nary arteries, and in Orion’s case, significant underdevel-opment 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 open-heart surgeries.

Orion is now an active pre-schooler who runs rings around his classmates, loves animals and is looking for-ward 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 touch-and-go so many times, and yet, here he is, going strong.”

Pediatric Cardiology Expands to Meet Demands and Exceed ExpectationsKeeping the Beat

The School of Medicine’s pediatric divisions of cardiol-ogy 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 num-ber 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 remark-able is 90. Her five-year-old son Orion’s 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

aBovE Orion showing off his pink toes.

lEFt No one watching five-year-old Orion race around the playground would know he was born

with severe heart defects.

Risk REductionOrion’s cardiac surgeries were performed at SSM Cardinal Glennon Children’s Medical Center, now home to the only pediatric hybrid cardiac catheter-ization suite in the St. Louis metro area. The suite, opened in 2011, enables interventional cardiolo-gists 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 condi-tion 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 heart-lung 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 interven-tional 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 cardiopulmo-nary bypass, or the ‘heart-lung machine,’ and stop the heart,” said Kenneth O. Schowengerdt Jr., M.D. (’84), Wieck-Sullivan Professor of Pediatrics, direc-tor 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.”

LEss is MoRESLU’s 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 nec-essary 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 Pulmo-nary 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 child’s 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 pediat-rics who performed all but one of Orion’s 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 we’ve been able to do in the catheterization lab before.”

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 catheter-ization lab. 2. Orion at play 3.schowengerdt listens to Orion’s heart.

PictuRE thisThe suite is only one of the highly special-ized services Cardinal Glennon has de-veloped during the last few years to treat children with congenital heart defects, the number-one birth defect worldwide. The hospital’s Dallas Heart Center opened in 2009 with nine exam rooms, four echocar-diography suites, a fetal echocardiography lab to find heart problems in babies still in the womb, and an exercise stress test-ing 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 child’s heart.

In 2013, Cardinal Glennon Hospital opened a new $8.7 million Imaging Center that offers the lowest radiation dose avail-able 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 car-diology’s expansion in 2014 will add more exam and echocardiography rooms to the Dallas Heart Center.

“ He has amazed me.

It was touch-and-go so

many times, and yet,

here he is, going strong.”

Julie SMithey mother of Orion

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 car-diologist scheduled to join the group this summer. Schoweng-erdt is continuing to recruit to deal with patient volume. He also revived the cardiology fel-lowship program, and the first fellow arrives in July.

A key faculty recruit in 2011 was Charles B. Hud-dleston, 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 congeni-tal heart disease. He joined the School of Medicine from St. Louis Children’s Hospital, where he spent two decades of his career.

“I was drawn to Cardinal Glennon by the opportunity to work in a family-oriented en-vironment where parents are welcome to participate in our care of their children,” Hud-dleston said. “I also can work with the latest diagnostic tools and therapeutic technologies to benefit our patients.”

Huddleston and fellow car-diothoracic 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 experi-enced pediatric cardiothoracic surgery team in the region.

“A key to our success is having a group of physicians, physician assistants and nurs-es who work in a collegial and completely unselfish manner with the goal of achieving ex-cellence 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 don’t 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 pa-tients who received treatment for congenital heart defects.

BEyond BRicks and MoRtaR

3

2

1

AL-JUREIDINI

HUDDLESTON

FIORE

SCHOWENGERDT

8 Grand Rounds

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., associ-ate 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, we’re 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. That’s what happens when you put patients first.”

Grand Rounds 11

New Comprehensive Cardiac Care Center breaks tradition and

benefits patients

taking the lead

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

Cont. c4 Cardio

Grand Rounds 13

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.

measure of successFewer 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 signifi-cantly, 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 we’d be this far this fast,” lee said. “We’ve 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 it’s 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 shouldn’t be difficult when they consider that heart disease is the nation’s leading killer and that “C4” is breaking new ground in the battle against it.

“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 depart-ments, including the department of neurology and psychiatry’s Souers Stroke Institute at SLUCare. Knowing that a significant number of strokes are cryptogenic in nature, the “C4” has part-nered 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 aren’t 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.”

right time, right PlaceAlthough fusing the two specialties is not an entirely new con-cept — Vallee L. Willman, M.D., former chair of the department of surgery, floated the idea more than 20 years ago — Lee said his return isn’t 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 tradi-tional fields of internal medicine and surgery. For example, he noted the new percutaneous aortic valve placement guidelines recommend collaboration between cardiologists and cardiac sur-geons. 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 transforma-tional change in care delivery.

“When you’ve 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.”

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 you’re a patient and you’re referred to a cardiologist and his expertise is catheterization and stenting, then that’s probably what you’ll get,” Lim said. “If his expertise is surgery, then that’s the route you’ll probably take. We’re removing that physician bias and leveraging the strength of a team to determine what’s best for our patients.”

homecomingLim said the idea of leveraging a team to treat heart conditions has been percolating for years, but he wasn’t 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.

This is not the first time Lim and Lee have teamed up. The two joined the medical school in the same year and began col-laborating on patient care in 2003 to determine whether surgery, medicine or interventional cardiology was indicated. In 2005, both appeared on the St. Louis Business Journal’s “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 we’re committed to this new algorithm,” said Lee, profes-sor 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.”

Getting CreativeOne of the new treatment options made possible by Lee’s return and the center’s team approach is designed to cure atrial fibrilla-tion (AFIB). Lim, Lee and Ali Mehdirad, M.D., F.A.C.C., profes-sor of internal medicine and director of electrophysiology, are working together to offer the full spectrum of procedures and therapies customized to a patient’s circumstances.

While at Northwestern, Lee pioneered the hybrid maze pro-cedure 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 patient’s chest. In the second stage, Me-hdirad performs catheter ablation to create more scars inside the heart. This cures a patient’s AFIB by putting the heart back into rhythm, all without a sternotomy and with a quicker recovery.

5

6

Grand Rounds 15

i T ’ S F r i D A y A F T E r N O O N and every exam room in the Clinical Skills Center is oc-cupied. Second-year medical students are flexing, extend-ing and rotating the joints of standardized patients to learn how to detect osteoar-thritis and bicipital tendonitis. Fourth-year medical students wander from room to room answering questions the stu-dents might have.

Every two hours, a new group of approximately 30 students listens to a brief lec-ture about a particular aspect of a physical exam – today it’s 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 cam-pus expands its interprofes-sional 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 Educa-tion Union (HSEU), the cen-ter nearly doubled in square footage and went from seven exam rooms to 11. The center has more than 130 standard-ized patients to help students develop their communication, assessment and evaluation skills.

L E A r N i N g

by DoingStudents develop diagnostic competencies at expanded Clinical Skills Center

right Both students and TAs receive checklists before beginning their clinical skills exercise – the students to make sure they don’t forget to cover everything during the exam and the TAs to make sure the students don’t 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 second-

year 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 SOM’s most experienced teaching assistants.

What would motivate someone to strip down to their underwear in front of an audience? Be poked and palpated by dozens of inexperi-enced medical students? Repeatedly answer personal health questions in front of a group of strangers?

It’s not the fame. Nobody’s asking for autographs. It’s 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 school’s most experienced TAs: “What’s your motivation?”

53-year old Ken Konchel is an art-ist 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: I’ve 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: We’re real, live people. Not man-nequins. We help guide the students and make suggestions, which they really seem to appreciate. It’s 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 phys-ical exam, top to bottom, because of the amount of feedback we can give students. We offer constructive criticism and point out what they’re doing right. It’s 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, I’ll say “Whoa.

Didn’t you forget something?” Or, sometimes they have to examine us in the groin area and they’ll start to remove my clothing and I’ll 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 important stuff.Gr: What impact has playing a patient had on your interactions with your own physician?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, “Let’s see if I can get it right this time.”KK: It does make things interesting when I go to my physician’s office. He’ll be examining me and I’ll think, “Oh, I know what you’re doing now. You’re 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. We’re doing the com-plete exams next week and we have 134 things to remember and check off. Sometimes we’re 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 there’s some-thing they want to do over again. They’ve made a big investment in their education and they should get their money’s worth.

1

2

3

“ With the expansion of the exam rooms and the state-of-the-art

technology, we’re moving forward in the evolution of utilizing

standardized patients in teaching, assessment and clinical

simulation.”

DeniSe townSenD program director of the Clinical Skills Center

T H E p A T i E N T p A T i E N T S

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.

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 mini-mize ventilator-induced injury,” said Hillman, associate professor of pediatrics and a neonatologist. “We’re 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 Children’s Hospi-tal Medical Center, where he was on fac-ulty 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 pre-term babies Hillman said the findings will be incorporated into resuscitation guide-lines 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.”

BrEATHiNg EASy

HillMaN

Ear infections caused by Haemophilus influenzae bacte-ria are common among children through-out the world, and there are no preventa-tive 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 discov-ered two bacterial proteins that have sur-faced as possible vaccine candidates. In his study, these two proteins will be tested for their ability to protect against ear infec-tions 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,”

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 me-dia, 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 anti-biotics and use a vaccination instead to prevent this disease,” he said.

TO THEriSE

16 GrandRounds

With a $1.8 million NIH grant, Robert Fleming, M.D., is examining the mechanisms by which transferrin, an iron bind-ing protein, regulates iron metabolism and red blood cells. This will develop transferrin as a possible

treatment for hereditary hemochromatosis and beta thalas-semia.

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 body’s iron regulatory hormone. Fleming, professor of pediatrics, dis-covered that the production of hepcidin is abnormally low in hemochromatosis.

In this project, Fleming’s 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 thalas-semic 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 thalas-semia: by directly signaling to hepcidin through a special-ized transferrin receptor cloned in Fleming’s laboratory; by removing toxic free iron from the circulation; or by limiting iron uptake into erythrocyte progenitor cells.

adriana M. Montaño, 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, Montaño 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 Mucopolysac-charidoses (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 Montaño, associate research professor in the department of pediatrics, the department of biochem-istry 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 disor-ders and begin treatment immediately, we could slow or even stop the progression of the disease, greatly improv-ing their quality of life and possibly prolonging it,” she said.

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 infec-tion 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 func-tion 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

apoptosis in neonatal inflam-mation. With her most recent $412,500 NIH grant, she is collaborating with Guangyong Peng, M.D., Ph.D., in the divi-sion of infectious diseases, al-lergy 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 pediat-rics, she instituted a monthly research seminar and created Pediatric Science Days, an an-nual symposium that brings in visiting professors and high-lights multidisciplinary pediatric research across SLU’s campus.

pediatric researchers

The challenge to secure National Institutes of Health

grants is more competitive than ever as federal funds

are limited and more re-searchers vie for the awards

– especially the coveted RO1, the gold standard grant mechanism for investigators.

Five basic science research-ers within the School of

Medicine’s 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.

irON MAN

ALLEViATiNg EAr iNFECTiONS

FleMiNg

BaReNKaMP

MoNtaño

KoeNig

CHALLENgE

CATCHiNg rArE DiSOrDErS EArLy

DECipHEriNg BABy’S FirST rESpONDErS

otolaryngologyeric appelbaum Virginia Commonwealth University Health SystemScott Montgomery Southern Illinois University School of Medicine and Affiliated HospitalsJohnathan yoon University of Nebraska Affiliated Hospitalsrishi Zaveri University of Illinois College of Medicine-Chicago

pathology-anatoMiC anD CliniCalJoanna Chaffin Medical College of GeorgiaStephen olsen Barnes-Jewish HospitalDaniel rowan Medical College of Wisconsin Affiliated HospitalsSherry tang Duke University Medical Center-N.C.

peDiatriCSalyson baker University of Connecticut School of Medicineryan brady Loyola University Medical Center-Ill.erin Davis Saint Louis University School of MedicineJonathan hintze Saint Louis University School of Medicinepeter Jung Loma Linda University-Calf.Margaret lau University of California Irvine Medical Centerbrian Madden Wright State University Boonshoft School of Medicine-OhioKaitlyn Murphy Case Western/University Hospitals Case Medical Center-Ohiolauren pommert Saint Louis University School of MedicineKaren pugh Saint Louis University School of MedicineKavya reddy Saint Louis Children’s Hospitalram rohatgi Mayo School of Graduate Medical Education-Minn.laura Schalembier Navy Medical Center San DiegoMichael Schildz Saint Louis University School of Medicine

garrett Searcy Indiana University School of MedicineStacy Stieren University of Colorado School of Medicine-DenverMark woolley Children’s Mercy Hospital-UMKC-Mo.

phySiCal MeDiCine anD rehabilitationJeffrey Derbas Marianjoy Rehabilitation Hospital-Ill.Jeremy hartman Barnes-Jewish Hospital

plaStiC Surgery (integrateD)brandon richland University of California Irvine Medical Center

pSyChiatryChristine Charles North Shore-LIJ Health System-N.Y.Chris Chen University of Southern CaliforniaJacob wilson Mayo School of Graduate Medical Education-Minn.

pSyChiatry/FaMily MeDiCineaaron Meyer University of California San Diego Medical Centeramy nuismer University of California Davis Medical Center

raDiation onCologyanupama Chundury Barnes-Jewish Hospital

raDiology-DiagnoStiCKevin bui University of California Medical CenterMariam Malik Loyola University Medical Center-Ill.Daniel Marion Saint Louis University School of Medicinebenjamin McDowell University of Illinois College of MedicineJordan nepute Saint Louis University School of MedicineSamuel nyon Loma Linda University-Calif.andrew Schreiner Cleveland Clinic Foundationtisha Singer Rhode Island Hospital/Brown University

Surgery-generallauren Cass Vanderbilt University Medical Center-Tenn.robert Dickason New York Hospital Medical Center Queensandrew huffman Rush University Medical Center-Ill.erin ibler St. Luke’s-Roosevelt-N.Y.brian Kilmartin University of Texas Southwestern Medical School-DallasJuliet Kim UCLA Medical Center-Calif.tripurari Mishra UIC/Metro Group Hospitals-Ill.David Myers Keesler Air Force Base-Miss.Steven nguyen Saint Louis University Medical Centerbethany nyland Central Iowa Health SystemJacinta robenstine West Virginia University School of MedicineXiaoming Shi San Antonio Uniformed Services Health Education Consortium-TexasMichael willman Saint Louis University School of Medicine

tranSitional yearStuart Conner San Antonio Uniformed Services Health Education Consortium-Brooke Army Medical Center-Texasandrew Krispinsky Navy Medical Center Portsmouth-Va.

urologypatricia heller University Hospitals Columbia-Mo.David Song Barnes-Jewish Hospital

VaSCular SurgeryChristopher Mcaninch University of Wisconsin Hospital and Clinics

Joban Vaishnav Johns Hopkins Hospital-M.D.Subeer wadia Rush University Medical Center-Ill.

internal MeDiCine/peDiatriCSSonalee ravi Saint Louis University School of Medicine

internal MeDiCine/pSyChiatryaaron hand University of Kansas School of Medicine-Kansas City

neurologiCal Surgerygeorge hanna Loma Linda University-Calif.James Smith West Virginia University School of Medicine

neurologyeric Kim Kaiser Permanente-Los AngelesMatthew preston University of Washington Affiliated HospitalsJason weller Boston University Medical Center-Mass.

obStetriCS anD gyneCologythomas ganz Saint Louis University School of Medicineemily Mills University of Connecticut School of Medicinelogan peterson Madigan Army Medical Center-Wash.Kristina pontarelli University of Illinois College of Medicine-Chicago

ophthalMologyKelly laurenti Medical College of WisconsinKevin Miller Stony Brook Teaching Hospitals-N.Y.ramsudha narala Loyola University/Hines VA Hospital-Ill.ryan Vogel Medical College of Wisconsin

orthopaeDiC Surgerythomas acott University of Tennessee College of Medicine-Memphisashley haegele University of South Florida College of Medicine-Tampatimothy lonergan University of Tennessee College of Medicine-Memphis

Grand Rounds 13

aneStheSiologyneeti arora New York Presbyterian Hospital-Weill Cornell Medical CenterSowmya Kantamneni University of Arizona Affiliated Hospitalseric lee Stanford University Programs-Calif.Matthew lyman University of Colorado School of Medicineakshay Menon Ochsner Clinic Foundation-La.Shoeb Mohiuddin University of Illinois College of Medicine-ChicagoChristian oliver University Hospitals-Jackson-Miss.andrew oster University of Missouri Kansas City Programsrina parmeshwar University of California Davis Medical CenterSaumil patel Hospital of the University of PennsylvaniaSuman rao Northwestern McGaw/NMH/VA-Ill.Sina Samie University of Southern CaliforniaSchirin tang University of Arizona Affiliated Hospitalslei tian Case Western/University Hospitals Case Medical Center-Ohioleon Vorobeichik University of Toronto

ChilD neurologyJoshua Kim North Shore-LIJ Health System-N.Y.Shiney Koshy UCLA Medical Center-Calif.

DerMatologyniraj butala Cooper University Hospital-N.J.Maulik Dhandha Saint Louis University School of MedicineMegan rogge Icahn School of Medicine at Mount Sinai-N.Y.Cassandra Simonetta Saint Louis University School of Medicinereena Varade Saint Louis University School of Medicinelindsey yeh St. Luke’s Roosevelt-N.Y.

eMergenCy MeDiCinenicholas busch Henry Ford Health Sciences Center-Mich.Caroline Dowers Henry Ford Health Sciences Center-Mich.Matthew Fellin Eastern Virginia Medical Schoolanne godbout Harbor-UCLA Medical Center-Calif.lucas haapapuro Western Michigan University School of MedicineClinton holaday Madigan Army Medical Center-Wash.yinjiang huang Harbor-UCLA Medical Center-Calif.andrew Krieger Saint Louis University School of MedicineSarah Kuehnle Maricopa Medical Center-Ariz.Daren Mahoney University of Nevada Affiliated Hospitals-Las Vegastian Mi Allegheny General Hospital-Pa.astha Mor Saint Louis University School of MedicineMax palatnik Vanderbilt University Medical Center-Tenn.Christopher Styles Morristown Memorial Hospital-N.J.william terrin Brooklyn Hospital Center-N.Y.

FaMily MeDiCineKristin bendert Oregon Health & Science UniversityKatelyn bezek Allina Family Residency Program-Minn.andrew bryant Mercy Hospital St. LouisSarah buller Brown Medical School/Memorial Hospital-R.I.Stephanie Du Kaiser Permanente Orange County-Calif.Joseph eckelkamp Mercy Hospital St. Louis

alex Fox University of Utah Affiliated Hospitalsanthony hoff University of Minnesota Medical Schoolgarrett huck Nellis Air Force Base-Nev.abigail ironside Texas A&M-Scott & WhiteCharity Kaiser Northwestern McGaw/NMH/VA-Ill.neil Kalsi Northwestern McGaw/NMH/VA-Ill.David Kim Methodist Hospital Sacramento-Calif.william Kim Kaiser Permanente Orange County-Calif.James Kirkpatrick University of Missouri Kansas City ProgramsMelissa lao Mercy Hospital St. LouisSri nimmagadda Community Hospitals-Ind.Jackson pugh Saint Louis University School of MedicineKarl Szafranski Greenville Hospital System/ University of South CarolinaVincent tichenor Scott Air Force Base-Ill.Christopher wedell Saint Louis University School of Medicinebroc white Utah Valley Regional Medical CenterDoyle witt University of Missouri Kansas City ProgramsChristopher young Mercy Hospital St. LouisJonathan yun Ohio State University Medical Center

internal MeDiCineabdullah abdussalam Saint Louis University School of MedicineJustin adams Medical College Wisconsin Affiliated HospitalsMatthew akin Indiana University Health Ball Memorial Hospitaltracey bertram Mercy Hospital St. Louisrichard bloomingdale Wayne State University Detroit Medical Center-Mich.william bzdawka University of Wisconsin Hospital and Clinicsamanda Cartee Mayo School of Graduate Medical Education-Minn.Cory Cheatham Saint Louis University School of Medicine

andrew Chen Loyola University Medical Center-Ill.philip Clerc Keesler Air Force Base-Miss.nicholas Crews Mayo School of Graduate Medical Education-Minn.Mary ehlman Mercy Hospital St. Louisnimah Jamaluddin UCLA Medical Center-Calif.ramzy Jandali Cedars-Sinai Medical Center-Calif.Sushma Jonna Barnes-Jewish HospitalStefan law University of Colorado School of Medicine-DenverSonia lin University of Southern CaliforniaJane Ma Olive View-UCLA Medical Center-Calif.rahul Malireddy New York Hospital Medical Center Queensrajeev Malireddy Alameda County Medical Center-Calif.Conor McCartney Saint Louis University School of Medicineaaron Miller Saint Louis University School of Medicineguilford parsons Virginia Mason Medical Center-Wash.akshar patel University of Michigan Hospitals-Ann Arborniral patel Henry Ford Health Sciences Center-Mich.ann perrin Oregon Health & Science UniversityMelissa reimers University of North Carolina HospitalsMatthew reisinger University of Colorado School of Medicine-Denverrae rohlfsen University of Nebraska Affiliated HospitalsShahed Shams St. Luke’s Hospital-St. LouisJeremy Sharp Kaiser Permanente San FranciscoJustin Sheehy Barnes-Jewish Hospitaleric Shelley University of Iowa Hospitals and Clinicsgurjit Sivia Loma Linda University-Calif.Stacey Stubblefield Scripps Clinic/Green Hospital-Calif.brandon Szeto Case Western/University Hospitals Case Medical Center-Ohiotheodore tollivoro Kaiser Permanente San FranciscoJesse tran University of California Irvine Medical Center

18 GrandRounds

day

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 Chicago’s anesthesiol-ogy program. 3. stefan law jumps with joy and is joined by his friends. Law will be going to University of Colorado for internal medicine.

1 2 3

Springfield, Ill. native aaron meyer holds up the match letter for his parents. Meyer is headed to University of California San Diego’s family medicine and psychiatry program.

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, that’s a 6.6 percent increase over last year and a 19 percent increase from 2009, a recent low.

Match

in MemoriamCasimir ‘Casey’ Firlit, M.D., Ph.D., 1939-2012Casimir “Casey” Firlit, M.D.,

adjunct professor in the School of Medicine and director of reconstructive urology, neuro-urology and

fetal urology at SSM Cardinal Glennon Medical Center, died in December at the age of 73.

“Dr. Firlit was a wonderful physician, teacher and mentor to many clinicians through-out the years,” said Sherlyn Hailstone, president of SSM Cardinal Glennon. “His kind-ness, compassion and ability to relate to the children he served were legendary.”

His love of children and helping improve their lives influenced Dr. Firlit every day. In a 2011 profile in St. Louis Magazine, Dr. Firlit put his pas-sion into words: “I found that kids, in spite of the adversity, [children] have the resilience to go through this and come out very positive. It’s what just lit my fire.”

Corinne Walentik, M.D. (’74), 1949-2012Corinne Walentik, M.D., M.P.H., professor of pediatrics in the division of neonatology died in December at the age of 63.

Colleagues and members of the community often described her as a passionate advocate for babies and families.

“She was a brave woman with tremendous unmatched knowledge of community

needs and re-sources regard-ing children’s health care,” said William Keenan, M.D., professor of neonatology at SLU and

Dr. Walentik’s colleague for 32 years. “She was a champion for children.”

During her 36 years at SLU, Dr. Walentik held several academic positions. Most re-cently, she was the professor of pediatrics in the division of neonatal-perinatal medicine and physician executive for managed care and public policy at SSM Cardinal Glennon Children’s Medical Center.

DeceaseD alumni

Owen eisele, m.D. (’38)christopher Vournas, m.D. (’38)edward laskowski, m.D. (’42)louis Browning, m.D. (’43)charles sherwin, m.D. (’43)edward Kinsella, m.D. (’44)James O’malley, m.D. (’46)W. Howard lewin, m.D. (’44)James Bellomo, m.D. (’47)Richard munger, m.D. (’47)Jack starrett, m.D. (’47)ismael Vilar, m.D. (’47)John malone, m.D. (’51)John Tisserand, m.D. (’51)curtis Flanagan, m.D. (’52)Donald mehan, m.D. (’52)David steigmeyer, m.D. (’52)Richard strassburger, m.D. (’53)carl Hertzman, m.D. (’55)John King, m.D. (’55)William mcKnelly, m.D. (’55)James Ransdell, m.D. (’55)Richard Hahn, m.D. (’56)Joseph Des Rosiers, m.D. (’57)John mcnally, m.D. (’57)marion Jabczenski, m.D. (’58)David mcKenna, m.D. (’59)Daniel semenoff, m.D. (’63)Jerome Goldschmidt, m.D. (’69)Peter litzow, m.D. (’78)michael malon, m.D. (’85)

From your Alumni Association president eDwarD J. o’brien Jr., M.D. (’67)

This spring we shared the excitement with our fourth-year medical students as they

celebrated Match Day and learned where they will continue their education and specialty training. We offer these students our best

wishes and welcome them into the Alumni Association.

In May, the University will formally celebrate the 25th Anniversary of the presi-dency of Lawrence Biondi, S.J. Under his leadership the University has been trans-formed significantly — both academically and aesthetically — and it continues to grow both physically and financially. The acquisitions and construc-tion projects since 1987 are numerous and exceptional. As for the once lonely medical school, the east side of Grand Boulevard from Choteau to Lafayette avenues has become a health science city. We con-gratulate Father Biondi on his insightful initiatives, continu-ing leadership and stewardship in the Jesuit tradition.

As for our Alumni Associa-tion, we urge members of the classes with years ending in “3” and “8” to consider lead-ership roles for the Medical School Reunion in October. Follow us electronically and watch for announcements and invitations in the mail. Feel free to contact the alumni office for any information or guidance.

May 2 John H. gladney, M.D., Diversity Award reception

May 17 School of Medicine precommencement

Aug. 4 White Coat Ceremony

Oct. 17-18 reunion Weekend

June 11-12 24th Annual Summer geriatric institute

June 21 3rd Annual JMF Conference CME Course of primary immunodeficiency Diseases

July 19-21 Cosmetic Blepharoplasty and Fundamentals of Face Lift

July 22-26 Masters Conference for Advanced Death investigation

July 29-30 Er Skills

Aug. 1-3 The 20th Advanced Techniques in Cervical Spine Decompression and Stabilization

Aug. 24 innovations in glaucoma Surgery

FOr iNFOrMATiON: 314-977-8335 medschool.slu.edu/alumni/

FOr iNFOrMATiON: 314-977-7401 medschool.slu.edu/cme/

Show your school colors www.clubcolors.com/slu

MArK yOUr CALENDAr

liVing the MiSSionTalking Turkey

After more than 50 years of practicing medicine outside Chicago, Lester Mann, M.D. (’62), retired several years ago, but isn’t 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 re-lief 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 I’ve got-ten 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 don’t say ‘no’ to those in need,” he said.

Mann’s commitment to service expanded in the early 1980s. He took breaks from his pediatric practice in Free-port, 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 hospital run by the Brethren in Christ Church, includes a comprehensive community health program, outpatient services, and HIV and TB clinics that serve an estimated 60,000 people, half under the age of 12.

“I had an immediate con-nection with the patients,” he said. “And I enjoyed the variety of medical problems that came through the door every day.”

Mann outlined a typical day at the hospital in a diary he kept: “In the morning I saw a premature infant with respiratory distress, a 4-year-old boy with a fever, a pregnant woman, a 50-year-old woman with osteomylitis of the mandible with puss running from her jaw. I went back to pediatrics, where 68 critically ill children were waiting for me.”

Because he wanted to commit more fully to serving the people of Zambia, Mann gave up his pediatric practice and worked in emergency medicine to allow him greater flexibility for travel. During the next 20 years, Mann and his wife, Leota, volunteered

for months at a time, spend-ing a total of about 8.5 years helping adult and pediatric patients.

“It became our second home,” he said.

The Manns often timed their trips to arrive in Zambia during the rainy season, when malaria outbreaks were so bad that pediatric patients had to share beds or sleep on floors. Mann contracted malaria dur-ing one of his stays and had to lie down on the operating room floor in the midst of performing a C-section. An-other physician took over.

“It wasn’t always the most ideal circumstanc-es, but we did the best we could with what we had, and the people were so grateful and trust-ing,” he said.

Mann and his wife stopped going to Zambia a couple of years ago for personal

health reasons, but they con-tinue to sponsor doctors and medical students who serve at the Macha Mission Hospital.

“I consider it a privilege to have served in the name of Christ,” he said. “And I ap-preciate Saint Louis University School of Medicine for mak-ing my life work possible.”

Alumnipulse

Firlit

WalEntiK

mann with Gift Hansumo, a farmer and friend who worked

the fields near the medical clinic in Zambia.

School of Medicine AluMni eventS

continuing MedicAl educAtion ProgrAMS

21 Grand Rounds Saint Louis University School of Medicine

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 Medi-cine, and Edward J. O’Brien 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.

r e u n i o n w e e K e n D 2 0 1 2 School of Medicine Honors a pioneer in the Field of Neuroradiology

DON’T FORGET rEunion 2013: oCt. 17-19 celebrating the classes of: 2008, 2003, 1998, 1993, 1988, 1983, 1978, 1973, 1968, 1963, 1958, 1953 and earlier.

o’Brien

A mother brought her daughter to see Mann for treatement of a cerebro-

meningeal protrusion.

Giving really does change lives.Though the amounts and the reasons may vary, there’s 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 you’ve already made a gift to SLU, thank you.

Please visit giving.slu.edu/igive and tell us your reason for giving.

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“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.”

PaUL J. ReILInG, M.D. (’62)