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News In Brief

Jefferson Surgical Solutions

Fernando Blanco, PhD, is working under the mentorship of Jonathan Brody, PhD, Director of the Division of Surgical Research, as a Clinical Pharmacology Fellow. Dr. Blanco came to Jefferson under a training grant with Drs. Scott Waldman and Walter Kraft in the Department of Pharmacology and Experimental Therapeutics. His work focuses on chemoresistance mechanisms of pancreatic cancer cells.

The annual Surgery Resident Research Presentations will take place on Thursday, May 29, 2014, from 7 – 8:30 a.m. in Foerderer Auditorium in the College Building. All are welcome to attend.

The annual Templeton Grand Rounds lecture is scheduled for 8 a.m. …

Gail Coleman Directs Generous Gift To Pancreatic Cancer Research

Jefferson Surgical Solutions

Gail Coleman of Alexandria, Virginia spent three decades as an attorney with the U.S. Department of Labor. Now retired, she enjoys traveling, volunteer activities, and taking history classes at George Mason University. And she still utilizes the analytical skills of an attorney. Indeed, before recommending a $100,000 grant to Jefferson (see “Changing Lives Through Research” on p. 3), Gail educated herself on the landscape of pancreatic cancer research, met with several institutions and evaluated a number of potential projects.

Gail’s initial decision to support pancreatic cancer research was not analytical, but deeply personal: The disease took her mother in 1989, …

Jamie Jay Rothstein, Rn, Ccrc

Jefferson Surgical Solutions

As Clinical Research Nurse and the Project Manager for the Department of Surgery, Jamie Jay Rothstein builds systems for implementing and managing all aspects of the Department’s clinical trials – from protocol development to fiscal management. She also guides the Department’s research coordinators, interacting with them regularly for ongoing education and training.

Before joining Jefferson in July 2013, Rothstein created, developed and managed a research department of 10 physicians. Through strategic planning, analysis, business plan development, quality and performance improvement, the department grew to a staff of several coordinators. She says that while she enjoyed the position, she jumped at …

Innovative Projects Explore Metabolism, Chemotherapy Resistance In Pancreatic Cancer Cells

Jefferson Surgical Solutions

A generous contribution via the Gail V. Coleman-Kenneth M. Bruntel Charitable Grant Fund (see “Those Who Give” on p. 4) has enabled Jordan M. Winter, MD, FACS, Associate Professor of Surgery, and his team to initiate two innovative studies in pancreatic cancer. Here, Dr. Winter provides an overview of the purpose – and potential impact – of each project.

Studying Cancer Cell Metabolism

As Dr. Winter explains, metabolism is a fundamental biologic process for the viability of any cell – including cancer cells. “If you can find a way to impair that biology, you have an opportunity to treat cancer …

Susan Lanza-Jacoby, Phd

Jefferson Surgical Solutions

It’s been 35 years since the Chair of Surgery at the time, Dr. Francis E. Rosato, Sr., hired Susan Lanza-Jacoby, PhD, to develop a research function within Jefferson’s Department of Surgery. Since then, her lab has been among the first to show that COX2 inhibitors are protective against the development of breast cancer. More recently, it was the first to identify that a 25-percent decrease in daily caloric intake delayed the onset of pancreatic cancer. And despite growing competition for grant dollars, Dr. Jacoby has been able to remain an independent investigator since coming to Jefferson in 1979.

Outside the …

Treating Acute Respiratory Failure

Jefferson Surgical Solutions

In March, Jefferson’s Adult ECMO Program saved the life of Kennett Square resident and entrepreneur Steve Burkes. Burkes, 59, and his wife, Caroline Henrich, an attorney, report that his symptoms started with chills and fever. Since Burkes had recently been playing with their new Amazon parrot, the couple thought perhaps he had contracted an infection from the bird. Instead, it turned out to be Acute Respiratory Distress Syndrome (ARDS), caused by a rare bacterial infection unrelated to the parrot.

By the time Henrich drove her husband to Jennersville Regional Hospital, he was incoherent. (“I felt like I was burning up …

Area Hospitals Turn To Jefferson's Adult Ecmo Program

Jefferson Surgical Solutions

In 2010, Thomas Jefferson University Hospital introduced new capabilities for portable extracorporeal membrane oxygenation (ECMO), which provides both cardiac and respiratory support to individuals with severely diseased or damaged heart and lungs. Since then, the hospital has built the area’s only comprehensive, surgeon-led Adult ECMO Program that includes a dedicated unit and team of clinicians with special training and experience in using this life-saving technology.

“Our program is gaining recognition in the community, with other hospitals increasingly referring critically ill patients to our team,” says Nicholas C. Cavarocchi, MD, FACS, FCCP, Director of the Surgical Cardiac Care Unit and Professor …

From The Chair: Overview

Jefferson Surgical Solutions

One Jefferson

There is palpable excitement in the air here at Jefferson. Efforts to transform our University, led by our new President Stephen K. Klasko, MD, MBA, are well underway. Many from our Department have contributed to the changes we see on the horizon. “Health Is All We Do”…has been embraced as our new motto.

“We will reimagine health care, health education and discovery to create unparalleled value”...has been embraced as our vision statement.

A recent extensive strategic retreat process has generated a Blueprint for Strategic Action (BSA) with four foundational enablers. These are:

• Partnerships

• Diversity

• Technology …

Colon Cancer Vaccine: Clinical Trial Enrollment Continues

Jefferson Surgical Solutions

Clinician-researchers at Jefferson are testing a vaccine that may support better outcomes for patients with colon cancer.

For people with Stage 1, 2 or 3 colon cancer, surgery is the standard of care. For most, it turns out to be a cure. But for a minority of patients who undergo surgery for colon cancer, disease later emerges in the liver, lung or another part of the body. When that occurs, the prognosis is poor.

“Once you have metastatic disease in colon cancer, a clock is ticking,” explains Scott Waldman, MD, PhD, Associate Dean, Clinical and Translational Research and Samuel M.V. …

News In Brief

Jefferson Surgical Solutions

Benjamin Phillips, MD, FACS, has joined the Division of Colon and Rectal Surgery. Dr. Phillips completed residency training in 2005 at University of Tennessee Medical Center in Knoxville and fellowship training in colorectal surgery in 2009 at Jefferson. He is dual- certified in General Surgery and Colon and Rectal Surgery and will practice in Center City and at Methodist Hospital.

Kudos: Drs. Paul J. DiMuzio and Scott D. Goldstein have been promoted to Professor of Surgery, Drs. Scott Cowan and Harish Lavu have been promoted to Associate Professor of Surgery, and Dr. Gurjyot Bajwa has been promoted to Assistant Professor …

Recent Residency Program Graduate Pledges Ongoing Support

Jefferson Surgical Solutions

After graduating from Jefferson’s surgical residency program in 2008, Negar Golesorkhi, MD, went on to complete a prestigious breast surgical oncology fellowship at Allegheny Medical Center. She has since returned to her native Virginia where she is in private practice at the National Breast Center in Lorton. Just a few years into her practice, Dr. Golesorkhi has already pledged to support the surgical residency program that trained and prepared her so well.

Dr. Golesorkhi’s commitment to the newly established Surgical Alumni for Education Fund will support academic enrichment for a surgical resident each year. “Surgical residency education is dual-faceted,” she …

Plant Biologist Shruti Lal, Phd, Identifies New Molecule That Could Prove Key In Treating Pancreatic Cancer

Jefferson Surgical Solutions

When Shruti Lal, PhD, joined the Division of Surgical Research as a post-doctoral researcher, she brought an intriguing blend of experience to the lab.

A veritable Renaissance woman, Dr. Lal has earned Master’s degrees in both Botany and Computational Biosciences. She holds a two-year diploma in e-commerce and web design, and has more than six years of professional experience in software development, teaching and research. She also studied Molecular Biology techniques at the U.S. Department of Energy’s Joint Genome Institute and explored microarray printing, scanning and hybridization at the University of California, San Francisco.

As a doctoral student at the …

Jeff-Chat Offers Students An Interprofessional Forum To Discuss Experiences, Danielle Elliot, Md, Scott Schmidt, Md, Claire Hoppenot, Md, Maria Hervada-Page, Mss

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Feelings of frustration, loss, and exhaustion are common among healthcare workers. Students placed among new experiences and in a dependent learning role are not shielded from these emotions but often experience them differently from other members of the healthcare team. In addition to the systematic and individual support available through TJUH, for the past year and a half Jeff‐ CHAT (Compassion, Humanism, Altruism, Trust) has provided a forum for students to discuss and reflect on difficult emotions and situations.

Six Sigma Methodology Applied To Immediate Use Sterilization At Thomas Jefferson University Hospital, Beth-Ann Schauer, Mba, Pmp, Ssgb, Lori Szymonowicz, Cpam, Ssgb, Precil Varghese, Pharmd

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Immediate use sterilization, also known as flash sterilization, is an expedited sterilization process used for surgical equipment needed in emergent clinical situations. Immediate use sterilization is a procedure used by Operating Room staff members to sterilize instrumentation on an as needed or just in time basis when instruments needed for a particular case are not immediately available or become contaminated in the course of the case. If instrumentation is not sterilized appropriately, the patient’s safety is possibly put at risk from the potential of surgical site infections. No specific literature data directly correlates immediate use sterilization with surgical site infection. …

How Will Comparative Effectiveness Research Influence Clinical Decision Making?, Nicholas Zaorsky, Md, Timothy Showalter, Md

The Medicine Forum

Most health care recommendations in the United States have come from trials designed to measure efficacy of medical interventions, with randomized controlled trials considered the gold standard for evidence-based medicine. Comparative effectiveness research has become an essential component of research to help define the benefits, risks, and effectiveness of different interventions for a particular illness. Comparative effectiveness research is informally defined as an assessment of all available options for a specific medical condition, with intent to estimate effectiveness in specific subpopulations. In this article, we contrast efficacy-based healthcare research and recommendations in the United States, under the model of evidencebased …

An American On Rotation In Switzerland, Jennifer Alloo Hong, Md

The Medicine Forum

It wasn’t easy getting to Switzerland. My husband started work at CERN at the end of 2009 when I was a 3rd year medical student and I was there helping him find an apartment during my winter break. In the back of my mind, I wondered if I could do an away rotation at les Hopitaux Universitaires de Genève (HUG) the following year. So I walked into the front entrance of the medical school associated with HUG. Bonjour! Do you have a program for students like me? Is it allowed for foreigners? Would I have to take a test in …

Quality Improvement Of Diabetic Care At A Resident Clinic, Carmi Santos Punzalan, Md, Sarah Rutherford, Md, Andrew Lerner, Md, Tasha Kouvatsos, Md, Sneha Thakkar, Md, Melissa Klein, Md, David Manoff, Md, Cecilia Kelly, Md, Dina Halegoua, Md, Gregory Kane, Md

The Medicine Forum

Our objective was to develop a quality improvement project on diabetes mellitus at our internal medicine residency clinic. Residents developed projects aimed at improving an aspect of diabetic care. Continuity of care, achievement of clinical targets, no-show rates, patient knowledge of diabetes, and preventive care were evaluated. Our data was obtained with a questionnaire and a retrospective review of medical records. A different provider was scheduled about every 1.78 visit. The no-show rate was 25.4%. About half of patients identified goal hgbA1c and BPs, and 35% and 60% achieved their hgbA1c and SBP goals respectively. Nearly all of the charts …

Persistent Severe Hyperkalemia In A Patient With Normal Renal Function, Michael L. Tobin, Md

The Medicine Forum

Case Report

A 75-year-old female with a past medical history significant for hypertension, hyperlipidemia, and colon cancer, status post colectomy with ileostomy, presented to the Methodist Hospital emergency room with muscular low back pain, which began a few hours prior, after abruptly bending over. Upon arrival to the hospital, she had no other complaints and noted that the back pain was starting to resolve without intervention.

In triage, her heart rate was measured at 38 beats per minute (BPM) with her other vital signs within normal limits. Her electrocardiogram (EKG) was read as a junctional rhythm with a rate of …

Sarcomatoid Mesothelioma In A Patient With Asbestos Exposure, Abhik Roy, Md, Merritt Brown, Md

The Medicine Forum

Case

A 76-year-old man with no significant past medical history presented with a two month history of progressive shortness of breath, 25-pound weight loss, and sharp right-sided chest, abdomen, and pelvic pain without radiation. The patient noted his dyspnea became more pronounced in recent weeks, notably worse with climbing stairs or performing work around the house. He described the pain as having a positional component, and exacerbated with deep-inspiration. On further questioning, the patient reported a 50-pack-year history of smoking and past exposure to asbestos while working with heating insulation. Physical examination revealed an age-appropriate, but cachectic appearing male with …

A 45-Year-Old Male With Hiv, Kaposi’S Sarcoma, And Squamous Cell Carcinoma Of The Skin, Jascha Rubin, Md, Hasan Bayat, Md

The Medicine Forum

Case

A 45-year-old male with a history of human immunodeficiency virus, (HIV), on highly active antiretroviral therapy (HAART), Kaposi’s sarcoma, and squamous cell carcinoma (SCC) of the right lower extremity complicated by chronic wound formation presented with worsening right leg pain and increasing wound drainage.

The patient described the pain as excruciating, with 10/10 intensity and exacerbated by movement. His wounds began draining purulent material and blood about two weeks prior to presentation. He has had several similar, though milder episodes in the past requiring hospitalization. When the wounds began to have a foul odor, he presented to the hospital. …

Thrombotic Thrombocytopenic Purpura Revisited: Upshaw Schulman Syndrome In A 20-Year-Old Male, Judy Wang, Md, Niluk Peiris, Md

The Medicine Forum

Case Report

A 20-year-old male with no significant past medical history presented to an outside hospital with a two-week history of progressive fatigue, malaise and decreased appetite. Prior to these events, he had been in his usual state of health with normal exercise tolerance and energy level. Upon development of his symptoms, the patient felt as though he had developed an upper respiratory infection (URI). The URI symptoms eventually resolved; however complaints of fatigue and malaise still remained. He then developed progressive dyspnea on exertion and tea-colored urine. The patient reported a singular febrile episode to 38.9˚C associated with nonbilious …

A Case Of Pyoderma Gangrenosum, Christopher T. Miller, Md

The Medicine Forum

Case Report

A 60-year-old man with past medical history of hypertension, post-traumatic stress disorder, major depression, hepatic steatosis, chronic kidney disease, and untreated hepatitis C virus (genotype 1b) initially presented to the outpatient primary care clinic with a chief complaint of an extremely painful right lower extremity ulcer that had developed and grown progressively larger after mild trauma against a metal corner 4 months prior to the appointment. He admitted to picking at the granulation tissue that would develop over the ulcer. He was treating the ulcer with antibiotic ointment. On initial exam, the ulcer was about 2x2 cm, located …

Two Cases Of Co-Infection With Babesiosis And Lyme Disease, Anthony Decicco, Md, B. Niluk Peiris, Md, Cecilia Kelly, Md, Michael Latreille, Md, Donald Jungkind, Phd

The Medicine Forum

Case 1

The patient is a 71-year-old female with past medical history significant for hypothyroidism and hyperlipidemia who presented to Thomas Jefferson University Hospital (TJUH) with complaints of myalgias for 6 weeks duration. The patient stated that she had begun an exercise program to lose weight and had subsequently noticed body aches and increased fatigue. She had presented to an outside hospital with these complaints, was told that the etiology was musculoskeletal, and was prescribed naproxen for pain relief. The pain did improve slightly with the naproxen but she noticed a rash and hives after starting the medication and stopped …

A Case Of A 32-Year-Old Female With Right-Sided Facial Droop And Numbness, Jason Schoenfeld, Msiii, Efstathia Andrikopoulou, Md

The Medicine Forum

Case Presentation

A 32-year-old Hispanic female with a past medical history of asthma, depression and insomnia presented to the emergency room with complaints of right-sided facial droop associated with ipsilateral facial numbness and diminished taste for the past three days. In addition, she reported a moderate to severe pulsatile headache for the past day. This headache was initially right-sided and frontal, but then became right-sided and occipital in location. She had a history of a similar headache episode four years ago. Additionally, she noted moderately severe intermittent chest pain described as sharp then dull occurring over the past day. On …

Mycobacterium Fortuitum Device Infection With Subsequent Endocarditis, Paurush Shah, Md, Alec Vishnevsky, Md

The Medicine Forum

Case

A 78-year-old female with a past medical history of mild dementia, hypertension, diabetes, coronary artery disease status post automatic implantable cardioverter defibrillator (AICD) for congestive heart failure presented with suspected bacterial endocarditis and AICD lead infection from an outside hospital (OSH). The patient initially presented to the OSH with chest wall tenderness, fevers up to 101° F, chills, decreased appetite, weakness and weight loss. She was diagnosed with a non-ST segment myocardial infarction based on elevated troponin levels without electrocardiogram changes. At the OSH, blood acid fast bacillus (AFB) cultures were checked after routine blood cultures and fungal cultures …

A 55-Year-Old Man With Rapid Onset Rectosigmoid Mass And Hepatic Metastases With An Afp Of > 3 Million Ng/Ml, Francis Kim, Md

The Medicine Forum

Case

A 55-year-old male with a past medical history of ulcerative colitis diagnosed in 1999, Barrett’s esophagus, hyperlipidemia, and diabetes mellitus presented with a 2-week duration of daily constant abdominal pain. He described the pain as a sharp, epigastric pain not worsened with food intake or bowel movements. He was unable to tolerate any oral intake for a week prior to admission secondary to increased epigastric pain. He stated an increase in bowel movements to 1 per day that was softer and less formed than usual. He also stated he had a near syncopal episode on the day of admission …

Not Your Typical Case Of Ascites: Pancreatic Ascites In A Patient With Cirrhosis And Pancreatic Duct Leak, Philip Montemuro, Md, Abhik Roy, Md

The Medicine Forum

Case

A 55-year-old male with a history of hepatic cirrhosis secondary to Hepatitis C and alcohol abuse presented to an outside hospital with progressive abdominal pain and distension. The patient initially complained of “punching” right upper quadrant and epigastric abdominal pain that was 10/10 in intensity and non-radiating. Although the pain had started one to two days prior to presentation, the patient had been experiencing several weeks of increasing abdominal distension. He reported drinking eight 40oz beers daily for over 40 years, and he felt that the abdominal pain improved slightly with cessation of alcohol use. The patient complained of …

Strongyloides Stercoralis Infection In A Patient With Aids, Abhik Roy, Md, Gregory Young, Md, Geoffrey Koff, Md, Tasha Kouvatsos, Md

The Medicine Forum

Case

A 46-year-old male with a past medical history significant for acquired immune deficiency syndrome (AIDS) presented with constant, non-radiating epigastric pain, nausea, non-bloody emesis, weakness, and lethargy. He had emigrated from Honduras twenty years prior. The patient denied fever, chills, recent travel, animal exposures, or sick contacts. His medications included efavirenz/emtricitabine/tenofovir, valganciclovir, trimethoprim/sulfamethoxazole, fluconazole, and iron.

Large, Solitary, High-Grade Duodenal Tubular Adenoma In A Patient Presenting With Gi Bleed, Paurush Shah, Md

The Medicine Forum

Case

A 71-year-old male with past medical history of hypertension, hyperlipidemia, aortic stenosis, and atrial flutter on warfarin presented to his primary care physician (PCP) a few days prior to admission with complaints of lethargy, lightheadedness, and mild shortness of breath (SOB) for about five days prior to admission. He stated that he had also been experiencing dark stools for one week while therapeutic on warfarin. His blood pressure in the office was slightly low, and he was told drink extra fluids as his symptoms were likely due to dehydration. The patient returned to his PCP a few days later …

An Indonesian Male With Abdominal Pain And Weight Loss: Abdominal Tuberculosis Presenting With Cervical Lymph Node Enlargement, Leah Duke Kaye, Md, Jayne Littlejohn, Md

The Medicine Forum

Case

A 21-year-old Indonesian male presented with a 6-month history of abdominal pain. The pain was described as a diffuse cramping that was worse with movement and after meals. He reported early satiety, and the pain was improved at rest. Associated with the pain, he reported a seventy pound weight loss, chills, decreased energy, and fatigue over the same time period. He denied nausea, vomiting, fevers, cough, dyspnea, or chest pain.

The patient emigrated from Indonesia to the United States in 2007 and has since had no travel or foreign visitors. He denied incarceration or military duty for both himself …