GrandRounds

Fall 08 Saint Louis University School of Medicine

New beginnings. Opportunities to grow and develop. These are common themes throughout this issue of Grand Rounds. Indeed they are common themes at the School of Medicine. They are worthy of exploration as we identify opportunities and face challenges in medical education, health sciences research and health care delivery. Students and residents enter the School of Medicine and its training programs in repeating, annual cycles. Each new group replaces one that has advanced to another stage in development. Graduates of the school have begun residency training in programs throughout the country. Other graduates from the past few years have completed specialty and subspecialty training and are entering practice or joining the faculty at hospitals. New beginnings. New faculty and departmental chairs bring their unique talents and experience and build on existing training, patient care and research programs. The research activity of a university is an integral component of its mission. Scientists build on and expand medical knowledge. They do this in a process that includes trainees, and this helps to ensure a supply of experienced investigators to continue to expand our understanding of medical science. This in turn leads to discovery of new ways to heal and relieve suffering. On page 20, we continue our Do You Remember feature and ask you to recall Dr. C. Rollins Hanlon and Dr. Vallee L. Willman. Those of you who have written in the past in response to this feature have told us of how your personal and professional lives were touched by faculty. You have told us how you came to grow and develop during your time at Saint Louis University School of Medicine. Please continue to be generous and share your memories. Also in this issue we are pleased to help you get to know our new dean, Dr. Philip Alderson, a little better. I know some of you have met him, and I know that many will have that opportunity in the future. Positions of leadership offer opportunities for growth and development as well. Dr. Alderson brings a wealth of experience in leadership positions in medical schools, hospitals and professional organizations. He brings his skills as a clinician and radiologist, a researcher and an administrator. He has committed to help our School of Medicine grow and develop. This is not a unilateral commitment. The search for a new dean may have ended with the appointment of Dr. Alderson, but the process of helping him to be successful has only just begun. All of us students, faculty, staff, alumni, University administrators have made a commitment to Dr. Alderson to help him to be the leader we want and need. We have promised him an opportunity to grow and develop. Some work has been done. Much remains. We all have a role to play. Regards, thomas J. olsen, M.d. (79)

From the Alumni Association President |

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. Dean Philip O. Alderson, M.D. | Saint Louis University School of Medicine Schwitalla Hall M268 1402 S. Grand Blvd. St. Louis, MO 63104-1028

On the cover
Philip O. Alderson, M.D., dean of the school of medicine, surrounded by the Class of 2012 at the annual White Coat Ceremony. Alderson told the students this is the beginning of a stimulating adventure and a rewarding career. It will be challenging, but savor it. Turn to page 6.

GrAnd roundS EditoriAL BoArd

Terence A. Joiner, M.D. 82 Philip O. Alderson, M.D. Edward J. OBrien Jr., M.D. 67 Thomas J. Olsen, M.D. 79
CoordinAtor

Marie Dilg | SW 94
dESiGnEr

writEr

Dana Hinterleitner Laura Geiser | A&S 90 | Grad 92 Nancy Solomon Carrie Bebermeyer | Grad 06 Sara Savat | Grad 02
ContriButorS

Steve Dolan | Cover, 1, 4, 8-9, 1213, 16-18, Back Cover Kabance Photography | 14-15, 21

Photo CrEditS

GrandRounds
Fall 08
Vol. 6 No. 2 Saint Louis University School of Medicine
page 6

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

A
Adenovirus Wasting No Time
Dean Alderson begins his + tenure. | page 6

Researcher Responds to Global Alarms Set Off by New Tuberculosis Strains New
vaccines and new delivery systems. | page 10

2008 moves on.

Match Day The Class of

| page 14

Vital Signs |

page 2

On the Front Lines

Living the Mission | page 19 Alumni Pulse |

page 2 page 20

B
page 16

SLU physicians help prepare military medics for the battlefield. | page 16

Poised for Discovery

CP

N
page 20

Researchers target chronic pain and cancer. | page 12

page 20

VitalSigns
Philip O. Alderson, M.D., dean of the school of medicine, has announced the appointment of three new department chairs whom he described as being committed to excellence in patient care, education and research.
journal articles and other reviews on family violence; child, intimate partner and elder abuse; medical safety; and end-of-life medical care. He also has been principal investigator on many research and training grants in these subject areas.

been named chairman of the department of family and community medicine. Schneider Schneider came to the SOM from the Texas Health Science Center of San Antonio, where he was professor of family and community medicine and vice chairman of the department. Schneider received his M.D. from Boston University School of Medicine in 1987. He completed his internship and residency training at the Duke Family Practice Residency Program in Fayetteville, N.C. He also completed a fellowship in academic family medicine at the University of Missouri-Columbia, during which he earned an M.S.P.H. in epidemiology. Schneider is nationally recognized for his work with the Academy on Violence and Abuse. He is one of the founders of the academy and serves on its nominating committee, board of directors and executive committee. Schneider is the author of numerous book chapters,

F. David Schneider, M.D., M.S.P.H., has

named chairman of the department of anesthesiology and critical care. Prior to coming to the SOM, Haynes was at the Medical University of South Carolina where he had been on faculty since 1990 most recently as professor and vice chairman of the department of anesthesia and perioperative medicine. Haynes received his Ph.D. and M.D. degrees from Case Western Reserve University in 1984 and 1986 before completing his anesthesiology residency at the Medical University of South Carolina. He received haynes his bachelors degree from Illinois College in Jacksonville, Ill., and his masters degree in experimental pathology from the University of Cincinnati. Haynes is the author of more than 50 publications. His research interests include evaluation of non-invasive bioimpedance cardiac output devices in pediatric cath labs and perioperative surgical and electroconvulsive therapy procedures.

Gary R. Haynes, M.D., Ph.D., has been

has been named chairman of the department of comparative medicine. Prior to this appointment, Long was associate professor of comparative medicine and vice chairman of the department. He also is the attending veterinarian at the medical school. Long received his bachelors of science degree from Southern Illinois University in 1991 and his doctor of veterinary medicine degree from Louisiana State University in 1997. He completed his residency and postdoctoral fellowship in laboratory animal medicine at Washington University School of Medicine in 2000. Long was a research instructor in the division of orthopedic surgery at Washington University. A Diplomate of the American College of Laboratory Animal Medicine, Long is a board member of the Academy of Surgical Research and program chair of the American Association

John P. Long, D.V.M.,

of Laboratory Animal Science. He is a member of the American Veterinary Medical Association and the American Society of Laboratory Animal Practitioners. Long succeeds Richard Doyle, D.V.M. who retired from the position.

suggests that a sophisticated robotic dog could be a good companion for your dogloving grandmother who cant care for a living pet. The researchers compared how residents of three nursing homes interacted with Sparky, a living, medium-sized gentle mutt, and Aibo, a doggie robot once manufactured by Sony that looks like a three-dimensional cartoon. The most surprising thing is they worked almost equally well in terms of alleviating loneliness and causing residents to form attachments, said William

Robotic Dog Makes Nursing Home Residents Less Lonely | A SLU study

A. Banks, M.D., professor of geriatric medicine. To test whether residents connected better with Sparky or Aibo, researchers divided a total of 38 nursing home residents into three groups. All were asked questions to assess their level of loneliness. One group saw Sparky once a week for 30 minutes, another group had similar visits with Aibo, and a control group saw neither furry nor mechanical critter. After seven weeks, all residents were asked questions about how lonely they felt and how attached they were to Sparky or Aibo. The residents who received visits from real and artificial pooches felt less lonely and more attached to their canine attention-givers than those who got visits from neither. There was no statistical difference between whether the real or robotic dog did a better job easing loneliness and fostering attachments. The research was published in the March issue of the Journal of the American Medical Directors Association.

CMX001 decreases adenovirus-induced lesions in the liver. Livers of adenovirusinfected hamsters were Adenovirus subjected to histopathological + and immunohistochemiCP cal evaluation, in which an antibody directed against an adenoviral protein stains infected cells brown. Animals infected with adenovirus and not treated with CMX001 exhibited extensive coagulation Adenovirus necrosis throughout the + liver (A) and widespread replication CP + of adenovirus, demonstrated CMX001 by staining for the adenoviral fiber protein (B). Treatment of Ad5-infected hamsters with CMX001 resulted in a significant reduction in hepatocellular injury (C) and greatly reduced staining for fiber (D). The arrows indicate intranuclear inclusion bodies. The scale bars represent 200 m for the larger pictures and 50 m for the insets. N: necrosis

I would love to have some clinical image friom Dr. Wold to run here.

Researchers Find Smallpox Drug May Also Target Adenovirus | SOM scientists have made two key
discoveries that could lead to the first-ever human testing of a drug to target the adenovirus. There are no drugs approved specifically to treat adenovirus infections in large part because there has been no animal model in which to test drug candidates. SLU researchers and their collaborators, however, have made two breakthrough findings: an animal model suitable for adenovirus testing the Syrian hamster and

Researchers Test Oral Medication for MS | Researchers at SLU are

testing an investigational pill to treat relapsing-remitting multiple sclerosis. There are various medications to slow or modify the progression of the disease, but all must be injected into the skin, muscle or veins, making the search for an oral medication a top priority.

SLU will be one of several dozen sites around the world where researchers will study how patients with relapsingremitting MS thomas respond to the experimental drug laquinimod, which is taken in tablet form once a day. About 1,000 patients will be enrolled worldwide. Laquinimod seems to modulate how the immune system works, said Florian P. Thomas, M.D., Ph.D., professor of neurology and the studys principal investigator. In smaller, earlier trials, the drug reduced the likelihood of relapses in patients, as well as the number of MS lesions seen on MRI tests.

a drug that successfully attacks the adenovirus in those animals. The drug, hexadecyloxypropyl-cidofovir or CMX001, is under development by Chimerix Inc. as a biodefense agent to meet the threat of smallpox or monkeypox viruses and as an antiviral agent in transplant patients. This is exciting news and a major step forward in finding a drug to treat adenovirus infections in humans, said William Wold, Ph.D., professor and chairman of the department of molecular microbiology and immunology and the studys lead author. CMX001 is an oral pro-drug of cidofovir, a drug developed by Gilead Sciences Inc. to treat a type of retinitis in AIDS patients. Chimerix licensed from Gilead the rights to develop CMX001. Cidofovir has long been a possible candidate to treat a number of virus infections, including the herpes virus, poxvirus and adenovirus infections in humans. The drug, however, is quite toxic to the liver and kidneys and is not available in oral form, which limits widespread use. Using the new animal model, the SLU researchers found that CMX001 provided protection from the adenovirus when it was administered prophylactically or therapeutically. The scientists found that the drug worked by greatly reducing the ability of the virus to replicate in key organs, mostly notably the liver. The SLU team also found that CMX001 was much less toxic and far more powerful than cidofovir. In addition, scientists discovered, two weeks after infection with the virus, CMX001 had reduced the viral load in the liver and blood to undetectable levels. The SLU research was published in a May edition of the Proceedings of the National Academy of Sciences.

Gladys Moore, a resident of NHC Healthcare of Maryland Heights, Mo., plays with Aibo, a robotic dog used in a study of companionship.

Grand Rounds Saint Louis University School of Medicine

has found that pelvic organ prolapse runs in families. Women with a family history of hernia or prolapse were at 1.4 times greater risk of prolapse than those without a close relative with the problem. SLU researchers studied 458 women who came into a gynecologists office for care. Nearly half had a family member a grandparent, parent or sibling with a hernia or prolapse. Of these, more than half had prolapse. Of the women without a relative who had a hernia or prolapse, about 29 percent had prolapse, significantly

Pelvic Organ Prolapse Runs in Families | A SLU study

fewer than those with a direct family connection. If your father has had a hernia, and your mother has prolapse, you already have a risk of prolapse and should look at changing the things you can control to reduce your risk, said Mary McLennan, M.D., director of the division of urogynecology and lead study author. Women with a family history should not take a job that requires them to do heavy lifting. They should watch their weight. They should avoid becoming constipated so they dont strain during bowel movements, she said. The research was published in an online edition of International Urogynecology Journal.

Researchers Study an Alzheimers Vaccination |

Endowed professorships help the medical school attract high-caliber faculty and provide the resources needed to conduct research, educate physicians and provide patient care. In the last few months, SLU School of Medicine has been proud to announce the creation and installation of four new chairs.

In May, SLU dedicated the building at 1438 S. Grand Blvd., as Monteleone Hall in honor of Patricia Monteleone, M.D., dean emerita of the School of Medicine. The building houses the department of neurology and psychiatry, and is used for academic offices, patient treatment and clinical research. Pat may have left SLU as a faculty member and administrator, but thanks to the stellar graduates she has shepherded through the School of Medicine, her legacy will live on during the decades to come, University President Lawrence Biondi, S.J., said at the dedication ceremony.

Researchers are studying whether an investigational intravenous drug given to patients who have been diagnosed with mild to moderate Alzheimers disease can enhance the bodys own immune response in fighting the disease. This therapy is the first treatment of its kind and holds great potential, said George Grossberg, M.D., Samuel W. Fordyce professor of psychiatry, director of the division of geriatric psychiatry and principal investigator for the clinical trial. Immune therapy has promise for being able to modify the course of Alzheimers disease rather than simply treat the symptoms of the disease as current FDAapproved therapies do. Grossberg called the treatment a vaccination approach because it introduces into the body an antibody to attack the plaque that forms inside the brain of those who have Alzheimers disease. Patients who participate in the research will receive an intravenous infusion of an antibody to the beta amyloid protein. Scientists believe beta amyloid protein triggers the death of brain cells in patients who have Alzheimers disease. Study participants will be randomly assigned to one of three groups: two receive different doses of the study drug, and one will receive a placebo. About 2,050 participants are sought at approximately 200 study sites in the United States and Canada. SLU is the only study site in St. Louis.

Endowed Professorship Named for Dr. Slavin | An

endowed professorship in allergy and immunology named for long-time faculty member Raymond Slavin, M.D. (56), and his wife, Alberta, recognizes Slavin as one of the giants in the field of allergy. Slavin has conducted research, treated patients and educated students, residents and allergy fellows at SLU for nearly 43 years. The lead donors in endowing the professorship are Bob Fox, founder and CEO of NewSpace Inc. and a University trustee, and his wife Maxine Clark, founder and chairwoman of Build-A-Bear Workshop. We are delighted to have participated in this way of honoring Ray. Hes done great work at the University, and we want to encourage that kind of commitment to go on forever, Fox said. Slavin and Fox first met about 30 years ago, running through Forest Park, and became friends who supported each other professionally. Our families friendship goes back many years, which is why Im so deeply touched by Bob and Maxines generosity, Slavin said. The endowed professorship creates a legacy that means what Ive built for the last 43 years is going to continue. Other donors have joined in recognizing the contributions of the Slavins by contributing to the endowed professorship.

Varvares Holds the Donald and Marlene Jerome Endowed Chair | Mark Varvares,
M.D. (86), chairman of the department of otolaryngology head and neck surgery, has been appointed as the inaugural holder of the Donald and Marlene Jerome Endowed Chair in OtolaryngologyHead and Neck Surgery. The chair is named for Donald Lee Jerome, M.D. (61), of Swansea, Ill., and his wife, Marlene. Jerome, an alumnus
Varvares

Labovitz Invested as Jack Ford Shelby Endowed Professor |

Arthur Labovitz, M.D., director of the division of cardiology has been named the Jack Ford Shelby Endowed Professor in Cardiology.
Labovitz

Former Faculty Member Endows Ophthalmology Chair | In June, the School

of Medicine celebrated the establishment of a chair in ophthalmology, which is endowed by Anwar Shah, M.D., a longtime benefactor and member of the University family. Through the Anwar Shah Endowed Chair in Ophthalmology, Dr. Shah will leave a legacy forever linking his name with Saint Louis Universitys, said Oscar A. Cruz, M.D., chairman of the department of ophthalmology. Shah began his relationship with SLU as an intern and resident in ophthalmology after coming to the United States from Pakistan as a Fulbright Scholar in 1955. Ive been part of Saint Louis University for a very long time. Its been getting better and bigger and more known nationally, said Shah, who now lives in California. Shah was a member of the SLU faculty for years, training numerous ophthalmology residents in retinal disease. He also created a two-year retinal fellowship program at SLU, among the few in the country to provide this advanced, specialized training to ophthalmologists. He built the St. Louis Eye Hospital, a $5 million nonprofit project, which was inaugurated with a benefit performance by legendary comedian Bob Hope in December 1980. The facility was later acquired by St. Marys Hospital.

The professorship is named for Jack Ford Shelby, chairman emeritus of Camie-Campbell Inc., former

and strong supporter of the SLU School of Medicine, was in private practice as an otolaryngologist in Belleville for

chairman of the board of the St. Louis Heart Association and a long-time benefactor of the medical school. My father always told me that joy is in giving. Now that Im older, I realize how wise my dad was, Shelby said. I love the University and have tremendous regard for the medical facility, particularly. I am so blessed in my life, with my family, my partners, my company and my friends at SLU. Im honored that Dr. Labovitz will hold the professorship that bears my name. Labovitz has been affiliated with SLU since he began his cardiology fellowship in 1981. I feel delighted, honored and greatly humbled by this recognition. I am going to be very proud to include this label in all of my correspondence, at all my meetings and during my professional interactions, Labovitz said.

33 years before retiring. For many years, Jerome was the only ear, nose and throat doctor in town and drew patients from as far as Evansville, Ind. He had served as a Medical Service Corps officer in the U.S. Army between 1966 and 1968, spending much time in Japan and hospitals in southeast Asia. Not only has Dr. Jerome directly touched the lives of his patients, but through his generosity he will expand his circle of influence to touch countless others he has not even met, said Varvares. Jerome had high praise for Vavares. Dr. Varvares came from Harvard and he is involved not only in the practice of medicine but also with some research projects, too, Jerome said. He really put SLU on the map as an excellent ENT program.

S aint Louis University School of Medicine Grand Rounds 4

VitalSigns

WASTING NO TIME
The School of Medicines 12th dean begins his tenure and lays out his plans for the schools future.

Clearly, Alderson hit the ground running when he started his

GR: What areas of the school need improvement?

new job on April 1, and he has no intention of slowing down. The internationally recognized radiologist said he plans to keep this pace to take the School of Medicine to the next level of scholarship, education and patient care. In this interview with Grand Rounds, Alderson talked about why he wanted the job and how he hopes to achieve his goals.

The school is expensive for our students. The scholarship support is not as strong as it should be. Its getting stronger, but we can do better.

GR: How do you plan to build that support?

GR: What attracted you to this job?

My wife and I grew up in St. Louis, and we liked the city. But my work kept us away for a long time. Then our daughter moved back here with her husband about four years ago, and they have two young children. We began visiting on a regular basis three or four times a year and we were reminded of how vibrant the city is. Our daughter did her cardiology training at SLU, and when wed pick her up on campus wed see how much SLU had changed. It was impressive. But all of this was theoretical, just impressions. We werent thinking of moving back until I learned the school was looking for a dean. I thought becoming a dean would be a natural step forward in my career as a department chair at a large research-oriented medical school, so I applied and, eight months later, here I am. I also saw tremendous potential in the job. The school of medicine now has the tangible assets and resources, such as the Doisy Research Center, to make a move up. Its not to say the school isnt doing well. Its a solid, mid-level school ranked number 56 in the county (U.S. News and World Report). Lets get into the top 50, and once were there, lets get into the top 40. We have to leverage our resources to enhance the visibility and reputation of the school, and I want to help do that.

We have to generate outside money to support scholarship, and Im eager to meet with donors who can help us do that. As I see it, my job as dean is to provide the resources for other people so they can do great work whether that means money for scholarships, research, endowed chairs or new facilities. Thats why fundraising is a major goal. Many people believe that if we are a giving, caring community of physicians and scientists and if we are about the business of doing things for the greater good, we shouldnt be constrained by worries about money. Unfortunately, thats not a recipe for success. Like every other organization in the real world, this medical school has to balance its budget. We have to pay for the things we get regardless of how lofty our goals might be. So the loftier our goals, the harder we need to work to convince other people who have the wherewithal to help us meet the goals.

GR: How do you plan to convince donors and alumni?

GR: What other assets or strengths do you see in the school?

Within 48 hours of opening the door to his new office, Philip O. Alderson, M.D., was unpacked. He had his Pendaflex file folders in alphabetical order and his professional journals neatly stacked on the shelves. Within the first week of taking over as dean of Saint Louis University School of Medicine, Alderson had met with nearly every SOM department chair and went on a walkabout in the Doisy Research Center, popping in on researchers to ask about their work. Within the first month on the job, Alderson had held town-hall-style meetings with faculty and students. He also had gone to the other end of campus to introduce himself to deans, department chairs and administrators there.
6

I think the commitments to service and education are strengths. A lot of schools talk about the importance of education and service, but it isnt really their main goal. Profit through research and clinical work is a major part of their business operation. Service is not as essential to their mission as it is here at SLU. I also think the clinical simulation center were designing will be a huge asset and will be another way to enhance our profile. Its the future of clinical education.

Ill meet with them, face to face whenever possible. In fact, after I accepted the job as dean but before I left New York, I met with some SLU alumni living in New York to talk about how we can help our school and our students. Ive met with alumni in San Francisco and this winter Ill meet with alumni in Chicago and Florida. I want their advice, their leadership and, yes, ultimately their financial support. For every graduate I engage, he or she should convince a classmate or friend to get engaged. I want our donors to know they can be a part of our future in a number of ways. I would hope our fundraising team keeps me moving in such a way that we can create a margin for excellence here.

GR: How would you describe your leadership style?

I like to believe that Im enthusiastic, committed and openminded. I like to work with people who enjoy what theyre doing. I dont like to second guess or micromanage. Id much rather delegate to capable people.

Grand Rounds 7

PROFESSIONAL STATS PhiLiP o. ALdErSon, M.d.

Received his undergraduate and medical degrees from Washington University in St. Louis. Completed his residency in radiology and nuclear medicine at the Mallinckrodt Institute of Radiology at Washington University. Spent more than 25 years at the College of Physicians and Surgeons of Columbia University in New York City. Most recently was chairman of the department of radiology and director of the radiology service at New YorkPresbyterian Hospital/Columbia. Spent four years as a faculty member at Johns Hopkins Medical Institutions before joining Columbia. Specializes in nuclear medicine, with special interests in disorders of the pulmonary vasculature. Has published more than 150 journal articles, 40 book chapters and four books. Recently was appointed by the NIH to serve on its national advisory council for the National Institute of Biomedical Imaging and Bioengineering 2008 - 2012

GR: How has your background prepared you for this new challenge?

Being a department chair at Columbia University in New York City for 20 years I had to navigate a lot of cross currents. Ive also had other leadership positions at Columbia, including five years as chairman of the board of Columbias midtown private practice group, a 17-department practice in Manhattan. I was president of the Columbia Campus Medical Board for two years, and for one year I was president of the medical board that spanned the New York Presbyterian health care system. It was a great experience that I enjoyed very much, and I think it prepared me well for my new adventure.

the Doisy Research Center to its full advantage. Walking around that building, talking to our scientists and seeing their discoveries is very exciting. Im eager to increase the support they need to continue their excellent work.

GR: How was your transition from New York to St. Louis?
It went well. I tell my friends that my wife has gone from seeing our grandchildren three times a year to three times a week. I see them at least twice a week. And we still know our way around the city. Its very manageable.

five years. Im way too old to be good at competitive sports now, but my dedication to exercise stems from that. I work out four days a week, usually before work. I dont have time for much more, and honestly, Id rather toss a wiffle ball to my five-yearold granddaughter than play golf or any other sport.

GR: What do you like to read?

GR: How difficult is it to follow a dean who had such a long tenure and successful track record?
Dean (Patricia) Monteleone laid a great foundation for me. The challenge now is to take what she started into some new, exciting directions.

GR: What was the first thing you unpacked?

I read history and biographies, rarely novels. One of my favorite books is Robert Kaplans Warrior Politics. I also enjoyed Blood and Thunder by Hampton Sides. Its a great story about Kit Carson and westward expansion. I also like Civil War history and have read several books by Stephen Ambrose.

Im pragmatic. At home I unpacked whatever box was in front of me. Here in the office I think I unpacked my Pendaflex files first. I live by my Pendaflex files. I spend time every day taking materials off my desk and putting them in the files so when an issue comes up, I know right where to find the relevant materials.

GR: Whats your favorite movie?

GR: What do you find exciting on the horizon?

Im excited about the idea of growing the University Medical Group so that it reaches beyond the campus and further into the St. Louis area. I also think theres no question that a new ambulatory care center is on the horizon. An architectural group is putting together a feasibility study to tell us how large and how expensive the project will be. The new center would be a huge asset to our community. And, as I mentioned earlier, I think expansion of the clinical simulation center next year will be amazing. I also get enthused seeing our researchers utilizing

GR: What do you do outside of work?

I spend time with my family and I exercise somewhat compulsively. My commitment to exercise is an outgrowth of the fact that when I was younger I was involved, at the amateur level, in competitive athletics. I played football and baseball in high school and football in college, and as a young adult I played a lot of mens fast-pitch softball around St. Louis. One team, L&P Sales, won two St. Louis city championships, one MUNI championship and went to the regional championships twice in

Its hard to pick one. My wife and I enjoy sumptuous period pieces. I wish it werent quite so violent, but I do like Braveheart. I also like Cider House Rules. It has a great soundtrack. I saw Jane Eyre, the version with William Hurt, in New York with my wife and daughters. Thats a beautiful film. We traveled to England for a conference sometime later and visited the Bront parsonage, which is in a small Yorkshire village on the moors. Its amazing to think that at a time in history when there were so few women writers and those who did write had to do so under a pen name, that this family turned out three women who were successful at the craft. I have the Laurence Olivier/Merle Oberon movie of Emily Bronts novel Wuthering Heights in my collection. I also have some of Errol Flynns movies on my shelf, including Robin Hood of course.

ALdErSonS GOALS
Increasing scholarships to make medical education more affordable Combining all of the School of Medicines simulation and robotics equipment into one organized center that becomes an important part of the SOM curriculum Improving patient-care facilities at SLUs urban medical practice Using the Doisy Research Center as a starting point to enhance the medical schools research profile

8 Grand Rounds

SLU Researcher Responds to Global Alarms Set Off by New Tuberculosis Strains
Daniel F. Hoft, M.D., Ph.D., delivers the bad news first. Despite the advent of the bacillus Calmette-Gurin (BCG) vaccine to prevent tuberculosis disease nearly 80 years ago, the vaccine has not managed to reduce disease prevalence especially in the developing world. A third of the worlds population is infected with TB, and approximately 1.5 million people die of the disease each year.
104 CD4 ->

Now, the good news. Hoft is leading efforts to find new vaccines, and his discoveries are showing promise.
In The Lancet, he provides details of the immune responses thought to be important for TB immunity, various mycobacterial antigens that seem to be promising targets for vaccine-induced immunity and different vaccination approaches being developed for use in people. Hoft said BCG is most helpful when given to infants within the first two months of life. BCG protection is more variable in adults. Sometimes, later in life when the immune system is weakened or when its compromised by malnutrition and/or disease, BCG vaccine immunity wanes, and the TB bug can start growing again, Hoft said. effective even if mutations in the organism have resulted in drug resistance. In one clinical trial, Hoft and his team found that a new vaccine, known as rBCG30, safely provided a significantly better immune response than the original vaccine. His findings are published in The Journal of Infectious Diseases. Hoft not only is investigating new vaccines, but new delivery systems.

Maybe we dont need a new vaccine. Maybe we just need to deliver the old one in a better way. | hoft
Given that TB is transmitted through mucosal surfaces, we might get a different, and hopefully better, immune response if, rather than injecting BCG, we deliver it directly to those surfaces through an oral vaccine or a nasal spray, for example.

Target Practice

102

101

Hoft demonstrates how aggressive by citing an epidemic in South Africa. Two years ago, 52 of 53 infected patients in a rural hospital were killed by extensively drug-resistant TB, and experts believe the disease could spread to neighboring countries. If that strain circulates throughout the world, were at square zero. We have no practical ways to treat it, especially in the developing world. All of our systems will become essentially useless. Hoft concludes his article with an urgent call for new TB vaccines. These developments have intensified the need for new TB treatments and for vaccines or vaccine strategies to protect against a disease that remains a scourge of the human race, he said.

61%
100 101 102 103

101

Border Crossing

102

In a review article in the July 12 issue of The Lancet, Hoft said important contributing factors fueling the continued TB pandemic include the lack of access to proper TB diagnosis and treatments, the lack of treatment compliance, the diversity of BCG strains and overattenuation of presently used strains. To make matters worse, during the last 15 years the TB organism has become more resistant to the combination drug therapy regimens that were considered a breakthrough in the 1950s. Cases of multidrug-resistant (MDR) TB and, more recently, extensively drug-resistant (XDR) TB are increasing. Usually when an organism becomes drug resistant it doesnt grow inside people as well, said Hoft, a professor and infectious disease specialist in the department of internal medicine, and director of the division of immunobiology. It accumulates mutations and is weakened. Thats not the case with some strains of XDR-TB. It can retain full virulence and be highly aggressive.

Tetanus

Mt b Isysate

A 58% 23%
100 101 102 103

44% 46%
100 101 102 103 104 CD3 ->

At the bench, Hoft and his team are working to identify the specific mycobacterial antigens that induce protective responses. Their work has provided the first evidence that human T cells might have an important role in vaccine immunity and need to be considered as possible new targets for vaccination. Their work also has identified specific mycobacterial antigens that can induce T cells inhibitory for intracellular mycobacterial growth. In the clinic, Hoft has conducted 10 human BCG vaccine trials designed to investigate, among other things, booster vaccinations with BCG or other new vaccines could enhance the levels of protective immunity pre and post infection. Hoft said they suspect a vaccine still could be
left In vitro stimulation with mycobacterial lysate results in marked expansion in T cells. Shown are two-parameter dot plots of flow analyses indicating the subsets of T cells present in cultures of PBMC from one representative BCG responder after in vitro expansion with tetanus toxoid and M.tuberculosis whole lysate. A Presents the results of dual staining for CD3 and CD4 surface markers. B Presents the results of dual staining for CD3 and CD8 surface markers. C Presents the results of dual staining for CD3 and TCR surface markers.

103

102

102

103

104 CD4 ->

104 CD8 -> 100

104

B 20%

104 CD8 -> 100

CD4+ T cell CD8+ T cell T cell Surface IgA Surface IgG

101

101

16% 74%
100 101 102 103 104 CD3 ->

Tuberculosis cavity with surrounding granuloma

103

103

Patient with tuberculosis

above

Susceptible non-infected person

104 CD3 -> 100

104

104 CD3 -> 100

Immune mechanisms potentially protect against tuberculosis infection of mucosal surfaces

The Money Trail: Hoft is collaborating with other investigators from throughout the world, NIH, industrial partners and the Aeras Global TB Vaccine Foundation, which receives substantial funding from the Bill and Melinda Gates Foundation.One of the exciting things about
TB research is the fusion of both government and private money, Hoft said. The NIH spends more money than any other government in the world on TB vaccine research. That said, TB still is considered an orphan disease by most pharmaceutical companies. Many people are less concerned about TB because its not as much of problem in this country as it is in developing countries, but that may change as we travel more. So you can see were never going to eradicate TB until weve done a better job worldwide of protecting against infection and disease.

103

102

102

103

2.4%

33%

101

100

100

101

102

103

104

100 100

101

101

102

103

104

10 Grand Rounds

Grand Rounds 11

Poised for Discovery

Although election season is upon us with the usual bombardment of political ads and debates, a poll shows many Americans feel uninformed about the views of their elected officials on scientific, medical and health research. The poll, conducted by Research!America, found that a vast majority of people in the United States believe that scientific discovery is very important to our health (86 percent) and competitiveness (78 percent) as a nation and barely 25 percent feel they know where their leaders stand on research issues. Ninety-one percent believe that research is essential in eliminating diseases, such as cancer, and 83 percent said they were more likely to vote for a candidate who supported increased government funding to find cures for and to prevent disease. In spite of public support for funding, however, government money for scientific research has been declining over the last several years. Saint Louis University demonstrated faith in its researchers to compete for those dwindling dollars by constructing the Edward A. Doisy Research Center. Even with the dry spell, many School of Medicine researchers continue to find government funding for their work, including the three profiled in this issue of Grand Rounds.

Research Professor Department of Internal Medicine Division of Pulmonary, Critical Care and Sleep Medicine Joined the School of Medicine in 2005

Daniela Salvemini, Ph.D.

Someone once told Salvemini that patients dont die of pain, they die in pain. She knew this was true after watching her mothers friend die from breast cancer. She was taking opiates like crazy, Salvemini recalled. The doctors kept upping her dose, but the pain wasnt getting better and the side effects were tremendous. Seeing what pain did to her and to her family was devastating. The experience was a turning point in Salveminis professional life. She decided to dedicate herself to identifying novel ways to manage pain. In particular, she focuses on understanding the molecular, biochemical and pharmacological actions of reactive oxygen/nitrogen species in the development of the tolerance associated with the use of opiates, such as morphine. Through this research, she and her colleagues discovered that a molecule known as peroxynitrite plays a critical role in the development of morphine tolerance. Repeated doses of morphine cause peroxynitrite to develop in the spinal cord, which in turn causes inflammation and damage to proteins and DNA in that area. Her research in animal models has shown that researchers could prevent morphine tolerance from occurring by blocking formation of this molecule or eliminating it once it forms. The benefits of our findings are potentially quite huge. Salvemini said. Researchers can use our work to develop therapies that will allow patients to take morphine without becoming tolerant of its benefits. For instance, when morphine is administered, another drug could be given simultaneously that prevents peroxynitrite from working and thus prevents tolerance. Together with her collaborators at Duke University, Salvemini is synthesizing novel chemical entities that

block the effects of peroxynitrite. Salvemini has been working in the area of pain and inflammation for more than 20 years. She worked in the private sector until 2005 when she came to the SOM full time. She was an adjunct professor at the SOM for more than a decade before becoming full-time faculty.

Salvemini recently received her first NIH award a five-year, $1.7 million grant to further elucidate the mechanisms and pathways in which peroxynitrite negatively impacts opioid-induced analgesia. NIH is looking for researchers who have the capacity to collaborate, which is what I do best, Salvemini said.
Professor | Department of Biochemistry and Molecular Biology Joined the School of Medicine in 2000

Dale Dorsett, Ph.D.

In the mid 1990s when Dorsett began exploring the factors that facilitated gene expression in fruit flies, he wasnt directing his research toward any human disease. His only goal was to understand how genes turn off and on to control development. What he discovered, however, shed light on the molecular mechanisms of a very human disease Cornelia de Lange Syndrome (CdLS). The syndrome is characterized by slow growth before and after birth, mental retardation, heart and other organ deficits, and, in acute cases, limb abnormalities. In the United States, approximately one of every 10,000 infants is born with CdLS, and Dorsett is one of the nations leading experts on the disease. His rise to prominence in the field began when he discovered Nipped-B, a gene in fruit flies that has multiple functions during development. Among other things, it promotes expression of the genes that control formation of a flys limbs and brain. If Nipped B is compromised in a fly, some genes are not

expressed at the right level, and a flys wings and other body parts do not develop properly. When other clinicians and researchers learned of Dorsetts work with NippedB they began calling. They suspected that changes in the human Nipped-B gene NIPBL were responsible for CdLS but were unsure of the mechanism. By comparing his fly data with data from CdLS patients, Dorsett found striking similarities suggesting that human NIPBL controls development of human infants in much the same way that Nipped-B controls development of flies. Although Dorsett continues to study various aspects of the fruit flys development, his labs primary focus is determining exactly how Nipped-B functions and why even the smallest change in Nipped-B can have such a major impact on development. His work is laying the foundation for the creation of new methods of screening for CdLS and for designing drugs that could counteract the genes misbehavior. The challenge with many genetic diseases is that by the time a child is born, some damage is done already, he said. But an infant still has a lot of growing to do. If we can counteract the problems with NIPBL as soon as CdLS is diagnosed, we might be able to avoid or minimize some of the downstream effects of the disease. Dorsetts work has been consistently funded by the NIH. In addition to his investigator-initiated research grants, he has program project grants with researchers at Childrens Hospital of Philadelphia and the University of California-Irvine.

Professor | Institute for Molecular Virology Joined the School of Medicine in 1974

Govindaswamy Chinnadurai, Ph.D.

For the past 30 years, Chinnadurai has been exploring why cancer cells do not follow the rules of normal cell proliferation and why they are able to evade the bodys defense mechanisms. His groundbreaking discoveries are helping scientists and clinicians at the SOM and throughout the world develop drugs to fight the more than 100 different types of cancers diagnosed today, including cancers of the breast and lung. By using two adenovirus genes E1A and E1B-19K Chinnadurai has discovered several cellular genes that are implicated in cancer cell proliferation and apoptosis. He discovered that a mutation in E1A, in cooperation with a cellular cancer gene known as Ras, induces highly aggressive and metastatic cancer cells. While searching for cellular proteins that are involved in controlling the tumorcausing activity of E1A, Chinnadurai also discovered the cellular protein, CtBP, which plays an important role in the spread of cancer cells. Chinnadurai hopes to design anti-cancer agents that target CtBP. If we could find a way to disrupt the interaction between E1A and CtBP, perhaps we can disrupt tumor growth, said Chinnadurai, who is considered the nations leading expert on the protein. Chinnadurai and his team also are credited with discovering important cell death regulatory genes, known as BH3-only members, during their work with E1B-19K, a gene that suppresses cell death.

Chemotherapy drugs cant kill some cancer cells because the cells express high levels of anti-cell death proteins, he said. Understanding E1B-19K will help us determine how these genes protect cells from death. Two of the BH3-only members discovered by Chinnadurais group are inactivated in a number of human cancers. He hopes that a new generation of drugs that efficiently activates these genes would be more effective anticancer agents than are available now. The NIH consistently has funded his research for the past three decades.

G R A N T S at a Glance
William A. Banks, M.D., professor of internal medicine and pharmacological and physiological science, has received a $1.5 million grant from the NIH for the project Oxidative Dysfunction of LRP at the Blood-brain Barrier in Alzheimers Disease. Richard D. Bucholz, M.D., professor and K.R. Smith Endowed Chair in Neurosurgery, has received a $5.3 million grant from the U.S. Department of Defense for the project Evidence Based Multimodal Neurodiagnostic Imaging of Traumatic Brain Injury and Post-Traumatic Stress Disorder. Xiaofen Fan, M.D., associate research professor of internal medicine in the division of gastroenterology and hepatology, has received a $1.4 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases for the project Hepatitis C. Virus Quasispecies in the Resistance to Antiviral Therapy. Jennifer K. Lodge, Ph.D., associate professor of biochemistry and molecular biology and associate dean for research, has received two grants from the National Institute of Allergy and Infectious Diseases a $1.8 million grant for the project Signal Transduction and Cell Wall Integrity in Cryptococcus Neoformans, and a $1.3 million grant for the project Chitin and Chitosan Production in Cryptococcus Neoformans. John E. Tavis, Ph.D., professor of molecular microbiology and immunology, has received a $1.3 million grant from the National Cancer Institute for the project HCV Genetic Variation and Hepatocellular Carcinoma. Daniel S. Zahm, Ph.D., professor of pharmacological and physiological science, has received a $1.4 million grant from the National Institute of Neurological Disorders and Stroke for the project, Convergent Versus Parallel Striatal Afferents.

12 Grand Rounds

Grand Rounds 13

Members of the Class of 2008 began their next stage of professional development this summer as they entered their residency programs. Of the 149 students matching with residency positions throughout the country, 19 will continue to call St. Louis home while they complete their residencies at the SLU School of Medicine.

MATCH DAy 2008

Match Day 2008

AnESthESioLoGY
Christopher Beuer Saint Louis University School of Medicine (Mo.) olatubosun dennis Saint Louis University School of Medicine (Mo.) John hille University of Utah Affiliated Hospitals (Utah) ryan hood Loyola University Medical Center (Ill.) nicholas hoskins Mayo School of Graduate Medical Education (Minn.) unhea Kim Brigham & Womens Hospital (Mass.) nitin Malhotra University of Louisville School of Medicine (Ky.) ryan Meier University of Utah Affiliated Hospitals (Utah) Aaron rund University Hospitals Case Medical Center (Ohio) Palak Shah Northwestern McGaw/NMH/VA-IL Sean Stoneking Saint Louis University School of Medicine (Mo.) robert wong Cedars-Sinai Medical Center (Calif.)

Phoebe King University of Texas Health Science Center (Texas) Jesse Matthews University of New Mexico School of Medicine (N.M.) Papiya ray National Naval Medical Center (Md.) Paul Schmidt University of Kansas School of Medicine (Kan.) david Stewart Rush University Medical Center (Ill.) Bithika thompson Barnes-Jewish Hospital (Mo.) Aaron Young University of Rochester/Strong Memorial (N.Y.) Malgorzata Zukowska Barnes-Jewish Hospital (Mo.)

oPhthALMoLoGY

Sonya Bamba Louisiana State University Ochsner (La.) Pooja Jamnadas Loyola University/Hines VA Hospital (Ill.) Christopher Pole Saint Louis University School of Medicine (Mo.)

Lauren Sterner University of Tennessee College of Medicine (Tenn.) Joanna thomson Cincinnati Childrens Hospital Medical Center (Ohio)

rAdioLoGY ONCOLOGY

PEdiAtriCS EMERGENCY MEDICINE

orthoPAEdiCS

intErnAL MEdiCinE PEDIATRICS

The 2008 residency matching results again demonstrate the strength of our medical students, said L. James Willmore, M.D., associate dean of the School of Medicine. Our newly graduated physicians will enter all fields of medicine and surgery and will be trained in programs all over the United States. We on the faculty are quite proud of our students, and we wish them well in this next step of their education. Students awaited word of their matches at a party in April held at Busch Stadium. Here is the Saint Louis University School of Medicine match list by specialty:

EMErGEnCY MEdiCinE

todd Crum University of Nebraska Affiliated Hospital (Neb.) Chris dewar North Shore University Hospital Manhasset (N.Y.) Jared Jones Hennepin County Medical Center (Minn.) Matthew Larsen Advocate Christ Medical Center (Ill.) Gabriel Marsh University of Wisconsin Hospital and Clinics (Wis.) ryan Pohl Resurrection Medical Center (Ill.) Jeffrey Spencer Barnes-Jewish Hospital (Mo.) Anjali Srivastava University of Chicago Medical Center (Ill.) irena Vitkovitsky Barnes-Jewish Hospital (Mo.) Luke wilder University of Kentucky Medical Center (Ky.) Christopher williams University of Arizona Affiliated Hospitals (Ariz.)

Matthew nelson Family Medicine Residency of Idaho (Idaho) Erika noonan Utah Valley Regional Medical Center (Utah) Lisa Phifer Allina Family Residency Program (Minn.) denise Pounds Swedish Medical Center (Wash.) Samuel recob Siouxland Medical Education Foundation (Iowa) Sara Schwager Saint Louis University School of Medicine (Mo.) richard Sheridan DeWitt Army Community Hospital (Va.) Susan Stephens Kaiser Permanente (Calif.) Bessevelyn tables St. Johns Mercy Medical Center (Mo.) Shawn usery Cox Medical Centers (Mo.)

olivia Giddings Vanderbilt University Medical Center (Tenn.) david niccum Medical College Wisconsin Affiliated Hospitals (Wis.) raegan Vanderput Banner Good Samaritan Medical Center (Ariz.)

Austin Crow University of Wisconsin Hospital and Clinics-WI Matthew dilisio Summa Health/Northeastern Ohio Universities, Colleges of Medicine and Pharmacy (Ohio) Bradley warlick Saint Louis University School of Medicine (Mo.) Kiley Ziegler University of Missouri/KC Programs (Mo.)

Lauren rice University of Maryland Medical Center (Md.)

Kristin Kowalchik Mayo School of Graduate Medical Education (Fla.) Kiwhoon Lee University of Louisville School of Medicine (Ky.) Maria thomas Barnes-Jewish Hospital (Mo.)

RESEARCH PSYChiAtrY

PhYSiCAL MEdiCinE And rEhABiLitAtion

Katherine doerr Harvard/Spaulding (Mass.) william Filer University of North Carolina Hospitals (N.C.) Katherine Payne Case Western Metro Health Medical Center (Ohio)

Sarah Bowron Washington University (Mo.)

SurGErY GENERAL

PSYChiAtrY

otoLArYnGoLoGY

Jennifer do Kaiser Permanente/Oakland (Calif.) Marsha Kadze University of California San Diego Medical Center (Calif.)

intErnAL MEdiCinE PRIMARY nEuroLoGY

PAthoLoGY

ryan westhoff Cook County Stroger Hospital (Ill.) Austin hake Saint Louis University School of Medicine (Mo.)

richard Cantley Rush University Medical Center (Ill.) Jeanette Prante University of Kentucky Medical Center (Ky.)

PEdiAtriCS

nEuroLoGY CHILD

thomas dye Cincinnati Childrens Hospital Medical Center (Ohio) Emily Gertsch Mayo School of Graduate Medical Education (Minn.) ivet hartonian UCLA Medical Center (Calif.)

intErnAL MEdiCinE

FAMiLY MEdiCinE

dErMAtoLoGY

more
Grand Rounds 15

medschool.slu.edu/alumni/

Sofia Chaudhry Saint Louis University School of Medicine (Mo.) Sonya Jagwani University Hospitals-Columbia (Mo.) tricia Missall Saint Louis University School of Medicine (Mo.) Anthony nuara University of Texas Southwestern Medical School (Texas)

Jennifer Bello West Suburban Medical Center (Ill.) Cory Bethmann University Hospitals-Columbia (Mo.) Amanda Bristol Saint Louis University School of Medicine (Mo.) Patricia Eusterbrock St. Johns Mercy Medical Center (Mo.) Amanda Gerber Cedar Rapids Medical Education Foundation (Iowa) Mark hooste Darnall Army Medical Center (Texas) Chrystal Jenkins University of Rochester/Strong Memorial Hospital (N.Y.) robert Konold Scott Air Force Base (Ill.) robert Myslin Camp Pendleton Naval Hospital (Calif.)

Peter Anderson Mayo School of Graduate Medical Education (Minn.) timothy Brinker Saint Louis University School of Medicine (Mo.) Mihir Faldu University of Florida College of Medicine Shands Hospital (Fla.) olga Fortenko University of California Davis Medical Center (Calif.) Kathleen Gally Wright Patterson Medical Center (Ohio) Amanda Gomes University Hospitals Case Medical Center (Ohio) James Grigg Einstein/Montefiore Medical Center (N.Y.) Bryce haslem University of Iowa Hospitals and Clinics (Iowa) Estebes hernandez Johns Hopkins Hospital (Md.) Amelia Kasper Barnes-Jewish Hospital (Mo.)

nEuroSurGErY

Sonia teufack Thomas Jefferson University (Pa.)

oBStEtriCS And GYnECoLoGY

Shelly Agarwal Rush University Medical Center (Ill.) Angela dicarlo Naval Medical Center (Va.) Linda hong Loma Linda University (Calif.) Sukruthi reddy Loma Linda University (Calif.) Katherine Scolari Saint Louis University School of Medicine (Mo.) Sonyoung Seo Emory University School of Medicine (Ga.) Staci tanouye Mayo School of Graduate Medical Education (Minn.) Kelly Vo University of California San Francisco (Calif.)

Patrick Basile Wright Patterson Medical Center (Ohio) Gregory Bross Phoenix Childrens Hospital (Ariz.) Karin Clauss Saint Louis University School of Medicine (Mo.) Kristen Covert Phoenix Childrens Hospital (Ariz.) Stacy dodt Naval Medical Center San Diego (Calif.) Matthew Fong Loma Linda University (Calif.) Susan Gage University of California Irvine Medical Center (Calif.) tina Mathai Rush University Medical Center (Ill.) Sarah Meyer Childrens Hospital Boston (Mass.) Kevin Morgan Wright State University Boonshoft School of Medicine (Ohio) william Payne University Hospitals Case Medical Center (Ohio) Abigail ryan Saint Louis University School of Medicine (Mo.) Andrew Sherman University of Rochester/Strong Memorial (N.Y.) Allison Sterner University Hospitals Case Medical Center (Ohio)

Gayle Copeland University of Southern California (Calif.) Sarah Fayad University of Florida College of Medicine/Shands Hospital (Fla.) nicole Garber Emory University School of Medicine (Ga.) Lauren Kissner Loma Linda University (Calif.) Andrew Linsenmeyer Harvard Longwood Psychiatry (Mass.) Jacob Pounds University of Washington Affiliated Hospitals (Wash.)

Andrew hall Keesler Air Force Base Medical Center (Miss.) nicole Kellis Naval Medical Center (Calif.) Katherine Fu University of California San Francisco-Fresno (Calif.) Charles Kim Saint Louis University School of Medicine (Mo.) Carolyn Pinkerton Medical College of Wisconsin Affiliated Hospitals (Wis.) Corey Stennes University of Tennessee College of Medicine (Tenn.) Jasmine wong Loma Linda University (Calif.)

SurGErY PRELIMINARY

rAdioLoGY DIAGNOSTIC

douglas Adolphson Mayo School of Graduate Medical Education (Fla.) raymond Azab Saint Louis University School of Medicine (Mo.) Mark Barrett University Hospitals-Columbia (Mo.) Shandon hatch Rochester General Hospital (N.Y.) Conor Kain Tripler Army Medical Center (Hawaii) ivy Lawson Saint Louis University School of Medicine (Mo.) Luke Ledbetter University of Kansas School of Medicine (Kan.) dwight Lee Stony Brook Teaching Hospitals (N.Y.) Kendall Martin Harbor UCLA Medical Center (Calif.) John Stanfill Baptist Memorial Hospital (Tenn.) Colin thompson Barnes-Jewish Hospital (Mo.) Scott tyson Cleveland Clinic Foundation (Ohio) Sri Preethi Vagvala Advocate Illinois Masonic Medical Center (Ill.)

Blake hamby Saint Louis University School of Medicine (Mo.) Edward Kessler Saint Louis University School of Medicine (Mo.) Lorraine Levers UVM/Fletcher Allen (Vt.)

uroLoGY

Brian Cross Emory University School of Medicine (Ga.) nilay Gandhi Saint Louis University School of Medicine (Mo.) Michael Gangel Akron General Medical/ Northeastern Ohio Universities Colleges of Medicine and Pharmacy (Ohio) Gregory McLennan William Beaumont Hospital (Mich.)

R A T S C
ON THE FRONT LINES
SLU physicians help prepare military medics for the battlefield.
Col. Jeffrey Bailey, M.D. (96), reminds them of this each time he brings a fresh group of U.S. Air Force medics through the hospital for two weeks of intensive trauma care training. The training is designed to ensure that military medical teams are more fully prepared for the rigors of combat medicine before they are deployed to potentially hostile environments. After the first Gulf War, the defense department realized a significant proportion of the physicians, nurses and medics sent to the war zone lacked experience in the field of trauma care, said Bailey, an active duty Air Force trauma surgeon and an associate professor of surgery in the medical school. Bailey said this is partly because during peacetime most Air Force medical personnel are stationed in smaller hospitals and clinics on military bases. They perform physicals and treat minor ailments, but they do not experience the variety and sheer number of cases that doctors see at a trauma center such as the one at SLU Hospital the only Level 1 Trauma Center certified for both Missouri and Illinois. Our ability to maintain our own competency in the care of critically ill patients is just impossible in our facilities, Bailey said. To fill that gap, the military looked to where the trauma patients are and where the expertise is. We found it in civilian trauma centers. The Air Force decided the best way

Saint Louis University School of Medicine faculty working in the emergency department and in the intensive care unit at Saint Louis University Hospital may never go to Iraq yet they are one degree of separation from treating the wounded soldiers there.
to train its soldiers was to embed a military training unit within civilian trauma centers and have its medics work side-by-side with civilian health care providers. The result is the Center for Sustainment of Trauma and Readiness Skills (CSTARS). Bailey directs the program at Saint Louis University, which is one of only three in the nation. If we do things right here at SLU, not only will we be able to save lives on the battlefield, but quality of life as well, he said. Instructors are active duty Air Force personnel. The team includes two trauma surgeons, a neonatologist, two physician as-

We believe that graduates of C-STARS have helped save the lives of Iraqis, Afghanis, coalition forces and our friends and neighbors serving in armed conflict. We can only hope that in so doing, they bring us closer to a lasting peace. | robert M. heaney, M.d.
sistants, two nurses and two medics, all with extensive experience in combat medicine. The students are physicians, nurses and medical technicians from active duty Air Force, Air National Guard and the Air Force Reserve Medical Service. All are fully trained, licensed health care professionals who rotate through the C-STARS program to refresh their skills. Most of the rotators, as they are called, are scheduled to deploy to Iraq or Afghanistan in the near future.
above technical Sergeant witt, Major Camille dema and Major Melanie Mcdonald with the 183rd Medical Group out of Springfield, Ill, in the middle of a simulation exercise inside mock field tent at the SOM. The patient they are treating suffered severe leg injuries when he stepped on a land mine.

Overcoming barriers

When the military initially approached the University in 2001 about permanently stationing the program within the School of Medicine, the immediate answer was yes, but there was a barrier. The Air Force wanted its rotators to do more than observe. They wanted them to have hands-on training with patients. Air Force medics are indemnified by the government, but that protection does not apply to their civilian colleagues or civilian
technical Sergeant tammy witt, a medic with the 136th Medical Group out of Fort Worth, Texas and Chief Master Sergeant Adam reading, a medic with the 182nd Airlift Wing out of Peoria, Ill. dress Nick Neeleys head wound in the emergency room at Saint Louis University Hospital. Neeley, of Desloge, Mo, was hit on the forehead with a crowbar.

institutions. If there were litigation, the Air Force medics would be covered, but the school and hospital would be vulnerable. Robert M. Heaney, M.D., associate dean for graduate medical education and veterans affairs, worked closely with University administration, SLU Hospital, the School of Nursing and the Air Force to forge a memorandum of understanding that addressed the concerns. The memorandum fully integrates the C-STARS staff into the medical faculty and grants them academic appointments. It allows the C-STARS curriculum to exist as a formal curriculum in the school. If C-STARS rotators are physicians, they function as residents or housestaff during their two weeks at SLU. They

Grand Rounds 17

are put on the trauma team and take calls. Nurses and medical technicians work shifts in the E.R. and I.C.U. Heaney said integrating the program was the right thing to do. It not only benefits the military medics, it benefits the medical school. We had the training venue, he said. The Air Force had a cadre of committed health care providers who needed real-world experience in trauma care and could learn by helping us take care of patients.

Immersion therapy

The 14-day trauma immersion experience begins with an orientation lecture for the 18 to 20 rotators and quickly picks up speed. Rotators are re-familiarized with the medical equipment used in expeditionary medical care, including special types of ventilators, suction machines and IV infusers small enough to fit into a backpack if need be. They begin working shifts in the hospital almost immediately and spend time at St. Johns Mercy Medical Center in the burn unit. Air Force medics also ride along as pre-hospital first responders in association with the St. Louis Fire Department and the Air Rescue Consortium of Hospitals. Other than spending time with patients at their bedsides, Bailey said perhaps the most powerful learning experience for the rotators takes place in a simulation lab in the lower level of the Learning Resources Center. A usually non-descript exam room is draped in canvas and stocked to look exactly like a military field hospital. Three times throughout the course, rotators will enter the tent and practice

Five rotators quickly remove the drape over the mannequin and begin assessing their patient. To make the experience more realistic, the instructors use computers to control the mannequins vital signs. If treatment is correct, the mannequins condition improves. If incorrect, the patient gets worse. In this case, the patient died. Bryan meets with the rotators after the exercise and reviews a video recording of the simulation with them. He stops the tape several times to offer constructive criticism. This is where you started losing him, he tells the rotators. You spent so much time worrying about his airway that you neglected to get him fluids. But dont be too hard on yourself. This is a learning process. I guess its better we make these mistakes here rather than out in the theater, said MSgt. Doug Coons, a medic from the 139th Aeromedical Evacuation Squadron in Scotia, N.Y. This was our first simulation. I think well get on a roll after we do it a couple more times, and well be more confident when we get over there.

Alumni Pulse
Alieta Eck, M.D. (80) and her husband, John Eck, M.D. (80), founded a clinic that provides free health care to the poor and uninsured in central New Jersey. They make certain, however, their patients feel like anything but charity cases. I tell them Im honored I can love God through them, John Eck said. I thank them for coming and for giving me the opportunity to give back. Ive had some patients, even some of our toughest tattooed Vietnam veterans break down and cry when I say this, but its my privilege to serve them. The Ecks established the Zarephath Health Care Center (ZHC) in Somerset, N.J., in 2003. Alieta Eck said the idea was born out of their increasing frustration with the lack of health care access for the poor and the governments ineffective programs to provide care. Medicaid is an extremely wasteful and bureaucratic system, and everybody games it, she said. The administrative overhead is too high, and as a result, quality goes down. The system is unjust. We wanted a better model. The Ecks feel they found that model charity-based health care in which churches meet the medical care needs of the poor, uninsured or underinsured. Faith-based charity care may seem like an outdated

Living the Mission Faith in Motion |

Preparing for the worst

Confidence is key according to Bailey. He said the rotators, without exception, have higher simulation scores by the end of their second week of training and are more confident in their skills. This is important given that many of the medics who come through the C-STARS program at SLU are headed to Balad Air Base Theater Hospital in Iraq, reportedly the busiest defense department trauma center since Vietnam. While the C-STARS training is designed to produce the best outcomes in the battlefield, Bailey said the training also can prepare soldiers for the worst. You take a young airman who went through training to be a medical technician and you assign him to a clinic or base to do physical exams, Bailey said. Hes never seen someone die before. Then they come here for training, and it happens. Theyre out on an ambulance ride or in the E.R., and it can be traumatic for anybody. Were exposing our medics to death and dying in a setting where theres support and understanding. We hope the experience gives them some resilience for what theyll have to face in the war zone because theres no question in my mind that they will encounter death.

When you get deployed, that isnt the time to be learning your job. Thats the time to know your job.
|
Col. Jeffrey Bailey, M.d.

Measuring success

their skills on artificial computerized patients who have injuries medics might see in war zones. Instructors sit behind two-way glass and score the teams performance based on trauma care guidelines established by the American College of Surgeons. C-STARS Instructor, Maj. Rance Bryan, R.N., sets the scene: You have a 21-year old male soldier shot in the right femur. No intervention in the field. Go.

Since C-STARS was launched at SLU in 2002, more than 1,000 Air Force medics from bases in the United States and overseas have gone through the training. Many of the rotators send feedback to Bailey and his team, thanking them for the training and offering suggestions on how to adapt the curriculum to reflect what they are seeing in the field. Baileys most cherished note of appreciation hangs on the wall in one of the simulation labs. It is a framed American flag and an engraved plaque. The plaque reads: Let it be known this American flag bears witness to the destruction of terrorist forces threatening the freedom of the United States of America. It was flown in honor of C-STARS through the enemy skies in Iraq. Please know the knowledge we gained has made our deployment smoother. The 33th Fighter Squadron.

notion, but its how we used to serve people in need and it worked think back to the Good Samaritan, Alieta Eck said. We call it a first century solution to a 21st century need. With this idea in mind, the Ecks approached their congregation at the Zarephath Christian Church. They were given permission to open the clinic in a small building on church property that had been nearly destroyed by Hurricane Floyd in 1999. The now tidy tan and brick building holds three exam rooms, a waiting area, a counselors office and a small pharmacy. Although the Ecks need to support their family of five children through their private practice hes a family practitioner and shes an internist they find time to keep the clinic open 10 hours a week. With the help of volunteer nurses and staff, the Ecks make the most of those 10 hours. On average, the ZHC serves 200 patients and provides approximately $50,000 in medical care per month. Supplies and equipment are donated by individuals, businesses and area churches. This is a nondenominational endeavor, John Eck said. We have Muslims, Jews, Baptists you name it who want to make a difference. The Ecks estimate the ZHC saves the state of New Jersey at least a half-million dollars a year by keeping patients out of hospital

emergency rooms and by providing preventative care, such as prenatal exams. If we see a patient, it costs us maybe $10, Alieta Eck said. If they go to the ER, that visit will cost $1,000. A donation box sits on a table in the waiting room with a few scrunched up dollar bills, some coins and the occasional $20 bill, but no one is required to pay. Seeing the look on a patients face when we tell them were not going to charge them a penny that never gets tiresome, said John Eck. The Ecks hope to see their clinic expand its hours and services. They recently recruited a cardiologist to run a monthly cardiology clinic

and an ultrasound technician who comes in monthly to perform prenatal exams on the new ultrasound machine donated to the ZHC. All volunteers are given free medical malpractice coverage from the federal government through the Federal Tort Claims Act. The act allows practicing and retired physicians to donate their time without having to buy expensive insurance coverage. In addition to the clinic in New Jersey, John Eck extends his charity overseas. He continues to go on international medical missions every other year or so sometimes with his children. He works among the lepers in India and the indigent in Peru.

The concept of service is crucial to medicine. If we lose that, we lose our soul. | John Eck, M.d. (80)
For more information about the Ecks and their clinic, go to zhcenter.org or contact the Ecks at zhcenter@aol.com.

18 Grand Rounds

Saint Louis University School of Medicine Grand Rounds 19

markyourcalendar

In Memoriam

Some of your professors may have inspired you, some may have intimidated you, and some may have entertained you. Whatever their style, they helped you become the physician you are today.

Do You Remember?
Grand Rounds would like you to submit your favorite stories about two of the schools most memorable educators: C. Rollins Hanlon, M.D., chairman of the surgery department for nearly 20 years, and his successor, Vallee Willman, M.D. You can send your stories to grandrounds@slu.edu. Submissions will be published in an upcoming issue of Grand Rounds.

Harry Staman, M.D. (33) Walter Miner, M.D. (36) Charles Stehly, M.D. (37) Augustine Sperrazza, M.D. (38) John Beare, M.D. (39) Courand Rothe, M.D. (39) William Escovitz, M.D. (40) Jerome Janson, M.D. (40) Drew Petersen, M.D. (40) Charles Pitegoff, M.D. (40) Harold Broady, M.D. (41) James Coughlin, M.D. (41) Adolph Surtshin, M.D. (41) Raymond Huger, M.D. (42) Richard Noda, M.D. (42) John Brennan, M.D. (43) David Brody, M.D. (43) Carl Dreyer, M.D. (43) John Hale, M.D. (43) Francis Marino, M.D. (43) Vincent Muscat, M.D. (43) Normal Blackman, M.D. (44) Edward DeFeo, M.D. (44) William Galeno, M.D. (44) Nelson Klamm, M.D. (44) James McFadden, M.D. (44) James McGlew, M.D. (44) James Morrison, M.D. (44) John Connors, M.D. (45) Henry Drake, M.D. (45) Gerald Lammers, M.D. (45) Frank Winters, M.D. (46) Donald Dockry, M.D. (47) Harold Hagan, M.D. (47) James OMalley, M.D. (47) Edward Wirthlin, M.D. (48) Cyril Bruno, M.D. (50) Douglas Cardozo, M.D. (51) Thomas Culkin, M.D. (51) William Sammis, M.D. (51) Cornelius Derrick, M.D. (52) Francis Skopec, M.D. (52) Peter Tobin, M.D. (52) Leo Furr, M.D. (53) Harry Helling, M.D. (53) Thomas OHern, M.D. (53) Rose Papac, M.D. (53) John Kanda, M.D. (54) Herbert Luke, M.D. (54) Thomas Maxwell, M.D. (55) Richard Bealka, M.D. (56) Edward Galla, M.D. (56) James Smiggen, M.D. (56) Theodore Christian Baiz, M.D. (58) Emory Beechwood, M.D. (59) John Joyce, M.D. (59) James Clark, M.D. (61) George Dent, M.D. (62) Raymond Muzzarelli, M.D. (64) William Scaring, M.D. (64) Paul Shuff, M.D. (69) Richard Barry, M.D. (71) Douglas Johnston, M.D. (74) Gregory Mantych, M.D. (82) Edward Bullock, M.D. (85)

Beloved Pediatrician Dies | Richard Barry, M.D.

Alumni Receptions Dec. 2 Meet the Dean Alumni Reception Chicago area (This event will be held in conjunction with the Radiological Society of North America Annual Meeting) Society of Thoracic Surgeons San Francisco American Academy of Orthopaedic Surgeons Las Vegas American Academy of Dermatology San Francisco Missouri State Medical Convention Kansas City American Academy of Neurology Seattle Pediatric Academic Societies American College of Obstetricians and Gynecologists Chicago American Psychiatric Association San Francisco University Events Dec. 14 Breakfast with Santa SLU campus CME programs Dec. 6 Dec. 6-7 Jan. 5-9 Jan. 8-11 Jan. 23-25 March 2-6 Best of the American Association for the Study of Liver Diseases Craniofacial Surgery and Transfacial Approaches to the Skull Base Medicolegal Death Investigator Training Course 2nd World Congress on Cerebral Revascularization Cosmetic Blepharoplasty Microsurgery of Aneurysms: Recent Advances

(71), professor of pediatrics at the School of Medicine and a pediatric emergency medicine physician at SSM Cardinal Glennon Childrens Medical Center, died unexpectedly in April. He was 63. Barry was director of emergency care services at Cardinal Glennon for 29 years and co-director of the pediatrics residency program at SLU for 30 years. The last day of his life was spent doing what he loved most taking care of children and teaching others how to, said Faye Doerhoff, M.D., assistant professor of pediatrics and a colleague for 26 years in Cardinal Glennons ER. Robert Wilmott, M.D., chairman of the department of pediatrics and pediatricianin-chief at Cardinal Glennon, described Barry as a warm and humble colleague. He would never boast or take credit for his achievements, Wilmott said. He was a warm person, very sociable and very loyal to Saint Louis University and Cardinal Glennon. Barry, who was not married and had no children, volunteered to work every Thanksgiving, Christmas Eve and Christmas Day so those who had families in town could spend holidays with their loved ones.

Jan. 26 Feb. 27 March 6 April 3

April 25-May 2 May 2-5 May 5 May 16-21

Golden Apple Award recipient robert J. Blaskiewicz, M.d. (75), celebrates during precommencement ceremonies with graduate Austin Crow.

Honoring Educators |
During precommencement ceremonies in May, the Class of 2008 honored the educators who helped them through medical school and prepared them for the next phase of their training. This years winners were:

Juan-Carlos Correa, M.D., won the Top Banana

Award (favorite resident).

William C. Mootz, M.D.,

professor of internal medicine and assistant dean for curricular affairs, won the Education Facilitator Award.

Robert J. Blaskiewicz, M.D. (75), professor and director

of general obstetrics, and gynecology in the department of obstetrics, gynecology and womens health, and Carole A. Vogler, M.D., professor and interim chairwoman of the department of pathology, won Golden Apple Awards (best teacher).

Stuart J. Slavin, M.D., M.Ed.,

professor of pediatrics and associate dean for curricular affairs, won the Father James McKelvey Tobin Award.

For information on the CME programs, please call the SLU School of Medicine continuing medical education office at 314 977-7401 See updates and details about Practical Anatomy Workshop programs at pa.slu.edu.

www.clubcolors.com/slu
Travel with alumni

Show your school colors

www.slu.edu/alumni/travel
Saint Louis University School of Medicine Grand Rounds 21

For any other events, please contact the Alumni Relations Office at 314 977-8335.

PROFILE OF PHILANTHROPY
Catherine Beal, M.D. (82), and her husband, Eugene Beal Jr., M.D. (MR 86) have multiple family members who attended Saint Louis University, and the tradition continues with their two sons Brandon and Michael, both of whom are pre-med students at SLU. We have longstanding ties to the University, and those ties are very strong, said Catherine Beal, a neuroradiologist at St. Anthonys Medical Center in St. Louis County. SLU has done a lot for us and our family, said Eugene Beal Jr., chairman of radiology at Lincoln County Medical Center in Troy, Mo. The University provided us with the opportunity to learn and gave us excellent training and the skills we needed to be successful. To show their appreciation, the Beals have become generous supporters of the School of Medicine. Their contributions to the Medical School Deans Education and Research Fund are helping the school fulfill its mission of education, service and research. Their contributions support student scholarship and faculty development as the medical school continues its upward trend. We see the significant improvements on both campuses, including the Doisy Research Center and the new Chaifetz Arena, said Eugene Beal Jr. We are proud to be a part of SLUs commitment to excellence. Giving back is a personal choice, Catherine Beal said. But its a natural choice for us.

the Beal Family: Brandon, Eugene, Catherine and Michael.

T O L E A R N M O R E about giving opportunities and tax benefits that may be associated with your gift,
contact the office of development at the School of Medicine at (314) 977-8317 or mdalumni@slu.edu.

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