Inspired FALL 2014
A PHYSICIAN PUBLICATION PAGE 1
Clinical trial for miniature leadless pacemaker PAGE 1
One patient, one room, two procedures: Robotic coronary bypass and cardiac stent placement 3D echocardiographyderived model of left ventricular endocardial surface of a patient undergoing LVAD optimization PAGE 4
New-generation LVADs hold promise as destination therapy for patients with advanced heart failure
NEW HORIZONS IN HEART AND VASCULAR CARE
ALSO IN THIS ISSUE PAGE 9
Multispecialty care for newborns diagnosed with SCID PAGE 10
Hip preservation surgery for femoroacetabular impingement (FAI)
The University of Chicago Medicine & Biological Sciences has been at the forefront of medical care, research and ®
AT THE FOREFRONT OF MEDICINE
teaching for more than 90 years. Located in historic Hyde Park on the South Side of Chicago, the University of Chicago Medicine & Biological Sciences includes: Patient Care » Bernard A. Mitchell Hospital » Center for Care and Discovery » Comer Children’s Hospital » Duchossois Center for Advanced Medicine » Numerous outpatient locations throughout the Chicago area Teaching Programs » Pritzker School of Medicine » Master’s and doctoral degree programs » Postdoctoral programs Research » Medical and basic science units
Our physicians push the boundaries of traditional care to offer groundbreaking therapies for complex heart and vascular conditions.
Among our many honors and acknowledgments: 12 Nobel laureates; ranked 11th of all U.S. medical schools;
DEAR COLLEAGUES,
one of only 41 National Cancer Institute–designated comprehensive cancer centers; ranked fifth in nation for National Institutes of Health grant support per researcher. University of Chicago Medicine & Biological Sciences Executive Leadership Kenneth S. Polonsky, MD, Dean of the University of Chicago Biological Sciences Division and the Pritzker School of Medicine, and executive vice president for Medical
From advanced imaging
testing the newest ventricular assist
to robotic surgery, the
devices. And interventional cardiologists
University of Chicago
are collaborating with cardiac surgeons
Medicine is known for its
inside the operating room to solve
expertise in evaluating
complex problems.
and treating complex heart and vascular conditions. We push
We are committed to teaming up with you
the boundaries of traditional care to offer
to offer patients novel treatments for the
Jeffrey Glassroth, MD, dean for clinical
groundbreaking therapies not found at
most challenging conditions. That’s one
affairs, University of Chicago Medicine
many other institutions.
reason we’ve launched Learning at The
Affairs for the University of Chicago Sharon O’Keefe, president of the University of Chicago Medical Center
Forefront, a new online resource for medical
T. Conrad Gilliam, PhD, dean for basic science, Biological Sciences Division
In this issue of Inspired, we bring you up
professionals. This education channel
Holly J. Humphrey, MD, dean for medical
to date on what’s new in heart and vascular
includes more than 80 presentations
research, diagnosis and treatment at
by our physicians on a wide variety of
UChicago Medicine.
topics. We hope you’ll join us online at
education, Pritzker School of Medicine INSPIRED IS PUBLISHED THREE TIMES A YEAR BY THE UNIVERSITY OF CHICAGO MEDICINE & BIOLOGICAL SCIENCES. Editor: Anna Madrzyk Assistant Editor: Gretchen Rubin Email us at: inspirededitor@uchospitals.edu Design: TOKY Branding + Design Contributing writers
learning.uchospitals.edu. Our cardiac imaging team, known for pioneering many of today’s imaging
We appreciate your continued interest in
techniques, is leveraging the strengths of
our programs and services at the University
these tools. Heart failure experts here are
of Chicago Medicine.
Thea Grendahl Christou, John Easton, Kevin Jiang, Eileen Norris, Angela Pirisi, Gretchen Rubin, Tiffani Washington and Matt Wood Contributing photographers David Christopher, Kevin Howe, Robert Kozloff, Jean Lachat and David Proeber
KENNETH S. POLONSKY, MD
ADDRESS
Dean of the University of Chicago Biological Sciences Division and the Pritzker School of Medicine, and executive vice president for Medical Affairs for the University of Chicago
The University of Chicago Medicine 5841 S. Maryland Ave., Chicago, IL 60637 The University of Chicago Medicine Comer Children’s Hospital 5721 S. Maryland Ave., Chicago, IL 60637 Telephone 1-773-702-1000 Appointments 1-888-824-0200 Follow the University of Chicago Medicine on Twitter at twitter.com/UChicagoMed or visit our Facebook page at facebook.com/ UChicagoMed. You can read more about our news and research at uchospitals.edu/news and at sciencelife.uchospitals.edu. This publication does not provide medical advice or treatment suggestions. If you have medical problems or concerns, contact a physician, who will determine your treatment. Do not delay seeking medical advice because of something you read here. For urgent needs, call 911 right away. Read Inspired online at uchospitals.edu/inspired.
ON THE COVER:
Left ventricular endocardial surface extracted from 3D echocardiographic images of a patient undergoing LVAD optimization. See story on page 4. The software was developed at the University of Chicago Medicine by then-postdoctoral scholar Francesco Maffessanti, PhD. Image courtesy of Victor Mor-Avi, PhD, director of cardiac imaging research, and Roberto M. Lang, MD, director of the noninvasive cardiac imaging laboratory.
AT THE FOREFRONT OF
HEART AND VASCULAR CARE
LEADLESS II CLINICAL TRIAL
HYBRID ALTERNATIVE
Miniature pacemaker does not require surgery
Robotic bypass and stent placement in one room
The Nanostim leadless pacemaker from St. Jude Medical is about the size of a AAA battery, 10 times smaller than a conventional pacemaker, and weighs only two grams. Research has shown that it can be securely implanted within the heart using a cardiac catheter inserted through a small incision in the groin.
Approximately 10 to 15 percent of patients who require a pacemaker could be candidates for this device, according to the manufacturer.
The distribution of the multivessel blockages in Leroy “Rocky” Cooper’s heart did not lend itself to an isolated robotic approach.
Moore has mycosis fungoides, a form of T-cell lymphoma that primarily affects the skin and can weaken the immune system. With his two previous standard pacemakers, he quickly developed an infection around the implant.
But University of Chicago Medicine heart surgeon Husam H. Balkhy, MD, and interventional cardiologist Sandeep Nathan, MD, MS, teamed up to offer Cooper, 61, a novel alternative to a sternotomy. The duo would work together in the hospital’s hybrid operating suite to perform robotassisted coronary bypass, immediately followed by balloon angioplasty and stent placement.
In July, University of Chicago Medicine patient Lamb Moore, 75, was the first person in “Of the three pacemakers I’ve Illinois to receive the tiny had,” Moore said, “this has pacemaker, currently being been the best one. I can tell it’s tested in a nationwide working. I don’t get so worn clinical trial. out now. I can go all day, and “This device is remarkably I sleep better at night.” compact and relatively The experimental pacemaker easy to implant,” said is currently available in University of Chicago the United States only as Medicine electrophysiologist part of the LEADLESS II Hemal M. Nayak, MD. Clinical Trial, a prospective, “We think it could prove to nonrandomized, multicenter be a good alternative, study designed to evaluate its especially for patients who safety and effectiveness. have had problems caused by a traditional pacemaker “This is one more tool we implant.” can deploy to help patients The Nanostim, a singlewith heart rhythm disorders,” chamber pacemaker, was said Martin C. Burke, DO, developed specifically for principal investigator for patients with bradycardia. this study.
On July 10, 2014, Balkhy completed the robotic LIMA-LAD coronary bypass totally endoscopically in about 2½ hours. Once the robotic tools were removed and the small incisions were closed, Nathan inserted the catheter through the radial artery in Cooper’s left wrist. After confirming the bypass graft was in place and functioning well, Nathan
opened the severely blocked right artery and installed two stents. Although Balkhy and Nathan each has performed hundreds of similar cases, it was the first time they worked in tandem in a hybrid operating room. “This all-in-one procedure is not done on a routine basis,” Nathan said. “I don’t know of another place that combines a totally endoscopic surgical approach with leading-edge interventional techniques. But it makes perfect clinical sense and benefits the patient greatly.” Out of the hospital in two days, Cooper, an avid golfer, was back on the course in less than two weeks. “It was a little too soon for all 18 holes, but I played 12,” he said. “It was good just to be out there.”
| RIGHT | Leroy “Rocky” Cooper
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| BELOW | Jayant M. Pinto, MD,
holds a Sniffin’ Stick.
Research News OLFACTORY DECLINE PREDICTS DEATH
For older adults, being unable to identify scents is a strong predictor of death within five years, according to a study by a multidisciplinary team of University of Chicago Medicine researchers. Thirtynine percent of subjects who failed a simple smell test died during that period, compared to 19 percent of those with moderate smell loss and just 10 percent of those with a healthy sense of smell. Olfactory dysfunction was better at predicting mortality than a diagnosis of heart failure, cancer or lung disease; for those already at high risk, it more than tripled the probability of death. “We think loss of sense of smell is an early warning that something has gone badly wrong,” said Jayant M. Pinto, MD, associate professor of surgery and lead author of the study published in the journal PLOS ONE.
We think loss of sense of smell is an early warning that something has gone badly wrong. JAYANT PINTO, MD
CIRCUMVENTING ANTIBIOTIC RESISTANCE
A novel method to identify new antibiotic therapies has pinpointed 101 drugs that show promise in fighting bacterial infections. University of Chicago researchers working at the Howard T. Ricketts Regional Biocontainment Laboratory looked at 640 FDA-approved drugs currently prescribed for conditions including diarrhea, allergies, high blood pressure and angina, and tested each for its ability to disrupt the growth of bacteria within human host cells. Led by microbiologist Howard Shuman, PhD, the team identified compounds that proved effective against four different types of bacterial infections. Their work was reported July 29 in mBio, the online journal of the American Society for Microbiology. “With the increasing prevalence of antibiotic resistance among clinically relevant bacterial pathogens, the necessity for alternative treatment options is at its highest,” said study author Daniel Czyz, PhD. “This approach may circumvent the problem of antibiotic resistance.”
READ MORE AT ScienceLife.uchospitals.edu @ScienceLife
DEPRESSION AND PROSTATE CANCER OUTCOMES
Men diagnosed with both cancer and depression have worse survival rates and EGGENER are less likely to undergo definitive treatment like surgery or radiation therapy. Scott Eggener, MD, co-director of the prostate cancer program at the University of Chicago Medicine, and a team of researchers from three other medical centers studied Medicare data and found that men with intermediate- or high-risk prostate cancer and depression more often opted to monitor the cancer’s progression. “The clear differences in outcomes point to the need for greater awareness among physicians of the effects of depression in these patients,” Eggener said. “They’re more complex cases, their decisionmaking is different and perhaps we need to be more attuned to provide high-quality care.” The study was published in the Journal of Clinical Oncology.
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CANCER’S FINANCIAL SIDE EFFECTS
Along with the distress and discomforts that accompany cancer, patients deal with “financial toxicity” — the anxiety and loss of confidence confronting those who face large, unpredictable costs, often compounded by decreased ability to work. University of Chicago cancer specialists designed a novel tool to quantify this burden. Described in the July issue of Cancer, COST (COmprehensive Score for financial Toxicity) comprises 11 questions gleaned from conversations with more than 150 patients with advanced cancer.
Patients’ responses can identify the need for education, financial counseling or referral to a support network. “Few physicians discuss this increasingly significant side effect with their patients,” said study author Jonas de Souza, MD. “This tool gives us a way to launch that discussion.”
INNOVATIVE APPROACH TO COMPLEX CASE When interventional cardiologist Atman P. Shah, MD, examined the results of Gerald Gill’s angiogram, he knew he had a unique case on his hands.
This case demonstrates not only our novel use of innovative technology, but also our multidisciplinary approach.
The 60-year-old Gill, who was visiting from Madeira Beach, Fla., had undergone a bypass several years earlier and had been diagnosed SHAH with aortic stenosis six months previously. “His aortic valve was fine,” said Shah, codirector of the cardiac catheterization laboratory and director of the coronary care unit. “But his angiogram showed he had two branches off of his bypass graft that were uncharacteristically diverting blood flow away from his heart."
ATMAN P. SHAH, MD
A
While the University of Chicago Medicine sees one or two similar cases a year, Gill’s situation was unusual because of the large branches involved. “It’s rare to see and has been recorded only once or twice in the literature,” Shah said. After consulting with Valluvan Jeevanandam, MD, chief of cardiac and thoracic surgery, Shah decided on a type of JEEVANANDAM vascular plug that had never been used for this application. “It’s made from metal designed by NASA called nitinol,” he said. “It’s rigid at room temperature and becomes malleable at body temperature. It’s typically used for arteries that come off the abdominal aorta.” Gill had flown to Chicago to be with his 78-year-old mother, who was scheduled for complex valvular surgery that included an aortic valve replacement and a bypass. Betty Gill, who is a Jehovah’s Witness, chose UChicago Medicine for its expertise in bloodless cardiac surgery. During his
mother’s consultation, Gerald discussed his symptoms — extreme shortness of breath and pain and discomfort upon exertion — with Jeevanandam. He was referred that same day to Shah, who ordered tests and immediately scheduled an interventional procedure. “The fact that we were able to treat Mr. Gill’s unique problem, as well as his mother’s complex surgery, really highlights our unique capabilities,” Jeevanandam said.
B
| ABOVE A | The left internal mammary artery (LIMA) is grafted onto the left anterior descending artery (white arrow). The branch off the LIMA is stealing blood that should be going to the heart (yellow arrow). | ABOVE B | The branch off the LIMA is now closed (yellow arrow). Vascular plugs are in place (white arrows).
“Mr. Gill’s situation was unusual because of the large branches involved.”
Gerald Gill immediately felt symptom-free after his procedure, which took 60 minutes and was performed with conscious sedation. In fact, he was able to be at his mother’s bedside as she was extubated. He was discharged the day after his surgery. “This case demonstrates not only our novel use of innovative technology, but also our multidisciplinary approach — as evident by the collaboration between cardiothoracic surgery and interventional cardiology — to come up with what we thought would be best for the patient,” Shah said. | RIGHT |
Gerald Gill and Buddy
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Nir Uriel’s clinical and research interests focus on high-risk heart failure, including treatment of HIV-positive patients as well as cancer survivors who have heart damage as a result of chemotherapy or radiation therapy.
VENTRICULAR ASSIST DEVICES Increasingly Offered as an Alternative to Transplant | ABOVE | Nir Uriel, MD, with images of the left ventricular endocardial surface extracted from 3D echocardiographic images of a patient undergoing LVAD optimization. The three images show the 3D models of the left ventricle obtained at different LVAD speeds: from lower speed (left), at which blood is pumped out of the ventricle slowly, so that it remains dilated, to higher speed (right), at which the blood is pumped out of the ventricle at a higher pace, resulting in a smaller ventricular volume and more normal shape. The models are shown with the radius color-encoded (see color scale on the right of the screen) to emphasize differences in size; other functional parameters also can be displayed in colors.
Until recently, most left ventricular assist devices (LVADs) implanted in advanced heart failure patients served as bridges to transplant. Today, close to 70 percent of LVADs are being used for long-term support (referred to as “destination” therapy). “A decade ago, I would have spoken to a patient who had advanced heart failure and was ineligible for heart transplant about the end of life and closing the circle,” said cardiologist Nir Uriel, MD, director of heart failure, transplant and mechanical circulatory support at the University of Chicago Medicine. “Today, we’re in a different time.” The University of Chicago Medicine has participated in studies to test, advance and approve the two most commonly used left ventricular assist devices,
4 » THE UNIVERSITY OF CHICAGO MEDICINE INSPIRED MAGAZINE | FALL 2014
HeartMate (I and II) and HeartWare. Both circulatory assist devices are FDA approved for bridge to transplant. HeartMate II is approved for destination therapy. The HeartWare system is being evaluated for this purpose in an ongoing clinical investigation. UChicago Medicine is one of 50 sites in the multicenter trial. Although placement of the two devices differs (see illustrations on page 5), they both are designed to assist the heart’s pumping function from the left ventricle into the aorta. Because the blood leaves the pump in a continuous stream, hemodynamics is not the same as with the pulsing beat of a normal heart. “The new generation of these devices has been a game changer,” said Uriel, noting that the older LVADs had limited durability
AT THE FOREFRONT
The University of Chicago Medicine Heart Failure Program CARDIOLOGY NIR URIEL, MD
Director, Heart Failure, Transplant and Mechanical Circulatory Support SAVITRI E. FEDSON, MD GENE H. KIM, MD GABRIEL SAYER, MD CARDIOTHORACIC SURGERY HEARTWARE ® VENTRICULAR
HEARTMATE II ® LEFT
ASSIST SYSTEM
VENTRICULAR ASSIST SYSTEM
The HeartWare pump is implanted completely in the pericardial space, directly adjacent to the heart. The pump is attached to the apex of the left ventricle. The outflow graft is attached to the ascending aorta.
The HeartMate II pump is implanted in the abdomen just below the heart. A flexible inflow conduit attaches it to the apex of the left ventricle. The outflow graft is attached to the ascending aorta.
Illustrations reprinted with the persmission of HeartWare, Inc. (left) and Thoratec Corporation.
VALLUVAN JEEVANANDAM, MD
Chief, Cardiac and Thoracic Surgery DAVID ONSAGER, MD TAKEYOSHI OTA, MD, PHD
THE UNIVERSITY OF CHICAGO MEDICINE HAS CLOSE TO 30 RESEARCH
and high complication rates. “Now we need to change the perception of who can benefit from the technology.” Uriel urges referring physicians to discuss mechanical circulatory support with patients when optimal medical management is no longer effective but before their heart disease reaches an irreversible stage. The University of Chicago Medicine advanced heart failure program has the expertise to identify who will do well
with LVAD treatment and/or heart transplant. Medical need, readiness and the patient’s support system are all considered. “Transplant offers a better quality of life for a longer time than LVAD,” Uriel said. “But with improvements in the technology, this may change. Already, many patients are living a good, healthy life with a circulatory assist device.”
or IV plus one of the following:
»
Serum sodium < 136 mmol/L
»
Diuretic dose > 1.5mg/kd/d
»
BUN > 40mg/dL
»
»
Intolerant or refractory to ACE-I /ARB/BB
One or more CHF-related hospital admissions within 6 months
CIRCULATORY SUPPORT AND HEART TRANSPLANT.
THE UNIVERSITY OF CHICAGO MEDICINE IS CERTIFIED by the Joint
Commission to offer LVAD treatment as a destination therapy.
will be in recovering the heart. Toward that goal, researchers around the U.S. are investigating stem cell transplantation, gene therapy and metabolic alteration.
Patients with the NYHA Functional Classification III
Inability to walk < 1 block without dyspnea (shortness of breath)
FAILURE, MECHANICAL
THE FUTURE OF HEART FAILURE TREATMENT
When to Refer to an Advanced Heart Failure Specialist
»
PROJECTS STUDYING HEART
»
CRT nonresponder
»
Hematocrit < 35%
To read a Q&A with Nir Uriel, MD, visit ScienceLife.uchospitals.edu.
Russell SD, Miller LW, Pagani FD. Advanced heart failure: a call to action. Congest Heart Fail. 2008;14:316-321
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Fusion of 3D Echo with CT Coronary Angiography for Chest Pain Evaluation The American Society of Echocardiography (ASE) Education and Research Foundation recently awarded a $200,000 grant to University of Chicago Medicine researchers Victor Mor-Avi, PhD, director of cardiac imaging research; Amit R. Patel, MD, co-director of cardiac magnetic resonance and computed tomography; Francesco Maffessanti, PhD, former postdoctoral scholar; and Roberto M. Lang, MD, director of the noninvasive cardiac imaging laboratory. The researchers will study 3D echocardiography in patients with acute chest pain as a way to assess the functional significance of coronary stenosis detected by computed tomography coronary angiography (CTCA).
While noninvasive CTCA has become widely accepted as an effective firstline diagnostic tool for these patients, abnormal findings on this test often result in downstream stress testing. Choosing appropriate management for patients with intermediate-grade stenosis is challenging for physicians because the impact of the disease is unclear. The project will explore the possibility of “fusion” of the two cardiac imaging techniques to help identify patients who need intervention. “This may have important implications in terms of reducing the number of unnecessary tests, resulting in significant savings,” Mor-Avi said.
Fused image of the coronary arteries obtained by computed tomography and a reconstructed 3D surface of the left ventricular endocardial surface obtained by echocardiography and color-coded according to the regional myocardial function.
Minimizing Radiation Exposure in Cardiac Stress Tests Ongoing advancements at the University of Chicago Medicine have resulted in new imaging strategies that reduce patients’ radiation exposure and improve image quality. Nuclear stress testing and stress echocardiography are widely used to noninvasively detect the presence of a hemodynamically significant coronary artery stenosis. Cardiologist Amit R. Patel, MD, codirector of cardiac magnetic resonance and computed tomography at the University of Chicago Medicine, specializes in the use of noninvasive imaging techniques for evaluating diseases of the heart muscle and coronary arteries. He is particularly interested in newly developed stress testing techniques using MRI and CT. Because cardiologists are often looking for answers to many questions when diagnosing coronary disease, Patel said the
type of stress test ordered often depends on the specific question being asked and the patient’s comorbidities. NONINVASIVE ASSESSMENT OF CORONARY DISEASE
While nuclear cardiac imaging (SPECT and PET) requires radionuclide dyes, our physicians employ a variety of strategies to minimize radiation exposure to the patient, including the use of new high-resolution cameras, single isotope imaging, weight-based radionuclide dosing algorithms and, when appropriate, stress-only imaging. Alternatively, stress echocardiography does not use radiation but can be technically challenging to perform. In order to improve the detection of coronary artery disease, our physicians routinely use state-of-the-art quantitative techniques and imaging enhancement agents. During the past several years, our team has introduced cardiac MRI stress testing, which does not expose the patient to any ionizing radiation. Several studies have now shown that stress MRI is as accurate as nuclear stress testing for detecting significant coronary artery disease and is
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the gold standard for measuring left ventricular ejection fraction and myocardial viability. In addition to information related to coronary artery disease and LV function, stress MRI can accurately quantify right ventricular function and aortic size as well as determine the etiology of cardiomyopathy. While stress tests can identify the presence of severe coronary artery disease, they do not directly visualize the coronary artery. This can be done noninvasively using cardiac CT. At the University of Chicago Medicine, cardiac CT is performed using a 256-slice CT scanner that provides sharp, high-resolution, 3D images of the coronary arteries to reveal not only the presence of a significant stenosis but even subclinical coronary atherosclerosis. Our physicians use the latest technology, such as 100KV imaging and prospective gating, to minimize radiation exposure. Because each study is meticulously planned on a patient-by-patient basis, our typical cardiac CT study uses less radiation than a nuclear stress test or invasive coronary angiogram.
TARGETING PROSTATE CANCER Prostate Cancer Diagnosis and Treatment PROSTATE MRI
We perform prostate MRI on state-of-the-art 3 Tesla MRI scanners using the endorectal coil. An endorectal coil provides unsurpassable image quality of the prostate. Images are interpreted by dedicated prostate imaging experts. MRI-GUIDED PROSTATE BIOPSY
We are one of the few hospitals in the U.S. performing MRI-guided biopsies of suspected tumors in the prostate. For eligible patients, targeted biopsies offer a minimally invasive, highly accurate diagnosis for prostate cancer. RADIATION ONCOLOGY
We were one of the first to implement and report on the use of intensity-modulated
radiation therapy (IMRT) for prostate cancer, which is now a standard method to optimize radiation dose to the tumor and minimize dose to the normal tissues. We also offer innovative clinical trial options for men who are treated primarily or postoperatively. ROBOTIC SURGERY
The robotic urologic surgery team is among the top programs in the world and has performed more than 4,000 robotic prostatectomies, the most in Illinois and among the most in the country. Our surgeons specialize in techniques that remove cancer tissue while preserving nerves for urinary and sexual function. CARE FOR ADVANCED PROSTATE CANCER
Our medical oncologists have access to the latest FDA-approved therapeutics, are acknowledged national and international experts, and are testing the next generation of novel drugs for advanced and metastatic prostate cancer.
PROSTATE CANCER PROGRAM
SURGERY
PATHOLOGY
SCOTT EGGENER, MD
TATJANA ANTIC, MD
ARIEH L. SHALHAV, MD
GLADELL PANER, MD
NORM SMITH, MD RADIATION ONCOLOGY GREGORY ZAGAJA, MD STANLEY LIAUW, MD MEDICAL ONCOLOGY RADIOLOGY CHADI NABHAN, MD, FACP
AT THE FOREFRONT
Prostate Cancer Research In 1966, Charles B. Huggins, MD, professor of surgery at the University of Chicago Medicine, HUGGINS received the Nobel Prize in Medicine for research that led to hormonal therapy for prostate cancer.
THE UNIVERSITY OF CHICAGO MEDICINE IS A MAJOR CENTER FOR CONDUCTING PROSTATE CANCER CLINICAL TRIALS THROUGH BOTH NCI AND PRIVATE SPONSORS.
A translational research team is using
CELL-IMAGING TECHNOLOGY to isolate and study circulating prostate tumor cells to help predict if a therapy is effective.
MRI-guided focal laser ablation shows promise for destroying cancer cells in patients with localized
WALTER M. STADLER, MD
disease. The University of Chicago Medicine has completed Phase 1 and
RUSSELL SZMULEWITZ, MD
Phase 2 trials of this less-
AYTEKIN OTO, MD PETER H. O’DONNELL, MD
DAVID VANDERWEELE, MD, PHD
invasive treatment.
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Olopade Honored by Roosevelt Institute Olufunmilayo I. Olopade, MD, the Walter L. Palmer Distinguished Service Professor of Medicine and Human Genetics and associate dean for global health, has been selected as the recipient of the Franklin D. Roosevelt Freedom from Want Medal. The award is one of the Four Freedoms medals presented annually to individuals whose leadership and achievements advanced the freedoms outlined by FDR in his 1941 State of the Union address. Olopade is recognized for her significant contributions to the prevention and treatment of breast cancer and leadingedge translational research in genetics. Past winners of the Four Freedoms awards include Nelson Mandela, Ted Kennedy, Elie Wiesel and the Dalai Lama. Olopade will accept the award in September 2015.
MAUNSELL AWARDED BRAIN INITIATIVE FUNDING University of Chicago neuroscientist John Maunsell, PhD, has been awarded funding from the National Institutes of Health as part of the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative. The funding will be used to develop laser technology to guide nerve cell firing and study how groups of neurons produce behavior. Launched by President Obama in 2013, the BRAIN Initiative is a large-scale effort to equip researchers with fundamental insights necessary for treating a wide variety of brain disorders, such as Alzheimer’s, schizophrenia, autism, epilepsy and traumatic brain injury. | ABOVE | John Maunsell, PhD, is director of the Grossman Institute for Neuroscience, Quantitative Biology and Human Behavior. | LEFT | Olufunmilayo I. Olopade, MD,
received the Franklin D. Roosevelt Freedom from Want Medal.
“An unprecedented number of new tools and approaches are enabling rapid progress on many fronts in neuroscience,” Maunsell said. “Support from the BRAIN Initiative is capitalizing on this opportunity to quickly make progress on understanding how healthy brains function and what goes wrong in disease states."
“The payoffs could be enormous. We’re very pleased to be able to contribute to this effort.” JOHN MAUNSELL, PHD
Maunsell, in collaboration with Mark Histed, PhD, research associate (assistant professor) of neurobiology at the University of Chicago, and Tommaso Fellin, PhD, senior researcher at the Italian Institute of Technology, received BRAIN Initiative funding to study the brain in action. The researchers are using an innovative laser technology that allows them to activate individual neurons with unprecedented precision. “For the first time, we are going to be able to produce specific patterns of activity in the brain and see what happens to behavior,” Histed said.
CONFERENCE DIGEST Endocrine Society Several University of Chicago Medicine physicians and researchers participated in the Endocrine Society’s 96th Annual Meeting in Chicago in June. Graeme Bell, PhD, chaired a symposium on “Lessons from Early-Onset Monogenic Diabetes,” while Louis Philipson, MD, PhD, spoke on “The Clinical and Genetic Spectrum of Monogenic Diabetes.” These genetic forms of diabetes are increasingly recognized based on the research of Bell and Philipson and their colleagues at the Kovler Diabetes Center. Patients with certain forms of monogenic diabetes have been weaned from insulin and placed on oral agents thanks to the work of this group. Siri Atma W. Greeley, MD, PhD, and Rochelle Naylor, MD, also gave poster presentations on their latest monogenic diabetes research.
The collaborative work of Robert Sargis, MD, PhD, and Matthew Brady, PhD, has implicated environmental toxins (endocrine disruptors, or EDCs) in the development of obesity and insulin resistance. Brady led a symposium entitled “EDCs and Adipocyte Metabolism.” Dianne Deplewski, MD, co-chaired a session on “Intrinsic/ Extrinsic Variations in Adipose Tissue Function.” Other presenters included Christopher Rhodes, PhD, “Foundation of Beta Cell Failure”; Alexandra Dumitrescu, MD, PhD, “Known Causes of Thyroid Dysgenesis in Humans”; and Erin Hanlon, PhD, “Alterations in the Circadian Rhythm of Circulating Levels of the Endocannabinoid (EC) Receptor Ligand, 2-Arachidonoylglycerol (2-AG), in Obese Individuals.” Faculty members who led sessions included Eve Van Cauter, PhD, “Assessing Sleep in Patients: Why and
8 » THE UNIVERSITY OF CHICAGO MEDICINE INSPIRED MAGAZINE | FALL 2014
How?”; David H. Sarne, MD, “Management Implications of the TSH Normal Range”; and Murray J. Favus, MD, “Osteoporosis — Clinical Trials.”
The University of Chicago Center in Beijing Jeffrey B. Matthews, MD, and J. Michael Millis, MD, collaborated with Yilei Mao, MD, PhD, of Peking Union Medical College, to organize the “Hepatobiliary, Pancreatic Surgery and Manuscript Writing Symposium,” held at the University of Chicago Center in Beijing in September. The conference focused on publishing hepatobiliary and pancreatic disease basic and clinical research. UChicago Medicine presenters included Matthews, Millis, Eugene Choi, MD, and Thuong Van Ha, MD.
Free Vascular Disease Screenings The University of Chicago Medicine is providing free vascular disease screenings for at-risk patients on Saturdays at our Hyde Park campus. Offered through a partnership with the Heart Health Foundation’s Dare to C.A.R.E. program, the screenings will test for four common vascular diseases: » Carotid artery disease » Abdominal aortic aneurysms » Renal artery stenosis » Extremity artery disease Any patient 60+ or a patient 50+ who has certain risk factors, such as smoking, diabetes or a family history, is eligible for the screening. The program also accepts 40+ diabetic patients. Results from the screening will be shared with the patient and the referring physician. SATURDAYS, 8 AM–3 PM
Duchossois Center for Advanced Medicine 5758 S. Maryland Ave. Suite 5B, Chicago, Ill.
To Make an Appointment Call 773-834-5599
Caring for Babies with SCID The Illinois Department of Health is now testing all babies born in Illinois hospitals for severe combined immune deficiency (SCID). The deficiency results in poorly functioning or nonfunctioning T and B lymphocytes. Infants born with the condition are prone to severe infections from birth. For those who develop infections, the prognosis is poor. Studies have shown that the only successful treatment is an early bone marrow or stem cell transplant. The University of Chicago Medicine Comer Children’s Hospital takes an integrated, multispecialty approach to managing children with SCID. A team of immunologists, hematologists and infectious disease experts assesses and manages all immunodeficient children. Twenty years ago, we were first in the Chicago area to offer pediatric hematopoietic stem cell transplantation. Today, we have one of the largest and most experienced stem cell transplant programs for children and adults in the nation. We now offer haplo-cord transplants using cord blood stem cells and half-matched stem cells from a related donor. This enables parents to become suitable stem cell donors for their children. We continue to study and devise innovative strategies that increase the applications and survival rates for stem cell transplant.
Learn More uchospitals.edu/dare-to-care
The University of Chicago Medicine received its sixth consecutive A grade in hospital safety, according to the latest Hospital Safety Score Survey released by The Leapfrog Group.
If you have a newborn patient diagnosed with SCID, please call us at 773-702-6808. We will see the infant immediately to confirm the diagnosis and collaborate with you to design a treatment plan for the patient. AT THE FOREFRONT
John M. Cunningham, MD, left, and Raoul L. Wolf, MD
Comer Children’s Hospital SCID Team PEDIATRIC HEMATOLOGY JOHN M. CUNNINGHAM, MD JAMES LABELLE, MD, PHD PEDIATRIC ALLERGY AND CLINICAL IMMUNOLOGY RAOUL L. WOLF, MD PEDIATRIC INFECTIOUS DISEASES DANIEL JOHNSON, MD
Babies with SCID who receive a transplant within three months of birth have a survival rate of 97 percent. The survival rate decreases to 60 percent if the transplant is done at six months and declines rapidly thereafter.
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High school baseball player Chase Payne could barely walk due to FAI.
AT THE FOREFRONT
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Minimally Invasive Treatment Relieves Hip Pain and Preserves Hip Joints in Young Adults Individuals in their late teens through early midlife whose activities involve extreme hip motions can develop femoroacetabular impingement (FAI). As the ball and socket of the hip rub together abnormally, joint and cartilage are damaged.
B
something weird in my back,” he recalled. He was confined to bed for the rest of camp and later was unable to participate in his other sports — golf and basketball — for his high school teams.
Kang diagnosed the 17-year-old with femoroacetabular impingement (FAI). “Some patients are predisposed to FAI due “Chase had a cam lesion, to a history of pediatric a large os acetabuli and a hip disorders or hip labral tear,” Kang said. “The fractures,” said University pain was so debilitating that KANG of Chicago Medicine he could barely walk.” orthopaedic surgeon Richard W. Kang, MD, MS. “Others develop the painful condition Kang used arthroscopic techniques to because of structural abnormalities in their correct Payne’s FAI. In the three-hour hip bones.” surgery, he repaired the labrum, removed the loose bone and reshaped the ball Kang specializes in hip preservation — and socket. surgical intervention to delay or prevent the onset of arthritis and the need for hip On the day Kang cleared Payne to play replacement. The arthroscopic procedure baseball on a limited basis, the junior from is a relatively new treatment for young Lexington, Ill., batted the game-winning hit. patients with severe hip pain. “I muscled it into right field and brought the “We address the hip disorder, including the soft tissue and the bony abnormalities associated with FAI,” Kang said. “The goal is to relieve the pain, preserve the hip joint and function, and prevent further damage.” KEEPING A THREE-SPORT ATHLETE IN THE GAME
While attending a baseball camp in summer 2013, Chase Payne dove into base. “I felt
guy on second base in,” he recalled. Now ready to play all three sports, Payne said he has more range of motion and is unafraid of any movement. “I think my hip is better power-wise.”
To read a Q&A with Richard Kang, MD, MS, please visit uchospitals.edu/ hip-preservation.
10 » THE UNIVERSITY OF CHICAGO MEDICINE INSPIRED MAGAZINE | FALL 2014
C
| ABOVE |
A Sagittal CT scan image demonstrating a cam lesion (arrow) and os acetabuli (circle). B 3D CT scan image demonstrating os acetabuli (arrow). C Intraoperative fluoroscopic image demonstrating removal of cam lesion and os acetabuli.
MICHELLE M. LE BEAU, PHD, the Arthur and Marian Edelstein Professor of Medicine and director of the University of Chicago Medicine Comprehensive Cancer Center, has been elected to the national board of directors of the Leukemia & Lymphoma Society for a three-year term. NEIL H. HYMAN, MD, has been appointed professor of surgery and chief for the new Section of Colon and Rectal Surgery. Hyman is recognized for his innovative surgical techniques and approaches to the management of colorectal disease. He came to the University of Chicago Medicine from the University of Vermont. MICHAEL J. LEE, MD, an expert in spine surgery, has been named associate professor of orthopaedic surgery. He specializes in the treatment of spinal injuries, degenerative conditions and spinal deformity as well as complex spinal column tumors. Lee was previously at the University of Washington Medical Center. MUYIBAT ADELANI, MD, a specialist in osteoarthritis and joint replacement surgery, including revision procedures, has been appointed assistant professor of orthopaedic surgery. Adelani completed her residency in orthopaedic surgery at Washington University in St. Louis and fellowship in joint reconstruction at Stanford University. NIKUNJ K. CHOKSHI, MD, a pediatric surgeon, has been appointed an assistant professor in the Department of Surgery. He specializes in surgical treatment for lung abnormalities, inflammatory bowel disease and solid tumors in infants and children. Chokshi was a pediatric surgery fellow at Saint Louis University.
INSPIRED TO DISCOVER, TEACH & GIVE BACK GAURAV A. UPADHYAY, MD, has been
appointed assistant professor of medicine and director of the Heart Station. Upadhyay is an expert in cardiac rhythm devices and focuses on innovative electrical therapies for heart disease. He completed his internal medicine residency and fellowship training in cardiology and clinical cardiac electrophysiology at Massachusetts General Hospital. The University of Chicago Medicine will share in a five-year, $6 million award from the Leducq Foundation in Paris, France, to study how genetic mutation affects the electrical rhythm of the heart. As members of Leducq’s Transatlantic Networks of Excellence program, researchers here will collaborate with experts from the U.S. and Europe on the atrial fibrillation research. IVAN MOSKOWITZ, MD, PHD, associate professor of human genetics, pediatrics and pathology, is the principal investigator. NANCY S. REAU, MD, associate professor of medicine, and HELEN S. TE, MD, associate professor of medicine, have been named inaugural fellows in the American Association for the Study of Liver Diseases. The new designation is awarded to “physicians, scientists, researchers or health care providers who have made a significant contribution to the knowledge and/or practice of liver and biliary diseases, and who are considered leaders in the field.”
The University of Chicago Medicine supports Bronzeville Dream Center The University of Chicago Medicine has partnered with Northwestern Medicine and the United Way of Metropolitan Chicago to back a South Side community organization’s innovative approach to combat violence and avert behaviors that may lead to conflict. Called the Bronzeville Dream Center, the program will be piloted in the Bright Star Church in Chicago’s Bronzeville neighborhood. The center draws on the model used by NATAL-Israel Trauma Center, which helps communities cope
with and reverse the traumatic aftereffects of violence. In addition to NATAL, Dream Center organizers will be working with Communities That Care, an approach that seeks to strengthen the community and prevent youth delinquency, substance use and violence. “Our communities need emotional restoration to break the cycles that caused the violence in the first place,” said the Rev. Chris Harris, founder of Bright Star Community Outreach and senior pastor of Bright Star Church.
AISHA SETHI, MD, assistant professor of
medicine, has been named a fellow in the Emerging Leaders Program of the Chicago Council on Global Affairs. The program brings together accomplished Chicagoans from diverse fields to address issues that have significant global implications. Sethi is interested in the field of global dermatology, infectious diseases and medical diplomacy programs. FREDRIC COE, MD, professor of medicine, has
been named the recipient of the 2014 Edward N. Gibbs Memorial Lecture and Award in Nephrology by the New York Academy of Medicine in recognition of his outstanding contributions to the pathogenesis and treatment of idiopathic hypercalciuria and calcium nephrolithiasis. JASON J. LUKE, MD, has been named
an assistant professor in the Department of Medicine. Luke focuses his research and clinical work on translational advances for cancer patients with a particular emphasis on melanoma and early-phase drug development. He joined the University of Chicago Medicine from DanaFarber Cancer Institute/Harvard Medical School. HUE H. LUU, MD, Hue H. Luu, MD, associate professor of orthopaedic and rehabilitation medicine, has been named a 2015 American-British-Canadian (ABC) Traveling Fellow. The ABC Traveling Fellowship was established after World War II to enable American and British orthopaedic surgeons to continue sharing ideas and techniques instituted during the war. An expert in hip and knee replacements as well as the surgical care of bone and soft tissue sarcomas, Luu will travel to the United Kingdom, Australia and New Zealand next spring.
In addition to financial support, UChicago Medicine will provide program evaluation, access to psychiatric expertise, research and medical resources. “The factors behind the prevalence of urban violence are multifaceted, and addressing them requires a personalized and adaptive approach,” said Kenneth S. Polonsky, MD, Dean of the Biological Sciences Division and the Pritzker School of Medicine, and executive vice president for Medical Affairs at the University of Chicago. “We are pleased to support this innovative model that draws from the cultural and spiritual strengths of communities to find solutions tailored to work for them.”
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Hepatology/Liver Transplant Clinic Now Open in Schererville, Ind. The University of Chicago Medicine’s Hepatology and Liver Transplant Clinic is now open at 222 Indianapolis Blvd. in Schererville, Ind. Helen S. Te, MD, hepatologist and medical director of the adult liver transplant TE program, is available for consultations on liver transplant, abnormal liver tests, hepatitis, autoimmune liver diseases, fatty liver, cirrhosis and liver cancers. To request a consultation or to refer a patient, call 773-702-6140.
CME & EDUCATIONAL OPPORTUNITIES
28th Annual Challenges for Clinicians DECEMBER 5–7, 2014
The Drake Hotel 140 E. Walton Place, Chicago SAVE THE DATE
12th Annual Current Concepts in Primary Care Sports Medicine MARCH 5–7, 2015
Millennium Knickerbocker Hotel 163 E. Walton Place, Chicago
20th Annual Conference 2015 Radiology Review MARCH 9–13, 2015
PHYSICIAN RELATIONS
Hyatt Chicago Magnificent Mile 633 N. St. Clair St., Chicago
Please contact your dedicated liaison by phone or email with any request. We are here to serve you. CAROL MARSHALL Executive Director Referral and Customer Insights Marketing 1-773-702-9205 carol.marshall@ uchospitals.edu DEMETRIA AVANT Regional and Western Suburbs 1-773-717-0458 demetria.avant@ uchospitals.edu MIKE DELAROSA Northwest Indiana 1-773-230-8496 michael. delarosa@ uchospitals.edu
ANTHONY TURNER South and Southwest Suburbs 1-773-729-0822 anthony.turner@ uchospitals.edu DIONNE MEEKINSMICHAUD North and Northwest Suburbs 1-773-717-0457 dionne.michaud@ uchospitals.edu BROOKE HERNANDEZ Pediatrics, All Regions 1-773-573-9500 brooke. hernandez@ uchospitals.edu
Endoscopy and Novel Technologies APRIL 17–18, 2015
University of Chicago Medicine Center for Care and Discovery 5700 S. Maryland Ave., Chicago
12th International Ultmann Chicago Lymphoma Symposium APRIL 24–25, 2015
W Chicago City Center Hotel 172 W. Adams St., Chicago
21st Annual Primary Care Orthopaedics JUNE 15–17, 2015
Millennium Knickerbocker Hotel 163 E. Walton Place, Chicago University of Chicago Medicine physicians are available to present in-office CME courses in greater Chicagoland and Northwest Indiana. For information, please contact Uchenna Hicks, uchenna.hicks@uchospitals.edu. Register for CME events at cme.uchicago.edu.
Endoscopic Center Adds Saturday Hours
New Pediatric Blood Diseases Clinics
The Center for Endoscopic Research and Therapeutics (CERT) at the University of Chicago Medicine is now offering services and procedures on Saturdays.
The University of Chicago Medicine Comer Children’s Hospital now offers two clinics providing support to physicians in managing patients — from infants to young adults — with special hematologic needs.
CERT uses the most innovative endoscopic techniques to provide patients with minimally invasive solutions to a wide range of digestive conditions. We also deliver precise endoscopic diagnosis and staging of cancer, enabling physicians to initiate the most appropriate and effective surgical and oncological care as quickly as possible. To request a consultation or to refer a patient, call 773-702-1459.
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The Pediatric Anti-Coagulation Clinic provides comprehensive management of oral and injectable anticoagulants for hematology/oncology patients. The Pediatric Hematology Education Clinic provides education for patients and their families on a wide variety of hematologic disorders. Contact Elizabeth Drumm, RN, MSN, at 773-702-6808.
John M. Cunningham, MD Professor and Chief, Section of Hematology/Oncology Department of Pediatrics, with Daniela Lakosilova, acute lymphoblastic leukemia survivor
His gift for innovation gave her the gift of health. When Daniela’s leukemia returned five years after her first round of treatment, a technique pioneered by John M. Cunningham, MD, restored the high school junior to health. The University of Chicago Medicine was the first medical center in the country to offer a haplo-cord stem cell transplant, using cells from a half-matched related donor plus well-matched, unrelated umbilical cord blood. Today, inspired by the art therapist who helped her cope with her illness, Daniela is a college sophomore studying art therapy — and her long-term prognosis is excellent. When you make a gift to the University of Chicago Campaign: Inquiry and Impact, you support groundbreaking research like Cunningham’s that leads to innovative new treatments and improved patient outcomes.
Everybody has a gift. Imagine the impact yours could make. Visit givetomedicine.uchicago.edu or call (773) 702-6565.
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INTRODUCING LEARNING AT THE FOREFRONT Learning at the Forefront is our new online education resource for medical professionals. We currently offer more than 80 video lectures and reviews by University of Chicago Medicine physicians as well as links to our science blog, physician directory and information about upcoming live conferences and events. Our physicians discuss emerging medical topics as well as leading-edge treatments, procedures and techniques. New videos added regularly. SPECIALTIES INCLUDE
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learning.uchospitals.edu Andres Gelrud, MD, MMSc, director of the Pancreatic Disease Center and Advanced Endoscopy, discusses Advances in Pancreatology.