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FOR PHYSICIANS WINTER 2013

University of Maryland

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CLINICAL AND RESEARCH UPDATES FROM THE UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE AND THE UNIVERSITY OF MARYLAND MEDICAL CENTER

Tackling Liver Cancer with Multi-Pronged Approach In this Issue Rounding Out Care

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The Anatomy of Tolerance | p4 New Discharge Information

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Hypertension Clinical Trial | p8 New Critical Care Tower | p9

A young man in his late thirties came to the University of Maryland Marlene and Stewart Greenebaum Cancer Center (UMGCC) with upwards of two dozen cancerous lesions on his liver — so many that imaging scans to diagnose him “lit up like a Christmas tree.” But his seemingly hopeless situation — which years ago would have caused physicians to throw up their hands in defeat — was tackled with unique, targeted therapy that resulted in clean CT scans for the patient six months later. Known as selective internal radiation therapy (SIRT), the non-surgical

medicine on a missionSM | OneCall 1-800-373-4111 umm.edu

outpatient treatment uses radioactive microspheres called SIR-Spheres to deliver up to 40 times more radiation to liver tumors than would be possible using conventional radiotherapy. Cutting-edge procedures such as this — which the University of Maryland Medical Center currently performs more of than any other hospital in the nation — combined with a variety of innovative surgical tactics place UMGCC at the forefront of comprehensive approaches to challenge this traditionally devastating malignancy. | cont’d p2


Tackling Liver Cancer with Multi-Pronged Approach | cont’d from p1 “We have many different options to present to our patients, and sometimes the physicians on the Liver Tumor Board combine techniques, going back and forth to create the best treatment, which doesn’t always happen elsewhere,” says Navesh Sharma, D.O., Ph.D., assistant professor of radiation oncology and associate director of the radiation oncology residency program. “I’ve actually had several patients who had been told to get their affairs in order, who were told they had a few months left but lived well beyond a year or more. We encourage patients to be proactive and research all available options.”

to make a lasting treatment effect with patients with these cancers,” he adds. “Multi-modality is important because other therapies can stop or shrink disease enough to allow surgery to be possible.”

SURGERY LEADS TO “LASTING TREATMENT EFFECT”

One of those advances is the use of laparoscopic or other minimally invasive surgery to remove some liver tumors, which wasn’t done until relatively recently. Aside from a faster recovery and less pain — both huge benefits — this technique also allows patients to begin chemotherapy more quickly afterwards than open surgery generally allows. But it’s not for everyone: Patients undergoing minimally invasive surgery typically have smaller tumors located in the outer portion of the liver, Dr. Reddy says.

To be sure, liver malignancies remain a formidable foe, with most presenting as metastases of colorectal cancer and a smaller percentage presenting as primary liver cancers. But surgical remissions or cures are possible for increasing numbers of patients seen annually at UMGCC whose tumors are resected. More patients are being attracted to the highly reputable program every year, says Srinevas K. Reddy, M.D., an assistant professor of surgery in the Division of General and Oncologic Surgery. “Of those with metastatic cancer, about 20% or 30% are resectable, where we can take out all the cancer and leave them with enough liver to survive,” Dr. Reddy explains. “Another 10% to 20% are resectable after chemo to shrink their disease, and about 20% of those with primary liver cancer are initially resectable. “With all of these diseases, despite improvements in chemo, the only chance for longer-term survival is surgery, and it’s one of the only ways

Ten-year data shows that newer chemotherapy agents and better surgical techniques have led to a dramatic improvement in survival, Reddy notes. About 60% of colorectal cancer patients with liver metastases are still alive five years after diagnosis, compared to about one in six a decade ago. “We’ve really made excellent strides,” he says.

“We’re still committed to safety and getting the tumor out,” he adds, “and we won’t compromise to do that through minimally invasive techniques. Every patient’s case is presented at a multidisciplinary liver tumor conference to really study the images and customize our approach.”

SIR-SPHERES SURPASS CONVENTIONAL RADIOTHERAPY For inoperable liver malignancies, a variety of radiotherapy treatment options may be appropriate depending on a patient’s individual

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needs. The use of SIR-Spheres — which will be implanted in about 150 patients this year — builds on UMGCC’s role as the first center in the nation, in 2000, to successfully perform liver-directed therapy with TheraSpheres, which delivered radiation to liver tumors with microscopic glass beads. Millions of tiny radioactive SIR-Spheres are transported to the tumor site through the hepatic arteries, trapping them in the tumor’s vascular bed where they can destroy adjacent tumor cells. The outpatient procedure, typically administered in two treatments, minimizes damage to healthy liver tissue and leaves patients feeling and functioning more normally within weeks, Dr. Sharma says. Since each patient’s blood supply is mapped out prior to the procedure, “each is customized, and that’s where our experience and the experience of our colleagues in interventional radiology really matters because we’re able to do things on a small, segmental level … and change things on the fly where blood vessels are a little different,” he adds. Treatment with SIR-Spheres can improve patient outcome with low toxicity — and hence better quality of life — than repeated chemotherapy cycles. “It depends on what stage we’re treating patients,” he says, “but it’s shown that at every stage of treatment ... SIR-Spheres improve both progression-free survival and overall survival.”

COMMUNICATION IS KEY Beyond cancer, UMMC physicians are routinely investigating other common liver conditions such as hepatitis, cirrhosis and fatty liver disease. In


EXPANDED

| CLINICAL SERVICES |

ROUNDING OUT CARE AND RESEARCH

N. SHARMA’S, D.O., Ph.D., research focus is in the application of radiation therapy for gastrointestinal, gynecological and hematological malignancies as well as in the improvement of treatment delivery for highly targeted radiation modalities.

“SCARLESS” KIDNEY DONATION

BOOSTS PATIENT SATISFACTION

• Selective internal radiation therapy known as SIR-Spheres is one treatment option for liver tumors

KEY POINTS:

• Surgery, including minimallyinvasive operations, leads to better life expectancy • Greenebaum Cancer Center physicians emphasize communicating with community physicians

fact, about half of Dr. Reddy’s time is spent on clinical outcomes research on fatty liver disease — not only its surgical outcomes, but whether the condition exacerbates problems with other organs such as the heart.

team effort. UMMC physicians give special focus to communicating with patients’ primary care doctors to make sure they understand what procedures have been planned or undertaken so it’s never a surprise.

“So many different diseases affect the liver, from cancers to diabetes,” he explains. “That’s what distinguishes us from other places that may have one surgeon who can only do liver cancer. We are so interested in clinical outcomes research, and we want to apply it to patient care as opposed to an institution that operates on patients all day.”

“I’m constantly on the phone with a patient’s doctor so that doctor and I have a firm plan of what’s going on,” Dr. Reddy says. “I think it’s also important because it shows patients and their local doctors that we’re not going to ‘steal’ their patient. We recognize that the local doctor is the key to managing that patient from both a local standpoint and a longterm standpoint.”

Managing these patients, he points out, is a multidisciplinary,

University of Maryland researchers found that living donors who donated a kidney that was removed through a single port in the navel report higher satisfaction in several key categories, compared to donors who underwent traditional multiple-port laparoscopic removal. The results were recently published in the Annals of Surgery. The single port technique has been described as virtually scarless, because nearly the entire incision, once healed, is hidden within the navel. Researchers at the University of Maryland, including lead author Rolf Barth, M.D., found the single port donation group had significantly improved satisfaction with the cosmetic outcome and the overall donation process. Additionally, this technique was associated with fewer limitations in bending, kneeling or stooping following surgery, and slightly less pain after surgery, compared to the multiple incision laparoscopic approach. The study also confirmed the safety of both procedures as equally safe methods of kidney donation for patients. Single-port donor nephrectomy, also known as laparoendoscopic single-site (LESS) surgery, has been the standard of care for living kidney donors at the University of Maryland Medical Center for the past three years; however, no objective data previously existed to compare the singleport with the multiple-port laparoscopic techniques. UMMC is one of the first hospitals in the country to consistently use this surgical approach on living donors and has employed the single-port technique in 230 donors. | cont’d p7

Dr. Sharma can be reached at 410-328-7617 or at nsharma@umm.edu. Dr. Reddy is at 410-328-6187 or at sreddy@smail.umaryland.edu. Log onto umm.edu/liverwebcast to see a presentation by Dr. Reddy on liver metastases.

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The Anatomy of Tolerance

Understanding Immune Response for Optimal Organ Transplantation Every day a stranger offers the greatest gift of all, the gift of life. In the U.S. alone, more than 100 million people have signed up to be organ donors. Yet, the need for transplantation is so great that nearly 75,000 people are currently waitlisted to receive an organ. Much has been learned since the first successful organ transplant in 1954 when an identical twin donated a kidney to his brother suffering from kidney disease. Since then, there have been tremendous advances in organ transplantation, including techniques to better match donors and recipients and the development of new immunosuppressive drugs. Discoveries in these areas have helped reduce acute organ rejection and improve transplant outcomes. However, even healthy organs transplanted between appropriately matched patients may be inadvertently rejected by the donor’s immune system. Immunosuppression, while helpful, can also offer some disadvantages. “The problem with immunosuppression drugs is that patients need to take them for life. The drugs have side effects and can at times lead to adverse medical reactions,” says Jonathan Bromberg, M.D., Ph.D., chief of the Division of Transplantation at the University of Maryland Medical Center. Dr. Bromberg’s background is unique because he is both a surgeon and an immunologist. “I was told follow your heart and your brain, so I did both,” says Dr. Bromberg, who obtained both a Ph.D. in immunology and his medical degree from Harvard University. Dr. Bromberg is a professor of surgery

and microbiology and immunology at the University of Maryland School of Medicine. Interdisciplinary research led by Dr. Bromberg between the University of Maryland’s School of Medicine and Department of Microbiology and Immunology may help to better understand the immune system at a more fundamental level. Dr. Bromberg’s work focuses on trying to determine how modulating immune system response can help support — rather than reject — organ transplants. The benefits to the patient would include fewer transplantation complications, the need for less medication and possibly even fewer doctor visits once the organ is transplanted.

TRAVELING T CELLS In the area of immunosuppression, the general approach has been to develop drugs that focus on a single molecule or cell. However, a broader approach may also be important because molecules, cells and organs don’t always interact in a linear fashion. In fact, they act more as a complex network with multiple interacting pathways. “We haven’t yet discovered all the guiding principles surrounding basic immunology and therefore haven’t yet determined how to best modulate the immune system for optimal organ transplantation,” says Dr. Bromberg. Although it hasn’t yet been achieved, the holy grail would be to perfectly regulate immune suppression to achieve complete tolerance of the transplanted organ. Dr. Bromberg’s research suggests that tolerance may have a lot to do with how, when and where specific white blood cells travel.

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One of the questions he is trying to answer is how certain cells, such as regulatory T cells, travel from the blood to the donated organ and then back into the blood and lymph nodes. Understanding regulatory T cell migration is crucial because research by various groups has shown that these cells can be involved in shutting off an immune response.

DECIPHERING SIGNALS AND PATHWAYS Regulatory T cell migration can be compared to a person taking a long road trip. The driver may decide to take a winding back road or a speedy highway. While traveling, the driver may also decide to stop somewhere to eat or even take a detour into a scenic road. With every trip, the person gains experiences and learns new things. “Signals tell regulatory T cells when to leave one place and go somewhere else,” says Dr. Bromberg. “And when it reaches its destination, another set of signals can tell it to do other things such as to mature, differentiate or proliferate.” Dr. Bromberg believes that understanding signaling that drives these and other cells is key. “Getting regulatory T cells to travel at the right time to the right place and in the right numbers may be important in helping suppress an immune response,” he says. Determining the signals that cause these cells to move into and out of the organ and lymph nodes — sites of immune reactivity — is therefore pivotal. This may not be achieved by hitting a single cell or molecule, but by better understanding the pathways that underlie cell migration and the complex interactive immune network.


OPTIMAL ORGAN

| TRANSPLANTATION |

KEY POINTS:

JONATHAN BROMBERG, M.D., Ph.D., studies immunosuppression and the migratory patterns of T cells with the hope of understanding what causes organ rejection.

• Dr. Jonathan Bromberg’s research focuses on gaining a better understanding of immunosuppression • Identifying T cell migration could potentially prevent acute and chronic organ rejection

“It’s a different way to look at the immune system, because we still don’t have drugs that take this traveling into account,” says Dr. Bromberg. “However, understanding these interactions may also help develop better immunosuppressive drug targets.” In his research in mice, Dr. Bromberg is studying how a combination of monoclonal antibodies, timing and transfusion of certain white blood cells and molecules can impact immune suppression. Results have shown that administering this combination as early as seven days prior to organ transplantation can play an important role in the immune response by establishing a more tolerant environment for organ transplantation which may eventually lead to better acceptance of the transplanted organ.

Developing a better understanding of the basic aspects of the immune system could even lead to improvements in other areas. Today, one of the most successful transplantations involves kidney transplants. On average, the chance of rejection in the first year after kidney transplantation is about 10% to 15%. However, as patients get further along — 5 to 15 years after transplant — they may develop something called chronic rejection, which involves chronic scarring.

“We believe this chronic scarring is due to ongoing, low-level rejection of the organ by the immune system. This happens with various transplants over time, and right now it can be difficult to diagnose or control,” says Dr. Bromberg. “However, if we understood the immune response to a point where we could achieve perfect immunosuppression, then we would be able to completely prevent both acute and chronic organ rejection in the first place,” he adds. “This would help us achieve complete tolerance.”

Dr. Bromberg can be reached by email at jbromberg@smail.umaryland.edu or by phone at 410-328-5408.

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Medicine on a Mission: New Discharge Notification Brings Crucial Information Full Circle One of the major contributions of academic medical centers such as University of Maryland Medical Center (UMMC) is providing outstanding care to patients hailing from far and wide. But getting each patient’s treatment information back to their primary or referring physicians — crucial to patients’ safety and continuum of care — has often been a challenge, with summaries of patients’ hospital care, lab tests and newly prescribed medications not arriving to professional colleagues in a timely or reliable way. Here at UMMC, we are applying our brand theme, “Medicine on a Mission,” to how we interact with physician partners. We are on a mission to be a valuable resource, providing timely, accurate information about patients cared for at the Medical Center. We have recently implemented new automated discharge notifications accompanied by a brief “clinical summary,” rapidly bringing primary and referring doctors up to date on their patients’ hospitalizations, faxed within 24 hours of discharge. Spearheaded by UMMC’s medical staff leadership and the Office of Referring Physician Services, this effort builds on a 2011 UMMC initiative to auto-fax doctors “admit notification” letters letting them know their patient had been admitted for care here. “We want to make it easy for doctors and patients to access the Medical Center, we want to provide excellent care and we want to return patients back to their doctors, making sure

they have all the relevant information to pick things back up,” says Mark Kelemen, M.D., senior vice president and chief medical informatics officer at the University of Maryland Medical System. Dr. Keleman works with physicians at the medical system’s 12 hospitals and the faculty of the University of Maryland School of Medicine to facilitate the successful adoption of leading-edge clinical information technology. “The final discharge summary may take a few weeks to complete, but we may ask patients to get to their doctors within a week of discharge. So the challenge of documenting complex care was competing with our desire to get key information promptly to doctors,” Dr. Kelemen adds. “The key to safe, wellcoordinated medical care involves strong communication, and this is an area we knew we needed to improve, so we leveraged technology to help.”

MAKING TECHNOLOGY MATCH THE CONCEPT Technology doesn’t always match communication concepts, and that was the case when UMMC physicians, administrators and IT professionals first conceived the idea to implement automated discharge notices. Janine Good, M.D., associate professor of neurology at the University of Maryland School of Medicine and medical director of ambulatory services at UMMC, was among the leaders to tackle improvements to the physician communication process. “That’s why this is exciting — it’s a big step for doing our part in the continuum of care,” Dr. Good says.

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“Now we have tools to help patients over the transom and guide them into models to keep them out of the hospital.” The first stage of the process was taking advantage of the tools available within patients’ electronic medical records, Dr. Kelemen explains. “We did some custom IT programming to be able to take relevant information out of UMMC’s electronic medical record system and put it in a format useful to referring physicians.” Each “clinical summary” includes: • • • • • •

 ate of discharge D Discharge diagnoses Pertinent clinical information Activity, diet and allergy information Symptoms for follow-up Names of all known referring physicians, whether primary care or specialists • Prescription medication list • Scheduled follow-up appointments • Most recent laboratory test results

INNOVATIONS ONGOING The new “clinical summary” circumvents many problems that present before they begin, such as patients returning to their primary or referring physicians with an entirely new list of medications they were taking, but no context to offer regarding their drug changes and additions. “The doctor wouldn’t have that in their record and wouldn’t necessarily know the major reasons for any change. This often required a series of phone calls and a lot of time and


NEW DISCHARGE

| NOTIFICATION |

effort spent on both sides to collect that information and present it back to the referring physician,” Dr. Kelemen says. “Medications, what happened in the hospital, and early follow-up recommendations and treatment plans are all part of this summary.” But innovations to this new system haven’t ended with its launch. Drs. Good and Kelemen hope that in the near future, discharge summaries will also include a mention of any pending lab tests done during hospitalization that hadn’t reported results upon discharge. That way, primary and referring doctors don’t duplicate tests and will know what results are imminent that may shed more light on their patients’ needs. “We also have a great care coordination program in the hospital that identifies patients at high risk of readmission,” Dr. Good says. “We’re looking at how we can red-flag these patients on discharge as well.”

To reach the Office of Referring Physician Services handling UMMC’s admission and discharge notifications, please call 410-328-8422 or email orps@umm.edu.

DR. ROLF BARTH removes a kidney from a donor through a single port.

ROUNDING OUT CARE | cont’d from p3 The UMMC transplant team is conducting workshops to train other transplant surgeons in the LESS technique, and has authored an updated chapter highlighting this technique in the latest surgical textbook “Kidney Transplantation.” To reach Rolf Barth, please email him at rbarth@smail.umaryland.edu.

PEDIATRIC EPILEPSY CARE The University of Maryland Children’s Hospital recently opened the state’s only pediatric-dedicated epilepsy monitoring unit. Since there is a greater demand for pediatric epilepsy programs than there is availability, the University of Maryland Children’s Hospital began a program in pediatric epilepsy, staffed with two pediatric epileptologists: Kathleen Currey, M.D., and Alpa Vashist, M.D., both assistant professors of pediatrics in the University of Maryland School of Medicine. This program has the capacity to put patients, including neonates, under simultaneous video and EEG monitoring. For appointments with the pediatric epilepsy program, please call 410-706-6091.

IS THERE A TOP DOC IN THE HOUSE? An all-time high 98 University of Maryland faculty physicians were recognized as “Top Doctors” in the annual Baltimore Magazine issue released in November 2012. The results are based on the magazine’s survey of nearly 10,000 physicians in the Baltimore area asking where they would send a member of their family in dozens of specialties. The University of Maryland Medical Center has more doctors on the list than any other hospital. Log onto www.umm.edu/topdocs to see the complete list.

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Treatment-Resistant Hypertension Clinical Trial Hypertension is endemic in the United States. The American Heart Association estimates that 76 million people, or one-third of adults, have high blood pressure. Of those adhering to multi-drug treatment regimens, an estimated 2% to 10% of patients still have severely elevated blood pressure of 160/90 mm Hg or greater. These patients are at double the risk for developing complications of hypertension, including heart attacks, heart failure and stroke. University of Maryland professor of medicine Elijah Saunders, M.D., points out, “… for African Americans, who tend to have a more severe form of hypertension, these risks are much greater, compared to their Caucasian counterparts.”

trial’s principal investigator, Anuj Gupta, M.D., an assistant professor of medicine at the University of Maryland School of Medicine. Patients who meet criteria for the study undergo renal denervation using the Symplicity Catheter System, a product of Medtronic. A catheter is placed through the groin and positioned at multiple locations within the kidney’s arteries. Radiofrequency energy is then delivered to interrupt the sympathetic nerves supplying the kidneys. Patients stay in the hospital overnight. They then have follow-up visits at one, three and six months and then additional visits every six months.

The University of Maryland Medical Center is the only site in the state enrolling in Symplicity HTN-3. This is a randomized, single-blind, placebocontrolled clinical trial examining the safety and effectiveness of renal denervation for patients with treatment-resistant hypertension and a systolic blood pressure greater than 160 mm Hg. In phase 1 and phase 2 trials of this treatment strategy, average systolic blood pressure reductions of 30 mm Hg were achieved without evidence of renal complications. “There are few options for treatmentresistant hypertension. For those patients who can’t control their blood pressure, despite being on three or more hypertension medicines at maximum doses, this clinical trial has potential for changing the way we manage one of the most common medical conditions,” explains the

ELIJAH SAUNDERS, M.D., F.A.C.C., F.A.C.P., F.A.H.A., F.A.S.H., has a research interest in hypertension with a focus on the incidence among the African-American population.

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Of those adhering to multi-drug treatment regimens, an estimated 2% to 10% of patients still have severely elevated blood pressure of 160/90 mm Hg or greater. Physicians who need more information may contact Joanne Marshall, R.N., M.S., at 410-328-8790 or at jmarshal@medicine. umaryland.edu.


TRAUMA CENTER

| EXPANSION |

A New Critical Care Tower Takes Shape Construction continues in downtown Baltimore, where the country’s highest volume trauma center is undergoing a much-needed expansion. A new Critical Care Tower at the University of Maryland Medical Center is taking shape, expanding the R Adams Cowley Shock Trauma Center, adding 64 new critical care ICU beds, five new operating rooms, a new post operative area with all private rooms, an expanded and renovated Emergency Department, a stateof-the-art lab, a national simulation training center and a large family waiting area designed with comfort and privacy in mind. The completion date is June 2013. Shock Trauma admits more than 8,600 patients a year, though the current building was designed to care for 3,500 patients a year. The new building will greatly expand capacity for care, research and teaching, allowing Shock Trauma teams to do what they do best: save the lives of people with severe, life-threatening injuries sustained in auto crashes, falls, violent crimes and other traumatic incidents. “The R Adams Cowley Shock Trauma Center is Maryland’s ‘safety net.’ We are here for our citizens when they unexpectedly need us. Injury can strike at any time and our team is committed to giving every person a second chance. We are proud to say that 96% of patients survive,” explains Thomas M. Scalea, M.D., F.A.C.S., physician-in-chief, R Adams Cowley Shock Trauma Center and Francis X. Kelly Professor of Trauma Surgery, University of Maryland School of Medicine. While most patients are

THE NEW BUILDING will greatly expand capacity for care, research and teaching.

Shock Trauma admits more than 8,600 patients a year, though the building was designed to care for 3,500 patients a year. admitted from the initial scene, 30% of patients come as an inter-hospital transfer. “This expansion means we can say ‘yes’ to every request for a transfer, as the new building will improve our flow of patients,” adds Dr. Scalea. “This new building is a collaborative investment of $160 million with funds coming from the state, the federal government, the city of Baltimore and the counties across Maryland. The community is also coming together as individual, corporate and foundation partners help to provide the $35 million needed to complete this valuable project,” says Marianne Rowan-Braun, vice president and director of the campaign for Shock Trauma. Shock Trauma remains the only facility in Maryland with a PARC (Primary Adult Resource Center) designation,

signifying that it provides the highest level of trauma care with every type of specialist in the hospital 24/7. Shock Trauma is also the designated statewide referral center for head and spinal cord injuries, multi-system trauma and severe orthopaedic injuries. Since 2001, the U.S. Air Force has partnered with the Medical Center and School of Medicine to use Shock Trauma as its readiness training site for its worldwide medical personnel. We invite you to tour the new tower with Dr. Scalea. See for yourself why Shock Trauma is a gift from the people of Maryland for the people of Maryland. Please contact Marianne Rowan-Braun, at 410-328-8437 to set up a convenient time. Please remember that referring a patient to Shock Trauma takes just one call to Maryland ExpressCare at 410-328-1234.

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New Leaders within University of Maryland James S. Gammie, M.D., professor of surgery, has been appointed chief of the division of cardiac surgery. In his new role, he oversees an extensive range of cardiac surgical services, from repairing congenital heart defects in infants and children to heart transplantations and other complex procedures for high-risk adult patients. Dr. Gammie, who has been a member of the University of Maryland faculty since 2002, is an expert in surgery of the mitral valve and a nationally known cardiac surgery outcomes investigator. He currently performs more than 200 mitral valve operations per year. He has developed a specialized practice focusing on mitral valve repair, minimally invasive mitral valve surgery and the surgical treatment of infective endocarditis. He has organized a clinical research unit within the division of cardiac surgery and serves as a principal investigator for the NHLBI-sponsored multi-center Cardiothoracic Surgery Trials Network. Dr. Gammie is a highly published physician-scientist and serves in editorial roles for numerous cardiothoracic journals, including Annals of Thoracic Surgery, Journal of Thoracic and Cardiovascular Surgery, Circulation and the Journal of Heart Valve Disease. Dr. Gammie received his A.B. in biochemistry at Brown University and his M.D. at the University of Massachusetts Medical School. His clinical training was performed at the University of Pittsburgh Medical School, where he completed his residency in general surgery, followed

by a research fellowship within the divisions of cellular therapeutics and cardiothoracic surgery, and a clinical fellowship within the division of cardiothoracic surgery. Dr. Gammie can be reached at 410-328-5842.

Minesh P. Mehta, M.B.Ch.B., F.A.S.T.R.O., has been appointed as medical director of the Maryland Proton Treatment Center (opening in 2015), as well as professor and associate director of clinical research in the department of radiation oncology, University of Maryland School of Medicine. He comes to Baltimore from Chicago where he was a professor and co-director of the Radiation Oncology Residency Training Program at Northwestern University. While the Proton Center is built, Dr. Mehta will be seeing and treating brain tumor and lung cancer patients within the Greenebaum Cancer Center. In his role as medical director, he will work in the development of clinical trials and research protocols for patients, assume a leadership role within the evolving nationwide proton center consortium, as well as develop and integrate criteria for proton therapy patient selection within the department of radiation oncology’s clinical practice guidelines. Dr. Mehta currently chairs the Brain Tumor Committee of the National Institutes of Health-funded Radiation Therapy Oncology Group focusing on innovative clinical trials for patients with various tumors of the central

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nervous system. He maintains an active interest in radiation-drug interactions, amelioration of radiation toxicities, incorporation of advanced radiation and imaging technologies, and is keenly interested in expanding the frontiers of personalized care in radiotherapy. Dr. Mehta received his medical degree with highest honors from the University of Zambia School of Medicine in Lusaka, Zambia. He completed his radiation oncology training at the University of Wisconsin, immediately joining the faculty at the university. He became professor and LISA SHULMAN, M.D. was chair of the department of human oncology at the University of Wisconsin for a decade from 1997-2007. Dr. Mehta can be reached at 410-328-2325.

Zeljko Vujaskovic, M.D., Ph.D., has been appointed as professor and director of the new division of translational radiation sciences in the department of radiation oncology. He joins us from Duke University, where he has been since 1999. The new division of translational radiation sciences will serve to further expand and centralize cutting-edge research in radiation biology, leading the exploration of new ways to treat and eradicate deadly cancers. Dr. Vujaskovic is an accomplished National Institutes of Health-funded physician-scientist with outstanding leadership skills and a distinguished career in research and patient care.


UNIVERSITY OF MARYLAND

| NEW LEADERS |

As a clinician, Dr. Vujaskovic will have a primary focus in genitourinary and prostate cancers. Dr. Vujaskovic joins the University of Maryland from his previous position as professor, director of the normal tissue injury laboratory and director of the Clinical Hyperthermia Program at Duke University Medical Center. Dr. Vujaskovic’s clinical and research work for the past two decades has been to elucidate the mechanisms associated with radiation normal tissue injury, identify potential biomarkers predicting individual patient risk for injury and develop novel therapeutic interventions/strategies to prevent, mitigate or treat radiation injury. He is a nationally and internationally recognized leader in the field of radiation-related normal tissue injury.

Dr. Vujaskovic received his medical degree from the University of Zagreb Medical School in Croatia. He earned his Ph.D. from Colorado State University. He completed an internship at the Medical Centre Karlovac in Croatia and trained as a resident at the Military Medical Academy in Belgrade, Yugoslavia. He also completed residency training at the Medical Centre Karlovac in Croatia. He finished a fellowship in medical oncology at the University of Colorado Cancer Center, and a postdoctoral fellowship in the department of radiological health services at Colorado State University. Dr. Vujaskovic can be reached at 410-328-7618.

CME Activities HUMAN VIROLOGY (IHV) CASE CONFERENCE MONTHLY SERIES January through December

>> FUNDAMENTALS OF CRITICAL CARE SUPPORT March 21-22 June 6-7 Sept. 26-27 Oct. 24-25 Dec. 5-6

The following are new leadership roles within the division of transplantation: • Rolf Barth, M.D., is director of liver transplantation and hepatobiliary surgery. • John LaMattina, M.D., is director of living donor liver transplant. • Steven Hanish, M.D., who is new to University of Maryland is director of hepatobiliary surgery. • David Leeser, M.D., is director of kidney pancreas transplant. All physicians within this division can be reached at 410-328-5408.

Upcoming

>> 2013 INSTITUTE FOR

DIVISION OF TRANSPLANTATION

Offered by the University of Maryland School of Medicine in conjunction with University of Maryland Medical Center.

>> LEADING EDGE ECHOCARDIOGRAPHY INTERVENTIONAL PROCEDURES FOR ACUTE CARE AND TRAUMA PHYSICIANS April 12 June 28 Sept. 13 Nov. 15

>> ADVANCES IN VASCULAR SURGERY AND ENDOVASCULAR THERAPY May 9-11

>> CURRENT TECHNIQUES IN MANAGEMENT OF COMPLEX FRACTURES FOR THE COMMUNITY ORTHOPAEDIC SURGEON June 21-22

>> 12TH ANNUAL TOWN/GOWN NEUROLOGY UPDATE June 26

All events will be held on the University of Maryland Baltimore campus. For details and registration information, please visit: https://cmetracker.net/UMD/Catalog

These activities have been approved for AMA PRA Category 1 Credit™ and are sponsored by the University of Maryland School of Medicine. The University of Maryland School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

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ranking high

in specialty care The University of Maryland Medical Center is recognized by U.S. News & World Report in Best Hospitals 2012-13 and is nationally ranked in these specialties: • • • • • • • • •

NON PROFIT US POSTAGE PAID University of Maryland Medical Center

22 South Greene St. Baltimore, MD 21201 OneCall 1-800-373-4111

Nephrology (#9) Cancer (#11) Diabetes & Endocrinology (#11) Urology (#15) Ear, Nose & Throat (#24) Pulmonology (#26) Cardiology & Heart Surgery (#27) Neurology & Neurosurgery (#48) Gynecology (#49)

University of Maryland Rounds is a publication of the University of Maryland School of Medicine and the University of Maryland Medical Center. Originally founded in 1823 as the Baltimore Infirmary, the University of Maryland has an extensive history of providing innovative and compassionate care to the people of Maryland and the surrounding region. As a tertiary/quaternary care center, we heal, we teach, we discover and we care.

E. ALBERT REECE, M.D., PH.D., M.B.A. Vice President for Medical Affairs University of Maryland John Z. and Akiko K. Bowers Distinguished Professor and Dean University of Maryland School of Medicine

JEFFREY A. RIVEST, F.A.C.H.E. President and Chief Executive Officer University of Maryland Medical Center

ADVISORY BOARD

STEPHEN T. BARTLETT, M.D.

Peter Angelos Distinguished Professor and Chairman, Department of Surgery University of Maryland School of Medicine Surgeon-in-Chief, University of Maryland Medical System

MAY H. BLANCHARD, M.D., F.A.C.O.G.

Associate Professor, Department of Obstetrics, Gynecology & Reproductive Sciences University of Maryland School of Medicine Chief, Division of General Obstetrics & Gynecology University of Maryland Medical Center

STEVEN J. CZINN, M.D., F.A.A.P., F.A.C.G., A.G.A.F.

Professor and Chair, Department of Pediatrics University of Maryland School of Medicine Physician-in-Chief, University of Maryland Children’s Hospital

For questions about Rounds or to receive an e-version of this newsletter, please email: rounds@umm.edu

STEPHEN N. DAVIS, M.B.B.S., F.R.C.P., F.A.C.P.

Theodore E. Woodward Professor of Medicine Professor of Physiology Chairman, Department of Medicine University of Maryland School of Medicine Physician-in-Chief, University of Maryland Medical Center

JANINE L. GOOD, M.D.

Associate Professor of Neurology University of Maryland School of Medicine Medical Director, Ambulatory Services University of Maryland Medical Center

WILLIAM E. TUCKER, M.B.A., C.P.A.

Assistant Dean for Practice Plan Affairs University of Maryland School of Medicine Chief Corporate Officer, Faculty Physicians, Inc.

DAVID A. ZIMRIN, M.D.

Associate Professor of Medicine University of Maryland School of Medicine Division of Cardiology

ALISON G. BROWN, MPH

Senior Vice President, Business Development, Marketing and System Strategy

JONATHAN GOTTLIEB, M.D.

Senior Vice President and Chief Medical Officer University of Maryland Medical Center Clinical Professor of Medicine University of Maryland School of Medicine

ALEXANDRA BESSENT Director, Marketing Editorial Director, Rounds

ANTHONY F. LEHMAN, M.D., M.S.P.H. Senior Associate Dean for Clinical Affairs Professor of Psychiatry University of Maryland School of Medicine

DEBORAH M. STEIN, M.D., M.P.H., F.A.C.S., F.C.C.M. Associate Professor of Surgery University of Maryland School of Medicine Medical Director, Neurotrauma Critical Care Chief, Section of Trauma Critical Care R Adams Cowley Shock Trauma Center

This publication does not constitute professional medical advice. Although it is intended to be accurate, neither the publisher nor any other party assumes liability for loss or damage due to reliance on this material. Websites not belonging to this organization are provided for information only. No endorsement is implied. Images may be from one or more of these sources: ©Thinkstock, ©iStock, ©Fotolia. ©2012 The University of Maryland Medical Center.


University of Maryland Rounds