FALL 1999 POSTOp - Stony Brook School of Medicine · Peter J. Garlick, PhD Fabio Giron, MD, PhD Arnold E. Katz, MD M. Margaret Kemeny, MD Irvin B. Krukenkamp, MD Cedric J. Priebe,

DEPARTMENT OF SURGERY • UNIVERSITY HOSPITAL AND MEDICAL CENTER • UNIVERSITY AT STONY BROOK —1 —

POSTOpNews Update from the Department of Surgery

FALL 1999Number 10

U N I V E R S I T Y . H O S P I T A L . A N D . M E D I C A L . C E N T E R . A T . S T O N Y . B R O O K

PERFORMINGENDOVASCULAR SURGERYNew Minimally InvasiveApproach to TreatingVascular Disease

The most attractive treatmentoption for many patients withcertain circulatory disorders maybe the newest technique available:endovascular surgery. With the re-cent recruitment of Rishad M.Faruqi, MD, and David B. Gitlitz,MD, both of whom joined our Divi-sion of Vascular Surgery in August,University Hospital is now the onlyhospital in Suffolk County to offerthis cutting-edge treatment of vascu-lar disease, and give patients the op-portunity to avoid conventional opensurgery.

Endovascular surgery is mini-mally invasive, as the incision is justlarge enough for the surgeon to inserta catheter (thin tube) into the bloodvessel, through which instrumentsand devices can be inserted to treatdiseased blood vessels, clean outblocked vessels, or deliver clot-dissolving medications directlyat the problem area.

All the surgeon’s work is donefrom within the vessels themselves(endo-, within + vascular, vessel), withthe aid of newly developed technol-ogy and instrumentation.

Because endovascular surgeryinvolves a smaller incision compared

with that used in conventional vascu-lar operations, it causes less disruptionof the patient’s physiology, or vitalprocesses. Consequently, the hospitalstay is usually much shorter and thepatient’s recovery much faster.

Given that these less invasivemethods have been sought for de-cades, endovascular surgery—origi-nally developed in the 1980s—is nowa rapidly growing field of therapy. Itmay be used independently or in com-bination with conventional operationsin the treatment of vascular disease.

At present, nearly every bloodvessel in the body can be approachedintraluminally (from within the ves-sels).

With the recent advent of the ex-perimental endograft, or “internal by-pass” graft, the minimally invasivetechniques of endovascular surgery

can now be applied to treataneurysmal as well as oc-clusive atherosclerotic dis-ease—that is, to correctcirculatory problems indamaged or blocked arter-ies without having to resortto open surgery.

ENDOVASCULARSTENT GRAFTING

Now undergoingclinical trials nationwide atonly a few select medicalcenters, endovascular stent

grafting involves actually doing a by-pass from within the vessel. The areaof largest investigation is for abdomi-nal aortic aneurysm (AAA)* repair.The use of endovascular technology isbeing compared to standard therapy inthese trials, and may be particularlybeneficial for patients so ill and infirmthat the risk of a conventional open re-pair is excessive. This experimentaltechnique is currently not availableoutside of clinical trials.

A clinical trial of aortic stentgrafting is planned to startthis fall at University Hospitaland Medical Center.

(Continued on Page 2)

* The abdominal aorta is the main artery thatsupplies blood to the internal organs and legs; ananeurysm, which is potentially life-threatening,is an enlargement or bulge in an artery causedby a weakened arterial wall.

DEPARTMENT OF SURGERY • UNIVERSITY HOSPITAL AND MEDICAL CENTER • UNIVERSITY AT STONY BROOK—2 —

POST-OP is published by theDepartment of Surgery

University Hospital and Medical CenterState University of New York

at Stony BrookStony Brook, New York

Editor-in-ChiefJohn J. Ricotta, MD

Writer/EditorJonathan Cohen, PhD

Contributing EditorRichard Bogenshutz, MBA

Advisory BoardCollin E.M. Brathwaite, MD

Peter J. Garlick, PhDFabio Giron, MD, PhD

Arnold E. Katz, MDM. Margaret Kemeny, MDIrvin B. Krukenkamp, MD

Cedric J. Priebe, Jr., MDHarry S. Soroff, MD

All correspondence should be sent to:Dr. Jonathan Cohen

Writer/Editor, POST-OPDepartment of Surgery/HSC T19

University Hospital and Medical CenterStony Brook, NY 11794-8191, USA

AAA is the 13th leadingcause of death in the UnitedStates, claiming over 15,000 livesannually. In this country alone,more than 190,000 AAAs are di-agnosed each year and 45,000patients undergo surgery.

Aortic stent grafting prom-ises to offer a simpler and saferalternative to open abdominalsurgery in the treatment ofAAA. It may prove to be one ofthe most dramatic advancesmade in the field of vascularsurgery, as it has the potentialto save many lives.

Candidates for the newtreatment are patients diag-nosed with AAAs, as well asother abnormalities of the abdominalaorta, such as arteriovenous fistula(abnormal communication betweenthe artery and a vein) and certaintypes of aortic blockages.

The traditional approach to AAArepair involves operating on the abdo-men, opening the aorta, and insertinga graft—a slender fabric tube—through the middle of the aneurysm,which is then sewn in place.

Because the conventional opera-tion generally involves a long abdomi-nal incision and a seven- to ten-dayhospital stay, the new endovascularprocedure may offer significant ad-vantages. This minimally invasive sur-gery, which can be performed usingregional or even local anesthesia, oftenallows patients otherwise too ill forthe conventional operation to be con-sidered for AAA repair.

Endovascular stent grafting en-ables physicians to accomplish the re-pair without resorting to open surgery.

The stent graft, a self-expandingdevice, is similar to the traditionalDacron graft but has a ring of tinyhooks at each end. These hooksand barbs allow the stent graft toanchor itself to the inner wall ofthe blood vessel.

The stent graftis collapsed andloaded into a tube-like delivery sys-tem. The arteries inthe groin are ex-posed by the sur-geon using twosmall incisions. Awire is thenthreaded up fromwithin the bloodvessel to a point be-yond the diseasedpart of the bloodvessel. This wireacts like a monorailon which the deliv-ery system andother catheters andstents can move up

and down the blood vessel.The delivery system carrying the

stent graft within it is threaded up theartery over the wire lying within theblood vessel, and is guided by fluoros-copy (x-ray imaging) into the aneu-rysm.

Once inside the aneurysm, thesheath of the delivery system is gradu-ally withdrawn, allowing the stentgraft to re-expand to its original sizeand anchor itself onto the inside of thearterial wall by the hooks and barbs ateither end.

Some stent grafts require a bal-loon to be inflated within them to pushthe anchoring hooks into the wall. Ac-curate placement is essential becausethe arteries to the kidneys are close byand should not be covered. Since theprocedure is minimally invasive, thepatient is usually able to eat the sameday, walk the next day, and go homein two or three days.

Several types of stents and stentgrafts are available and can be usedfor various procedures. Most of thestents function as supports for the ar-terial wall and hold blocked or nar-rowed arteries open after balloonangioplasty.

The purpose of the aortic stentgraft, on the other hand, is not to bracethe artery open, but to create a new pas-sageway for blood, allowing it to bypassthe weakened/diseased area. Moreover,the stent graft prevents blood from flow-ing into this weak segment of the arterywhere the aneurysm formed.

Although this newly developedstent graft is now used only for the re-pair of AAA, it is anticipated that in thefuture, the procedure will be used to re-pair aneurysms at multiple locations.Drs. Faruqi and Gitlitz are skilled notonly in the use of aortic stent grafts butin other endovascular procedures aswell. These include balloon angioplasty,clot dissolution, and stenting of arteries.

ANGIOPLASTYWITH STENTING

Balloon angioplasty, a procedurewhich increases the amount of bloodflowing through a narrowed area by dis-rupting and stretching the plaque, has

(Continued on Page 3, third column)

Endovascular Surgery(Continued)

Reconstruction afterendovascular repairof an abdominal aorticaneurysm. After trans-femoral insertion of thestent graft, sealing ofthe graft is accomplishedby implantation of theself-expanding hookedattachment system intothe arterial wall (arrows).


been around for many years. It is suc-cessfully used in coronary arteries, re-nal arteries, and in some of the largerarteries of the body. It is, however, lesssuccessful in small leg arteries and incompletely-blocked arteries.

To support the work done by anangioplasty balloon that opens up ablocked vessel, the stent—a wire“cage” or “frame”—is placed insidethe vessel at the site of the problem.Under some circumstances, the stentincreases the durability of angioplasty,yet adds little to the complexity or riskof the procedure.

Our vascular surgery team hasbeen performing angioplasty withstenting as part of open reconstruc-tions and also as a separate procedure.Now, with the expertise of Drs. Faruqiand Gitlitz, we can provide the newendovascular stent grafts as well.

Board certified inboth general andvascular surgery, Dr.Faruqi received hismedical degree(Bachelor of Medi-cine/Bachelor of Sur-gery) from India’sArmed Forces Medi-cal College in 1982.

After his surgical internship in India, hecompleted his first residency training ingeneral surgery in England, where in1988 he became a Fellow of the RoyalCollege of Surgeons of England as well asa Fellow of the Royal College of Surgeonsof Edinburgh.

For the next two years, Dr. Faruqipracticed general and vascular surgery inEngland. His interest in an academic ca-reer as a surgeon-scientist motivated himto come to the United States in 1990 topursue vascular research at the ClevelandClinic Foundation in Ohio. He then decidedto continue his career in America, ratherthan returning to England.

In order to fulfill the requirementsfor board certification in surgery in theUnited States, Dr. Faruqi completed hissecond residency in general surgery atGeorgetown University Hospital in Wash-ington, DC, and at Case Western ReserveUniversity in Cleveland, OH.

Subsequently, in 1998, Dr. Faruqicompleted his one-year fellowship train-ing in vascular surgery at the University ofCalifornia at San Francisco. He then helda one-year faculty appointment there as aclinical instructor in vascular surgery.

It was during these two years thathe learned the new techniques ofendovascular surgery under the directionof Dr. Timothy Chuter, one of the pioneersand world leaders in this field.

To further develop his endovascularskills, Dr. Faruqi has spent five months ofthis year at Malmö University Hospital atLund University in Sweden, where heworked closely with both vascular sur-geons and interventional radiologists.The divisions of vascular surgery andinterventional radiology at Malmö Univer-sity Hospital are world renowned in thefield of endovascular interventions and re-search, as well as in the development ofnew devices and techniques in theendovascular management of vasculardisease.

BIO-

NOTE

Dr. Faruqi’s research interests in-clude the pathology and treatment of tho-racic and abdominal aortic aneurysms,visceral and renal artery disease and theirtreatment, and the endovascular manage-ment of vascular disease.

With publications in vascular cell bi-ology and vascular surgery, Dr. Faruqi isfirst author and also co-author of severalreports published in the Journal of ClinicalInvestigation, American Journal of Physi-ology, FASEB Journal, British Heart Jour-nal, and Journal of Endovascular Surgery.

Dr. Faruqi joins our faculty as an as-sistant professor of surgery. In addition toendovascular surgery, he will also prac-tice general vascular surgery.

Dr. Gitlitz, whojoins our facultyas an assistantprofessor of sur-gery, received hisMD from NewYork University in1992. He thencompleted hisresidency trainingin general surgeryat the AlbertEinstein College of

Medicine/Montefiore Medical Center in1997. Subsequently, he was an attendingsurgeon there for one year.

In June 1999, Dr. Gitlitz completedhis one-year fellowship training in vascu-lar surgery at New York’s Mount SinaiMedical Center, where he pursued aspecial concentration in endovascularsurgery.

Dr. Gitlitz’s clinical practice encom-passes endovascular surgery, as well asgeneral vascular surgery. His research in-terests include the use of endovasculargrafts for the treatment of atheroscleroticocclusive disease, and also the preventionof intimal hyperplasia, a principal cause oflate graft failure.

This year Dr. Gitlitz has given twopresentations on endovascular surgery atprofessional meetings. In January, he lec-tured on endovascular AAA repair andpost-implantation syndrome at a sympo-sium sponsored by the New York Cardio-vascular Society. At the annualsymposium on vascular surgery spon-sored by the Society for Clinical Vascular

BIO-

NOTE

Surgery, which was held in March, he pre-sented the findings of a study he conductedon the impact of aortic neck thrombus onendovascular stent-graft fixation.

Commenting on the new endovascularprocedures, Dr. Gitlitz says: “It is importantfor patients to know that endovascular pro-cedures other than angioplasty with stentingand clot dissolution are currently being per-formed on an experimental basis, in order toevaluate their safety and effectiveness com-pared to conventional open surgery.”

“The fact that, at Stony Brook, thenew endovascular procedures such asaortic stent grafting are being performedunder approved protocols, with appropri-ate oversight by the FDA and StonyBrook’s institutional review board, shouldgive patients a sense of confidence andquality assurance.”

For consultations/appointments with ourendovascular surgeons, or for more informationabout the clinical trial of aortic stent grafting,please call (516) 444-2565.

Endovascular Surgery(Continued from Page 2)

OUR ENDOVASCULAR SPECIALISTS


Community physicians whorefer patients to the UniversityVascular Disease Center can beassured of continuity of care, asclose communications aremaintained with them as partof our approach to comprehen-sive patient management.

We wish to express our sinceregratitude to all who madepossible the very successful1999 Research ClassicGolf Tournament,the proceeds of whichhave been donated tobenefit the Department’sbasic and clinical researchon vascular disease.

John J. Ricotta, MDProfessor and Chairman

Barle H, Essen P, Nyberg B, Olivecrona H, Tally M,McNurlan MA, Wernerman J, Garlick PJ.Depression of liver protein synthesis duringsurgery is prevented by growth hormone. Am JPhysiol 1999;276:E620-27.

Bilfinger TV. Role of morphine in blood pressuremodulation: influence of nitric oxide. ActaPharmacol Sin 1999;20:458-9.

Cersosimo E, Garlick P, Ferretti J. Insulin regulation ofrenal glucose metabolism in humans. Am J Physiol1999;276(1 Pt 1):E78-84.

Cersosimo E, Garlick P, Ferretti J. Renal glucoseproduction during insulin-induced hypoglycemiain humans. Diabetes 1999;48:261-6.

Chuter TA, Faruqi RM, Reilly LM, Kerlan RK, SawhneyR, Canto C, Gordon RL, Wall SD, Messina LM.Large sheaths, Z-stents and polyester [abstract]. JEndovasc Surg 1999;6:81-2.

Chuter TA, Kerlan RK, Faruqi RM, Reilly LM, SawhneyR, Canto C, Gordon RL, Wall SD, Messina LM.Endovascular management of late complicationsfollowing endovascular aneurysm repair in high-risk patients [abstract]. J Endovasc Surg1999;6:80-1.

Dalsing MC, Ricotta JJ, Wakefield T, Lynch TG, OurielK. Animal models for the study of lower extremitychronic venous disease: lessons learned and futureneeds. Ann Vasc Surg 1998;12:487-94.

d’Audiffret A, Soloway P, Saadeh R, Carty C, Bush P,Ricotta JJ, Dryjski M. Endothelial dysfunctionfollowing thrombolysis in vitro. Eur J VascEndovasc Surg 1998;16:494-500.

Faruqi RM, Chuter TA, Reilly LM, Gordon RL, KerlanRK, Sawhney R, Wall SD, Canto C, Messina LM.Anatomic limitations to endovascular repair ofabdominal aortic aneurysm in a high-riskpopulation [abstract]. J Endovasc Surg 1999;6:87.

Faruqi RM, Chuter TA, Reilly LM, Gordon RL, KerlanRK, Sawhney R, Wall SD, Canto C, Messina LM. Isendovascular repair of abdominal aortic aneurysmjustified in high-risk patients? [abstract]. JEndovasc Surg 1999;6:86-7.

Fimiani C, Mattocks D, Cavani F, Salzet M, DeutschGG, Pryor S, Bilfinger TV, Stefano GB.Morphine and anandamide stimulate intracellularcalcium transients in human arterial endothelialcells: coupling to nitric oxide release. Cell Signal1999;11:189-93.

Some Recent Publications*

* The names of faculty authors appearin boldface.


University Vascular DiseaseCenter Offers a FullComplement of Services

The University Vascular DiseaseCenter at Stony Brook—established asa collaboration between the Divisionof Vascular Surgery and the Divisionof Interventional Radiology—providesdiagnosis and treatment of vasculardisease ranging from routine to highlycomplex cases, and offers a fullcomplement of services for patientswith vascular disease.

Clinical services include:oComplete, nationally accredited non-

invasive vascular laboratoryoMinimally invasive vascular therapies

using the latest treatment advances, in-cluding angioplasty, stent therapy, andstent graft repair

oState-of-the-art surgical treatment ofcarotid artery disease, aneurysms, andleg ischemia

oSclerotherapy, laser therapy, and sur-gery as indicated for varicose/spiderveins

oScreenings for vascular disease(carotid [neck] artery, for risk ofstroke; abdominal aorta, for presenceof aneurysms; lower extremity [leg],for risk of peripheral vascular disease)

VASCULARSURGERY TEAM

Our vascular surgeons are spe-cialists in the diagnosis and treatmentof vascular disease. Our vascular teamincludes the following five physicians,all of whom are members of our full-time surgical faculty, as well as nursepractitioner Susan W. Callahan, ANP,who works closely with them to helpfacilitate the most sophisticated, com-passionate care:John J. Ricotta, MDFabio Giron, MD, PhDRishad M. Faruqi, MDDavid B. Gitlitz, MDPaul S. van Bemmelen, MD, PhD

Based in the Department of Ra-diology, the four radiologists withwhom our vascular surgeons collabo-rate are:John A. Ferretti, MDMatthew D. Rifkin, MDJames V. Manzione, MDJeanne Choi, MD

CONSULTATIONS/APPOINTMENTS

Our physicians see patients atStony Brook, as well as at our officesin East Setauket and Hampton Bays.To make an appointment for a consul-tation, please call the appropriatephone number listed below:

oStony BrookUniversity Hospital and Medical Center(516) 444-2565

oEast SetauketStony Brook Surgical Care Center(516) 444-4545

oHampton BaysStony Brook Life Care Medical Center(516) 723-5000



INNOVATIONS IN THESURGICAL TREATMENT OFFACIAL PARALYSISReanimating the Paralyzed Face

Facial paralysis is a potentially devastatingdisorder. Few impairments have a more negativeeffect on the quality of an individual’s life. The pa-ralysis, which results from injury to the facialnerve, can lead to a variety of troubling symptoms,including ocular problems, speech difficulties,drooling, and nasal obstruction. Thus, this disordercan be quite debilitating for patients who suffer theemotional impact from the facial disfigurement aswell as difficulties with communication, eating,and drinking in a social setting.

At Stony Brook, Maisie L. Shindo, MD, associate professor of surgery (oto-laryngology-head and neck surgery) and director of head and neck oncology, isusing the latest microsurgical techniques in the treatment of facial paralysiswhich have the ability to reanimate the face and restore spontaneous facial mi-metic function.

A highly respected figure in her subspecialty, Dr. Shindo has gained na-tional recognition for her expertise in the treatment of facial paralysis, as well asthe art of microvascular free-flap reconstruction in the head and neck region. Inaddition, her specialties include the treatment of thyroid and parathyroid disor-ders, head and neck cancers, voice disorders, and paralyzed vocal cords.

THE FACIAL NERVEThe facial nerve has many functions, of which the most physically obvious

are the conveyance of emotion, eye closure, and assistance with speech andchewing. Nerve injury causing facial paralysis may result from tumor growth;trauma; surgical procedures involving the parotid gland, ear, and skull base; in-fection; and several other causes. The facial nerve is further susceptible to spasmfrom compression by nearby intracranial vessels or tumors. It has a tortuousbony course longer than any other nerve through the densest bone in the body,making surgery on it quite difficult.

Depending on the type of injury to the nerve, the resulting facial paralysismay be temporary or permanent. When the insult does not sever the facialnerve, functional recovery is generally expected, which may take anywherefrom weeks to months. Therefore, if the facial nerve injury is suspected to bedue to inflammation or contusion of the nerve, the patient is observed, and pro-tective care is given to the paralytic eye to prevent corneal abrasion.

If the nerve is suspected to be severed, for example, from a temporal bonefracture or following parotidectomy, the suspected site of injury should be ex-plored and the nerve repaired to provide the patient with the best chance for re-covery. The decision regarding whether or not to explore can be difficult insituations in which the nature and degree of the injury are unclear. Advances inelectrodiagnostic testing and radiographic imaging have provided greater in-sights into the pathophysiology and diagnosis of facial nerve injury, and aid inthe decision process.

Dr. Maisie L. Shindo

Table 1. Procedures for Rehabilitationof Prolonged Facial Paralysis

Dynamic ReanimationI. Interposition nerve graftsII. Crossover reinnervation procedures

HypoglossalAnsa hypoglossiCross-facial

III. Regional muscle transferTemporalisMassaterDigastric

IV. Microneurovascular free-flapGracilisLatissimus dorsiRectus abdominisSerratus anteriorPectoralis minorAbductor hallucisExtensor digitorum brevis

Static Reanimation andCosmetic ProceduresI. Eyelid procedures

GoldweightSpringLower lid tightening

II. Brow and forehead liftIII. Correction of midfacial deformity

SlingsFascia lataAlloplastic sheetsMalar augmentation

IV. FaceliftV. Lower lip wedge resectionVI. Botulinum toxin

TREATING FACIALPARALYSIS

Treatment of facial paralysis isaimed at restoring facial symmetry: 1) atrest, 2) during voluntary facial move-ments, such as smiling, and 3) during in-voluntary facial movements, such asspontaneous laughter or blinking. Of thethree, the last function is extremely im-portant because lack of it would be mostnoticeable, since human facial expres-sions are seen mostly as involuntary fa-cial movements during awake hours.

Numerous options are available forrehabilitation of prolonged facial paraly-sis (see Table 1). The majority of thesewill restore facial symmetry at rest andduring voluntary movements, but rarelyinvoluntary motion. Prolonged, chronicfacial paralysis is challenging to treatand rehabilitate, particularly if onewishes to restore spontaneous facial mi-metic function.

The rehabilitation procedures canbe categorically divided into dynamic andstatic reanimation procedures. Static pro-cedures are simple to perform, but they


Garlick PJ, McNurlan MA, Patlak CS. Adapta-tion of protein metabolism in relation to limitsto high dietary protein intake. Eur J Clin Nutr1999;53:S34-43.

Lynch TG, Dalsing MC, Ouriel K, Ricotta JJ,Wakefield TW. Developments in diagnosisand classification of venous disorders: non-invasive diagnosis. Cardiovasc Surg1999;7:160-78.

Maitra SR, Gestring ML, El-Maghrabi MR, LangCH, Henry MC. Endotoxin-induced alterationsin hepatic glucose-6-phosphatase activity andgene expression. Mol Cell Biochem1999;196:79-83.

Maitra SR, Homan CS, Beuhler MC, Thode HC Jr,Henry MC. Alterations in hepatic gluconeo-genesis, prostanoid and intracellular calciumduring sepsis. Acad Emerg Med 1999;6:588-95.

Malik AZ, Bilfinger TV, Vlay SC. Shear syndrome:the worst case scenario of crush syndrome.Pace 1999;22:819-20.

Manzione JV, Madajewicz S, Roque C, Roche P,Tfayli A, Shindo ML. Regional therapy ofhigh grade astrocytomas. Semin InterventRadiol 1998;15:365-71.

Moncure M, Brathwaite CE, Samaha E,Marburger R, Ross SE. Carboxyhemoglobinelevation in trauma victims. J Trauma1999;46:424-7.

Moncure M, Salem R, Moncure K, Testaiuti M,Marburger R, Ye X, Brathwaite C, Ross SE.Central nervous system metabolic andphysiologic effects of laparoscopy. Am Surg1999;65:168-72.

Ohki T, Veith FJ, Kraas C, Latz E, Gitlitz D,Quintos RT, Sanchez LA. Endovasculartherapy for upper extremity injury. SeminVasc Surg 1998;11:106-15.

Pankiewicz KW, Malinowski K, Jayaram HN,Lesniak-Watanabe K, Watanabe KA. Novelmycophenolic adenine bis(phosphonate)s aspotential immunosuppressants [1]. Curr MedChem 1999;6:629-34.

Ricotta JJ. Combined carotid and coronarysurgery: is it standard of care? CardiovascSurg 1998;6:446-7.

Ricotta JJ. Surgical management of carotidocclusive disease. In: Schein M, Wise L,editors. Crucial Controversies in Surgery.Philadelphia: Lippincott Williams & Wilkins,1999: 237-45.

Ricotta JJ, Hargadon T, O’Brien-Irr M. Costmanagement strategies for carotid endarter-ectomy. Am J Surg 1998;176:188-92.

Saltman AE, Dzik WH, Levitsky S. Immediate veingraft thrombectomy for acute occlusion aftercoronary artery bypass grafting. Ann ThoracSurg 1999;67:1775-6.

Saltman AE, Svensson LG. Chronic traumaticaortic pseudoaneurysm: resolution withobservation. Ann Thorac Surg 1999;67:240-1.

Smouha EE, Shapiro AW, Davis RP, Shindo ML,Sobol LL, Acker DE. Image-guided surgery ofthe skull base using a novel miniature positionsensor. Skull Base Surg 1999;9:101-7.

Recent Publications(Continued from Page 4)

Surgery for Facial Paralysis(Continued from Page 5)

Patient with left-sided facialparalysis present since birth,caused by traumatic delivery atbirth, before dynamicreanimation surgery (left)performed by Dr. Shindo andone year after surgery (right);note her ability to smile.

Patient with right-sided facialparalysis, due to nerve injuryfrom tumor growth, beforedynamic reanimation surgery(left) performed by Dr. Shindoand five months after surgery(right); note his ability to smile.

BEFO

RE

AFTE

R

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restore facial symmetry only at rest anddo not restore movement. These proce-dures include static slings, ocular pro-tective procedures, and adjunctivecosmetic procedures.

Dynamic procedures are aimed atrestoring symmetry at rest as well asduring facial expressions. Dynamic re-animation can be accomplished usingneurorrhaphy (nerve repair) proce-dures, or if the facial nerve is not avail-able for neurorrhaphy, by transferring amuscle flap to the face.

Improvements in microsurgicaltechnique and instrumentation haveyielded increasing success in restoring

represented by this disorder. Two basicdynamic reanimation options, as notedabove, are currently available: 1) recon-struction of nerve continuity throughdirect micro suture, with interpositiongrafts or nerve transpositions; and 2) re-gional muscular transposition, most of-ten using the temporalis.

Dr. Shindo has been using theseadvanced microsurgical approacheswith considerable success.

Facial reanimation with thetemporalis transfer has withstood thetest of time and still is a reference tech-nique. In a few weeks, good results canbe obtained with a single and rathersimple surgical procedure.

In the last two decades, functionalfree-flaps have been used with increas-

symmetric facial movement usingmicroneurovascular muscle transferfrom such muscles as the gracilis andlatissimus dorsi. These muscles aretypically grafted to the upper lip andoral commissure. Such transfers arebenefiting patients in terms of both re-turn of function and independent func-tion of the two sides of the face.

SURGICAL ADVANCESSeveral surgical procedures have

been proposed through the years forthe treatment of facial paralysis. Themultiplicity and diversity of techniquesportray the complexity and challenge

ing frequency, most often combininga cross-facial nerve graft followed bya gracilis free-flap nine months later.With this method there is a potential

for restoration of spontaneous facial mi-metic function.

At present, the functional resultsachieved with this technique are goodto excellent. Restoration of function,however, is at times limited by lack ofaxonal regeneration in the nerve(s).Current research is now actively study-ing and identifying nerve growth fac-tors and pharmacological agents thatmight have an important and comple-mentary role in the near future.

For consultations/appointments with Dr.Shindo, please call (516) 444-4121.


OBESITY SURGERY PROGRAMRE-ESTABLISHED

We are pleased to announcethe re-establishment of our bariatricsurgery program for the treatmentof morbid obesity. The new programis directed by Collin E.M. Brathwaite,MD, associate professor of surgeryand chief of trauma/surgical criticalcare. An active general surgeon, Dr.Brathwaite has considerable experi-ence in nutrition and currently chairsUniversity Hospital’s nutrition com-mittee.

John S. Brebbia, MD, assistantprofessor of surgery, is also involvedin the program. He has a strong inter-est in both nutrition and obesity sur-gery. In addition, Barbara A. Smith,RN, MS, a nurse practitioner in sur-gery, coordinates the program.

Morbid obesity is that statewhere body weight exceeds ideal bodyweight by 100 pounds or more. Obe-sity of this degree is truly morbid sinceindividuals with it face increased com-plications from their obesity or may beexpected to die earlier than predictedon the basis of life-expectancy tables.

Among the serious illnesses asso-ciated with obesity are diabetes, heartdisease, high blood pressure, stroke,gallbladder disease, and certain can-cers. Although they are not causedexclusively by being severely over-weight, they may be exacerbated byit, or they may be accelerated in theirdevelopment.

Recognizing that a multidis-ciplinary approach to the treatment ofobesity is necessary, a special supportgroup will supplement the surgicaltherapy. This group therapy providespatients with psychological support tohelp ensure successful outcomes.

To contribute to efforts to furtheradvance obesity surgery, the programis enrolled in the International BariatricSurgery Registry (formerly known asthe National Bariatric Surgery Regis-try). One of its goals is to enable sur-geons to evaluate and improve theirexpertise in obesity surgery, and ben-efit from the combined experience of allparticipants.

Although our new obesity sur-gery program was just initiated in the

summer, increasing num-bers of patients are nowseeking surgical therapy atUniversity Hospital forcritical weight manage-ment.

SURGERY FOROBESITY

Surgery has been atreatment option since theearly 1950s. Because surgi-cal intervention is so inva-

sive and, in a sense, radical, it is onlyindicated in selected patients. Obesityhas degrees, and the patients who arecandidates for surgery are those whoare classified as morbidly obese.

The most effective procedures forweight loss utilize the principle of gas-tric restriction. If the stomach pouch ismade smaller, this reduction will limitthe amount an individual can eat andweight loss will result. The operationsused include gastric banding, verticalbanded gastroplasty, and Roux-en-Ygastric bypass (popularly known just asgastric bypass).

Drs. Brathwaite and Brebbia per-form both vertical banded gastroplasty


and gastric bypass—the two operationsmost commonly used today for treatingobesity, both of which have been en-dorsed by medical experts assembled bythe National Institutes of Health. Theseexperts concluded that surgery for obe-sity, with its high rate of success, is anoption that should be considered afternonsurgical weight-control measureshave failed.

Vertical banded gastroplasty cre-ates a small upper pouch in the stomachand then uses a vertical band of syn-thetic material to restrict the opening be-tween this upper pouch and the lowerstomach. Food then leaves the stomachin the normal fashion after passing outof the upper pouch. Weight losses of50% to 60% of excess weight can be ex-pected after this surgery.

Gastric bypass also creates a smallupper pouch in the stomach (about 1-2ounces in size), but this pouch is com-pletely separated from the lower stom-ach by multiple rows of surgical staples.To allow drainage from the stomach,this small pouch is connected to thesmall intestine, a portion of which is by-passed.

The extra step of draining foodfrom the upper pouch directly into thesmall intestine gives this operation anextra mechanism for weight loss becausenot all of the foods are as effectively ab-sorbed (malabsorption). The weight losswith this procedure is considered suc-cessful when the mean excess weightlost is between 48% and 74%.

Both of these operations do requirethat patients change their eating habits.Because of the small size of the stomachpouches which are created surgically,large meals cannot be tolerated. Eatingtoo much may result in regurgitation orvomiting.

In this fashion, behavior modifica-tion is enforced upon the patient. Pa-tients are also advised to exercise to

The most effective procedures forweight loss utilize the principle ofgastric restriction. If the stomachpouch is made smaller, this reductionwill limit the amount an individualcan eat and weight loss will result.


Improving the TreatmentOf Colorectal CancerLiver Metastases

Colorectal cancer is the fourthmost diagnosed malignancy as well asthe second leading cause of death fromcancer in the United States. This yearalone, about 132,000 Americans will bediagnosed with colorectal cancer, and56,500 will die of the disease. Liver me-tastases occur in about 60% of patientswith colorectal cancer. Patients who un-dergo surgical removal of diseased liverhave only a 30% five-year survival.

Bettertherapy isclearly needed.To this end, M.MargaretKemeny, MD,professor ofsurgery (in-terim) andchief of surgi-cal oncology,has made asignificant

contribution with her current research.In May, Dr. Kemeny presented

the promising early results of her clini-cal trial of intra-arterial infusiontherapy for colorectal cancer liver me-tastases, at the annual meeting of theAmerican Society of Clinical Oncology(ASCO), in Atlanta, GA. Sponsored bythe Eastern Cooperative OncologyGroup and the Southwest OncologyGroup, this multi-center trial, of whichDr. Kemeny is the principal investiga-tor, is the largest clinical study to dateof hepatic arterial infusion therapy fol-lowing hepatic resection.

A total of 109 patients were ran-domized before surgery for liver me-tastases to receive surgery pluscontinuous hepatic arterial infusion offloxuridine combined with 5-FU bysystemic infusion (35 eligible patients)

or surgery alone (45 patients). At amedian follow-up of four years, three-year recurrence-free survival is 34% inthe surgery alone group versus 58% inthe combined adjuvant therapy group(p = .035).

Of those patients who had recur-rences, those in the no chemotherapygroup (surgery alone) were morelikely to have recurrence in the liverthan those in the chemotherapy group(73% versus 50%, respectively).

“Historic” study promises toadvance the care of patientswith colorectal cancer livermetastases.

Overall survival has not yetreached statistical significance, Dr.Kemeny says, but the trend favors theuse of surgery plus chemotherapy. “Westill haven’t reached median survivalfor the chemotherapy patients,” shenotes. “It is 63% at five years for thechemotherapy group versus 32% for thesurgery alone group.”

Dr. Kemeny and her colleaguesconclude that hepatic artery infusionand systemic therapy after resection canbe done safely with no increase in op-erative morbidity or mortality, and re-sults in a significant decrease in liverrecurrences, a significant increase infive-year disease-free survival, and atrend toward an improved five-yearoverall survival rate.

At the ASCO meeting, the resultsof this study were hailed as “historic”by Nicholas Petrelli, MD, of RoswellPark Cancer Institute in Buffalo, NY,who served as discussant of Dr.Kemeny’s presentation. He said the“big news” is that “surgery alone is notadequate therapy,” as shown in Dr.Kemeny’s “close to ideal” trial.

Dr. Petrelli emphasized that al-though Dr. Kemeny’s study requireslonger follow-up, the question now fac-ing physicians treating liver metastasesof colorectal cancer is no longerwhether to use chemotherapy, butrather “which chemotherapy to choose”for the best possible patient care.

Dr. M. Margaret Kemeny

COLORECTALCANCER SCREENING

Early Detection IsBest Chance for Cure

Colorectal cancer, a major killer,continues to take a high toll of lives.The cause of colorectal cancer is un-known. However, we do know thatmost colorectal cancers start as a smallbenign polyp and, if left untreated,progress to cancer.

In its early stage, colorectal canceris curable in most cases. In its laterstages, cure is much more unlikely. Un-fortunately, there are often no warningsigns or symptoms from colorectal can-cer until it has progressed to beyondthe curable stage. For this reason, mostpatients do not seek out treatment untilthe cancer has reached these laterstages.

In an effort to try to detectcolorectal cancer early, in its curablestage, the American Cancer Society hasmade recommendations regardingcolorectal cancer screening for indi-viduals. University Hospital and Medi-cal Center offers these screeningservices to the Long Island community.

By calling Stony Brook’s

Colorectal Cancer Screening

referral line—(516) 444-4393—

one can get answers to questions

about colorectal cancer and

screening.

Our gastrointestinal specialistsand gastrointestinal surgeons will pro-vide the proper screening and, if neces-sary, the proper treatment for colorectalcancer. A grant awarded to Stony Brookfrom the New York State Department ofHealth, Bureau of Chronic Disease Ser-vices, helps provide these services to un-insured and underinsured individuals.

Research Focus


Last year, ACoSOG receivedfunding from the National Cancer In-stitute (NCI) to conduct multi-centercooperative group trials. In cancer re-search, cooperative groups are net-works of medical centers around thecountry that conduct studies jointly.ACoSOG is the first new cooperativegroup sponsored by the NCI in 18years and the only one to focus onsurgery.

The American College of Sur-geons is a scientific and educationalorganization of surgeons that wasfounded in 1913 to raise the standardsof surgical practice and to improve thecare of the surgical patient. The Col-lege is dedicated to the ethical andcompetent practice of surgery; itsachievements have established it as animportant advocate for all surgical pa-tients.

The participation of our thoracicsurgeons in the ACoSOG trials—inaddition to that of our surgicaloncologists—will make a significantcontribution to Stony Brook’s CancerInstitute, now in the final stages of itsdevelopment to become a world-class,regional comprehensive cancer insti-tute for the very best in cancer care,research, and prevention.

For more information, please call(516) 444-1820.

SCREENING for colorectal cancermay include:

• Digital rectal exam: Examines the lastfew inches of the colon (rectum).

• Fecal occult blood test (FOBT): Teststhe stool for microscopic blood, whichmay be one of the earliest signs ofcolorectal cancer.

• Flexible sigmoidoscopy: Examines thelast 2 feet of the colon (rectum, sigmoidcolon, and descending colon) with aflexible lighted scope. Sixty percent ofall cancer occurs in this region.

• Colonoscopy: Examines the entire co-lon (rectum to cecum) with a flexiblelighted scope.

• Air contrast enema: Uses x-rays to ex-amine the colon (rectum to cecum).

NEW CLINICAL TRIALS INTHORACIC SURGERY FOR CANCERIn May, the Division of Cardiothoracic Surgery joined the recentlyestablished American College of Surgeons Oncology Group (ACoSOG)in order to participate in multi-center clinical trials of thoracic surgeryfor the treatment of lung cancer and other cancers in the chest. Oursurgeons’ participation will provide patients with the only availableaccess to these trials in Suffolk County.

The primary goal of theACoSOG is to conduct clinical tri-als evaluating surgical therapies inthe management of patients withmalignant solid tumors. Initiallystudied will be patients with themost common tumors, such as lungcancer, breast cancer, andcolorectal cancer. The trials willalso evaluate selected new opera-tions, technology, and instrumenta-tion as they are introduced intoclinical practice.

In addition, the ACoSOG willperform trials that are based onnew basic science discoveries, suchas the evaluation of new molecularmarkers in the diagnosis and treat-ment of patients with cancer andthe role of interventional therapy inpatients who are found to have agenetic predisposition for cancer.

At present, eligible patients may be en-rolled in the following four ACoSOG clini-cal trials designed to evaluate potentialtreatment advances for lung and esoph-ageal cancer:

• Randomized prospective trial of mediastinallymph node sampling versus complete lym-phadenectomy during the conduct of pul-monary resection in patients with N0 andN1 (less than hilar) non-small cell carci-noma

• A prospective multi-institutional study inresectable lung cancer of the prognosticsignificance and incidence of occult distantdisease

• A multi-center clinical trial to assess theutility of positron emission tomography(PET) in the staging of potentially operablenon-small lung carcinoma

• A multi-center clinical trial to assess theutility of positron emission tomography(PET) in the staging of potentially operableesophageal carcinoma

IF YOU:• Are over 50 years oldOR• Have seen blood in your stool• Have a family history of colorectal cancer or

colon polyps• Have a personal history of inflammatory

bowel disease, colon polyps, colorectal can-cer, breast cancer, or any female genital can-cer

• Have unexplained weight loss or fatigue• Have had a change in the caliber or consis-

tency of your stool• Have diarrhea or constipation• Have stomach discomfort, bloating, fullness,

cramps, or excessive gas

THEN YOUSHOULDCALL TODAY:(516) 444-4393


Our fully accredited five-year nonpyramidal residency program fulfills the standards for professional excel-lence adopted by the American Board of Surgery, and leads to Board eligibility. Our residents receive a broad-based surgical education, which includes not only the clinical but the biological aspects of surgery as well, andprovides the foundation for a successful career in private practice, research, or academic surgery. Five surgicalresidents are selected each year through the National Resident Matching Program.

Residency Update

1999 Graduating Chief ResidentsName Medical School (Grad. Year) Career DirectionIman Karimpour, MD George Washington U (’94) Cardiothoracic Surgery Fellowship at SUNY-BrooklynJames Lukan, MD SUNY-Stony Brook (’94) Trauma/Critical Care Fellowship at U of LouisvilleTong Ma, MD U of Pennsylvania (’94) Private Practice in MarylandDean Pappas, MD SUNY-Stony Brook (’94) Colorectal Surgery Fellowship at Orlando Regional Medical CenterSaad Shukri, MD U of Baghdad (’79) Private Practice on Long Island

New Chief ResidentsName Medical School (Grad. Year)Luis Angarita, MD Central U of Venezuela (’92)Jaroslaw Bilaniuk, MD SUNY-Stony Brook (’95)Daniel Char, MD SUNY-Stony Brook (’95)Hassan Reda, MD American U of Beirut (’95)Gustavo Torres, MD Francisco Marroquin U (’93)

Incoming Residents/All Categorical PGY-1*Name Medical School (Grad. Year)Victor Cruz, MD SUNY-Stony Brook (’99)Piotr Dumicz, MD SUNY-Stony Brook (’99)Vitaly Lyaskovsky, MD SUNY-Brooklyn (’99)Denise Ortega, MD Cornell U Medical College (’99)Jenny Speranza, MD SUNY-Buffalo (’99)

* As of July 1, 1999.

Dr. John Ricotta (left) with our 1999 graduating chief residents (from left to right),Drs. Dean Pappas, James Lukan, Iman Karimpour, Saad Shukri, and Tong Ma, atthe celebration banquet held on June 13.

Our graduatingotolaryngologyresident (left), Dr.Rajesh Kakani, withDr. Arnold Katz, chiefof otolaryngology-headand neck surgery.

Our graduating vascular surgery resident (second from left),Dr. Yara Gorski, with our vascular faculty (left to right),Drs. Fabio Giron, John Ricotta, and Paul van Bemmelen.


OUR ELECTRONICPHYSICIAN DIRECTORYThe Department provides a physician directory as part of its website on theInternet—please visit us at the following address to find information about ourindividual surgeons (see sample page below), as well as our programs in pa-tient care, education, research, and community service:

MD: SUNY-Downstate Medical Center (1981).Residency Training: General Surgery, Hospital of theUniversity of Pennsylvania.Fellowship Training: Pediatric Surgery, Kings CountyHospital/SUNY-Downstate Medical Center.Board Certification: Pediatric Surgery; Surgery; SurgicalCritical Care.Specialties: Surgical management of congenital and ac-quired anomalies/diseases of the neck, chest, abdomen,anorectum, and soft tissues in children (newborns toadolescents aged 17 years), including, but not limited to,repair of inguinal hernias, repair of undescended testes,treatment of appendicitis, and management of tumors of

the kidneys, adrenal glands, gastrointestinal tract, lymphatics, and soft tissues;surgical consultation in pediatric trauma.Additional: Fellow, American College of Surgeons (FACS); Fellow, AmericanAcademy of Pediatrics (FAAP).Honors: One of the “Doctors of Excellence” featured in the latest edition (1999)of the Castle Connolly guide, How to Find the Best Doctors—New York Metro Area.Languages Spoken: English; Polish.Consultations/Appointments: 516-444-4538.Email (to contact Dr. Kugaczewski directly): [email protected]

http://www.uhmc.sunysb.edu/surgery

Dr. Jane T. Kugaczewski

Alumni NewsSince the class of 1975entered the profession ofsurgery, 139 physicians havecompleted their residencytraining in general surgery atStony Brook. The alumni ofour residency program nowpractice surgery throughoutthe United States, as well asin numerous other countriesaround the world.

Dr. Richard V. Dowden (’76), aplastic surgeon, maintains three of-fices in different parts of Ohio—inMayfield, Independence, andWestlake. His practice focuses on cos-metic surgery of the face, particularlyendoscopic and laser procedures; andcosmetic and reconstructive breastsurgery, including endoscopic bodysculpting and liposuction. He is oneof a few plastic surgeons in theUnited States trained to performbreast augmentation through the na-vel (transumbilical breast augmenta-tion). The former head of the breastsurgery section of the plastic surgerydepartment at the Cleveland Clinic,he is the medical advisor for theAmerican Cancer Society Breast

Reconstruction Unit of the State of Ohio.He has been active in medical missionarywork since 1970, and currently leads ayearly charity surgery expedition for chil-dren with birth defects in South America.He recently published the following letter:• Dowden R. Brown pigmentation in the outer

lumen of breast implants. Plast Reconstr Surg1999;103:1093-4.

The new address of his website ishttp://dr-dowden.com.

Dr. Tom R. Karl (’81), director ofthe cardiac surgery department at theRoyal Children’s Hospital in Melbourne,Australia, was visiting professor at theChildren’s Hospital of Philadelphia inFebruary and March of this year. In June,he was visiting professor at the JapaneseSociety of Pediatric Surgery, NaganoChildren’s Hospital, and Jikei University,

(Continued on Page 14)enhance their weight loss. For somepatients this is a new experience sincetheir preceding obesity may havemade exercise impossible.

Dr. Brathwaite comments: “It isimportant to emphasize that surgeryis not for everybody. Patients shouldcome to the decision for surgery ontheir own and not be forced into it,since surgical therapy does require anumber of changes in their lifestyle tobe most effective. Support by thepatient’s family is crucial.”

“However,” he adds, “once pa-tients do undergo the surgery, theirfuture may be significantly changed,not only with respect to their healthbut also because of improved bodyimage and psychosocial well-being.”

Perhaps the most importantthings to recognize about obesity arethe enormity of the problem and itsassociated risks. Whatever method ofweight management is used is not asimportant as the pressing fact thatobesity needs to be controlled.

For more information about the obesitysurgery program, please call (516) 444-1045.

Obesity Surgery(Continued from Page 7)


Division BriefsCardiothoracic Surgery

Dr. Thomas V. Bilfinger, pro-moted in September to clinical profes-sor of surgery, was recognized as oneof the “Best Doctors in New York” incardiac surgery in the June 9th issue ofNew York magazine. He was againcited as one of the “Doctors of Excel-lence” in the latest edition (1999) of theCastle Connolly Guide, How to Find theBest Doctors—New York Metro Area.

As chief of the thoracic surgerysection, Dr. Bilfinger is pleased to an-nounce our participation in new clini-cal trials of treatment advances forlung and esophageal cancer (see page9). In recognition of his outstandingwork as a teacher, he received the“Teacher of the Year” award pre-sented by the 1999 graduating chiefresidents of our surgical residencyprogram.

In May, Dr. Bilfinger traveled toChina, where he gave a presentationtitled “The Role of Morphine in BloodPressure Modulation: The Influence ofNitric Oxide Release,” at the Interna-tional Symposium on Advances inNeuroimmunology sponsored by theChinese Academy of Sciences andheld in Shanghai. Then, in June, hetraveled to Denmark, where he partici-pated in the 25th Congress of the Scan-dinavian Society of Anesthesiologists,speaking on morphine, stress, and im-munity. There he also took part in aminisymposium on the cost benefit offast-track surgery, arguing against it.

Dr. Irvin B. Krukenkamp, pro-fessor of surgery and chief ofcardiothoracic surgery, has recentlyreceived two grants for basic sciencestudies of which he is co-principal in-vestigator. Funded by the AmericanHeart Association ($259,637), thestudy titled “Flow-Induced Throm-boembolism and the Effect of Implan-tation Techniques in Mechanical HeartValves” was initiated in January and

will be completed in December 2002.Funded by the National Science Foun-dation ($237,025), the study titled“Whole Field Deformation Measure-ments of the Heart with CASI” wasinitiated in June and will be completedin May 2002.

So far this year, Dr. Krukenkamphas presented his research findings atthe annual meeting of the Society ofThoracic Surgeons (“Nitric Oxide Gen-erating Adrenergic Blocker NipradilolPreserves Post-Ischemic Cardiac Func-tion”) and the annual meeting of theBiophysical Society (“A Novel Tech-nique for Measuring Epicardial Defor-mation with High Spatial Resolution”;“Is If the Only Pacemaker Current inMammalian Atrial Myocytes Resolu-tion”; “Low Concentrations ofDihydroouabain [DHO] Stimulate theNa/K Pump in Human, Canine andGuinea Pig Cardiac Myocytes Resolu-tion”).

Dr. Adam E. Saltman, assistantprofessor of surgery, received a Tar-geted Research Opportunity Award($30,000) from SUNY-Stony Brook tosupport his one-year basic sciencestudy titled “The Mechanism, Treat-ment, and Prevention of PostoperativeAtrial Fibrillation,” starting in July. Inaddition, he also received a StudentScholar in Cardiovascular MedicineAward ($2,000) from the AmericanHeart Association for mentoring medi-cal student Joby Chandy on this topicduring the course of this summer.

Otolaryngology-Head andNeck Surgery

Dr. Arnold E. Katz, professor ofsurgery and chief of otolaryngology-head and neck surgery, served inApril as guest examiner for the Ameri-can Board of Otolaryngology (as hedid last year). In July, he participatedas a guest faculty member in thehands-on course titled “Anatomy, Re-

construction, and Cosmetic Surgery”sponsored by Boston University’sSchool of Medicine; he contributed thesection on cheek repair, one of the areasof his expertise in facial reconstruction.He was again cited as one of the “Doc-tors of Excellence” in the latest edition(1999) of the Castle Connolly Guide,How to Find the Best Doctors—New YorkMetro Area.

Dr. Eric E. Smouha, associate pro-fessor of surgery, has been selected forinclusion in the forthcoming Wood-ward/White publication, The Best Doc-tors in America. He was again cited asone of the “Doctors of Excellence” inthe latest edition (1999) of the CastleConnolly Guide, How to Find the BestDoctors—New York Metro Area.

In April, Dr. Smouha presentedhis study titled “Hearing Preservationafter Partial Labyrinthectomy” at theFourth International Symposium onMeniere’s Disease, in Paris, France. Heis currently collaborating with DukeUniversity colleagues in a multi-centerclinical study of the effect of antiviraldrugs on sudden sensorineural hear-ing loss.

A specialist in the management ofacoustic neuroma, Dr. Smouha partici-pated in a regional conference onacoustic neuroma, sponsored by theAcoustic Neuroma Association of NewYork, which was held in August atHofstra University in Hempstead, NY.

Pediatric SurgeryDr. Jane T. Kugaczewski, assis-

tant professor of surgery, will give apresentation titled “SpontaneousRegression of a Neuroblastoma toGanglioneuroma: A Relief for the On-cologist, A Challenge to the Surgeon,”at the 68th Annual Scientific Meetingof the Southeastern Surgical Congress,to be held in Lake Buena Vista, FL, inFebruary 2000. Her paper, co-authoredwith Hassan Reda, MD, clinical assis-


tant instructor of surgery, and SusanE. Olsen, CPNP, clinical assistant in-structor of surgery, will be publishedin the American Surgeon.

Dr. Kugaczewski was cited asone of the “Doctors of Excellence” inthe latest edition (1999) of the CastleConnolly Guide, How to Find the BestDoctors—New York Metro Area.

Dr. Cedric J. Priebe, Jr., profes-sor of clinical surgery and chief of pe-diatric surgery, was again cited as oneof the “Doctors of Excellence” in thelatest edition (1999) of the CastleConnolly Guide, How to Find the BestDoctors—New York Metro Area.

Plastic andReconstructive Surgery

Dr. Steven M. Katz, assistantprofessor of surgery, has joined themultidisciplinary wound care team ofthe Stony Brook Leg and Foot UlcerTreatment Group, for which he isdoing evaluation and surgical man-agement of chronic wounds; the surgi-cal management of these wounds afterdebridement includes skin graftingand soft-tissue flap coverage.

In addition, Dr. Katz is now pro-viding laser treatment of skin lesions(eg, small leg veins/telangiectasias;cherry angiomas; hemangiomas; facialspider veins), using the Department’sstate-of-the-art Laserscope system,which minimizes the undesirable sideeffects (eg, bruising, scarring) associ-ated with use of other lasers.

Further expanding his practice,he is now accepting patients with in-juries of the hand, for which he hasexpertise in the microsurgical repairof bony, soft tissue, and nerve injuries.

Surgical OncologyDr. M. Margaret Kemeny, pro-

fessor of surgery (interim) and chief ofsurgical oncology, traveled in June toSwitzerland to participate as a distin-

guished faculty member in the five-day workshop, “Methods in ClinicalCancer Research,” sponsored jointlyby the Federation of European CancerSocieties, American Association forCancer Research, and American Soci-ety of Clinical Oncology.

In October, Dr. Kemeny will bean invited speaker at the Sixth AnnualInternational Conference on Gas-trointestinal Cancer, to be held inWilliamsburg, VA. Her presentationwill focus on trials of intra-arterialtherapies (see Research Focus, page8). Dr. Kemeny was again cited as oneof the “Doctors of Excellence” in thelatest edition (1999) of the CastleConnolly Guide, How to Find the BestDoctors—New York Metro Area.

Dr. Brian J. O’Hea, assistant pro-fessor of surgery and medical directorof the Carol M. Baldwin Breast CareCenter, was cited as one of the “Doc-tors of Excellence” in the latest edition(1999) of the Castle Connolly Guide,How to Find the Best Doctors—New YorkMetro Area.

TransplantationDr. Kazimierz Malinowski, re-

search associate professor of surgeryand director of the Histocompatibilityand Immunogenetics Laboratory, ispleased is announce that, as of August15, our fully operational polymerasechain reaction(PCR)-based DNA typ-ing laboratory will exclusively useDNA methods for typing human leu-kocyte antigen (HLA) class II antigens.These methods are based on new stan-dards adopted in March 1998 by theAmerican Society for Histocompatibil-ity and Immunogenetics.

Our Histocompatibility and Im-munogenetics Laboratory is now inthe process of establishing a programdesigned to provide nucleotide se-quence-based typing of HLA allelesfor solid organ, bone marrow, andstem cell transplantation. Accredita-

tion of this new program will be soughtfrom the New York State Department ofHealth, American Society for Histocom-patibility and Immunogenetics, Collegeof American Pathologists, United Net-work for Organ Sharing, and NationalMarrow Donor Program.

Dr. Felix T. Rapaport, SUNY dis-tinguished professor (surgery/trans-plantation), received a high honor inMarch when he was promoted to therank of commander in France’s Order ofthe Legion of Honor by special decreeof French President Jacques Chirac. Thepremier French order and decoration,this international honor was bestowedupon Dr. Rapaport for his continued ef-forts to further the trans-Atlantic coop-eration of French and Americanscientists, together with his careerachievements in transplantation whichhave contributed to the renown ofFrance. He was originally inducted intothe Legion of Honor in 1990.

Trauma/Surgical Critical CareDr. Robert D. Barraco, assistant

professor of surgery, joined our facultyin July, coming to Stony Brook from theUniversity of Maryland Medical Cen-ter/R. Adams Cowley Shock TraumaCenter in Baltimore. He received his MDin 1989 from the University of Medicineand Dentistry of New Jersey-RobertWood Johnson Medical School.

After two years of active duty withthe US Public Health Service (during

which time hewas a staff medi-cal officer, clini-cal director ofhealth services atthe federalprison inOtisville, NY,and also recipi-ent of a Hazard-ous Duty Awardand Unit



Commendation), Dr. Barraco com-pleted his residency training in gen-eral surgery at the MorristownMemorial Hospital in Morristown, NJ,in 1997, and then his one-year fellow-ship training in trauma/surgical criti-cal care at the R. Adams Cowley ShockTrauma Center.

During the past academic year,Dr. Barraco was clinical instructor intrauma/surgical critical care at the R.Adams Cowley Shock Trauma Center.In addition, in May 1999 he received amaster’s degree in public health, withcertificate in injury studies, from theJohns Hopkins School of PublicHealth.

Dr. Barraco’s clinical practice atStony Brook will focus on the surgicalmanagement of injured patients, in-cluding all aspects of traumatology,and the pre- and post-operative criti-cal care of adult surgical patients.

A practicing general surgeon, hewill also contribute to our general/gastrointestinal surgery service. Hehas a special interest in the surgicalcare of the elderly.

Dr. Barraco’s current research in-terests include the natural history ofdeep venous thrombosis in extremitytrauma, the application of noninvasivemodalities of cardiac output measure-ment, and the use of nonoperativemanagement in multiple solid organinjuries.

Dr. Subir R. Maitra, research as-sociate professor of surgery and emer-gency medicine, recently received agrant ($626,763) from the National Insti-tute of General Medical Sciences to sup-port a three-year basic science studytitled “Glu-6-Pase and 6PF2K/FBPaseGene Regulation in Sepsis,” starting inJuly. He is the principal investigator ofthis study, as well as a related three-year study to be completed in Decem-ber of this year, titled “HemorrhagicShock Effect on Glu-6-Pase Gene Ex-pression” (also funded by the NationalInstitute of General Medical Sciences).

At the 86th Indian Science Con-gress, held in India last January, Dr.Maitra was awarded the silver medaland certificate for the invited lecturehe presented there: “Hormonal Regu-lation of Glucose-6-Phosphatase GeneExpression Following Shock andTrauma.”

Dr. J. Martin Perez, assistantprofessor of surgery, joined our fac-ulty in August, coming to Stony Brookfrom the University of Miami/JacksonMemorial Hospital and the RyderTrauma Center in Miami. He receivedhis MD from Harvard Medical Schoolin 1992. During the period of hismedical studies at Harvard, he alsospent time as a research fellow inHarvard’s Department of Microbiol-ogy and Molecular Genetics and atMerck, Sharp, and Dohme, in WestPoint, PA.

Dr. Perez completed his resi-dency training in general surgery atthe New York Hospital-Cornell Medi-cal Center in New York in 1997; he

was a specialrotating resi-dent in surgicaloncology atMemorialSloan-Kettering Can-cer Center.Subsequently,in 1999, hecompleted histwo-year fel-lowship train-

ing in trauma/surgical critical care atJackson Memorial.

Dr. Perez’s clinical practice atStony Brook will focus on the surgicalmanagement of injured patients, in-cluding all aspects of traumatology,and the pre- and post-operative criti-cal care of adult surgical patients. Hehas a special interest in trauma care ofthe elderly.

in Tokyo. This September he was avisiting professor (Spinoza Lecturer)at the University of Amsterdam, andthis October he will be the RastelliLecturer of the Italian Cardiac Society,in Bergamo, Italy. Among Dr. Karl’snumerous recent publications are:• Karl TR. Short-term circulatory support in

children. J Thorac Cardiovasc Surg 1999.• Karl TR, Cochrane AD, Brizard CP, Buxton B,

Kitamura S, Frazier OH. Coronary anomalies inchildren. In: Buxton B, Frazier OH, Westaby S,editors. Ischemic Heart Disease: SurgicalManagement. London: Mosby, 1999: 261-87.

• Karl TR, Stellin G. Early Italian contributionsto cavopulmonary shunt surgery. Ann ThoracSurg 1999;67:1175.

• Fulton JO, Mas C, Brizard CP, Cochrane AD,Karl TR. Does left ventricular outflow tractobstruction influence outcome of interruptedaortic arch repair? Ann Thorac Surg1999;67:177-81.

• Sohn YS, Brizard CP, Cochrane AD, WilkinsonJL, Mas C, Karl TR. Arterial switch in heartswith left ventricular outflow and pulmonaryvalve abnormalities. Ann Thorac Surg1998;66:842-8.

For more information about Dr.Karl’s department, visit its homepageat http://ourworld.compuserve.com/homepages/hrt/.

Dr. Mark E. Mausner (’84) is aplastic surgeon currently practicing inChevy Chase, MD. He is one of thefounding members of Premier PlasticSurgeons, a large private group. In ad-dition, he is a clinical instructor onstaff at Georgetown University Hospi-tal. He recently served as president ofthe National Capital Society of PlasticSurgeons. Dr. Mausner founded a na-tional wound care consulting firmcalled BioCare, which trains and certi-fies nurses, enterostomal therapists,physical therapists, and primary carephysicians in wound care and sharpdebridement skills; since 1992 he hasserved as its CEO. Last year, Dr.Mausner developed a multispecialtyambulatory surgery center—the Sur-gery Center of Chevy Chase—whichhas four operating rooms. This center,of which he currently serves as presi-dent, provides orthopedic, generalsurgical, ENT, gynecological, urologi-cal, podiatric, and plastic surgery careto both adults and children.

Alumni News(Continued from Page 11)


Division Briefs(Continued from Page 13)


Board-certified in general sur-gery, Dr. Perez will also contribute toour general/gastrointestinal surgeryservice. He has expertise in the surgi-cal management of alimentary tract,soft tissue, and breast disease; herniarepair; and minimally invasive diag-nostic and therapeutic laparoscopy.

Dr. Perez’s current research in-terests include shock (basic science)and, with regard to clinical studies,trauma in the elderly, pulmonary con-tusions, and infectious disease in thesetting of surgical critical care.

Vascular SurgeryDr. Fabio Giron, professor of

surgery and chief of vascular surgery,was again cited as one of the “Doctorsof Excellence” in the latest edition(1999) of the Castle Connolly Guide,How to Find the Best Doctors—New YorkMetro Area.

Dr. John J. Ricotta, professorand chairman of surgery, in Marchwas elected vice president of the Soci-ety for Clinical Vascular Surgery,which is a leading national organiza-tion of about 1,000 academic and com-munity vascular surgeons. He has alsobeen elected to serve as president ofthe Eastern Vascular Society, and se-

Division Briefs(Continued from Page 14)

lected for membership in the Ameri-can Surgical Association, the premiersurgical society in America.

In May, Dr. Ricotta served as aboard examiner for the AmericanBoard of Surgery’s vascular surgerycertifying examination, and also wasthe Seventh Annual Dale Lecturer ofthe Department of Surgery atVanderbilt University, where he deliv-ered a presentation titled “Manage-ment of Combined Carotid andCoronary Disease: A Paradigm forClinical Research.”

Dr. Ricotta was recognized asone of the “Best Doctors in NewYork” in the June 9th issue of NewYork magazine. He was also cited asone of the “Doctors of Excellence” inthe latest edition (1999) of the CastleConnolly Guide, How to Find the BestDoctors—New York Metro Area.

Recently, Dr. Ricotta received athree-year grant ($1,050,000) from theNational Institutes of Health to con-duct a multi-center study on the tim-ing of carotid endarterectomy inpatients having coronary bypass sur-gery. He is the principal investigatorof this study, which involves fivemedical centers from around the coun-try led by Stony Brook.

Dr. Kara H.V. Kvilekval (’88)and Dr. Michael J. Petersen (’92), bothformer members of our Division ofVascular Surgery, have gone into pri-vate practice together in Stony Brook.

Dr. John J. Doski (’93) has com-pleted his pediatric surgery fellowshipat the University of Texas Southwest-ern Medical Center in Dallas, and isnow in practice in San Antonio withDr. Frank M. Robertson, with whomhe formed San Antonio Pediatric Sur-gery Associates ([210] 615-8757). Dr.Doski remains active in the PediatricOncology Group (POG), a NationalCancer Institute-sponsored clinical tri-als cooperative group of individualsand institutions dedicated to control-ling cancer among children and ado-lescents (it is one of only twocooperative groups research groups inthe United States dedicated to thetreatment of childhood cancers). Re-cent presentations of his are “Manage-ment of Empyema in Infants andChildren,” presented at the meeting ofthe North Texas Chapter of the Ameri-can College of Surgeons, in Februaryin Dallas, and also at the annual meet-ing of the American Pediatric SurgeryAssociation, in May in Palm Springs,CA (this paper was honored as the“best overall paper” presented at themeeting in Dallas, and will be pub-lished early next year in the Journal ofPediatric Surgery); and “Updates ofHepatoblastoma, Neuroblastoma,Wilms’ Tumor, and Rhabdomyosar-coma Protocols on the PediatricOncology Group Website,” anonline demonstration of protocolshe reviewed and edited, whichare posted on POG’s website(http://www.pog.ufl.edu/).

Dr. Alex F. Argotte (’97) is in pri-vate practice in Crystal River, FL, spe-cializing in general, vascular, andthoracic surgery. A personal note: Dr.Argotte says that he and his wife, Mel-issa, have “two lovely daughters.”

Dr. Dean P. Pappas (’99) hasstarted his one-year clinical fellowshipin colorectal surgery at the Colon and

Rectal Clinic in Orlando, FL. The fel-lowship program is based at OrlandoRegional Healthcare System (ORHS),a community-based teaching hospitalaffiliated with the University ofFlorida College of Medicine inGainesville. His primary experiencewill be gained in the acute care inpa-tient setting of Orlando RegionalMedical Center, the flagship hospitalof the ORHS, a 517-bed facility locatedon the downtown campus. Oncompletion of this fellowship, he willqualify for the board examinations ofthe American Board of Colon and Rec-

tal Surgeons. His special interests are an-orectal physiology and laparoscopic tech-niques in colon and rectal surgery.

Dr. Saad A. Shukri (’99) is now prac-ticing general surgery as a member ofCaremax Surgical in East Patchogue, NY.

For current mailing addresses of our alumni, pleasesee the Department’s Alumni Directory on theInternet at http://www.uhmc.sunysb.edu/surgery/alum-dir.html.

To submit alumni news online, please go tohttp://blackwidow.informatics.sunysb.edu/surgery/alumsubmit.cfm.


STONY BROOK SURGICAL ASSOCIATES, PC

In this issue . . .

For consultations/appointments with our physicians, please call• (516) 444-4550 for our specialists in breast care• (516) 444-1820 for our specialists in cardiothoracic surgery• (516) 444-4545 for our specialists in general/gastrointestinal surgery• (516) 444-4121 for our specialists in otolaryngology-head and neck surgery (ENT)• (516) 444-4538 for our specialists in pediatric surgery• (516) 444-4545 for our specialists in plastic and reconstructive surgery• (516) 444-4545 for our specialists in surgical oncology• (516) 444-2209 for our specialists in transplantation• (516) 444-1045 for our specialists in trauma/surgical critical care• (516) 444-2565 for our specialists in vascular surgery• (516) 723-5000 for our specialists at the Life Care Center in Hampton Bays:

breast care - general/gastrointestinal surgery - pediatric surgery - vascular surgery

The State University of New York at Stony Brook is anequal opportunity/affirmative action educator and employer.This publication can be made available in alternative format.

________________________________________________________________________________________________________________

DEPARTMENT OF SURGERY

SCHOOL OF MEDICINE

STATE UNIVERSITY OF NEW YORK

AT STONY BROOK

Stony Brook, New York 11794-8191

BREAST CAREJohn S. Brebbia, MDMartyn W. Burk, MD, PhDM. Margaret Kemeny, MDLouis T. Merriam, MDBrian J. O’Hea, MDVimala S. Sivaraman, MD

BURN CARECollin E.M. Brathwaite, MDJohn S. Brebbia, MDHarry S. Soroff, MD

CARDIOTHORACICSURGERYThomas V. Bilfinger, MD, ScDIrvin B. Krukenkamp, MDAllison J. McLarty, MDAdam E. Saltman, MD, PhDFrank C. Seifert, MD

GENERAL/GASTROINTESTINALSURGERYRobert D. Barraco, MDCollin E.M. Brathwaite, MDJohn S. Brebbia, MDMartyn W. Burk, MD, PhDLouis T. Merriam, MDJ. Martin Perez, MDVimala S. Sivaraman, MDThomas R. Smith, MD

OTOLARYNGOLOGY-HEADAND NECK SURGERY (ENT)Arnold E. Katz, MDDenise C. Monte, MDGhassan J. Samara, MDMaisie L. Shindo, MDEric E. Smouha, MD

PEDIATRIC SURGERYJane T. Kugaczewski, MDCedric J. Priebe, Jr., MD

PLASTIC ANDRECONSTRUCTIVESURGERYSteven M. Katz, MDSteven L. Shoen, MD

SURGICAL ONCOLOGYMartyn W. Burk, MD, PhDM. Margaret Kemeny, MDLouis T. Merriam, MDBrian J. O’Hea, MDVimala S. Sivaraman, MD

TRANSPLANTATIONFelix T. Rapaport, MDJohn J. Ricotta, MDWayne C. Waltzer, MD

TRAUMA/SURGICALCRITICAL CARERobert D. Barraco, MDCollin E.M. Brathwaite, MDJohn S. Brebbia, MDJ. Martin Perez, MDThomas R. Smith, MD

VASCULAR SURGERYRishad M. Faruqi, MDFabio Giron, MD, PhDDavid B. Gitlitz, MDJohn J. Ricotta, MDPaul S. van Bemmelen, MD, PhD

■ Performing Endovascular Surgery■ Innovations in the Surgical

Treatment of Facial Paralysis■ New Program in Obesity Surgery■ Research to Improve Therapy for

Colorectal Cancer Liver Metastases■ New Clinical Trials for Thoracic

Cancer Surgery■ Electronic Physician Directory■ Residency Update/Alumni News■ Division Briefs—And More!

Documents

FALL 1999 POSTOp - Stony Brook School of Medicine · Peter J. Garlick, PhD Fabio Giron, MD, PhD Arnold E. Katz, MD M. Margaret Kemeny, MD Irvin B. Krukenkamp, MD Cedric J. Priebe,