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DEPARTMENT OF SURGERY ANNUAL REPORT 2008

MISSION

We advance health through research,education, clinical practice and community partnerships, providing each person the best care, in the right place, at theright time, every time.

VISION

Achieve the healthiest population possible,leading the transformation of health care in our region and setting the standard for our nation.

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TABLE OF CONTENTS

Chair’s Letter

Department of Surgery Sections

Cardiothoracic Surgery

General Surgery

Neurosurgery

Ophthalmology

Otolaryngology and Audiology

Pediatric Surgery

Plastic Surgery

Transplantation Surgery

Urology

Vascular Surgery

Maxillofacial Surgery

Surgical Research Laboratory

Program Highlights

Surgical Robotics Program 2008

Comprehensive Breast Program

Colo-Rectal Program

Minimally Invasive General Thoracic Surgical Program

Office of Surgical Education

Training Program in General Surgery

Resident Training Programs

Medical Student Education Programs

Sponsored Research

Clinical Trials

Federal & Corporate Sponsored Projects

Awards

Publications

ADMINISTRATION

Richard Dow, MD, FACSChair

Daniel Walsh, MDVice Chair

Samuel Finlayson, MDResidency Program DirectorVice Chair for Academic Affairs& Faculty Development

Kerry RyanDirector

Linda BarieAdministrative Manager

Peter BeaulieuProgram Assistant

Audrey CarrFinancial Manager

Christina ColeSurgery Clerkship ProgramCoordinator

John HigginsDatabase Manager

Donald Likosky, PhDDepartmental Epidemiologist

Dawn RobinsonResidency ProgramAdministrator

Laura StancsAssistant to the Chair

SURGICALRESEARCH LAB

P Jack Hoopes, DVM, PhDAssociate Professor of Surgery and Medicine

Kathleen Martin, PhDResearch Assistant Professor ofSurgery and Pharmacology &Toxicology

Mary Jo Mulligan-Kehoe, PhDResearch Associate Professor of Surgery

Brian Pogue, PhDAdjunct Associate Professor of Surgery

Mark Savellano, PhDResearch Assistant Professor of Surgery

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6

8

10

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14

16

18

20

22

24

25

26

27

28

29

30

32

33

34

35

36

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Earlier this year, I informed the Dean and the Presidents of my intention to retire. Accordingly, a search process wasinitiated and a distinguished pool of applicants was developedand vetted by the Search Committee. A series of visits andinterviews followed as a “short list” was compiled by theCommittee and forwarded to the Dean and the Presidentsfor their consideration. As this Annual Report goes to press,discussions and further interviews are underway but have notbeen completed _ so I can not announce or welcome thenew leader for the Department.

But, as the time for my retirement has fully arrived, I askedthe Dean and the Presidents to identify a current member ofthe Department’s faculty to serve in an “acting” role as thesearch continues. Larry Dacey, MD, a cardiac surgeon,current member of the Board of Trustees and Board ofGovernors, and long time member and supporter of theDepartment, has agreed to fill that role.

Over the last year, the prospect of retirement has promptedme to reflect on the progress of the Department over thepast decade. Again this year, the annual report reflects thecommon threads of growth and development which havecharacterized these last ten years.

Within the Department’s eleven sections, the maturation ofsubspecialty clinical programs has continued as a consistenttheme. The Minimally Invasive Surgery Program, the SolidOrgan Transplantation Program, the Face of a Child Programin functional and cosmetic reconstruction of craniofacialdefects in children, the Cochlear Implant Program, theComprehensive Breast Program, the Bariatric SurgeryProgram, the Thoracic Oncology Program, the TraumaProgram, the Prostate Program, and the Aortic Center areexamples _ among many others _ of this kind of ongoingsubspecialty programmatic development. Some of these

programs and each of the Department’s sections are furtherhighlighted among the following pages of this report. Eachof these programs and their sponsoring sections support theclinical mission of the Institution in providing effective,efficient, compassionate, and safe care for each of ourpatients. Similarly, the educational mission of the Departmenthas also continued to mature with growth in both the sizeand the number of ACGME approved training programs andsubspecialty fellowship opportunities. Along with our “traditional” fellowship in Vascular Surgery, we have nowintegrated a “primary certificate” program as an option fortrainees seeking certification in Vascular Surgery. This year, anew program in Otolaryngology accepted its first residents.Our programs in General Surgery, Vascular Surgery, PlasticSurgery, and Urology have all grown over the decade, andwe continue to offer a fellowship in Minimally InvasiveSurgery. Six of our seven ACGME training programs arefully approved and accredited while the new program inOtolaryngology enjoys the typical “conditional” approval ofa new program.

The Department’s commitment to its educational mission is exemplified again this year by the participation of our faculty in many CME offerings _ locally, nationally, andinternationally. The faculty continues to fully contribute toundergraduate medical education by training students fromour own Dartmouth Medical School and by offering a widevariety of externships and “sub-I’s” to students from otherschools. Dartmouth medical students have recognized and appreciated the Department’s contributions to theireducational experience by selecting faculty and residentsfrom the Department for individual “teaching awards.” Overthe past decade, one of our surgical residents has been selected(in 9 of the 10 years) as the recipient of the “Thomas A.Almay Award” _ a teaching award for residents within theMedical Center.

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MESSAGE FROM THE CHAIR

In research, our faculty has increased our understanding of the mechanisms of health and disease through investigations inthe basic sciences. They have improved the effectiveness ofcare, which we provide in the clinical environment, throughstudies of the processes of care and outcomes. We’ve continuedto disseminate this new knowledge through publications inpeer-reviewed media as illustrated in the publication sectionof this report.

I have vicariously enjoyed the accomplishments and successesof the Department’s sections and individual faculty over thepast years, and I am pleased to be ending my tenure on a positive note with a robust, enthusiastic, and growing facultyand presence for the Department within our Organization.

It has been an honor for me to serve our Organization.But, of course, I have left many things undone, so there ismuch still to do. I am confident that future leaders of theDepartment will further advance Dartmouth-Hitchcock’s mission and vision in all areas.

Richard W. Dow, MD, FACSChair, Department of Surgery

3DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 2008

DEPARTMENT STATISTICS 2008

Department of Surgery Total Gross Professional Revenue

FY03 FY04 FY05 FY06 FY07 FY08

$200M

$150M

$100M

$50M

Department of Surgery Total Cases


16K

12K

8K

4K

Section

Audiology

CT Surgery

General Surgery

Maxillofacial

Neurosurgery

Ophthalmology

Otolaryngology

Pediatric Surgery

Plastic Surgery

Transplantation

Urology

Vascular

Surgical Res. Lab

Dept. of Surgery

Total

Faculty

6

20

1

5

9

8

8

7

4

7

12

1

1

89

Associate

Providers

8

7

3

2

3

10

2

1

1

2

1

32

Residents

34

7

2

3

7

5

58

Research

Projects

1

3

1

1

2

2

3

4

4

21

Clinical Trials

4

5

1

3

5

4

28

50

Publications

3

19

1

32

1

6

16

5

4

4

28

7

7

134

Outpatient

Appointments

7,595

2,587

10,669

1,522

4,946

28,934

14,792

4,562

8,508

2,259

11,312

6,394

111,121

OR Cases

793

2,901

174

840

844

1,452

1,114

1,257

316

908

1,002

11,556

CARDIOTHORACIC SURGERY

The Division of Cardiac SurgeryThe Division of Cardiac Surgery, underthe leadership of Lawrence Dacey, MD,will see some significant personnelchanges this year. In November, JohnSanders, MD will retire from active surgical practice after 32 years of practice.Dr. Sanders completed his surgical residency at Peter Bent Brigham Hospitaland joined the staff at NorthwesternHospital in Chicago in 1976. There herose to the rank of Professor of Surgerybefore relocating to DHMC in 1995.Since joining our ranks, Dr. Sanders hasbecome the “surgeon’s surgeon,” gracingthe operating room with his good cheer,robust laugh, and excellent judgment andtechnical skills. Replacing Dr. Sanderswill be Joseph DeSimone, MD.Dr. DeSimone actually joined the Divisionone year ago after completing his generalsurgical training at DHMC prior tocompleting his cardiothoracic training at John’s Hopkins Hospital. His past year was spent between the cardiac surgical operating room and the cardiaccatheterization laboratory where hefunctioned as an advanced fellow incatheter-based interventions with theSection of Cardiology. In addition tothese unique skills, Dr. DeSimone willcontinue to lead our heart failure andLeft Ventricular Assist Device (LVAD)program.

The Aortic Center at Dartmouth continuesto thrive under the directorship of AnthonyDiscipio, MD. This multidisciplinary initiative offers patients with complexdiseases of the thoracic and abdominalaorta many of the most sophisticatedsurgical interventions performed today.Patients with life-threatening aortic diseases can now be evaluated and electively treated by the most advanceddiagnostic and therapeutic modalitiesavailable and by a team of professionalsdedicated to understanding and treatingthese conditions.

The Division of General Thoracic SurgeryThe Division of General ThoracicSurgery, under the leadership of DavidJohnstone, MD, will also see significantpersonnel changes this year. CherieErkmen, MD joined the Division inOctober after completing her generalsurgical training at Stanford University in San Francisco and her thoracic surgical training at Brigham and Woman’sHospital in Boston. Dr. Erkmen bringswith her a laboratory, with researchinterests aimed at defining lymph nodedrainage patterns within the thorax,and clinical skills in minimally invasivethoracic surgery. With the addition of Dr. Erkmen, the Division will offer amore complete video assisted thoracicsurgery (VATS) program that willinclude, when appropriate,VATS lobectomy and VATS esophagectomy.

The General Thoracic Division continuesto be an integral part of Dartmouth-Hitchcock Medical Center’s and NorrisCotton Cancer Center’s ComprehensiveThoracic Oncology Program. This multidisciplinary initiative offers allpatients with malignant diseases of thechest direct “one-stop” access to a multi-disciplinary team of experts dedicated tobetter understanding and treating thesedevastating conditions. This programmeets weekly and combines a clinicalconference, where individual patients’conditions are discussed and treatmentplans generated, with a clinic that placesclinicians from medical oncology, surgicaloncology, pulmonary, diagnostic andinterventional radiology, and pathologyin one place. This has offered bothpatients and clinicians the opportunityfor “real-time” collaboration and consultation.

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William C. Nugent, Jr., MDSection Chief

Professor of Surgery

Introduction The Section of CardiothoracicSurgery now consists of theDivisions of General ThoracicSurgery and Cardiac Surgery.This allows Dartmouth-Hitchcock Medical Center tooffer a full range of focused andinnovative surgical options to allpatients with surgical diseases ofthe thorax. With this increasedspecialization of the CT Surgicalfaculty, the hospital has witnessedan increasingly complex caseloadwith excellent outcomes whilethe Section continues to lead theInstitution in inpatient, outpatient,and referring physician satisfaction.Our continued involvement withthe General Surgical Training Program and Dartmouth MedicalSchool allows medical studentsand surgical residents to experiencesupervised training in a busy outpatient clinic, inpatient consultand critical care service, andoperating room.

The Division of General ThoracicSurgery continues to grow withdirect ties to Norris Cotton CancerCenter at Catholic Medical Centerand the addition of a surgical outreach clinic in Manchester, NH.This has allowed patients from thesouthern regions of NH to getevaluated and followed-up close tohome and has allowed referringphysicians in Manchester andNashua increased direct access toour surgical team.

OutcomesCardiac surgery remains the mostscrutinized speciality in all of medicine. Since healthcare payorsand their patients have insisted on increased accountability and

transparency in outcomes, theSection of Cardiothoracic Surgeryhas responded by making our surgical outcomes transparent to thepublic. DHMC now provides patientaccess to our surgical outcomes in a patient-friendly format atwww.dhmc.org/qualityreports/list.

This initiative, combined with ourcontinued involvement with theNorthern New EnglandCardiovascular Disease StudyGroup, www.nnecdsg.org, makesthe Section of CardiothoracicSurgery an international leader inunderstanding and improvinghealthcare outcomes.


FACULTY

Jean Clark, ARNPInstructor in Surgery

Lawrence Dacey, MDProfessor of Surgery andCommunity & Family Medicine

Joseph DeSimone, MDAssistant Professor of Surgery

Anthony DiScipio, MDAssistant Professor of Surgery

Cherie Erkmen, MDAssistant Professor of Surgery

Ryan Hafner, PA-CInstructor in Surgery

David Johnstone, MDAssociate Professor of Surgery

Elizabeth Maislen, ARNPInstructor in Surgery

William Nugent, Jr, MDProfessor of Surgery andCommunity & Family Medicine

John Sanders, Jr, MDProfessor of Surgery

Jamie Wortman, PAInstructor in Surgery

Cardiothoracic Surgery Gross Professional Revenue


$14M$12M$10M$8M$6M$4M$2M

Cardiothoracic Surgery Cases


1,000

800

600

400

200

GENERAL SURGERY

Patient CareIn the past year, we have recruitedJohn Murray, MD to lead a newlyformed Division of Colorectal Surgery.Dr. Murray, an accomplished academicsurgeon, has directed the colorectalsurgery fellowship at the Lahey Clinicfor the past 15 years. This expertisewill allow us to better serve patientswith inflammatory bowel disease andbenign conditions of the colon andrectum. The remainder of patient careremains organized under the Divisionof Minimally Invasive Surgery, directedby William Laycock, MD; the Divisionof Surgical Oncology, directed byRichard Barth, MD; and the Divisionof Trauma and Acute Surgical Care,directed by John Sutton, MD.

The Division of Minimally InvasiveSurgery is pleased to have recruitedThadeus Trus, MD back to Dartmouth.Dr.Trus brings with him externalfunding for several research projects aswell as expertise in the lap adjustableband procedure for the treatment of morbid obesity. By combiningincreased volumes with our long track record of excellent outcomes, welook forward to achieving center ofexcellence status for bariatric surgery.

The Division of Surgical Oncology hastaken the DHMC strategic plan toheart by establishing a breast canceroutreach program in Manchester. Bytraveling to Manchester once a week,Kari Rosenkranz, MD has remarkablyimproved our ability to provide surgicalcare for breast cancer patients fromsouthern NH. We look forward toexpanding this presence in the followingyear with the recruitment of additionalsurgical oncology faculty.

The Division of Trauma and AcuteSurgical Care continues to work witha large interdisciplinary Level 1 traumateam to expand and improve traumaand acute surgical care. Jared Barton,MD has joined this Division aftercompleting his training at Dartmouth,and we anticipate an additional facultymember will be joining us in the nearfuture.

General Surgery patients continue tobe very satisfied with the care theyreceive. Our patient satisfaction scoresare significantly above the DHMCmean, and for the period of April 2007 through March 2008, we wereplaced second of all surgery sections.Seventy-six percent of all patients felt their provider’s clinical skills andpersonal manner were excellent.

EducationSamuel Finlayson, MD has greatlyexpanded his responsibilities by acceptingan appointment as Director of theGeneral Surgery Residency Program.Education demands the concertedefforts of several faculty. Paul Kispert,MD continues to lead the weeklyMorbidity and Mortality conferencewith insight and humor. KenBurchard, MD and Horace Henriques,MD co-direct the surgery clerkship formedical students. Gina Adrales, MD is leading an institution-wide effort touse the Surgical Simulation Lab tohelp train our medical students and residents in this unique learning environment. Dr. Laycock has nowsuccessfully trained two fellows in a thriving fellowship in advancedlaparoscopic surgery.

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Richard J. Barth, Jr., MDSection Chief

Associate Professor of Surgery

Research Burt Eisenberg, MD, funded by an R-01 grant, continues to evaluate molecular pathways in the oncogenesis of gastrointestinalstromal tumors. In the last year,Dr. Barth has published papersshowing that neoadjuvant therapycan decrease local recurrence ratesin patients with pancreatic cancerand MRI of the breast is not routinely indicated for follow-upof breast cancer patients. He hasalso continued to accrue patientsto a novel clinical study designed to test whether cryoablation ofhuman breast cancer induces anti-tumor immunity.Dr. Finlayson has published severalpapers examining discrepancies in rural vs. urban surgical care.Drs. Burchard and Henriques have published their study examiningthe process of student examination.


FACULTY

Gina Adrales, MDAssistant Professor of Surgery

Lori Alvord, MD Assistant Professor of SurgeryAssociate Dean, Student &Minority Affairs

Richard Barth, Jr., MDAssociate Professor of Surgery

Jared Barton, MDInstructor in Surgery

Kenneth Buchard, MDProfessor of Surgery andAnesthesiology

Thomas Colacchio, MDProfessor of Surgery

Daniel Croitoru, MDAssociate Professor of Surgeryand Pediatrics

Burton Eisenberg, MDProfessor of Surgery

Samuel Finlayson, MDAssociate Professor of Surgery Associate Professor of TheDartmouth Institute

Benjamin Forbush, MDAssistant Professor of Surgery

Rajan Gupta, MDAssistant Professor of Surgery

Jeffrey Harnsberger, MDAssistant Professor of Surgery

Horace Henriques, III, MDAssociate Professor of Surgery

Paul Kispert, MDAssistant Professor of Surgery andAnesthesiology

Laurie Latchaw, MDAssociate Professor of Surgeryand Pediatrics

William Laycock, III, MDAssociate Professor of Surgery

Jean Liu, MDAssistant Professor of Surgery

Elizabeth McCabe, ARNP, MSInstructor in Surgery

Ellen McKinnon, ARNPInstructor in Surgery

Joseph Meyer, MDAdjunct AssociateProfessor of Surgery

John Murray, MDVisiting Professor and Instructor in Surgery

Nick Perencevich, MDAdjunct Associate Professor of Surgery

Frank Pindyck, MDAssociate Professor of Surgery

Maureen Quigley, ARNP, MSInstructor in Surgery

Kurt Rhynhart, MDAssistant Professor of Surgery

Kari Rosenkranz, MDAssistant Professor of Surgery

John Sutton, Jr., MDProfessor of Surgery

Thadeus Trus, MDAssociate Professor of Surgery

General Surgery Gross Professional Revenue


$25M

$20M

$15M

$10M

$5M

General Surgery Cases


3,5003,0002,5002,0001,5001,000

500

NEUROSURGERY

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David W. Roberts, MDSection Chief


Patient CareDemand for clinical services has propelled the gains noted in theIntroduction. We continue to growour staff, with active recruitments inprogress. Patricia Quebada, MD hasnow joined our faculty full-time,enabling the Section to meet itspatient access goals. Nathan Simmons,MD continues to ramp up his heavyclinical responsibilities across pituitary,spine, and tumor. With KevinWilliams,Tobi Cooney, and StephanieStone, he leads our OR UtilizationQA team. Perry Ball, MD, with Dr.Simmons, represents Neurosurgery inthe multidisciplinary Spine Center, andas a member of the Critical Care serv-ice, bridges two vital disciplines for thehead-injured patient. Kadir Erkmen,MD oversees our skull base tumorprogram as well as heads up the cerebrovascular service; both have seencontinued growth in volumes. He hasalso assumed a leadership role asMedical Director of the NeuroscienceSpecial Care Unit. Neuroradiology’sCliff Eskey, MD, PhD now has a jointappointment with us collaborativelybringing interventional radiology skillsfor the endovascular treatment ofselected intracranial aneurysm. DavidRoberts, MD heads up the functionaland stereotactic activities, includingepilepsy and deep brain stimulationsurgery for movement disorders. Wehave successfully recruited Jo Speaker,PA to join our outstanding midlevelteam of David Sargent, PA, SharonMorgan,ARNP, and Carissa Thurston,RN, CNRN. Ann-ChristineDuhaime, MD and Susan Durham,MD (represented in this publication in the Pediatric Surgery section) areintegral parts of our comprehensiveneurosurgery program and provide

dedicated expertise in pediatric neuro-surgery. Drs. Durham and Ball remainactive in peripheral nerve. An excitingnew clinical program this year involvesthe use of fluorescence imaging toguide brain tumor resection.

EducationThe Dartmouth NeurosurgeryResidency training program remainsthe pride of the Section. Scott Lollis,MD, our current chief resident,successfully completed his NIH-sponsored investigative work on magnetic resonance elastography andpresented a top paper at the NewEngland Neurosurgical Society oncauses of death among neurosurgeonsnationally. He has been accepted into a prestigious spine fellowship at theCleveland Clinic, beginning July, 2009.George Kakoulides, MD (Tufts MedicalSchool, 2007, and a solid third basemanwith a good bat) joined our residencyprogram. Residents had multiple presentations at the annual meetings of the American Association ofNeurological Surgeons, the Congressof Neurological Surgeons, and thePediatric Neurosurgery Society. TheDartmouth Neurosurgical ResidencyProgram was one of 16 institutionsrepresented at the 5th AnnualNeurosurgical Softball Tournaments inNew York City in June. Our fourth-year medical student elective inNeurosurgery remains active, and thispast year saw Gareth Davies, MD goon to a neurosurgical residency atPenn State. Our first- and second-year medical student elective remainsoversubscribed. Dr. Erkmen againserved as faculty for the St. Louis skullbase surgery course. Dr. Duhaime wasa visiting professor at the University of Toronto and NYU, and was an

IntroductionThe Section of Neurosurgery is pleased to report another year of continued growth in our clinical programs, researchactivities, and training program.For the third consecutive year,clinical volumes in operativecases, discharges, and appointmentshave increased. External fundingfor investigative work hasincreased. Our neurosurgery residents continue to gainregional and national recognitionfor their accomplishments.

invited speaker at the annual meetingof the American Society of PediatricNeurosurgeons. She also assumedthe Chair of the AANS/CNS JointSection on Pediatric Neurosurgery.Dr. Roberts was a visiting professorat Columbia and the University ofWisconsin, and gave a keynoteaddress at the inaugural meeting ofthe Intraoperative Imaging Society.Dr. Ball joined the Long RangePlanning Committee of theNeurosurgical Society of America,and continues his work with theAANS Professional LiabilityCommittee. Dr. Roberts was invitedto join the American Board ofNeurological Surgery.

ResearchOur five-year NIH-sponsored fluorescence-guided tumor resectionstudy began enrolling patients.Dartmouth garnered the first andonly FDA IND for the neurosurgicaluse of 5-amino levulinic acid, a drug selectively converted to intraoperatively fluorescing proto-porphyrin IX in glioma tumor cells,thereby enabling visualization of

tumor tissue for resection. Similarfluorescent technology is beingexplored in aneurysm surgery. Ourinvestigation of computational brainmodeling for image-guided surgery,collaborative with the ThayerSchool of Engineering and alsosupported by the NIH, furtheredunderstanding of computationalefficiency in the OR setting andincorporated three-dimensionalintraoperative ultrasound imaging.In the field of epilepsy, Dartmouthhas remained one of the leadingenrollers in the NeuroPace responsive stimulation trial, wherebya fully implanted device detects theonset of seizure activity and providesa therapeutic counter-stimulus to the involved brain region.The Section is also participating in a national multi-center studyinvestigating an agent for sealing of dural leaks. The journal,Stereotactic and FunctionalNeurosurgery, edited here atDartmouth, saw an increase in its Impact Factor for the fifth consecutive year.


FACULTY

Perry Ball, MDAssociate Professor of Surgery and Anesthesiology

Ann-Christine Duhaime, MDProfessor of Surgery

Susan Durham, MDAssistant Professor of Surgery and Pediatrics

Kadir Erkmen, MDAssistant Professor of Surgery

Sharon Morgan, ARNP, MSNInstructor in Surgery

Patricia Quebada, MDInstructor in Surgery

David Roberts, MDProfessor of Surgery

David Sargent, PAInstructor in Surgery

Nathan Simmons, MDAssistant Professor of Surgery

Joellen Speaker, MSPAInstructor in Surgery

Neurosurgery Gross Professional Revenue


$20M

$15M

$10M

$5M

Neurosurgery Cases


1,200

1,000

800

600

400

200

OPHTHALMOLOGY

10

Christopher B. Chapman, MDSection Chief

Assistant Professor of Surgery

and Pediatrics

IntroductionWe are now seeing the expectedincrease in the incidence ofmajor eye disorders includingmacular degeneration, glaucoma,and diabetic eye disease. Theincreased incidence of eye diseaseis commensurate with the agingof the American population.Fortunately, we are able to providenew and highly effective medicaland surgical treatment strategiesfor many blinding disorders.Our fellowship-trained ophthal-mologists and optometristsprovide care through a multidis-ciplinary and collaborativeapproach. This past year, theSection of Ophthalmology provided services for over25,000 patient visits. Our teamalso provides laser refractive surgery, cataract surgery, anddefinitive care for pediatric eye disorders, trauma, disorders ofthe eyelids and orbit, cornealdisease, and neuro-ophthalmicdisorders.

Patient CareThe Section is pleased to welcome ournewest faculty member, NicholasUzcategui, MD who provides medicaland surgical care for patients withcomplex oculoplastic and orbital disorders. Dr. Uzcategui completed fellowship training in OphthalmicPlastic and Reconstructive Surgery atthe Doheny Eye Institute and theUniversity of Southern Californiawhere he established the USC-DohenyEye Center for Pediatric Oculoplastic,Craniofacial, and Orbital Disorders.William Rosen, MD, Director ofOculoplastics, and Dr. Uzcategui areboard certified surgeons and fellows ofthe American Society of OphthalmicPlastic Surgeons.

Michael Zegans, MD provides surgicalcare for patients with complex cornealdisorders and uveitis syndromes. Hebegan the DSAEK (Descemet’sStripping Automated EndothelialKeratoplasy) Program at Dartmouthwhich is a promising and excitingapproach to corneal transplantation.Donald Miller, MD and BasilioKalpakian, MD provide onsite laserrefractive surgery (LASIK) for farsightedand nearsighted patients and haveachieved superb visual outcomes.Ms. Nancy Patterson serves as coordinatorfor the LASIK and refractive surgeryteam. The advent of toric intraocularlenses now has a role in selected

patients with cataract and refractive disorders.

David Campbell, MD, serves asDirector of the Glaucoma Service andFellowship Director for the Section ofOphthalmology. An internationalexpert in glaucoma, Dr. Campbell performs complex glaucoma andcataract surgery.

Susan Pepin, MD serves as Director of Neuro-Ophthalmology. Dr. Pepinprovides definitive consultation forpatients with disorders of the visualpathway and complex motility disorders.Dr. Pepin is a fellowship-trained, boardcertified, ophthalmic surgeon who alsoperforms complex cataract surgery.

Christopher Chapman, MD andRosalind Stevens, MD provide comprehensive medical and surgicalexpertise for patients with complexdisorders of the retina, vitreous, andmacula including trauma and lasertreatment for premature infants withretinopathy of prematurity. CrystalColby, PA joined our service inOctober.

Chris Fields, OD, Peter Lapre, OD, andTed Petrowski, OD provide primaryeye care and optometric services andcoordinate care at our Court Streetoutreach office. Dr. Fields is Director of Low Vision Services.

EducationAll providers in the Section ofOphthalmology provide educationalopportunities onsite at DHMC aswell as regionally, nationally, andinternationally. Our vibrant grandrounds program features nationallyrecognized leaders in ophthalmology.Visiting professors for this past yearincluded Emily Chew, MD, DeputyDirector of the National EyeInstitute, and Ashley Schauer, MD,from the University of Virginia.Dr. Pepin serves as coordinator of medical student and residenteducation. We are proud of ourcollective success in matchingDartmouth Medical School students each year to competitiveophthalmology residency programs.Drs. Stevens and Uzcategui havebeen invited speakers at severalinternational meetings in Chinaand Japan. Dr. Stevens serves asinterim Director for the flying eyehospital program-Project ORBIS.Dr. Fields leads the development ofan eye care hospital in Nicaraguaand provides an international eyecare elective for DMS students.The Section of Ophthalmologysponsors a yearly symposium for ophthalmic technicians andophthalmic photographers.

Drs. Campbell and Pepin wereinvited lecturers at this year’sLancaster Ophthalmology ReviewCourse.

Clinical Trials and ResearchOur providers have published substantive studies in leading eyecare journals and serve as reviewersand members of several editorialboards. Dr. Zegans has securedfunding from the National EyeInstitute to study biofilm formationand pseudomonas infection in theeye. Dr. Zegans directs the steroidsfor corneal ulcers internationaltrial. Dr. Stevens has secured funding through the WorldDiabetes Foundation to study diabetic retinopathy in Jakarta.Dr. Pepin conducts several clinicaltrials including therapeutic studiesinvolving multiple sclerosis,Alzheimer’s disease, and ischemicoptic neuropathy.

The FutureThe Section of Ophthalmologywill begin formal reporting of clinical outcome data this year.We look forward to our glaucomafellowship program, new clinicaltherapeutic trials, and tissue engineering research.


FACULTY

David Campbell, MDProfessor of Surgery

Christopher Chapman, MDAssistant Professor of Surgery and Pediatrics

Crystal Colby, PAInstructor in Surgery

Chris Fields, ODInstructor in Surgery

Peter Lapre, ODInstructor in Surgery

Donald Miller, MDAssistant Professor of Surgery

Susan Pepin, MDAssociate Professor of Surgery

William Rosen, MDAssociate Professor of Surgery

Christopher Soares, MDAdjunct Assistant Professor of Surgery and Instructor in Surgery

Rosalind Stevens, MDProfessor of Surgery

Nicolas Uzcategui, MDAssistant Professor of Surgery

Michael Zegans, MDAssociate Professor of Surgery and Microbiology & Immunology

Ophthalmology Gross Professional Revenue


$20M

$15M

$10M

$5M

Ophthalmology Cases


1,4001,2001,000

800600400200

OTOLARYNGOLOGY AND AUDIOLOGY

12

Daniel H. Morrison, Jr., MDSection Chief


It has been another exciting year forthe Section of Otolaryngology andAudiology. We have grown, changed,and improved to meet our patients’needs and to fulfill our desire tobecome the preeminent otolaryngology/audiology unit in New England. Themost anticipated development hasbeen the start of our new residencytraining program in otolaryngology.The approval to begin this programcame after nearly four years of effortby many faculty members. Seeing the smiling faces of our new residentson July 1st brought a great sense ofsatisfaction and pride to the entireSection. In addition, several key new faculty members have joined usthis past year, bolstering our alreadystrong educational focus, and addingadditional clinical expertise andresearch interests.

A few weeks ago, U.S. News and World Report ranked our hospital-wide otolaryngology services at #39in the country. This was our debut on the top 50 list, and we are one ofonly three clinical units in DHMC tomake the top 50 list. This recognitionspeaks volumes about the hard workand dedication of our entire ENTteam _ the nursing staff on the floorand in the clinic, our secretarial staff,audiologists, midlevel providers,physicians, and administrative team.We are not satisfied with simply being a good otolaryngology program; our desire is to be the best. This attitude is also reflected in the recent completion of ourSection’s comprehensive evaluation by the Ambulatory Performance

Improvement Department. Everyaspect of our day-to-day functioningwas scrutinized and as a result manychanges were made. We expect continued improvement in patientaccess, QI/QA initiatives, and productivity. We welcome the opportunity to work smarter, notharder, and to improve patient satisfaction _ and as a consequence,staff and provider satisfaction.

James Saunders, MD left the Universityof Oklahoma to join us in January as an otologist and neurotologist.Dr. Saunders did his fellowship trainingat the prestigious House Ear Institutein Los Angeles and comes to us tocontinue his very productive 14 yearacademic career. Giri Venkatraman,MD joined us in December as a rhinologist and sinus surgeon. He hit the ground running, was awardedthe Harmes Scholarship this year,and is working with members of The Dartmouth Institute and the VAOutcomes Group on a potentiallyground breaking outcomes studyinvolving sinus surgery trends acrossthe US. Two new audiologists joinedthe team this year _ Kerry Gudlewski,AuD is an adult audiologist andKaitlin McLaughlin, MA, a pediatricaudiology specialist. They bring added expertise to our cochlearimplant program and our pediatricdiagnostic and aural rehabilitative programs. Mitzi Hanke took over as Administrative Assistant and hasworked wonders with her fabulouscombination of engaging personalityand technical expertise in the secretarialrealm.

The FutureIt has indeed been another banner year for us. We enter the next yearfinancially healthy, academically solid,and clinically well rounded. Our relationships with regional otolaryngol-ogists and other referring providerscontinue to grow. We have positionedourselves as the tertiary referral hub ofa regional ENT healthcare network.The next year will see the addition ofa second pediatric otolaryngologist,another pediatric audiologist, and anurse manager. We hope to expand our subspecialty services in theManchester area, making ourselvesmore accessible to our largest patientgroup. In a very real sense, we strive to embody the Institution’s mission inthat we are advancing health throughresearch, education, clinical practice,and community partnerships and providing each person the best care,in the right place, at the right time,every time.


FACULTY

OTOLARYNGOLOGYSharon Bry, ARNPInstructor in Surgery and Medicine

Louise Davies, MDAssistant Professor of Surgery andCommunity & Family Medicine

Peter Dixon, PAInstructor in Surgery

J Oliver Donegan, MB, BChProfessor of Surgery

JJ Benoit Gosselin, MDAssociate Professor of Surgery

Daniel Morrison, Jr, MDAssistant Professor of Surgery

Joseph Paydarfar, MDAssistant Professor of Surgery

James Saunders, MDAssistant Professor of Surgery

Mark Smith, MDAssistant Professor of Surgeryand Pediatrics

Giridhar Venkatraman, MD, MBAAssistant Professor of Surgery

AUDIOLOGYKerry Gudlewski, AUDInstructor in Surgery

Julie Johnson, AUDInstructor in Surgery

Maria Stella McHugh, MSInstructor in Surgery

Katelyn McLaughlin, MA, CF/AInstructor in Surgery

Leah Mosenthal, MEdInstructor in Surgery

Michael Norris, AUDInstructor in Surgery

Cynthia Nulton, MAInstructor in Surgery

Erin Pospychala, CCC-AInstructor in Surgery

Otolaryngology Gross Professional Revenue


$20M

$15M

$10M

$5M

Otolaryngology Cases


1,6001,4001,2001,000

800600400200

PEDIATRIC SURGERY

14

Laurie A. Latchaw, MDSection Chief


and Pediatrics

Patient CareThe Section continues to provide a wide variety of clinical programs,including chest wall deformities, pediatricperipheral nerve, and pediatric epilepsyand movement disorders. DanielCroitoru, MD (pediatric general andthoracic surgery), a world renownedexpert in chest wall deformities, has nowperformed more than 53 minimallyinvasive pectus excavatum repairs sincehis arrival in 2005 and has referrals fromas far away as Arizona. Both Drs. Daniel Croitoru and Laurie Latchaw haveexpanded the pediatric laparoscopic andthoracoscopic procedures available atDHMC. Dr. Croitoru performed thefirst thoracoscopic thymectomy and alsothoracoscopically placed the first phrenicnerve pacemaker for a patient with central hypoventilation syndrome. Themultidisciplinary Peripheral NerveClinic, led by Susan Durham, MD (pediatric neurosurgery), has seentremendous growth since its inception in 2005. As the only multidisciplinaryperipheral nerve program in northernNew England, both children and adults with complex peripheral nerveproblems are treated. Working with ourcolleagues in plastic surgery, neurologyand rehabilitation medicine, the clinicalpractice on the Lebanon campus has grown and outreach services in the southern region are planned.Ann-Christine Duhaime, MD (pediatricneurosurgery) continues an active practicein spasticity and movement disorders.Her expertise in brain mapping andepileptogenic foci excisions for children with intractable seizures has created a busy pediatric epilepsy service.Daniel Herz, MD (pediatric urology)

has pioneered work in pediatric roboticsurgery and now leads the only roboticlaparoscopic genitourinary surgery program in the state. ChristineDanielson,ARNP and Lynn Brenfleck,RN have begun a biofeedback programfor urinary and fecal incontinence. PaulMerguerian, MD (pediatric urology)continues his role as Interim MedicalDirector of the Children’s Hospital atDartmouth. Both Dr. Merguerian andDr. Herz now see patients at Wentworth-Douglas Hospital in Dover as well as inLebanon and Manchester. Dr. Latchawcontinues to see patients and operate at the Surgicenter at the ManchesterClinic three times a month and providesconsultations for pregnant women withprenatally diagnosed abdominal andchest anomalies.

EducationEducational activities for the Section of Pediatric Surgery included didacticand informal sessions with medical students and residents in GeneralSurgery, Neurosurgery, Urology, andPediatrics at the Lebanon campus.The Pediatric General and ThoracicSurgery service was assigned third-yearDartmouth Medical School students forthe first time last academic year withoutstanding reviews. Sharon Haire,MSN,ARNP was appointed to the clinical teaching faculty of the nursingschools at Colby Sawyer College,University of New Hampshire, andNorwich University. Our faculty continuesto be invited speakers locally, nationally,and internationally. In August, Dr. Durhamwill travel to Santiago, Chile as an invitedlecturer for the Latin American PediatricNeurosurgery Society.

IntroductionThe Section of Pediatric Surgery,which includes the PediatricSurgical Specialties of PediatricGeneral and Thoracic Surgery,Pediatric Neurosurgery, andPediatric Urology, had a busy andproductive year. With the recentrecruitment of Leslie McQuiston,MD, the Division of PediatricUrology will have three physicians,two nurse practitioners, and anurse coordinator to staff theLebanon campus as well as theManchester and Dover OutreachClinics. Dr. McQuiston, who willbegin seeing patients in October,completed a residency in Urologyat Brown University/RhodeIsland Hospital and a fellowshipin Pediatric Urology at theChildren’s Hospital MedicalCenter in Cincinnati, Ohio. Shereturns to New England via theCook Children’s Hospital in FortWorth,Texas, where she wasnamed one of the “Best Doctors”in Fort Worth Magazine, 2007.Access for both urology patientsand referring providers is expectedto improve significantly with Dr. McQuiston’s arrival.

ResearchDr. Durham completed her Master’sDegree at The Dartmouth Institutefor Health Policy and ClinicalPractice in May 2007. As a result of her thesis work, she receivedfunding through the Joint Sectionon Pediatrics of the AmericanAssociation of NeurologicalSurgeons and the Congress ofNeurological Surgeons to head apediatric neurosurgical workforcetask group. In addition, she has several ongoing clinical researchprojects, including a natural historystudy of Chiari 1 malformation inchildren and her continued workstudying the effects of head impactsin recreational snowboarders, whichis supported by the Harmes ScholarProgram. Dr. Duhaime continuesher work as a co-investigator onmultiple NIH grants in addition toher ongoing RO1 NIH grant inpediatric traumatic brain injury.Dr. Herz is investigating bladdersmooth muscle growth on a poly-lacto-glycolic acid scaffold matrix

using chemical nano-etching.Drs. Herz and Merguerian havestarted a North American andCanadian regional database oninfants born with prenatalhydronephrosis. The pediatric urology and neurosurgery groups arealso participating in a multi-centergrant on occult tethered cord release.Dr. Merguerian continues his clinicalresearch project looking at the efficacy of sedated versus unsedatedVCUG’s. Multiple papers were published and presentations given at societal meetings throughout the year.

HighlightsIn May 2008, Drs. Mergeurian andHerz were among a select group ofpediatric urologists who passed thenewly created Pediatric Urologycertification examination.Dr. Durham achieved specialtyboard certification in PediatricNeurological Surgery in December2007.


FACULTY

PEDIATRIC GENERAL AND THORACIC SURGERY

Daniel Croitoru, MDAssociate Professor of Surgeryand Pediatrics

Sharon Haire, ARNP, MSNInstructor in Surgery

Burton Harris, MDVisiting Professor and Instructorin Surgery and Pediatrics

Laurie Latchaw, MDAssociate Professor of Surgeryand Pediatrics

PEDIATRIC NEUROSURGERY

Ann-Christine Duhaime, MDProfessor of Surgery andPediatrics

Susan Durham, MDAssistant Professor of Surgery and Pediatrics

PEDIATRIC UROLOGY

Christine Danielson, ARNP, MSInstructor in Surgery

Daniel Herz, MDAssistant Professor of Surgeryand Pediatrics

Leslie McQuiston, MDAssistant Professor of Surgeryand Pediatrics

Paul Merguerian, MDProfessor of Surgeryand Pediatrics

Pediatric Surgery Gross Professional Revenue


$12M

$10M

$8M

$6M

$4M

$2M

Pediatric Surgery Cases


1,200

1,000

800

600

400

200

PLASTIC SURGERY

Patient CareImproving patient satisfaction was at theforefront of our improvement activitiesthis year. This stemmed from the awarenessthat we ranked 25th institutionally (outof 52) on patient satisfaction scores.We set a target of being in the top 15ranking. We set an expectation thatevery team member would ask everypatient “is there anything else we can dofor you today;” we implemented AIDETin the clinics with staff having to:acknowledge the patient, introducethemselves, clarify the duration andexpectation of the visit, explain theroles of staff and their expertise, andbeing sure to thank patients for choosingDHMC. As a team, we also insisted onfinding ways to go that extra mile tomake a memorable visit for patients -from offering to pay for a surgicalpatient’s local overnight stay when wecould not accommodate them aftertheir three hour travel; to inviting a surgical patient and his escort fromChina to one of our homes when surgical complications were concerning;to finding a quiet spot for a patient indistress to sit and make calls to familymembers; to simply coordinating carefor an appointment in another sectionwhen they had difficulties doing sothemselves. Our results? Scores showthat we are now 9th institutionally onoverall patient satisfaction, and haveremained there for the past four months.Our goal for 2009: top 5 ranking!

Participation in this year’s LeadershipPreventive Medicine ResidencyOverview of Clinical MicrosystemsCourse has helped us launch animprovement in communication for ourpatients across “silos.” Having found thatpatients receive differing instructionsfrom our surgeons, nurses, OR nurses,

rehab medicine, and the same day servicespersonnel, we have begun to develop arefined patient care plan that is easilyaccessible to all involved in their care aswell as the patient themselves.

Plastic Surgery, Orthopaedics, andRehab Medicine heightened the levelof their work on HOP, a multidisciplinaryhand service at DHMC. A “hand”phone line was activated; our secretariesare now empowered to scheduleappointments for providers across silosbased on first available appointment thatworks best for the patient. We began aformal ad campaign for hand services atDHMC. We held a patient-directedlunch seminar with another planned forthe fall.

Having hired two excellent surgeons inthe summer of 2008, we are at long lastable to speak to regional practices aboutoutreach services. We are excited aboutthese new community partnerships.

EducationOur ACGME accredited residencytraining program graduated our secondresident in the expanded three-year format, Christopher Jensen, MD, whohas begun a hand surgery fellowship atNew York University. Renee Comizio,MD has been named Associate ProgramDirector. Walter Chang, MD successfullypassed his American Board of PlasticSurgery exams.

ResearchChristopher Demas, MD has two ongoing clinical studies: 1) the effects ofperioperative temperature on woundinfection and healing in body contouringpatients; 2) psychological profiles ofbody contouring patients before andafter surgery.

IntroductionThe Section of Plastic Surgerymembers have two jobs whenthey come to work each day _

doing their own work andimproving their work. Our successes have been recognizedby invitations to present onpatient access improvement,shared medical appointments,shared decision making, staffingredesign, and more.

16

Carolyn Kerrigan, MDSection Chief


Carolyn Kerrigan, MD is fundedby 3M to study their wound closuredevice: steri-strip S. Also, she iscollaborating with researchers fromMemorial Sloan Kettering todevelop outcome measures forwomen undergoing breast surgery.

E. Dale Collins, MD is the PI on amultimillion dollar grant from theFoundation on Informed MedicalDecision Making to integrateshared decision making in GeneralInternal Medicine and the breastcancer population. She is also theclinical PI on an NCI grant todevelop a platform for patientreported outcomes in oncology atDHMC.

Mitchell Stotland, MD is exploringperceptual response to facial difference (collaborating with Anne Krendl, PhD at DartmouthPsychological and Brain Sciences).He is also studying the effect ofglabellar botox injections on emotional processing (collaboratingwith Paul Whalen, PhD atDartmouth Psychological andBrain Sciences).

Joseph Rosen, MD’s grants includedeveloping a telemedicine healthcare

system for Vietnam using RICE(Remote Interaction ConsultationEpidemiology and ReconstructiveInternational Cooperation Exchange),which is privately funded. He is Chair of the Clinical andRehabilitative Advisory Team(CREATE), and Synergy groupmember. In addition, he is co-chairfor the New Jersey Symposium on Biomaterials Science andRegenerative Medicine. During the year, he chaired the MedicalSubpanel for the Joint ImprovisedExplosive Device DefeatOrganization (JIEDDO) under theUS Defense Science Board (DSB).

Physician HighlightsDr. Kerrigan is the immediate Past-President of the PlasticSurgery Educational Foundation.She is a council member of theNew England Society of Plasticand Reconstructive Surgeons.Dr. Rosen was locally and nationallyrecognized for his active work withreconstructing soldiers returningfrom Iraq. Dr. Collins completedthe 2007-2008 Class of the Hedwigvan American Executive Leadershipin Academic Medicine (ELAM)Program, and was promoted to fullProfessor this year.


FACULTY

E Dale Collins, MDProfessor of Surgery andCommunity & Family Medicine

Renee Comizio, MDAssistant Professor of Surgery

Christopher Demas, MDAssociate Professor of Surgery

Gerald Doherty, PAInstructor in Surgery

Carolyn Kerrigan, MDCM, MScProfessor of Surgery

Kenneth Leong, MDAssistant Professor of Surgery

Joseph Rosen, MDProfessor of Surgery and Radiology

Mitchell Stotland, MD, CMAssociate Professor of Surgeryand Pediatrics

Plastic Surgery Gross Professional Revenue


$12M

$10M

$8M

$6M

$4M

$2M

Plastic Surgery Cases


1,4001,2001,000

800600400200

TRANSPLANTATION SURGERY: KIDNEY AND PANCREAS TRANSPLANT

about kidney and pancreas transplant”in Manchester and will soon have our first session in Portsmouth. Ourplan is to continue these offerings in the upcoming year around NewHampshire and Vermont.

In addition, we have developed a“Review of Transplant for DialysisNursing” course, that we will beginoffering in the fall. This course isaccredited for 7.5 hours of CEU’s andwill be offered to nurses involved in thecare of renal patients across the region at no charge. We are proud to say ourfirst five dates are already full. CathyPratt, RN, our senior coordinator, hasdone an outstanding job in preparingand coordinating this vital outreach program.

Renal TransplantationKidney transplantation remains a keycomponent of the transplant servicesprovided at DHMC. Last year we performed close to 60 renal transplantsand despite the nation-wide decrease indeceased donors, we are on track toperform over 50 this year. The numberof referrals to our Clinic for evaluationhas continued to increase, as has thenumber of patients active on the waitlist for transplant. This ensures furthergrowth and development of the DHMCtransplant services.

Pancreas TransplantThe Pancreas Transplant Program hasgrown rapidly during the past 24months. This year was a milestone for the program as we performed our25th pancreas transplant this past spring.To date, we have transplanted a total of28. For many of these patients, this represents the first time in over 30 years that they have not needed to use

insulin. We are particularly pleased thatthe majority of our patients havereturned to work and are able to participate actively with their families.

Hepatobiliary SurgeryThis year has also seen growth in ournewly formed Multidisciplinary LiverTumor Clinic. To date, we have seenclose to 100 patients with liver tumorsand/or End Stage Liver Disease.The Clinic is co-directed by BrianBerk, MD of Hepatology and David Axelrod, MD, Section Chief ofTransplantation Surgery. This clinic provides comprehensive care for patientswith liver and bile duct malignancies aswell as care for patients with end stageliver disease. The Clinic is cooperativelystaffed by Transplantation Surgery,Gastroenterology, InterventionalRadiology, Palliative Care, and Oncology.During their evaluation, patients are ableto have a complete assessment and careplan developed at a single visit. This hasimproved care coordination and patientsatisfaction. We are particularly pleased asthis clinic is unique in Northern NewEngland. In cooperation with MarcPipas, MD of Oncology, we are initiatinga trial of new chemotherapeutic agentsfor hepatocellular carcinoma.

The Clinic has also evaluated and listedpatients for liver transplantation at LaheyClinic where members of the DHMCsurgical faculty have participated in the transplant procedures. Members of the DHMC liver team meet via teleconference twice monthly to listpatients with Lahey as well as participatingin educational opportunities. This offersan important opportunity for patients in Northern New England to have local evaluation and follow-up with anintegrated team approach.

18

David Axelrod, MDSection Chief


and Community & Family Medicine

IntroductionThis past year has been one ofcontinued growth and developmentfor the Section of TransplantationSurgery. One area of focus thisyear for us has been meeting theneeds of our patients in theSouthern Region. We now offertwice-a-month clinics in thatarea, and this fall will offer bothpost-transplant follow-up visits as well as our comprehensive pre-transplant workup. We haveworked to strengthen our relationship with the nephrologistsin that area by offering educationaltalks as well as meeting withthem individually and in smallgroup formats to promote opencommunication. Patient educationhas been another area of focus forus. This past year saw our firstsupport groups for transplantrecipients. We have initiated acommunity educational event“Everything you wanted to know

Educational ActivitiesThe Transplantation SurgerySection remains deeply involved inresident and fellow education. Wehave launched a senior transplantsurgery resident rotation dedicatedto providing a comprehensive education in all aspects of trans-plantation and care of patients withend stage organ failure. In addition,each month a nephrology fellowjoins the team to learn about theevaluation and management oftransplant patients in both the pre-operative and post-operative

session. We are pleased that thiscollaboration has led to severalaccepted abstracts at national renaland transplant meetings.

Looking AheadWe anticipate further expansion of the DHMC Multi-organTransplant Program. With the addition of additional professionalstaff, we believe that we can continue to expand our outreachto patients in need of transplantcare in Northern New England.


FACULTY

David Axelrod, MDAssistant Professor of Surgery andCommunity & Family Medicine

Michael Chobanian, MDAssociate Professor of Surgeryand Pediatrics

Richard Dow, MDProfessor of Surgery

Sarah Parmelee, FNPInstructor in Surgery

Transplantation Gross Professional Revenue


$4M

$3M

$2M

$1M

Transplantation Cases


350

300

250

200

150

100

50

OtherKidneyPancreas

UROLOGY

20

William Bihrle, III, MDSection Chief


Patient CareUrology has completed a successful year in terms of improving patient care.The continued growth in the volume ofrenal surgeries and cystectomies stronglysuggest that DHMC has successfully provided our community with a timelyand comprehensive genitourinary oncological program. Since January wehave enrolled over 30 patients in thebladder cancer Quality Improvementstudy, an institutionally funded programdesigned to provide timely consultationand treatment to patients with high riskbladder cancer.

With two experienced laparoscopic surgeons, the Institution is uniquely positioned to remain on the forefront ofthe minimally invasive approach to thetreatment of GU malignancies. The pioneering work of John Heaney, MD in laparoscopically-assisted pelvic surgeryfor prostate cancer has been an unalloyedsuccess. Dr. Heaney continues to providestate-of-the-art surgical care to ourpatients with organ confined prostatecancer with the aid of the da Vincirobotic surgical platform. ThePSA/Prostate Biopsy Clinic, under thedirection of John Seigne, MD, has been aresounding success; an example of aninterdisciplinary (urology and radiology)endeavor providing “one stop consultativeand diagnostic shopping” for men withelevated PSAs and abnormal digital rectalexaminations. The Minimally InvasiveAblative Therapy Program for solid renalmasses, operated in conjunction with the Section of Interventional Radiology,has been expanded to include cryoablationas well as radiofrequency ablation.Dr. Pais is expanding the Section’s level ofservice in the area of renal stone disease.Trained in all aspects of minimally invasive

therapies of the upper urinary tract,including percutaneous access, Dr. Pais is expanding our ability to provide timely and comprehensive care topatients with complex stone disease.An interdisciplinary stone clinic, to berun in conjunction with the Section ofNephrology, will provide a frameworkfor the critical evaluation of the metabolicstone former.

EducationThe Dartmouth Program in Urology wasrewarded with a five-year accreditationby the Residency Review Committee ofthe ACGME following last fall’s site visit,an acknowledgement of the consistentlyhigh level of urological training deliveredby a stable and committed faculty to atalented group of residents. Under thewatchful stewardship of Ann Gormley,MD, Program Director, the residency hassuccessfully grown to two residents/yearwith vibrant affiliations at the WRJ,VAand Concord Hospital. The faculty hasinitiated a discussion regarding a changein the traditional six-year trainingschema to one which incorporates surgical training in a five-year block.We graduated two residents in June, oneof whom is pursuing fellowship trainingin trauma and plastic and reconstructivesurgery. Peter Steinberg, MD, our risingchief resident, has been accepted into atwo-year fellowship in laparoscopy andendourology at the University ofRochester to begin in July, 2009.

The pediatric urological experience ofour residents, under the direction of PaulMerguerian, MD, and Daniel Herz, MD,continues to expand in depth and volume;evidence of the growth in this area is therecent hire of a third pediatric urologistdue to join the staff in October, 2008.

IntroductionThe Section of Urology enjoyeda particularly productive year,expanding its role as a regionalreferral service in oncology, lowerurinary tract reconstruction, and,with the recent addition ofVernon Pais, MD to the faculty,in the area of stone disease. Wewitnessed significant growth inoutpatient visits, surgical volumes,and discharges, a reflection of theSection’s commitment to patientaccess and referral services. Theacquisition of a da Vinci roboticsurgical platform represents theInstitution’s resolve to assessingand acquiring state-of-the-arttechnology to assist in the care ofour patients.

FacultyDr. Pais joined the Section faculty in June, 2008. Dr. Pais comes toDHMC from the University ofKentucky where he served asProgram Director for theEndourology Fellowship. With clinical and scholarly interests inmetabolic and surgical stone disease,Dr. Pais is fast becoming a regionalresource for the treatment of complex stone disease.

Section faculty remains generouslyactive in regional and nationalorganized urology; we count nofewer than ten officer and committeeassignments in our various societies.Dr. Gormley, Vice President of theSociety of Female Urology andUrodynamics, sits on the AUAResidency Training Task Force, shecontinues as her Society’s editor forthe Journal of Urology, and last fallwas elected Secretary of the NewEngland Section of the AUA, a five-year leadership position in ourregional organization. Dr. Seignecompleted his second term as NewHampshire representative to theNES _ AUA Board of Directors,continues to serve on the AUASuperficial Bladder CancerGuidelines Panel, and was recently

made the Program Director of theGenitourinary Oncology Group atthe Norris Cotton Cancer Center.

ResearchPeter Steinberg, MD, our rising chiefresident, has executed a number ofoutcomes-based initiatives in theareas of stone disease and bladdercancer. Working with Drs. Seigneand Bihrle, he has developed a clinicalpathway for the efficient evaluation,scheduling, and post-surgical management of patients with muscle invasive bladder cancer.The Section, in collaboration withAlan Schned, MD of AnatomicPathology and Marc Ernstoff, MD,of Medical Oncology, has developeda tissue microarray for renal cell carcinoma, a database which shouldprove invaluable in the years ahead.This study has recently receivedextramural funding. Our pediatriccolleagues are leading a multi-institutional collaborative in thestudy of pediatric diagnostic practicepatterns. Dr. Heaney and RyanHalter, PhD, of the Thayer School,recently published seminal work inthe Journal of Urology on the clinical utility of electroimpedancein the diagnosis of prostate cancer.


FACULTY

William Bihrle, III, MDAssociate Professor of Surgery

E Ann Gormley, MDProfessor of Surgery

Kelley Hamill Lemay, ARNPInstructor in Surgery

John Heaney, MB, BChProfessor of Surgery

Daniel Herz, MDAssistant Professor of Surgeryand Pediatrics

Leslie McQuiston, MDAssistant Professor of Surgeryand Pediatrics

Paul Merguerian, MDProfessor of Surgeryand Pediatrics

Vernon Pais, MDAssistant Professor of Surgery

John Seigne, MB, BChAssociate Professor of Surgery

Laura Stempkowski, ARNPInstructor in Surgery

Urology Gross Professional Revenue


$15M

$10M

$5M

Urology Cases


1,4001,2001,000

800600400200

VASCULAR SURGERY

22

Richard J. Powell, MDSection Chief

Professor of Surgery and Radiology

Patient CareOur core focus remains the care ofpatients with vascular disease. Annualoutpatient visits continue to increase.As the primary referral center for a geographically large and rural area, wehave developed outreach clinics inKeene and Central Vermont MedicalCenter to better serve our patients. Toprovide more comprehensive patientcare, we have developed a multidisciplinaryvascular clinic where cardiologists andvascular surgeons see patients with vasculardisease. This project has been facilitatedby Brian Nolan, MD through work with The Dartmouth Institute usingmicrosystems techniques to improve caredelivery. This endeavor is a componentof an initiative to develop a multidisci-plinary Heart and Vascular Center atDartmouth-Hitchcock Medical Center.

Our case volume remains steady. MarkFillinger, MD has developed the branchedand fenestrated stent graft program forthe repair of thoracoabdominal aorticaneurysms. DHMC is one of only ahandful of centers in the United Statescapable of performing this procedure.To facilitate the development of this program, a new state-of-the-art operatingroom containing fixed imaging equipmentwill open this fall.

EducationLast year Dr. Fillinger assumed the dutiesof program director from Jack Cronenwett,MD for both the five-year vascular residency and the vascular fellowship. Weare in the process of implementing neweducational tools, including endovascularand open surgical simulators, to improvethe efficiency and quality of trainingwhile maintaining patient safety.

Our Vascular fellowship continues toattract high quality applicants. RobertChang, MD and Philip Goodney, MDare the first graduates of our expanded

Vascular Fellowship Program. Theiropen surgical and endovascular experiencehas not diminished following expansionof the training program.

Dr. Chang, our 19th vascular fellow,performed 303 major open surgical procedures and 354 interventional procedures. He has joined the vascularsurgery group at Kaiser in San Francisco.

Dr. Goodney, our 20th vascular fellow,performed 252 open surgical proceduresand 332 interventional procedures. Wewere fortunate to recruit Dr. Goodneyto join our vascular surgery group atDartmouth-Hitchcock Medical Center.

Section faculty delivered 50 international,national, and regional educationpresentations this year of which 26 werefor vascular surgical society meetings.A quarterly regional educational CMEmeeting in the southern region forproviders interested in the care ofpatients with vascular disease has beendeveloped. This series covers lower legischemia, aneurysmal disease, carotidocclusive disease, and renal and mesentericdisease. Research activity resulted in 16 peer-reviewed journal articles andtwo book chapters published by facultythis year.

Vascular Surgery conferences are heldeach Monday morning when faculty andtrainees have protected time to attend.These include multidisciplinary biweeklyclinical case conferences, a biweeklymorbidity and mortality conference as well as monthly vascular laboratoryconference, clinical and basic scienceresearch conference, and journal club.

ResearchOngoing bench research to study theregulation of smooth muscle cell phenotype remains a central focus of the laboratory. Kathleen Martin, PhD

has received RO1 funding by the NHLBI of the NIH and additionalfunding from the Flight AttendantsFoundation. Richard Powell, MD isthe national principal investigator forthe HGF-STAT Trial evaluating theuse of HGF gene therapy in the treatment of critical limb ischemia.

Dr. Powell is the local principle investigator for a stem cell therapy and an adenoviral gene therapy trial for the treatment of vascular disease.

Section members remain heavilyinvolved in industry sponsored devicetrials. Dr. Fillinger is the national principle investigator for thePythagoras Endoprosthesis Trial forabdominal aortic aneurysms and is thelocal principle investigator for severalendoprothesis trials for AAA.Dr. Powell is the local principle investigator for six carotid stent trials including the recently completedNIH sponsored CREST Trial. DavidStone, MD is the local principle investigator for the Atirum Iliac StentGraft Trial.

Eva Ruzcidlo, MD leads a clinical trial comparing cryoplasty and stentingto stenting alone for treatment ofsuperficial femoral artery lesions.

Outcomes research is lead by Drs.Nolan and Goodney who haveworked closely with researchers fromThe Dartmouth Institute. Dr. Nolanhas received multiple sources of

funding to compare the outcomes ofvarious treatment modalities inpatients with critical limb ischemia.

Dr. Cronenwett continues to lead theVascular Study Group of NorthernNew England. This multi-institutionalgroup now has more than 9,300 vascular surgery operations analyzed to provide hospital-specific feedbackfor improving outcomes.

Faculty AchievementsDavid Stone, MD has joined ourgroup from Duke University as anAssistant Professor of Surgery.Dr. Cronenwett is the Editor ofRutherfords text book in VascularSurgery. Robert Zwolak, MD hasbeen elected Vice-President of theSociety for Vascular Surgery and has been appointed Member ofAMA/Specialty Society Relative Value Committee Medical HomeWorkgroup. Daniel Walsh, MD iscompleting his term as president of the New England Society ofVascular Surgery and the CollierSurgical Society. Eva Rzucidlo, MDwas promoted to Associate Professor of Surgery and was appointed to theResearch and Education Committeeof the Society for Vascular Surgery.Dr. Powell has been elected to serve on the NIH/NHLBI data safety monitoring board for the CLEVERTrial and has been elected to membership on the Surgery andBioengineering Study Section of the NIH.


FACULTY

Jack Cronenwett, MDProfessor of Surgery andCommunity & Family Medicine

Mark Fillinger, MDProfessor of Surgery

Philip Goodney, MDAssistant Professor of Surgery

Brian Nolan, MDAssistant Professor of Surgeryand The Dartmouth Institute

Richard Powell, MDProfessor of Surgeryand Radiology

Eva Rzucidlo, MDAssociate Professor of Surgeryand Pediatrics

David Stone, MDAssistant Professor of Surgery

Daniel Walsh, MDProfessor of Surgery

Mark Wyers, MDAssistant Professor of Surgery

Robert Zwolak, MD, PhDProfessor of Surgery

VASCULAR RESEARCH LAB

Kathleen Ann Martin, PhDResearch Assistant Professor ofSurgery

Mary Jo Mulligan-Kehoe, PhDResearch Associate Professor ofSurgery

Vascular Surgery Cases


1,100

1,050

1,000

950

900

850

Vascular Surgery Gross Professional Revenue


$30M

$25M

$20M

$15M

$10M

$5M

MAXILLOFACIAL SURGERY

groups of patients in need of wisdomteeth extractions are seen together forconsultation. The result has been anoptimal learning environment for ourpatients and staff. Second, we haveexpanded our offering of “nurse only”visits for follow-up care for ourpatients. The combination of thesechanges has resulted in a reduction ofnew patient wait times by ten daysover the last six months. We are proudof this, as well as the high patient satisfaction scores seen during thisyear. We look forward to continuedimprovements in these areas of ourpractice.

Rocco Addante, DMD, MD remainsactive academically as a journalreviewer for articles submitted for publication to the Journal of Oral andMaxillofacial Surgery and the Journal ofOral Surgery, Oral Medicine, and OralPathology. Dr.Addante also had a manuscript entitled, “Early Onset ofHereditary Gingival Fibromatosis in a28 Month Old - Case Report” acceptedfor publication in Pediatric Dentistry.He continues to mentor students fromDartmouth with an interest in careerscombining medicine and dentistry.

Dr. Addante continues his active participation in a number of DHMCinterdisciplinary care clinics. He is akey member of the Craniofacial

Anomalies Clinic and participates inOtolaryngology’s Head and NeckCancer Care Team. He also providescare for patients from the HematologyOncology Service who typicallyexhibit coagulation disorders andimmune suppression along with theirneed for oral surgery care.

EducationLocally, Dr.Addante hosts monthlymeetings for our hospital dental staff,and he regularly presents lectures tomembers of the dental community ontopics of mutual interest. He also serves as regional consultant to theAmerican Board of Oral andMaxillofacial Surgery.

Nationally, Dr.Addante was reappointedas a consultant to the Commission ofProfessional Conduct of the AmericanAssociation of Oral and MaxillofacialSurgery. He was also an invited speakerat Grand Rounds at Vanderbilt University,Department of Oral and MaxillofacialSurgery, speaking on “Evaluation andTreatment of Oral Cancer.”

Although there is no residency inMaxillofacial Surgery at DHMC,Dr.Addante maintains close affiliationswith the Sections of Plastic Surgeryand Otolaryngology and is an activeand valued contributor to the residentprograms in each of these specialties.

24

Rocco Addante, DMD, MDSection Chief

Professor of Surgery and Anesthesiology

IntroductionOral and Maxillofacial Surgeryprovides a wide array of care,from primary to tertiary levels.Complex cases involvingpathology and structural deformities of the maxillofacialregion are referred toDartmouth-Hitchcock from the tri-state area.

Patient CareWishing to meet the new institutional goal of significantlyimproving access for our patients,the Section began two newservices this year. First, we initiated Shared MedicalAppointments for wisdom teethto our patients. In this setting,

Maxillofacial Surgery Gross Professional Revenue


$2M

$1.5M

$1M

$.5M

Maxillofacial Surgery Cases


250

200

150

100

50

SURGICAL RESEARCH LABORATORY

The SRL is comprised of an animal ORand six bench laboratories. The SRL isoperated under the direction of theDepartment of Surgery and receivesadministrative input from the DartmouthMedical School Dean’s Office and theDartmouth College’s Animal Care andUse Program and DC Institutional AnimalCare and Use Committee (IACUC). TheSRL is under the direction of P. JackHoopes, DVM, PhD. The operating suiteis directed by Karen Moodie, DVM, alicensed veterinary surgeon, and managedby Susan A. Kane, a certified veterinarytechnician. Rendall Strawbridge, SeniorLaboratory Technician and Manager,provides oversight for bench laboratoryactivities. Audrey Carr, Department ofSurgery Financial Manager, provides administrative support, grant/contractsubmission, and management consultation.

The SRL experimental animal operatingsuite includes state-of-the-art anesthesiadelivery and monitoring, dedicated clinicalfluoroscopy/angiography, ultrasound, andCT imaging as well as laser and ionizingradiation laboratory. MRI, PET, andnuclear imaging for large and small animalmodels are available through the Departmentof Radiology and Norris Cotton CancerCenter associations. Expertise and instrumentation for endoscopy andlaparoscopy are also available.

The SRL operates and/or facilitates acomplete array of molecular biologyinstruments and techniques including:DNA microarray, proteomics array, northern,western, and southern blots, ELISA,TUNNEL assay, COMET assay, RT-PCR,autoradiography, etc. The SRL has dedicated expertise in light and fluorescentmicroscopy, automated/computer-basedmicroscopic image analysis, and hasrecently added whole animal fluorescentand intravital microscope imaging capabilities. Although performed in theDepartment of Pathology (adjacent to theSRL), the SRL has dedicated expertise in

histologic preparation and staining/labelingtechniques including histochemistry,immunohistochemistry, in situ-hybridization,and laser dissection.

SRL Resident Faculty Currently, the SRL houses 13 Dartmouthfaculty members including: P. J. Hoopes,DVM, PhD; Mary Jo Mulligan-Kehoe,PhD; Kathleen Martin, PhD;Ann-Christine Duhaime, MD; Susan Durham,MD; Mark Savellano, PhD; KarenMoodie, DVM; Richard Powell, MD; EvaRzucidlo, MD; Brian Pogue, PhD; BinChen, PhD; and Cherie Erkmen, MD.All faculty have dedicated laboratoryspace, funding, and DMS appointments.Six are practicing DHMC surgeons (Drs.Duhaime, Durham, Chen, Erkmen,Powell, and Rzucidlo), and two haveappointments at the Thayer School ofEngineering, (Drs. Pogue [primary] andHoopes [adjunct]). The major researchthemes of these investigators include:- Pediatric and translational brain injury

research;- Anitbody and non-antibody directed iron

oxide nanoparticle cancer treatment;- Genetic and molecular understanding

and targeting of vascular disease;- Photodynamic therapy: treatment

efficacy and mechanism;- Use and development of fluorescence in

cancer imaging, diagnosis and treatment;- Development and assessment of

interventional cardiovascular models andtechnologies;

- Angiogensis and associated developmentalbiology.

Academic Productivity and FundingIn recent years, the SRL (resident faculty)has experienced a dramatic increase inextramural funding and academic produc-tivity. For 2007-08, the SRL resident facultyheld (PI), or were associated (funded posi-tions) with, 41 extramurally funded grantsand authored more than 110 peer reviewedmanuscripts. This number represents analmost four-fold increase since 2008.

25

P. Jack Hoopes, DVM, PhDDirector


and Medicine

DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 2008

IntroductionThe Surgical ResearchLaboratory (SRL) is a benchlaboratory and experimental ORresearch facility that originatedin the Dartmouth MedicalSchool Vail Building on theHanover campus more than 30 years ago. The facility wasoriginally developed byDartmouth-Hitchcock MedicalCenter surgeons to test new surgical devices and procedures.At the time of origin, the facilitywas and remains unique in that it contains a large animalexperimental OR facility that islocated outside of the institutionalanimal research facility anddirected by a Department ofSurgery faculty member. Dueto the fact that the SRL ORshave been able to use bothinternal and external funds to add new equipment and technology, the decision wasmade two years ago to conductDHMC/DMS/Thayer School-based large animal research inthe SRL OR space.

DHMC Surgical RoboticsProgram 2008

Surgical Robotics in 2008 impliesthe utilization of the da Vincisurgical platform in laparoscopicsurgery. The surgeon sits at a console visualizing the operativefield with binocular optics andcontrolling articulated laparoscopicinstruments within a patient on aremote operating table.

The institution of surgical robotics at DHMC has embodiedteamwork throughout the MedicalCenter. The concept was drivenby John Heaney, MD andendorsed by Richard Dow, MDand William Bihrle, MD. Thelogistics team, formed in spring2007, was led by Bill Mroz andCatherine Garfield. To enhancepatient care, it had to be efficient,safe, and make fiscal sense. WithCapital Budget Committeeapproval in August 2007, the $1.8M da Vinci Surgical Systemarrived in October. Simultaneously,OR teams comprising nursing,anesthetic, and surgical componentswere formed to facilitate the elements peculiar to RoboticAssisted Laparoscopy (RAL) withthe da Vinci platform.

PROGRAM HIGHLIGHT

Carol Majewski, RN, MS appointedLorraine Leonard, RN to lead nursingand together they recruited a team ofexperienced and talented operating nursesand technicians who would commit toconsistent excellence. The anesthesiateam introduced specific techniques. Thesurgical and nursing teams in Urologyand Gynecology completed the onsite andoff-site training required by the IntuitiveCorporation.

The DHMC Credentials Committee identified criteria for system utilization.Clinic, OR, and leadership providedsolutions for scheduling, block times,billing, and other logistic issues.

Early on, the pivotal role of OR nursingin RAL was recognized. LorraineLeonard stepped up and recruited for theDepartment a committed team of classindividuals including _ Ursula Davis,Chris Sylvester, Jennifer Fox, ShannonLapierre,Tracy Stokes, Rebecca Parkhurst,Bonnie Bossier, Ellie Munro, and ScarlettAbston. There would be no “program”without them.

In January 2008, the three mandatory “mentored” urology cases were completedby the surgical team of John Heaney,MD, John Seigne, MD, and John Munoz,MD, (DHMC Urology, 2002) _ two radical prostatectomies for prostate cancer (RALP) and a most difficult re-redo pyeloplasty. Subsequently, DanHerz, MD, from Pediatric Urology, and a

team of Gynecological Surgeons havebeen credentialed in RAL.

From February 2008 to the present,urologic teams using the da Vinci roboticplatform have completed - 100 RALP,two enucleative prostatectomies for BPH,and five pyeloplasties. In August 2008,the standard of care for the surgical management of prostate cancer is RALP.With the adaptive process from “straight”laparoscopic prostatectomy (750 casessince 2001) to RALP a distant memory,we can say that we do a “better prostate-ctomy” with the post operative recoveryof the functions of continence and erectilefunction appearing more rapid. The ORteams have achieved more rapid “set-up”times, shorter operative times, andsmoother operative technique. The da Vinci binocular vision system providesincredible tissue-plane visualization andan unquestionable technical advantagewith the articulating instruments; thesefeatures out-balance any loss of hapticfeedback using the system. Urology residents now train on the da Vinci system, with dry lab experience andpatient “console time.”

In summary, 15 months after initiating the process of obtaining surgical roboticsat DHMC, we are providing a state-of-the-art, high-level, clinicalresource to our region and training ournurses and urological residents in thisconventional technology.

26

John A. Heaney, MB, BChProfessor of Surgery

Section of Urology


PROGRAM HIGHLIGHT

Approximately 130 patients a year withbreast cancer undergo mastectomy atDartmouth-Hitchcock Medical Center(DHMC). DHMC is one of the fewmedical facilities north of Boston andsouth of Montreal offering the choiceof immediate breast reconstruction.The number of patients choosingimmediate reconstruction has increasednearly four-fold at Dartmouth-Hitchcock over the past four years.

Women who express an interest inbreast reconstruction during the consultation process with clinicians inthe Comprehensive Breast Programreceive a decision aid and materialsfrom the Center for Shared DecisionMaking explaining the various types ofreconstruction. If a woman choosesimmediate reconstruction, appointmentsare scheduled to discuss her optionswith a general surgeon and a plasticsurgeon, often on the same day in theInterdisciplinary Breast Clinic. If thepatient and her care team decide thatimmediate reconstruction is an option,a surgery is scheduled for the combinedprocedure.

Immediate breast reconstruction is possible through a partnership betweenGeneral Surgery, Plastic andReconstructive Surgery, the FamilialCounseling Program, and the Centerfor Shared Decision Making. Womenidentified as having a high genetic riskfor breast cancer by the FamilialCounseling Program may choose to have a prophylactic mastectomy and reconstruction. Under these circumstances, immediate reconstructioncan ease the aftermath of this emotionalsurgical decision.

Immediate reconstruction in the settingof cancer surgery improves the cosmeticresult, reduces cost and anesthetic risk,

and has been proven to be safe and welltolerated. Richard Barth, MD, BurtonEisenberg, MD, and Kari Rosenkranz,MD are fellowship-trained surgicaloncologists at Dartmouth-Hitchcockwho perform the mastectomy toremove the cancer followed by one ofthe plastic surgeons, E. Dale Collins,MD, Renee Comizio, MD, ChristopherDemas, MD, Carolyn Kerrigan, MD, orKenneth Leong, MD, who performreconstruction to complete the surgery.

Dartmouth-Hitchcock surgeon,Carolyn Kerrigan, MD, is a nationalleader in developing the shared medicalappointment process. Patients choosingdelayed reconstruction have the optionto attend a shared medical appointmentin which various options for reconstructionare discussed, the reconstruction procedureis reviewed, and questions are answeredabout insurance issues.

The Comprehensive Breast Program(CBP) has found that it is feasible andbeneficial to integrate decision supportinto routine care. Working in careteams, both patients and clinicians areable to receive shared benefit.

27

E. Dale Collins, MDProfessor of Surgery and Community

and Family Medicine

Section of Plastic Surgery

The Comprehensive Breast Program

The Comprehensive BreastProgram team strives to improvethe quality of the patient/surgeoninteraction, increase satisfactionwith the decision makingprocess, and reduce distress and decisional conflict. TheComprehensive Breast Programoffers state-of-the-art medicalcare to breast cancer patients.Patients have access to manyservices not readily available elsewhere, including immediatebreast reconstruction, shareddecision making tools, patientnavigators, new clinical trials, andadvanced radiation and radiologytechnologies.

Colo-Rectal Program

In March 2008, the Departmentof Surgery created a newDivision of Colon and RectalSurgery (CRS) within theSection of General Surgery.The Department has expressed acommitment to recruit a total ofthree colon and rectal surgeonsover the next few years to builda Division that provides the full range of clinical servicesencompassed by the specialty.It is expected that the Divisionwill organize and coordinatecare of patients with diseases of the colon, rectum, and anusthroughout the geographic areaserved by the Dartmouth-Hitchcock Clinic and serve as areferral site for patients fromcentral and northern NewEngland.

PROGRAM HIGHLIGHT

The primary clinical interests of theDivision will include:

1. A multidisciplinary approach to thetreatment of patients with cancer ofthe rectum that emphasizes the role of sphincter-saving resections. TheDivision will also offer options forlocal treatment of carefully selectedpatients with early-stage rectal cancers.The Division will be actively engagedin treatment of patients with carcinomaof the colon, as well.

2. Division members will maintain an active practice in diagnostic andtherapeutic colonoscopy and will participate in DHMC’s colorectal cancer screening program.

3. In collaboration with the Section of Gastroenterology, members of theDivision of Colon and Rectal Surgerywill be actively engaged in treatingpatients with Inflammatory BowelDisease and will offer the full range of surgical options for managingUlcerative Colitis and Crohn’s Disease.The Division will provide longitudinalcare for patients suffering debilitatingcomplications of anal Crohn’s disease.

4. Treatment of benign and malignantdisorders of the anal canal. TheDivision will serve as the primaryresource for care of patients withanorectal abscess/fistula and will provide the full range of treatmentoptions for managing complex anal fistulas. In addition, the Division willcoordinate multidisciplinary treatmentof patients with anal canal carcinomaand will provide longitudinal care forthese patients.

5. The Division of CRS at DHMCwill assist in the development of a

coordinated, multi-disciplinaryapproach to the evaluation and treatment of patients with pelvic floor disorders.

6. Colon and rectal surgeons haveplayed a prominent role in the application of minimally invasive surgical techniques to the treatment ofbenign and malignant disorders of thelower GI tract. The Division of CRS at DHMC will continue to expand therole of laparoscopic intestinal resectionsas optimal treatment for the majorityof patients with benign and malignantdisorders of the colon and proximalrectum.

The Division will have a strong commitment to academic and educational pursuits as one of its primary missions. Division memberswill pursue clinical research and willbe committed to graduate and under-graduate medical education. Residentswill be active participants in all aspectsof our clinical practice. In collaborationwith other members of the Section ofGeneral Surgery, we will ensure thatresidents and students acquire a soundunderstanding of the pathophysiologicbasis for diseases of the lower gastroin-testinal tract and have in-depth exposureto the surgical management of thesedisorders.

As the newest subspecialty division inthe Department of Surgery at DHMC,Colon and Rectal Surgery willenhance patient care by providing anexpanded array of clinical services andby offering an additional perspectiveon the management of common, butoften complex clinical problems. As the Division expands it should augmentan already vibrant academic medicalcenter.

28

John J. Murray, MDVisiting Professor and Instructor

in Surgery

Section of General Surgery


PROGRAM HIGHLIGHT

Dr. Erkmen, who joined us in October2008, received both her general and thoracic surgery training at Brigham& Women’s Hospital in Boston,Massachusetts. She brings with her awealth of experience with these newerminimally invasive techniques.

Thoracoscopic surgery utilizes a videocamera, one to three small “port”incisions measuring less than 1-inch long,and occasionally a small 1- and 2-inchutility incision to gain access to thechest. Since these incisions are smallerand do not require spreading and sometimes breaking ribs, pain is reducedpost operatively, and often times recoveryis faster and more complete.

Video assisted thoracoscopic techniqueshave been available to our patients for a number of years, although reservedprimarily for patients needing moreminor procedures such as lung biopsy,lung wedge resection, and for the surgical treatment of many forms ofpleural and pericardial disease.

Now, in some patients, VATS techniquescan be extended to include more complex procedures, including anatomiclobectomy and esophagectomy. VATSapplied to anatomic lobectomy withlymphadenectomy has been shown to decrease pain, frequency of bloodtransfusions, and length of stay. Becauseof the shorter recovery time, VATSlobectomy can facilitate the administrationof adjuvant chemotherapy as well.Recently, long-term data with VATSlobectomy confirm equivalent outcomesto traditional open lobectomy for earlystage lung cancer (stage I and II).Similarly,VATS esophagectomy hasbeen shown to result in decreased

pain, fewer blood transfusions, fewerpulmonary complications, and shorterlength of stay. Minimally invasiveesophagectomy is equally effective instaging and treating esophageal cancerin appropriately selected patients.

While we believe that the addition ofVATS lobectomy and esophagectomyare important options to offer to ourpatients, not every patient is appropriatelytreated with these techniques. The successful treatment of patients withsurgical diseases of the chest wall requiresthe integration of minimally invasivethoracic surgery into our multidisciplinaryprogram of care. The Division ofThoracic Surgery remains dedicated toproviding state-of-the-art streamlinedyet personalized care to patients withsurgical diseases of the chest.

29

Cherie Erkmen, MDAssistant Professor of Surgery

Section of Cardiothoracic Surgery

Minimally InvasiveGeneral Thoracic SurgicalProgram

The Division of GeneralThoracic Surgery has developeda multidisciplinary programwithin the Norris CottonCancer Center to provide progressive and personalized care to patients with malignantdiseases of the chest. With the addition of our newest staffmember, Cherie Erkmen, MD,we have expanded our servicesof minimally invasive thoracicsurgery to include video-assistedthoracoscopic surgery (VATS) lobectomy and VATSesophagectomy.

TRAINING PROGRAM IN GENERAL SURGERY

Samuel R. G. Finlayson, MDGeneral Surgery Residency

Program Director

Vice Chair for Academic Affairs and

Faculty Development, Department

of Surgery


Section of General Surgery

30

Visiting Professors

The residency program in GeneralSurgery trains twenty categorical generalsurgery residents, including four residentsat each of the five levels of residencytraining. In addition, fourteen moresurgical residents participate in the GeneralSurgery Program preliminary to pursuingtraining in other surgical residencies.

Residents benefit from the rich array of surgical cases. As MHMH continues to grow, surgical cases have not onlycontinued to increase in number, butalso in complexity as measured by thecase mix index and specific measures for trauma patients.

The Surgical Residency Program drawson the strengths of a committed depart-mental faculty and a growing array ofresources. Gina Adrales, MD serves asDirector of the Surgical SimulationLaboratory, the activities of which will

soon be integrated into the DartmouthSimulation Center currently under construction. Dr.Adrales’s responsibilitiesinclude oversight and coordination ofthe laparascopic and trauma simulationsas well as training in basic surgical skills.In addition, the Program includes regularly scheduled surgical seminars _

directed by Paul Kispert, MD, KariRosenkranz, MD, and Gina Adrales, MD_ that provide the surgical residentsopportunities for didactic and interactive,case-based learning in clinical and basicsurgical sciences.

The Training Program hosted nine visiting professors who presented GrandRounds and interacted with residentsand faculty.

The Training Program is supported by agrowing array of data centers that collectand analyze information about procedures

Keith Calligaro, MD, Department of Vascular Surgery, Pennsylvania Hospital.

Timothy Chuter, MD, Professor of Surgery, University of California.

Daniel Clair, MD, FACS, Chairman & Program Director, Department ofSurgery,The Cleveland Clinic Foundation.

Ronald L. Dalman, MD, Chief, Division of Vascular Surgery, Stanford UniversityMedical Center.

Tim Hardcastle, MD, Senior Surgeon,Senior Lecturer in Surgery, DirectorTrauma Unit,Tygerberg Hospital,University of Stellenbosch,WesternCape, South Africa.

Richard C. Karl, MD, Richard G. Connar,Professor & Chairman, University ofSouth Florida College of Medicine.

Michael McLeod, MD, Program Director, Department of Surgery,Michigan State University, KalamazooCenter for Medical Studies.

John Mellinger, MD, Professor of Surgery, Program Director, GeneralSurgery Residency, Chief, Section ofGastrointestinal Surgery, Medical Collegeof Georgia.

Robert Merion, MD, Professor of Surgery, University of MichiganTransplant Surgery.

and outcomes for surgical patientsadmitted to MHMH. These includeregistries administered by the SurgicalOutcomes Assessment Program atDartmouth, the Northern NewEngland Cardiovascular Disease StudyGroup, and the Vascular Study Groupof Northern New England. Specific complications are identified, collated,and sorted into defined categories.Data from these centers are madeavailable in a confidential manner tohouse officers and faculty, and are usedto inform the discussion at the weeklyMorbidity & Mortality conference.

The residency program continues toprovide a popular rotation at ConcordHospital for second- and fourth-yearsurgical residents. This rotation allowsthe program to take further advantageof the robust clinical volumes andincreasing case complexity occurring in southeastern New Hampshire.

The teaching conference schedulewithin the Training Program remainsrobust. Fourteen conferences areavailable on a weekly basis on variousservices.These include GI TumorBoard,Trauma Rounds, the SurgicalSeminars, Surgical Grand Rounds,Morbidity & Mortality conference, aninterdisciplinary GastrointestinalDisease Conference, and a weeklyteaching conference with the ProgramDirector.

The Surgical Residency Program atDartmouth is an academic programand continues to strongly encourageand support resident research. Overthe last year, residents in the TrainingProgram produced six scientific presentations at national and regionalmeetings, and six peer-reviewed publications.

TRAINING PROGRAMS

32

Research and PreventiveMedicine Training Opportunities

We offer research opportunities in molecular labs and outcomes research.Some residents elect to join ourLeadership in Preventive MedicineResidency Program, where they getformal training in outcomes research,earn an MPH, and become eligible forPreventive Medicine certification.

2008-2009Abhishek Chatterjee, MD _

Outcomes Research - DHMC/VAMCJoshua Goldberg, MD _

Vascular Research - DHMC

2007-2008John Gorechlad, MD _

Cancer Research _ DHMCSarah Greer, MD, MPH _ Leadership

in Preventive Medicine Residency -DMS

Joseph Lupo, MD - OutcomesResearch _ DHMC/VAMC

2006-2007Sarah Greer, MD _ Leadership in

Preventive Medicine Residency -DMS

Jason Kemp, MD _ OutcomesResearch _VAMC

Arne Olsen, MD _ Cancer Research _

DHMCIan Paquette, MD _ Outcomes

Research _ DHMCSarah Pletcher, MD _ Research _

DHMC

2005-2006Justin Dumouchel, MD _ Vascular

Research _ DHMCLydia Choi, MD _ Cancer Research _

Memorial Sloan KetteringSarah Greer, MD _ Cancer Research

_ National Institute of HealthDavid Hughes, MD _ Cancer

Research - DHMCDaniel Wiener, MD _ Cancer Research

_ Dana Farber Cancer Institute

2004-2005Jared Barton, MD _ Leadership in

Preventive Medicine _ DHMCLydia Choi, MD _ Cancer Research _

Memorial Sloan KetteringMichael VanBibber, MD _ Outcomes

Research _ DHMCDaniel Wiener, MD _ Cancer

Research _ Dana Farber Cancer InstituteFellowship Programs:Minimally Invasive SurgeryPlastic SurgeryVascular Surgery

Resident Training 2008-2009General SurgeryEstablished: 1946Prerequisite Training: 4 years of medical schoolProgram Description: 5-year program,training in all divisionsResidents per year: 4

NeurosurgeryEstablished: 1947Prerequisite Training: 1-year internship,includes 3 months neurology, 2 monthscritical care.Program Description: 6-year program,includes 4 years in clinical neuro-surgery including 6 months minimumof pediatric neurosurgery, and 6months of related clinical rotations inneuroradiology and neuropathology,one year of independent research, andculminates in a 1-year Chief Residentexperience.Residents per year: 1

Plastic SurgeryEstablished: 1960Prerequisite Training: 3 years of generalsurgery or completion of a residency inanother surgical discipline.Program Description: 3-year trainingwith a period of research integratedinto the programResidents per year: 1

UrologyEstablished: 1949Prerequisite Training: 2 years of generalsurgeryProgram Description: 4-year program,including 6 months of research.Training in pediatric and adult urology;including oncology, female urology,BPH, reconstruction, stone disease, and transplant. Ample experience is gainedin open, laparoscopic, robotic, andendoscopic surgery.Residents per year: 2

Vascular SurgeryEstablished: 2007Prerequisite Training: 4 years of medical schoolProgram Description: 5-year program,includes 26 months of vascular surgery,10 months of interventional/endovas-cular surgery, and 24 months of coregeneral surgery experience. Optionalnon-accredited research education year(including option for formal course-work at The Dartmouth Institute leadingto master's degree in public health withfocus on outcomes research) Residents per year: 1

TRAINING PROGRAMS

General Surgery (32)

Urology (7)

Neurosurgery (7)

Vascular (5)

PlasticSurgery (3)

MEDICAL STUDENT EDUCATION

We continue to have success with our Director of Learning Program,and have been able to focus efforts oncommunication skills, almost uniquelyin the third-year clerkship experience.Engaging faculty and residents withformal education goals has been animportant dialogue and continued ourunderstanding of core competenciessuch as communication, interpersonalskills, and professionalism. We continueto emphasize understanding and teachingsurgical concepts leaving acquisition offactual knowledge to the student. Indefining this teaching/learning boundary,we model the core competency of self-learning. Our educational researchefforts also continue in this vein ofcommunication and interpersonal skills.We have published papers in Focus(Association of Surgical Education) andThe American Journal of Surgery over thelast year.

The eight rotation options; Vascular,Trauma/Consult,Transplant/IBD,Oncology/Breast, Cardiothoracic,Pediatric, Minimally Invasive, and themultidisciplined VA rotation (General,Vascular, Plastics, ENT, Orthopaedics),continue to offer a broad view of themany disciplines within surgery, as wellas providing students with a diversity ofdisease and practice models. All studentscontinue to participate in night callwith the Trauma/Consult team. Nightcall also allows students to routinelyinteract and experience non-core surgicaldisciplines such as Orthopaedics,Neurosurgery, Urology, Plastics, andOphthalmology. There is a formaldidactic morning every Wednesday,

starting with Surgical M&M and GrandRounds and followed by student-focused case studies and presentations.The Class of 2008 graduated with 21%of students entering a surgical field,above the national average of 10 _ 12%.The Arthur Naitove Surgical ScholarAward commemorates one ofDartmouth’s great clinician-scientistsand is awarded by the Faculty of theDepartment of Surgery to a graduatingstudent. Douglas Jones, MD ‘08 wasthis year’s recipient of the NaitoveAward, and he will receive his trainingat NYP Hospital-Weill CornellMedical Center, New York, NY inGeneral Surgery. Dr. D. JoshuaMancini, a general surgery chief resident, was this year’s recipient of theThomas P. Almy Housestaff TeachingAward. This honor is awarded to a resi-dent by the graduating medical schoolclass. This year marks the fifth year in arow, and the tenth time in twelve years,that a surgery resident has been awardedthis unique honor.

Clerkship Advisory BoardThe Clerkship Advisory Board meetsmonthly and is comprised of individualsactively involved in student education.The committee conducts ongoingreviews of the curriculum, examinationprocess, and student progress. The group makes revisions as necessary to maintain a current curriculum andto advance the educational climate.It is the forum by which the surgeryclerkship formally interacts with the Dean’s Office in student and curriculum issues.


Kenneth W. Burchard, MDSurgery Clerkship Co-Director,

Consult/Trauma Faculty Learning Leader

Professor of Surgery and

Anesthesiology

Horace F. Henriques, MDSurgery Clerkship Co-Director

General Surgery Service Faculty

Learning Leader


CLINICAL TRIALS

34

Ball, Perry, MD• Dura Sealing Study, Confluent Surgical

Barth, Richard, MD• Alternative Breast Imaging Modalities:Correlation with Local Tissue PropertyMeasurements and Histopathological Indicesin Benign and Malignant Lesions• A pilot study of US guided cryoablation ofsmall unifocal invasive ductal breast cancerusing MRI to evaluate tumor viability andimmunologic assays to identify and charac-terize a cryoablation induced immuneresponse• A prospective study of adjuvant radiationtherapy for malignant phyllodes tumors• A phase II trial of erbitux, radiotherapyand twice weekly gemcitabine in patientswith adenocarcinoma of the pancreas

Collins, E. Dale, MD• Preserving Function in Rural BreastCancer Patients Undergoing Chemotherapy• Implementing Shared Decision Making InClinical Care at Dartmouth HitchcockMedical Center and the White RiverJunction VA• To design and test Shared DecisionMaking practice models for breast cancerpatients facing decisions related to surgery,reconstruction, and adjuvant care, that can bewidely distributed and used in other interest-ed health care settings• Platform-Independent Hub for PatientReported Outcomes in Oncology

Durham, Susan, MD• Analysis of head impacts in pediatricsnowboarders• Pediatric neurosurgical workforce analysis• Natural history of asymptomatic Chiari 1malformation in the pediatric population

Erkmen, Kadir, MD• DHMC Glioma Vaccine Trial

Fillinger, Mark, MD• Cordis Corporation, a Johnson andJohnson Company• A Clinical Study Comparing Use of theModified Bifurcated EXCLUDEREndoprosthesis to Open Surgical Repair inthe Primary Treatment of InfrarenalAbdominal Aortic Aneurysms (AAA)-GoreModified Study• A Clinical Evaluation of the GOREEXCLUDER® Bifurcated Endoprosthesis-Low Permeability in the Primary Treatmentof Infrarenal Abdominal Aortic Aneurysms-Gore 04-04 Study• Clinical Study Evaluating the Use of theGORE EXCLUDER® BifurcatedEndoprosthesis-31 mm In the PrimaryTreatment of Infrarenal Abdominal AorticAneurysms (AAA)-Gore 03-02 Study• Evaluation of the Medtronic Ave Talent

Thoracic Stent Graft System for theTreatment of Thoracic Aortic Aneurysms-Valor Study• Evaluation of EndoRefix EndovascularDelivery System and Staple Study 2008-01 • A Phase II, Single-arm, Prospective Studyof the safety and Efficacy of the UniFit™Aorto-uni-iliac Endoluminal Stent Graft forthe Repair of Abdominal Aortic Aneurysmsin Patients who are not Candidates forRepair with Commercially AvailableBifurcated Endovascular Prostheses-UniteStudy• Zenith® TX2™ Thoracic TAAEndovascular Graft Clinical Investigation-Zenith Study• Prospective Aneurysm Trial: High AngleAorfix™ Bifurcated Stent Graft-PythagorasStudy• Evaluation of EndoRefix EndovascularDelivery System and Staple Study 2008-01• A Phase III Evaluation of the Safety andEfficacy of the AneuRx Stent Graft Systemin the Treatment of Abdominal AorticAneurysm (AAA)-AneuRx Study• AneuRx Comparison of EVAR UsingAneuRx Stent-Grafts with High-DensityVersus Reduced-Porosity Graft Material• The Pivotal Study of the AptusEndovascular AAA Repair System Staple 2• Endologix Bifurcated Powerlink StentSystem Clinical Study Size 34 mm InfrarenalBifurcated Stent Graft • Endurant Stent Graft System US ClinicalStudy

Kerrigan, Carolyn, MD• Closing Linear Incisions in Plastic Surgery:A Randomized Study

Nangia, Ajay, MBBS• An analgesia protocol for renal colic in theDHMC ED

Nolan, Brian, MD• Dartmouth Critical Leg Ischemia Registry

Powell, Richard, MD • Asymptomatic Carotid Stenosis, Stentingvs. Endarterectomy Trial- The ACT I Study• Carotid Revascularization Endarterectomyvs. Stent Trial-CREST Study• The ViVEXX™ Carotid RevascularizationTrial (VIVA) for High Surgical Risk Patientswith Extracranial Carotid Artery Stenosisusing the Bard® ViVEXX™ Carotid Stentand Emboshield® BareWire™ RapidExchange Embolic Protection System-VIVABARD Study• The Embolic Protection with reverse Flow(EMPiRE) Study of the GORE NeuroProtection System In Carotid Stenting ofSubjects at High Risk for CarotidEndarterectomy• Stenting and Angioplasty with Protectionin Patients at High-Risk for

Endarterectomy-Sapphire Study• Use of Tissue Repair Cells (TRC’s-Autogous Bone Marrow Cells) in Patientswith Peripheral Arterial Disease to TreatCritical Limb Ischemia• A Phase II Double-blind, Randomized,Placebo-Controlled Study To Assess TheSafety and Efficacy of AMG0001 to ImprovePerfusion in Critical Leg Ischemia inSubjects Who Have Peripheral IschemicUlcers• Safety and Efficacy of Propionyl-L-Carnitine in Combination with MonitoredExercise Training in Peripheral ArterialDisease (Intermittent Claudication) AsAssessed by a Graded Treadmill Protocol• Genzyme Protocol No. PADHIF00704• A Phase III, Randomised, double blind,parallel-group study of the efficacy and safetyof oral dabigatran eterxilate (150 mg bid)compared to warfarin (INR 2.0-3.0) for 6month treatment of acute symptomaticvenous thromboembolish, following initialtreatment (5-10 days) with a perenteral anti-coagulant approved for this indication• A Phase III, Randomized, Multi-Center,Double-Blind, Parallel-Group,Active-Controlled Study to Evaluate the Efficacyand Safety of Oral Dabigatran Etexilate (150mg bid) Compared to Warfarin (INR 2.0-3.0) for the Secondary Prevention of VenousThromboembolism, RE-MEDY

Roberts, David, MD• Responsive Neurostimulator (RNS)System for Patients with Severe Epilepsy(Neuropace)• Coregistered Fluorescence-EnhancedResection of Malignant Gliomas• Model of Brain Deformation• DHMC Glioma Vaccine Trial

Rzucidlo, Eva, MD• Randomized Controlled StudyComparing Treatment of Femoropoplitealdisease with primary stenting and postangioplasty vs. primary stenting and post cry-oplasty

Seigne, John, MB, BCh• Risk Bladder Cancer Pre-OperativePathway• Renal Tumor Tissue Microarray• Informed Decision Making in ProstateCancer

Simmons, Nathan, MD• DHMC Glioma Vaccine Trial• Dura Sealing Study, Confluent Surgical

Stone, David, MD• Cast Iliac Stent Pivotal Study

Zegans, Michael, MD• Steroids for Corneal Ulcer Trial

FEDERAL AND CORPORATE SPONSORED PROJECTS


General Surgery

Plastics

Vascular

Neuro

Pediatrics

Ophthalmology

Urology

CT Surgery

General Surgery

Neurosurgery

Ophthamology

Plastics

Pediatric Surgery

Urology

Vascular

Surgical Research Lab

Clinical Trials Federal & Corporate Research Grants

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3

1

1

2

2

3

4

4

5

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5

3

1

4

Alvord, Lori, MD• Surgical OutcomesBarth, Richard, MD• ACOSOG Studies Z10 and Z11Collins, E. Dale, MD• Platform Independent Hub for Patient • Reported Outcomes (PRO) in

Oncology Practice• FIMDM CoreCronenwett, Jack, MD• Aortic Aneurysm• Quality ImprovementDavies, Louise, MD• Thyroid CancerDuhaime, Ann-Christine, MD• Biomechanics of Pediatric Head Trauma• Trauma to the Immature Brain:

Response, Repair, & TreatmentEisenberg, Burton, MD• RTOG Committee Chair Agreement• Mesylate in GistsFinlayson, Samuel, MD• Rural Veterans Access to Surgical Services• Access Quality Care• Esophageal Reflux• Endovascular GraftsGormley, Elizabeth, MD• UITN Steering Committee ChairHeaney, John, MD• Selenium and Vitamin E Cancer • Prevention Trial (SELECT)• PCPT Companion Long Term Follow-Up

• Study for Men with Diagnosed ProstateCancer

Hoopes, P. Jack, DVM, PhD• Endoluminal Pyloric• Surgery Vs Endo• Feline Model-Phas Ii• Glycofi Rituxan Proj• Wave Contract• Modifying Epo• Tissue Structures• Intratumoral Iron• Warwick Fiber StudyJohnstone, David, MD• Multicenter Randomized Double Blind

Placebo Controlled Phase III Study ofSingle Agent Tarceva Following TumorResection

Keetay, Victoria, PhD• Dynamic AssessmentKerrigan, Carolyn, MD• Carpal Tunnel SyndromeLikosky, Donald, PhD• Redesigning Cardiac Surgery to Reduce

Neurologic InjuryMartin, Kathleen, PhD• Novel Targets of Rapamycin and Akt in

Vascular Smooth Muscle CellDifferentiation

• Secondhand SmokeMulligan-Kehoe, Mary Jo, PhD• Mechanisms of PAI-1 Induced Anti-

Angiogenesis• Anti-Angiogenesis II

• Philips MasterNolan, Brian, MD• Quality of Life in Veterans with an

Abdominal Aortic AneurysmPowell, Richard, MD• Carotid Revascularization Endarterectomy

vs. Stenting Trial (CREST)• Endothelial Cell RegQuebada, Patricia, MD• NRSA/NIH T-32 Translational • Neuroscience Postdoctoral Training GrantRoberts, David, MD• Modeling of Brain Deformation During

Surgery• Coregistered Fluorescence-Enhanced

Resection of Malignant GliomaRzucidlo, Eva, MD• Mtor RegulationSavellano, Mark, PhD• New Strategies for

Photoimmunodetection/TherapySimmons, Nathan, MD• Dura Sealing Study, Confluent SurgicalZegans, Michael, MD• Steroids in Corneal Ulcers Trial• Biofilm Formation

Sponsored Research

FY99 FY00 FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08

$3.5M$3M

$2.5M$2M

$1.5M$1M$.5M

AWARDS

The Arthur Naitove Distinguished Teaching Award

Richard W. Dow, MD, FACSChair, Professor of Surgery

The Arthur Naitove Distinguished Teaching Award was instituted by the residents in 1997 to recognize a faculty member’s commitment to the housestaff. The award is presented to an attending staff for their commitment to enhance the residency educationalexperience. The 2008 recipient of the Arthur Naitove Distinguished Teaching Award isDr. Richard Dow.

The Harmes Surgical Scholar Award

Giridhar Venkatraman, MD, MBAAssistant Professor of Surgery, Otolaryngology

The Harmes Surgical Scholar Award is awarded annually to a faculty member at theAssistant or Associate Professor level in the Department of Surgery. The annual financialaward is provided over three years to facilitate career development by strengthening individual professional skills; enhancing contributions to the academic, clinical, and administrative programs of the Department; improving the regional and national visibilityof DHMC; and increasing each individual’s sense of professional competence and satisfaction. The Harmes Scholar named for 2008 is Dr. Giridhar Venkatraman.

The Surgical Chair’s Award

Daniel Morrison, MDSection Chief, Otolaryngology Assistant Professor of Surgery, Otolaryngology

Each year, the Chair of the Department has the opportunity to acknowledge the contribution of an individual, or several individuals, through the Chair’s Award. TheAward is intended to recognize an individual’s accomplishments which have especiallyreflected the ideals or goals of the Department. The 2008 Surgical Chair’s Award recipient is Dr. Daniel Morrison.

36

PUBLICATIONS

DEPARTMENT OF SURGERY

Donald S. Likosky, PhDHernandez F, Brown J, Likosky D, Clough R,Hess A, Roth R, Ross C, Whited C, O’Connor G,Klemperer J. A Prospective, RandomizedControlled Trial Comparing Off Pump CoronaryArtery Bypass Surgery with ConventionalCoronary Artery Bypass Surgery UtilizingCardiopulmonary Bypass. Ann Thorac Surg2007;84:1897-1903.

Dacey L, Likosky D, Ryan T, Robb J, Quinn R,DeVries J, Hearne M, Leavitt B, Dunton R, CloughR, Sisto D, Ross C, Olmstead E, O’Connor G,Malenka D. Long-Term Survival following Surgeryversus Percutaneous Intervention inOctogenarians with Multivessel CoronaryDisease. Ann Thorac Surg 2007;84:1904-1911.

Cronenwett J, Likosky D, Russell M,Eldrup-Jorgensen J, Stanley A, Nolan B: ARegional Registry for Quality Assurance andImprovement. The Vascular Study Group ofNorthern New England (VSGNNE). J Vasc Surg2007;46:1093-1102. Epub October 19, 2007.

Burchard K, Henriques H, Walsh D, Ludington D, Rowland P, Likosky D. Is it Live or is itMemorex? Student Oral Examinations and theUse of Video for Additional Scoring? Am J Surg2007;193(2):233-236.

Likosky D, Dacey L, Baribeau Y, Leavitt B,Clough R, Cochran R, Quinn R, Sisto D,Charlesworth D, Malenka D, McKenzie T,Olmstead E, Ross C, O’Connor G. Long-TermSurvival of the Very Elderly Undergoing CoronaryArtery Bypass Grafting. Ann Thorac Surg2008;85:1233-1238.

DioDato C, Likosky D, DeFoe G, Groom R,Shann K, Krumholz C, Warren C, Pieroni J, BenakA, McCusker K, Olmstead E, Ross C, O’Connor G.Cardiopulmonary Bypass Guidelines in Adults:The Northern New England Experience. JExtracorporeal Tech 2008;40:16-20.

Gorechlad J, McCabe E, Higgins J, Likosky D,Lewis P, Rosenkranz K, Barth R. Screening forRecurrences in Patients Treated with BreastConserving Surgery: Is there a Role for MRI? AnnSurg Oncol 2008;15:1703-1709.

Shann K, Giacomuzzi C, Harness L, Myers G,Paugh T, Mellas N, Groom R, Gomez D, Thuys C,Charette K, Ojito J, Tinius-Juliani J, Calaritis C,McRobb C, Jacobs J, Bacha E, Cooper D, LikoskyD. Perfusion Complications Secondary toCongenital Cardiac Surgery. Cardiology in theYoung (in press).

CARDIOTHORACIC SURGERY

Lawrence J. Dacey, MDBrown J, Cochran R, Leavitt B, Dacey L, Ross C,MacKenzie T, Kunzelman K, Kramer R, HernandezF, Helm R, Westbrook B, Dunton R, Malenka D,O’Connor G. Multivariate Prediction of Renal

Insufficiency Developing after Cardiac Surgery.Circulation. 2007;116[suppl I]:I-139-I-143.

Dacey L, Likosky D, Ryan T, Robb J, Quinn R,DeVries J, Hearne M, Leavitt B, Dunton R, CloughR, Sisto D, Ross C, Olmstead E, O’Connor G,Malenka D. Long-Term Survival following Surgeryversus Percutaneous Intervention inOctogenarians with Multivessel CoronaryDisease. Ann Thorac Surg 2007;84:1904-1911.

Likosky D, Dacey L, Baribeau Y, Leavitt B, Clough R, Cochran R, Quinn R, Sisto D, Charlesworth D,Malenka D, McKenzie T, Olmstead E, Ross C,O’Connor G. Long-Term Survival of the VeryElderly Undergoing Coronary Artery BypassGrafting. Ann Thorac Surg 2008;85:1233-1238.

GENERAL SURGERY

Richard J. Barth, MDGreer S, Pipas J, Sutton J, Zaki B, Tsapakos M,Colacchio T, Gibson J, Wiener D, Ripple G, Barth R.Effect of Neoadjuvant Therapy on LocalRecurrence after Resection of PancreaticAdenocarcinoma. J Am Coll Surg 2008;206:451-457.

Gorechlad J, McCabe E, Higgins J, Likosky D,Lewis P, Rosenkranz K, Barth R. Screening forRecurrences in Patients Treated with BreastConserving Surgery: Is there a Role for MRI? AnnSurg Oncol 2008;15:1703-1709.

Kenneth W. Burchard, MDBurchard K. Critical Care: The Unknown. InRowland P, Lang N (ed). Communications andProfessionalism Competencies: A Guide forSurgeons. Cine-Med, Inc. 2007.

Coe N, Rowland P, Burchard K. Oral Examinations: A Survival Guide. In Rowland P,Lang N (ed). Communication andProfessionalism Competencies: A Guide forSurgeons. Cine-Med, Inc. 2007.

Burchard K, Henriques H, Walsh D, Ludington D,Rowland P, Likosky D. Is it Live or is it Memorex?Student Oral Examinations and the Use of Videofor Additional Scoring? Am J Surg2007;193(2):233-236.

Burton L. Eisenberg, MDOzols R, Herbst R, Colson Y, Gralow J, Bonners J,Curran W, Eisenberg B, Banz P, Kramer B, et al.Clinical Cancer Advances 2006: Major ResearchAdvances in Cancer Treatment, Prevention, and Screening _ A Report from the American Society of Clinical Oncology. J Clin Oncol January,2007;25:146-162.

Eisenberg B, Rosenkranz K. Gastrointestinal Stromal Tumors. Shacklefordís Surgery of theAlimentary Tract, 6th edition 2007.

Blanke C, Demetri G, von Mehren M, Heinrich M,Eisenberg B, Fletcher J, Corless C, Fletcher C,Roberts P, Heinz D, et al. Long-Term Results froma Randomized Phase II Trial of Standard-versusHigher-Dose Imatinib Mesylate for Patients withUnresectable or Metastic Gastrointestinal

Stromal Tumors Expressing KIT. J Clin OncFebruary, 2008;26(4):620-625.

Tarn C, Rink L, Merkel E, Flieder D, Koumbi D,Testa J, Eisenberg B, von Mehren M, Godwin A.Insulin-Like Growth Factor 1 Receptor: aPotential Therapuetic Target for GastrointestinalStromal Tumors. Cancer Research 2008 (inpress).

Samuel R. G. Finlayson, MDKemp J, Zuckerman R, Finlayson S. Trends inAdoption of Laparoscopic Cholecystectomy inRural vs. Urban Hospitals. J Am Coll Surg2007;45:1179-1184.

Axelrod D, Guidinger M, Finlayson S, Schaubel D, Goodman D, Chobanian M, Merion R. Rates ofSolid Organ Wait-Listing, Transplantation, andSurvival Among Residents of Rural and UrbanAreas. JAMA 2008;299:202-207.

Paquette I, Smink D, Finlayson S. Outpatient Cholecystectomy at Hospitals vs. FreestandingAmbulatory Surgical Centers. J AM Coll Surg2008;206:301-305.

Doty B, Zuckerman R, Finlayson S, Jenkins P,Rieb N, Henegham S. General Surgery at RuralHospitals: A National Survey of Rural HospitalAdminstrators. Surgery 2008;143:599-606.

Doty B, Zuckerman R, Finlayson S, Jenkins P,Rieb N, Heneghan S. How Does Degree ofRurality Impact the Provision of Surgical Servicesat Rural Hospitals? J Rural Health (in press).

Kemp J, Finlayson S. Secular Trends in Laparoscopic Colectomy from 2000-2004. SurgEndosc (in press).

Rajan Gupta, MDStawicki S, Pryor J, Hyams E, Gupta R, Gracias V,Schwab C. The Surgeon and the Intensivist:Reaching Consensus in Intensive Care Triage. JSurg Educ 2007;64(5):289-293.

Haut E, Gupta R. Trauma Resuscitation in the Austere Environment. In Bledsoe G, ManyakM, Townes D (ed). Expedition Medicine 2007 (inpress).

Gupta R. Error Rates Resulting from Anemia can be Corrected in Multiple Commonly usedPoint-of-Care Glucometers. Discussion for MannE, Salinas J, Pidcoke H, et al. J Trauma2008;64(1):20-21.

Gracias V, Sicoutris C, Meredith D, Horan A,Gupta R, Haut E, Auerbach S, Sonnad S,Hanson C, Schwab C. Critical Care NursePractitioners Improve Compliance with ClinicalPractice Guidelines in a “Semi-Closed” SurgicalIntensive Care Unit. JNCQ 2008 (in press).

MAXILLOFACIAL SURGERY

Rocco R. Addante, MDBreen G, Addante R, Black C. Early Onset ofHereditary Gingival Fibromatosis in a 28 MonthOld. J Pediatr Dentis (in press).


NEUROSURGERY

Perry A. Ball, MDZarovnaya E, Pallatroni H, Hug E, Ball P,Cromwell L, Pipas J, Fadul C, Meyer L, Park J,Biegel J, Perry A, Rhodes C. AtypicalTeratoid/Rhabdoid Tumor of the Spine in an Adult: Case Report and Review of the Literature.J Neurooncol. 2007;84:49-55.

Lee K, Lin J, Pallatroni H, Ball P. An Unusual Case of Penetrating Injury to the Spine Resultingin Cauda Equine Syndrome: case presentationand a review of the literature. Spine2007;32:E290-3.

Kadir Erkmen, MDErkmen K. Brain Tumors. In: Eds: Verma A, KimD. Year Book of Neurology and Neurosurgery, 2007.

Mamourian A, Erkmen K, Pluta D. Non-helical Acquisition CT Angiogram after AneurysmClipping: In Vitro Testing Shows DiminishedArtifact. American Journal of Neuroradiology,Jan 9, 2008.

Patricia B. Quebada, MDMissios S, Forero J, Quebada P, Pekala J,Durham S, Duhaime A. Use of Quick-BrainMagnetic Resonance Imaging for Non-hydro-cephalus Indications (abstract). In: 36th AnnualMeeting of the American Association ofNeurological Surgeons/Congress of NeurologicalSurgeons Section on Pediatric NeurologicalSurgery; Miami, FL, 2007.

Lollis S, Quebada P, Friedman J. Disorders of Consciousness: Traumatic Brain Injury, Handbookof Clinical Neurology, Vol. 90 3rd series.Amsterdam, The Netherlands: Elsevier 2008;pp217-229.

Quebada P, Greenwald R, Buck A, Eypper D,Duhaime A. Instrumented Headgear to StudyHead Kinematics in Infants and Toddlers(abstract). In 26th Annual NeurotraumaSymposium; Orlando, FL, 2008

Quebada P, Duhaime A. Serum Markers in a Piglet Scaled Cortical Impact Model: Effect ofAge and Gender (abstract). In 26th AnnualNeurotrauma Symposium; Orlando, FL,(abstract), 2008

Duhaime A, Dodge C, Lee Y, Quebada P,Curtis R, Hillier S, Simoni M, Adams L, Costine B.Scaled Cortical Contusion in Immature Swine:Effect of Age and Gender on Lesion Volume(abstract). In: 26th Annual NeurotraumaSymposium; 2008; Orlando, FL, 2008.

David W. Roberts, MDLee K, Kristic K, van Hoff R, Hitti F, Blaha C, HarrisB, Roberts D, Leiter J. High FrequencyStimulation of the Subthalamic NucleusIncreases Glutamate in the Subthalamic Nucleusof Rats as Demonstrated by In Vivo Enzyme-Linked Glutamate Sensor. Brain Research2007;1162:121-129.

Dowman R, Darcey T, Barkan H, Thadani V,Roberts D. Human Intracranially-recordedCortical Responses Evoked by Painful ElectricalStimulation of the Sural Nerve. Neuroimage2007;34: 743-763.

Roberts D. Corpus Callosotomy. In Engel J,Pedley T (eds): Epilepsy: A ComprehensiveTextbook, 2nd Edition. Philadelphia, LippincottWilliams & Wilkins2007, pp 1907-1914.

Roberts D, Darcey T: Applications in Epilepsy Surgery. In Barnett G, Maciunas R, Roberts D(eds): Computer-Assisted Neurosurgery, 2nd ed.(in press, 2007)

Roberts D. Fundamentals of Registration. In:Barnett G, Maciunas R, Roberts D (eds):Computer-Assisted Neurosurgery, 2nd ed. (inpress, 2007)

Barkan H, Darcey T, Thadani V, Williamson P,Roberts D. Perioperative SensorimotorMapping by Task-Related EEG Activation: Amethod validation based on a series of ten sur-gical epilepsy patients. Neurology 2007;68 (suppl1):338, 2007.

Lollis S, Roberts D. Robotic Catheter Ventriculostomy: Feasibility, Efficacy, andImplications. J Neurosurg 2008;108:269-274.

Hartov A, Roberts D, Paulsen K. A Comparative Analysis of Co-Registered Ultrasound andMagnetic Resonance Imaging in Neurosurgery.Neurosurg 2008;62 [ONS Suppl 1]: ONS91-ONS99.

Fadul C, Roberts D, et al. A Phase II Study of Thalidomide and Irinotecan for Treatment ofGlioblastoma Multiforme. Neuro-Oncology (inpress).

Spire W, Jobst B, Darcey T, Thadani V, Williamson P, Roberts D. Robotic Image Guided DepthElectrode Implantation for Medically IntractableEpilepsy. Neurosurg Focus (in press).

Darcey T, Roberts D. Technique for the Localization of Intracranially ImplantedElectrodes. Neurosurg Focus (in press).

Ji S, Hartov A, Roberts D, Paulsen K, et al.Mutual-Information-Based Image to Patient Re-registration using Intraoperative Ultrasoundin Image-Guided Neurosurgery. Medical Physics(in press).

Roberts D. Corpus Collosectomy. In Shorvon S,Perucca E, Engel J (eds): Treatment of Epilepsy,3rd ed. (in press, 2008)

Roberts D, Jobst B. Occipital-parietal Resections. In Baltuch G, Villemure J (eds):Operative Techniques in Epilepsy Surgery. NewYork, NY: Thieme. (in press, 2008).

Wheeler M, DeHerdt V, Vonck K, Gilbert K,Manem S, Jobst B, Roberts D, Williamson P,Boon P, Thadani. Efficacy of Vagus NerveStimulation for Refractory Epilepsy: A Re-Analysis using the Engel Classification (Abstract).

American Epilepsy Society, December 2007meeting, (Abstract), (in press).

Hirashima F, Dinnerstein E, Gilbert K, Roberts D,Thadani V, Williamson P. Seizure Outcome inPatients with Mesial Temporal Sclerosis andRefractory Epilepsy after Standard or SelectiveTemporal Lobectomy (Abstract). AmericanEpilepsy Society, December 2007 meeting,(Abstract), (in press).

Residents:Spire W, Jobst B, Darcey T, Thadani V, WilliamsonP, Roberts D. Robotic Image Guided DepthElectrode Implantation for Medically IntractableEpilepsy. Neurosurg Focus (in press).

Lollis S, Quebada P, Friedman J. Disorders of Consciousness: Traumatic Brain Injury,Handbook of Clinical Neurology, Vol. 90 3rdseries. Amsterdam, The Netherlands: Elsevier2008;pp 217-229.

Lollis S, Roberts D. Robotic Catheter Ventriculostomy: Feasibility, Efficacy, andImplications. J Neurosurg 2008;108:269-274.

Khan R, Mamourian A, Radwan T. Utility of Multislice CT and Reformatted Images:Illustrative Case of Migratory Intraventricular ClotExacerbating Obstructive Hydrocephalus. JNeurosurg 2008;109(1):156-158.

Radwan T. Surgical Neurology. In: Levin M,Holmes G, Cohen J. (Eds). Educational ReviewManual in Neurology, 2nd Ed., Castle ConnollyGraduate Medical Publishing. New York, NY, 2008.

Missios S. Hippocrates, Galen, and the Uses of Trepanation in the Ancient Classical World.Neurosurg Focus 2007;23(1):E11.

Missios S, Forero J, Quebada P, Pekala J,Durham S, Duhaime A. Use of Quick-BrainMagnetic Resonance Imaging for Non-Hydrocephalus Indications (abstract). In: 36thAnnual Meeting of the American Association ofNeurological Surgeons/Congress of NeurologicalSurgeons Section on Pediatric NeurologicalSurgery; Miami, FL, 2007.

OPHTHALMOLOGY

Michael E. Zegans, MDKirn T, Levy N, Gosselin JJB, Rosen W, Zegans M.Systematic T-Cell Lymphoma Presenting asSclerouveitis. Cornea October, 2007; 26(9):1147-1149.

OTOLARYNGOLOGY

Benoit J. Gosselin, MDGosselin, JJB. Peritonsillar Abscess. eMedicineJournal of Medicine, Obstetrics/Gynecology andSurgery, September 2007.

Kirn T, Levy N, Gosselin JJB, Rosen W, Zegans M.Systematic T-Cell Lymphoma Presenting asSclerouveitis. Cornea October, 2007; 26(9):1147-1149.

38

PUBLICATIONS

James E. Saunders, MDSaunders J. Prevalence and Etiology of HearingLoss in Rural Nicaraguan Children. TheLaryngoscope March, 2007;117(3):387-398.

Hales N, Shaki F, Saunders J. Titanium Middle Ear Prostheses in Revision Ossiculoplasty, DoesMass Really Matter? Am J Otolaryngol May-June,2007;28(3):164-167.

Saunders J. Early Surgical Intervention of Middle Ear Atelectasis Improves Long TermResults and Prevents Cholesteatoma? Archivesof Otolaryngology Head & Neck Surgery. InvitedManuscript (accepted for publication).

Mark C. Smith, MDBrookes J, Smith R, Menezes A, Smith M.Median Labiomandibular Glossotomy Approachto the Craniocervical Region. Childs Nerv SystSpecial Annual Edition April, 2008.

PEDIATRIC SURGERY

Ann-Christine Duhaime, MDDurham S, Duhaime AC. Basic Science:Maturation-Dependent Response of theImmature Brain to Experimental SubduralHematoma. J Neurotraum 2007;24(1):5-14.

Duhaime AC. Demographis of Abusive Head Trauma. J Neurosurg: Pediatrics February, 2008.

Hunter J, Duhaime AC. Accidental and Non-Accidental Craniocerebral Trauma in Children. In:Naidich T. (ed.). Imaging of the Brain and Spine.Elsevier 2008 (in press).

Saatman K, Duhaime AC. Manley G.Classification of Traumatic Brain Injury forTargeted Therapies. J Neurotrauma 2008 (in press).

Koob A, Harris B, Duhaime AC. Cellular Genesis in the Postnatal Piglet. (Ms. Ref. No.: DN-D-08-00026RI) Int J Developm Neuroscience 2008 (inpress).

Susan R. Durham, MDSites B, Durham S, Gallagher J, Bertrand M.The Use of Intraoperative Ultrasound byAnesthesiologists to Facilitate the SurgicalManagement of Peripheral Nerve Tumors of theUpper Extremity. Anesth Analg 2007;105(6):1845-1847.

Durham S, Duhaime A. Basic Science:Maturation-Dependent Response of theImmature Brain to Experimental SubduralHematoma. J Neurotraum 2007;24(1):5-14.

Durham S, Shipman S. A 15-Year Review of Pediatric Neurosurgical Fellowships: Implicationsfor the Pediatric Neurosurgical Workforce. JNeurosurg Ped 2008;2:3-10.

Durham S, Olenec K. Posterior Fossa Decompression with and without Duraplasty forthe Surgical Treatment of Chiari 1 Malformationin Children: A Meta-Analysis. J Neurosurg Ped2008;2:42-49.

Burton H. Harris, MDLopez M, Whyte C, Harris B, et al. LaparoscopicExcision of a Gastric Diverticulum in a Child. JLaparoendoscopic Surg 2007;17:246-48.

Ramos C, Whyte C, Harris B. Non-Traumatic Compartment Syndrome of the Extremities inChildren. J Pediatr Surg 2007;41:E5-7.

Vech S, Harris B. Appendicitis and Malrotation.J Pedatr Surg 2007;42:905-906.

Levin T, Blitman N, Harris B, et al. Non-Operative Management of Ruptured Appendicitis inChildren: Can CT Predict Outcome? J PediatrSurg 2007;17:186-190.

Whyte C, Lopex M, Harris B. Early Decisions in Perforated Appendicitis in Children: Lessonsfrom a Study of Non-Operative Management. JPediatr Surg 2008;43 (in press).

Lopez M, Whyte C, Harris B. Laparoscopic Interval Appendectomy as an OutpatientProcedure. J Pediatr Surg 2008:43 (in press).

Ramos C, Boley S, Harris B. Gastrointestinal Reconstruction after Emergency TotalGastrotomy for Gastric Volvulus. World J Surg2008 (in press).

PLASTIC SURGERY

E. Dale CollinsBarnato A, Llewellyn-Thomas H, Peters E,Siminoff L, Collins D, Barry M. Communicationand Decision Making in Cancer Care: SettingResearch Priorities for DecisionSupport/Patients’ Decision Aids. Med DecisMaking 2007;(27)626-634.

Hegel M, Collins D, Kearing S, Gillock, K,Moore C, Ahles T. Sensitivity and Specificity of

the Distress Thermometer for Depression inRecently Diagnosed Breast Cancer Patients. JPsycho-Onc October, 2007.

Wennberg J, O’Connor A, Collins D, Weinstein J.Extending the Pay-for-Performance Agenda: PartOne How Medicare Can Improve the Quality ofPatient Decision Making and ReduceUnnecessary Care. Health Affairs November,2007;26(6)1564-1574.

McCarthy C, Collins D, Pusic A. Where Do We Find the Best Evidence? Plastic andReconstructive Surgery, 2008 (in press).

Carolyn L. Kerrigan, MDMcCarthy C, Pusic A, Kerrigan C. Silicone BreastImplants and Magnetic Resonance ImagingScreening for Rupture: Do U.S. Food and DrugAdministration Recommendations Reflect anEvidence-Based Practice Approach to PatientCare? Plast Recon Surg 2008;121(4):1127-1134.

SURGICAL LAB RESEARCH

P. Jack Hoopes, DVM,PhDZeng Q, Baker I, Loudis J, Hoopes P. Synthesisand Heating of Effect of Iron/Iron Oxide

Composite and Iron Oxide Nanoparticles.Proceedings SPIE, Biomedical Optics2007;8(17)64400-K:138-148.

Pierce Z, Strawbridge R, Gaito C, Dulatas L,Tate J, Ogden J, Connolly K, Savellano M,Hoopes P. In-Vitro Investigations ofNanoparticle Magnetic Thermotherapy: AdjuvantEffects and Comparison to ConventionalHeating. Proceedings SPIE, Biomedical Optics2007;8(17)6440:180-187.

Gibbs S, O’Hara J, Hoopes P, Pogue B. Improved Murine Glioma Detection Following Modified Dietand Photobleaching of Skin PplX Fluorescence.Proceedings SPIE, Biomedical Optics 2007;6427-12:130-139.

Zhou X, Chen B, Hoopes P, Hasan T, Pogue B.Tumor Vascular Volume DeterminesPhotosensitizer Uptake in MATLyLu ProstateTumor Model. Proceedings SPIE, BiomedicaOptics 2007;6427-27:240-249.

Sheng C, Hoopes P, Hasan T, Pogue B.Photobleaching-Based Dosimetry PredictsDeposited Dose in ALA-PpIX PDT of RodentEsophagus. Photochem Photobiol; 83(3):738-48.

Chen B, Crane C, He C, Gondek D, Agharkar P, Savellano M, Hoopes P, Pogue B. DisparityBetween Prostate Tumor Interior versusPeripheral Vasculature in Response toVerteporfin-Mediated Vascular-Targeting Therapy.Int J Cancer 2008;123:695-701.

Dennis C, Jackson A, Bouchers J, Ivkov R,Foreman A, Strawbridge R, Pierce Z, Goerntiz E,Gruettner C, Hoopes P. The Influence of Magneticand Physiological Behavior on the Effectivenessof Iron Oxide Nanoparticles for Hyperthermia. JPhys D: Appl Phys March, 2008 (in press).

TRANSPLANTATION SURGERY

David A. Axelrod, MDAxelrod D, Schnitzler M, Salvalaggio P, SwindleJ, Abecassis M. The Economic Impact of theUtilization of Liver Allografts with High DonorRisk Index. Amer J Transplantation. 2007; 7:990-7.

Salvalaggio P, Schnitzler M, Abbot K, Brennan D,Irish W, Takemoto S, Axelrod D, Santos L, KocakB, Willoughby L, Lentine K. Patient and GraftSurvival Implications of Simultaneous PancreasKidney Transplantation from Old Donors. Amer JTransplantation. 2007; 7:1561-71.

Buchanan P, Schnitzler M, Brennan D,Dzebisashvili N, Willoughby L, Axelrod D,Salvalaggio P, Abbott K, Burroughs T, LentineK.Novel Methods for Tracking Long-TermMaintenance Immunosuppression Regimens.Clin J Am Soc Nephrol. 2008;3:117-24.

Axelrod D, Guidinger M, Finlayson S, Schaubel D, Goodman D, Chobanian M, Merion R. Accessto Heart, Liver, and Kidney Transplantation forResidents of Rural and Urban Areas in the U.S.JAMA. 2008; 299:202-7.


PUBLICATIONS

Lentine K, Schnitzler M, Brennan D, Snyder J,Hauptman P, Abbott K, Axelrod D, Salvalaggio P,Kasiske B. Cardiac Evaluation before KidneyTransplantation: A Practice Patterns Analysis inMedicare-Insured Dialysis Patients. Clin J Am SocNephrol. 2008;3:1115-24.

UROLOGY

Elizabeth Ann Gormley, MDGormley E. Urinary Incontinence. In RakelRobert E (ed). Connís Current Therapy. W.B.Saunders Co. 2007.

Gormley E. Management of the Patient with IC. In Goldman H (ed). Cases in Female Urology2007.

Gormley E. Urinary Incontinence. In Rakel Robert E (ed). Connís Current Therapy. W.B.Saunders Co. 2007.

Gormley E. Fasical Slings. In Resnick M (ed).Hinman’s Atlas of Urologic Surgery 3rd Ed (inpress).

VASCULAR SURGERY

Jack L. Cronenwett, MDCronenwett J, Liapis C. Vascular SurgeryTraining and Certification: An InternationalPerspective. J Vasc Surg 2007;46:621-629.

Cronenwett J, Likosky D, Russell M,Eldrup-Jorgensen J, Stanley A, Nolan B. ARegional Registry for Quality Assurance andImprovement: The Vascular Study Group ofNorthern New England (VSGNNE). J Vasc Surg2007;46:1093-1102. Epub October 19, 2007.

Fillinger M, Cronenwett J, Primary Vascular Certificate and the Five-Year Integrated VascularSurgery Training Program Pathway. VascularSurgery in the Endovascular Era. Evanston,Greenwood Academic Press, 2007;32-37.

Yuo T, Goodney P, Powell R, Cronenwett J.“Medical High Risk” Designation is notAssociated with Survival after Carotid ArteryStenting. J Vasc Surg. February 2008;47(2):356-362 Epub December 26, 2007.

Calligaro K, Toursarkissian B, Claggett G, Towne J, Hodgson K, Moneta G, Sidawy A, Cronenwett J.Clinical Practice Council, Society for VascularSurgery, Guidelines for Hospital Privileges inVascular and Endovascular Surgery:Recommendations of the Society for Vascular Surgery. J Vasc Surg January, 2008;47(1):1-5. EpubDecember 3, 2007.

Schemerhorn M, Zwolak R, Velazquez O,Makaroun M, Fairman R, Cronenwett J.Ultrasound Screening for Abdominal AorticAneurysm in Medicare Beneficiaries. Ann VascSurg (accepted for publication).

Mark F. Fillinger, MDFillinger M, Cronenwett J, Primary VascularCertificate and the Five-Year Integrated VascularSurgery Training Program Pathway. VascularSurgery in the Endovascular Era. Evanston,Greenwood Academic Press, 2007;32-37.

Kathleen Ann Martin, MDMartin K, Merenick B, Rzucidlo E, Fetalvero K,Ding M, Kozul C, Brown D, Chiu H, Shyu M,Drapeau B, Wagner R, Powell R. RapamycinPromotes VSMC Differentiation through IRS-1Feedback Signaling to Akt2 December 7,2007;282(49):36112-36120. Epub September 30,2007.

Rzucidlo E, Martin K, Powell R. Regulation of Vascular Smooth Muscle Cell Differentiation. JVasc Surg June, 2007;45(Issue 6, Suppl 1): 25-32.

Arehart E, Gleim S, Kasza Z, Fetalvero K, Martin K,Hwa J, Prostacyclin Atherothrombosis, andCardiovascular Disease. Current MedicinalChemistry 2007 (in press).

Arehart E, Stitham J, Asselbergs F, Douville K,MacKenzie T, Fetalvero K, Gleim S, Kasza Z, RaoY, Martel L, Segel S, Robb J, Kaplan A, Simons M,Powell R, Moore J, Rimm E, Martin K, Hwa J.Acceleration of Cardiovascular Disease by aDysfunctional Prostacyclin Receptor Mutation:Potential Implications for Cyclooxygenase-2Inhibition. Circ Res April, 2008;25;102(8):986-993.

Mary Jo Mulligan-Kehoe, MDMulligan-Kehoe M, Simons M. VascularDisease in Scleroderma: Angiogenesis andVascular Repair. Rheum Dis Clin N Amer 2008;34:73-79.

Richard J. Powell, MDYuo T, Goodney P, Powell R, Cronenwett J.“Medical High Risk” Designation is notAssociated with Survival after Carotid ArteryStenting. J Vasc Surg. February 2008;47(2):356-362 Epub December 26, 2007.

Martin K, Merenick B, Rzucidlo E, Fetalvero K,Ding M, Kozul C, Brown D, Chiu H, Shyu M,Drapeau B, Wagner R, Powell R. RapamycinPromotes VSMC Differentiation through IRS-1Feedback Signaling to Akt2 December 7,2007;282(49):36112-36120. Epub September 30,2007.


Arehart E, Stitham J, Asselbergs F, Douville K,MacKenzie T, Fetalvero K, Gleim S, Kasza Z, Rao Y,Martel L, Segel S, Robb J, Kaplan A, Simons M,Powell R, Moore J, Rimm E, Martin K, Hwa J.Acceleration of Cardiovascular Disease by aDysfunctional Prostacyclin Receptor Mutation:Potential Implications for Cyclooxygenase-2Inhibition. Circ Res April, 2008;25;102(8):986-993

Eva M. Rzucidlo, MDMartin K, Merenick B, Rzucidlo E, Fetalvero K,Ding M, Kozul C, Brown D, Chiu H, Shyu M,Drapeau B, Wagner R, Powell R. RapamycinPromotes VSMC Differentiation through IRS-1Feedback Signaling to Akt2 December 7,2007;282(49):36112-36120. Epub September 30, 2007.


David H. Stone, MDDeMartino R, Stone D. Repair of Multiple RightRenal Artery Aneurysms with AssociatedFibromuscular Dysplasia in a Solitary Kidney. JVasc Surg (accepted for publication).

Stone D, Walsh D. Graft Thrombosis:Interrogation, Etiology, and Management. InCronenwett J (ed). Vascular Surgery, 7th edition. W.B. Saunders Company, Philadelphia PA 2008 (inpress).

Daniel B. Walsh, MDBurchard K, Henriques H, Walsh D, Ludington D,Rowland P, Likosky D. Is it Live or is it Memorex?Student Oral Examinations and the Use of Videofor Additional Scoring? Am J Surg 2007;193(2):233-236.

Stone D, Walsh D. Graft Thrombosis:Interrogation, Etiology, and Management. InCronenwett J (ed). Vascular Surgery, 7th edition. W.B. Saunders Company, Philadelphia PA 2008 (inpress).

Robert M. Zwolak, MD, PhDWyers M, Zwolak R. The Role for PercutaneousTreatment of Chronic and Acute MesentericIschemia. In: Pearce W, Matsumura J, Yao J (ed).Trends in Vascular Surgery. Greenwood Academic,Evanston, IL 2007 (in press).

Zwolak R. Government Relations Update. In:Pearce W, Matsumura J, Yao J (ed). Trends inVascular Surgery. Greenwood Academic Evanston,IL 2007 (in press).

Schemerhorn M, Zwolak R, Velazquez O,Makaroun M, Fairman R, Cronenwett J. UltrasoundScreening for Abdominal Aortic Aneurysm inMedicare Beneficiaries. Ann Vasc Surg (acceptedfor publication).

Duong M, Mackenzie T, Zwolak R, Kaplan A,Robb J, Thompson C. Correlation of InvasiveDoppler Flow Wire with Renal DuplexUltrasonography in the Evaluation of Renal ArteryStenosis: The Renal Artery Stenosis InvasiveDoppler (RAIDER) Study. J Vasc Surg 2007;45:284-288.

Zwolak R, Kent C. Screening for Abdominal Aortic Aneurysms, an Update. Endovascular Today2008;7:51-54.

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PUBLICATIONS

This 2008 Annual Report was produced by the Department of Surgery with contributions from numerous faculty and staff members.A special thank you to Laura Stancs and to Bob Hagen of The Hagen Group, Hanover, NH, for all their efforts in coordinating this annual report.

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