JAMA Article Highlights Critical Need for Surgeons to Address Smoking Cessation with Patients

A recent Viewpoint article  in JAMA, co-authored by  John Maa, M.D., Assistant Professor of Surgery at UCSF, highlighted the importance of smoking cessation before surgery, a conversation that both improves surgical outcomes and creates a teachable moment in the life of the patient:

"Elective surgery offers a powerful opportunity for physicians to help smokers quit, yet 25% to 30% of patients smoke perioperatively, and approximately 10 million patients who smoke undergo surgical procedures annually. Approximately 42% of all surgeons and 70% of anesthesiologists do not routinely counsel patients to stop smoking before an operation or do not refer them to appropriate cessation services........Perioperative smoking is linked to surgical complications including wound infection, respiratory failure, cardiac arrest, myocardial infarction, prolonged hospital stay, stroke, sepsis, shock, and anastomotic leak."

Maurice Galante, M.D., Legendary Surgeon and Renaissance Man, Dies

Dr. Maurice Galante, whose professional career at UCSF spanned an incredible 44 years (1945-1989), passed away on February 5, 2013. Dr. Galante was born in Rhodes in 1919 and came to the United States alone to receive his undergraduate and medical education. He entered his residency training in general surgery at UCSF in 1945. He subsequently became a member of the Department of Surgery faculty. As a faculty member at UCSF, Dr. Galante was celebrated as a master surgeon and for his varied interests in medical ethics, music and the arts. His reputation with patients was legendary and his grateful patients helped him and the Department of Surgery establish the Galante Lecture Program, The Galante Research Program and the Maurice Galante Distinguished Professorship.

Rogers Urges Caution on New Medical Device to Treat GERD

A recent study in the New England Journal of Medicine touts a new medical device for the treatment of  Gastroesophageal Reflux Disease (GERD) as an alternative to standard therapy, long-term proton-pump inhibitors or Nissen Fundoplication. The new treatment is a surgical procedure in which a small band of magnetic beads is surgically implanted  to augment the lower esophageal sphincter, the valve between the esophagus and stomach. 

But Stanley J. Rogers, M.D., Associate Professor of Surgery at UCSF, Chief of Minimally Invasive Surgery, and Chief of Bariatric Surgery, expressed concern about its use, telling CBS/KCBS News Healthwatch that the device  was essentially untested except for the small study cited above. He cautioned that the beads were a foreign object and where the device was placed could potentially cause serious complications including infection, perforation and abdominal sepsis, leading to ultimate removal. He emphasized that long-term data was needed to demonstrate its safety and effectiveness. 

CFCF Awards New Research Grant to Dr. Eric Nakakura to Study Resistance to mTOR Inhibition in Pancreatic Neuroendocrine Tumors

Eric Nakakura, M.D., Ph.D. has been awarded the 2012 Caring for Carcinoid Foundation-AACR Grant for Carcinoid Tumor and Pancreatic Neuroendocrine Tumor Research. Dr. Nakakura will receive $250,000 over two years to understand why some patients develop resistance to mTOR inhibiting drugs like everolimus. In particular, he will focus on INK128, a new mTOR inhibitor to see if it can overcome this resistance in mouse models of pancreatic neuroendocrine cancer. He will also evaluate the utility of (68)GA-DOTATOC PET-CT to monitor tumor response to mTOR inhibiting therapies like everolimus and INK128. 

Bariatric Surgery May Improve Chances for Successful Organ Transplantation

"Bariatric surgery has been widely accepted in the medical field, but now we're trying to apply it to specific patient groups," said Matthew Y.C. Lin, M.D., a gastrointestinal surgeon, a former surgical fellow*, and now an Assistant Professor of Surgery at UCSF. In a pilot study of 26 morbidly obese patients waiting for a kidney or liver transplant, Dr. Lin and colleagues in the UCSF Bariatric Surgery Program found laproscopic sleeve gastrectomy, a procedure that removes most of the stomach and reshapes it into a small tube or sleeve, significantly improved the chances of undergoing successful organ transplantation. "The reason why physicians are skittish about bariatric surgery for organ transplant is that these patients have more medical comorbities," said Lin, who is the lead author of the study. "But our study shows that it is safe to proceed."

* Fellowship in Minimally Invasive Surgery generously underwritten by Foundation for Surgical Fellowships.

Jonathan Carter, M.D. Discusses Obesity in America and Treatment Options on UCTV

In a recent UCTV presentation,  Jonathan Carter, M.D., an Assistant Professor of Surgeryand bariatric and gastrointestinal surgeon, discussed in a video why Americans are increasingly obese and medical and surgical approaches to treatment.

Captain Chesley B. “Sully” Sullenberger, III Discusses Relationship between Aviation Safety & Optimal Patient Care

On November 5th,  Captain Chesley B. "Sully" Sullenberger, III spoke to a UCSF audience at Cole Hall on "Leadership in Advancing National Efforts in Patient Safety and Optimal Quality of Care". Captain Sullenberger spoke at the invitation of Nancy L. Ascher, M.D., Ph.D., Chair of UCSF Department of Surgery. Sullenberger had previously collaborated on healthcare issues with UCSF surgeon John Maa, M.D. He was introduced by Hobart W. Harris, M.D., M.P.H., Chief of the Division of General Surgery, who underscored how Sullenberger's aviation experience has informed patient safety and the evolution of modern clinical practice.

Drawing on his 43-year career as a pilot and safety expert, Captain Sullenberger demonstrated the importance of effective leadership, the necessity of understanding the science of safety, and the vital need for all health care institutions to build a robust culture of safety that improves outcomes, saves lives and reduces costs. For the benefit of those who could not attend, the lecture was recorded.

"Inside Surgery", The Department of Surgery Newsletter, Summer 2012

This issue of Inside Surgery describes several exciting developments that are advancing our ability to provide outstanding care for a range of patients including the new Hepatobiliary Service, under the direction of  Carlos Corvera, M.D., which provides comprehensive, multidisciplinary care for patients with liver and bile duct disease. Other topics include updates on  Endocrine Surgery, San Fancisco General Hospital's Wraparound Project, and notable rankings of our surgeons within U.S. News & World Report annual update.

Deadly Liver Cancer May Be Triggered by Cells Changing Identity, UCSF Study Shows

Intrahepatic bile duct cancer, a rare and deadly form of cancer, known formally as cholangiocarcinoma, has been assumed to derive from cells in the bile ducts of the liver. However, an international team, led by  Holger F. Willenbring, M.D., Ph.D., Associate Professor of Developmental and Stem Cell Biology in the Division of Transplant Surgery, Xin Chen, Ph.D.,and other prominent researchers, has shown that the disease actually may develop when hepatocytes, the most common type of liver cell, are transformed into intrahepatic cholangiocarcinoma cells or (ICCs),   a process scientists previously thought all but impossible. The researchers were able to induce cholangiocarcinoma in mice by activating two well-known genes, Notch and AKT. Their discovery has therapeutic potential in that drugs targeting the aberrant activity of those genes could lead to the effective treatments currently lacking and to improved long-term survival.

Hepatobiliary & Pancreas Service at UCSF

In July 2011, the Department of Surgery created a new  Hepatobiliary and Pancreas Service naming Carlos Corvera M.D., a hepatobiliary surgical oncologist, as its Chief. The multidisciplinary program brings together faculty members from surgery, hepatology, medical oncology, anesthesia, radiology and pathology to care for patients with benign and malignant conditions of the liver, gallbladder, biliary tract and pancreas. The service holds clinics and weekly tumor boards at the Mt. Zion and Parnassus campuses of UCSF. "Rather than isolated silos of care, we have a team approach, which makes a big difference for the overall care of the patients," said Dr. Corvera. "When you are looking at a broad spectrum of disease, there are often competing therapies for which a patient  might be a good candidate," said John Roberts, MD, FACS, chief of the  UCSF Transplant Service."

Targeted Gene Therapy Offers Relief from Pain and Inflammation

Chronic pain affects an estimated 116 million Americans and costs $635 billion each year in medical treatment and lost productivity. Aditi Bhargava, PhD, Associate Professor in the UCSF Department of Surgery and Director of the Bhargava Lab, is using a technique known as RNA interference (RNAi) to develop a gene therapy system that sends specific commands to certain neurons, or nerve cells, telling them to turn off pain, or stop inflammation.

"The current treatments for pain dull everything," Bhargava said. "You have a little fire in the kitchen, but your only solution is a fire hose that floods the entire house. You put out the fire, but you're affecting the whole house in the process - a huge negative side effect."

Likening her method to a Trojan horse, Bhargava's novel therapeutic approach essentially hides the pain-silencing commands, carried by distinct proteins that affect cellular function, inside other proteins which bind only to the troublemaker cells. Once attached, they release their hidden power.  Text above includes excepts from UCSF News story by Kate Rauch

Twenty-Five Department of Surgery Faculty Named to U.S. News Top Doctors List

In its most recent survey, U.S. News in collaboration with Castle Connolly Medical Ltd. listed twenty-five (25) surgeons in the UCSF Department of Surgery, nearly one-third (1/3) of the clinical faculty, on the list of U.S. News "Top Doctors". The list, compiled from the opinion of colleagues, denotes the top 10% of physicians within a region practicing a given specialty. Fifteen of the 25 department surgeons were also named by their peers to the list of America's Top Doctors (ATD), a distinction reserved for the top 1% of physicians in the nation for that specialty. The listings are published online at U.S. News. The group rankings are intended to guide patients in selecting a doctor and physicians in making specialty referrals.

Physicians Emphasize Importance of Story Telling to Advance Patient Care

"Two doctors who have learned the art of telling stories are convinced that it has become indispensable to top-notch medical care. "A slow cultural shift over the past 20 years led by television - from "St. Elsewhere" to "ER" - has been humanizing society's view of the practice of medicine," said John Maa, M.D., an assistant professor in the UCSF Department of Surgery. "... As physicians, we must now harness the power of storytelling to enlighten Capitol Hill to enact new laws" to support emergency health care personnel. Maa spoke at Grand Rounds on "The Future of Emergency Care in America: Doctors as Storytellers." He was joined in Cole Hall by Neal Baer, M.D., executive producer and writer for television's "ER" and "Law & Order: Special Victims Unit." His current show is "A Gifted Man."

Code Red: Repairing Blood in the Emergency Room

UCSF/SFGH surgeon and trauma researcher, Mitchell J. Cohen, MD, has teamed up with researchers around the globe to change the way acute traumatic coagulopathy is treated.  His work is leading to a new understanding of the causes of and appropriate treatment for uncontrolled bleeding after trauma.

"It seems that sometimes major injuries trigger a problem with the blood-clotting process, causing blood to leak from the body faster than it can be stemmed. This clotting disorder affects as many as 1 in 4 major trauma victims. So Brohi and others have developed a way of treating people that prioritises fixing their blood over fixing their body. It's a radical departure from standard procedures, and one that is by no means widely accepted, but if they're right it could save thousands of lives every year worldwide, and a whole chapter of trauma care will have to be rewritten."

UCSF Accredited by the American College of Surgeons as Level 1 Accredited Bariatric Center (ACS BSCN)

UCSF has been accredited by the American College of Surgeons (ACS) as a Level 1 Accredited Bariatric Center (ACS BSCN). The American College of Surgeons Bariatric Surgery Center Network Accreditation Program (ACS BSCN) accredits facilities in the United States that have undergone an independent, voluntary and rigorous peer evaluation in accordance with nationally recognized bariatric surgical standards. This adds to the prestige of the program which previously also earned the Blue Distinction for Bariatric Surgery   from Blue Shield of California and was designated a Blue Cross "Center of Expertise Hospital for bariatric surgery.