GrandRoundsSaint Louis University School of MedicineFall 08

Match Day The Class of 2008 moves on. | page 14

On the Front Lines SLU physicians help prepare military medics for the battle-field. | page 16

Poised for Discovery Researchers target chronic pain and cancer. | page 12

Vital Signs | page 2

Living the Mission | page 19

Alumni Pulse | page 20

Wasting No Time Dean Alderson begins his tenure. | page 6

Researcher Responds to Global Alarms Set Off by New Tuber-culosis Strains New vaccines and new delivery systems. | page 10

page 16

page 6For more information about

the magazine or to submit story suggestions, please contact

314 | 977-8335 or grandrounds@slu.edu.

page 20

GrandRoundsVol. 6 No. 2 Saint Louis University School of MedicineFall 08

page 2

On the coverPhilip O. Alderson, M.D., dean of the school of medicine, sur-rounded by the Class of 2012 at the annual White Coat Ceremony. Alderson told the students this “is the beginning of a stimulat-ing adventure and a rewarding career. It will be challenging, but savor it.” Turn to page 6.

Grand Rounds is published biannually by

Saint Louis UniversityMedical Center

Development and Alumni Relations.

Grand Rounds is mailed to alumni and friends of the

School of Medicine.

Philip O. Alderson, M.D.Dean | Saint Louis University

School of MedicineSchwitalla Hall M2681402 S. Grand Blvd.

St. Louis, MO 63104-1028

GrAnd roundS EditoriAL BoArd Terence A. Joiner, M.D. ’82

Philip O. Alderson, M.D.Edward J. O’Brien Jr., M.D. ’67

Thomas J. Olsen, M.D. ’79

CoordinAtor | writErMarie Dilg | SW ’94

dESiGnErDana Hinterleitner

ContriButorSLaura Geiser | A&S ’90 | Grad ’92

Nancy SolomonCarrie Bebermeyer | Grad ’06

Sara Savat | Grad ’02

Photo CrEditSSteve Dolan | Cover, 1, 4, 8-9, 12-

13, 16-18, Back CoverKabance Photography | 14-15, 21

From the Alumni Association President | New

beginnings. Opportunities to grow and develop. These are com-

mon themes throughout this issue of Grand Rounds. Indeed

they are common themes at the School of Medicine. They are

worthy of exploration as we identify opportunities and face

challenges in medical education, health sciences research and

health care delivery.

Students and residents enter the School of Medicine and

its training programs in repeating, annual cycles. Each new

group replaces one that has advanced to another stage in

development. Graduates of the school have begun residency

training in programs throughout the country. Other graduates

from the past few years have completed specialty and subspe-

cialty training and are entering practice or joining the faculty at

hospitals. New beginnings.

New faculty and departmental chairs bring their unique

talents and experience and build on existing training, patient

care and research programs. The research activity of a univer-

sity is an integral component of its mission. Scientists build

on and expand medical knowledge. They do this in a process

that includes trainees, and this helps to ensure a supply of

experienced investigators to continue to expand our under-

standing of medical science. This in turn leads to discovery of

new ways to heal and relieve suffering.

On page 20, we continue our “Do You Remember” feature

and ask you to recall Dr. C. Rollins Hanlon and Dr. Vallee L.

Willman. Those of you who have written in the past in re-

sponse to this feature have told us of how your personal and

professional lives were touched by faculty. You have told us

how you came to grow and develop during your time at Saint

Louis University School of Medicine. Please continue to be

generous and share your memories.

Also in this issue we are pleased to help you get to know

our new dean, Dr. Philip Alderson, a little better. I know some

of you have met him, and I know that many will have that op-

portunity in the future. Positions of leadership offer opportuni-

ties for growth and development as well. Dr. Alderson brings

a wealth of experience in leadership positions in medical

schools, hospitals and professional organizations. He brings

his skills as a clinician and radiologist, a researcher and an ad-

ministrator. He has committed to help our School of Medicine

grow and develop. This is not a unilateral commitment. The

search for a new dean may have ended with the appointment

of Dr. Alderson, but the process of helping him to be success-

ful has only just begun. All of us — students, faculty, staff,

alumni, University administrators — have made a commitment

to Dr. Alderson to help him to be the leader we want and need.

We have promised him an opportunity to grow and develop.

Some work has been done. Much remains. We all have a role

to play.

Regards,

thomas J. olsen, M.d. (’79)

Adenovirus +

CP

Adenovirus+

CP+

CMX001

A B

C

N

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page 20

VitalSignsjournal articles and other reviews on family violence; child, intimate partner and elder abuse; medical safety; and end-of-life medical care. He also has been principal investigator on many research and training grants in these subject areas.

Gary R. Haynes, M.D., Ph.D., has been named chairman of the department of anesthesiology and critical care.

Prior to coming to the SOM, Haynes was at the Medical University of South Carolina where he had been on faculty since 1990 — most recently as professor and vice chairman of the department of anesthesia and periopera-tive medicine.

Haynes received his Ph.D. and M.D. degrees from Case Western Reserve Univer-sity in 1984 and 1986 before completing his anesthesiol-ogy residency at the Medical University of South Carolina.

He received his bachelor’s degree from Illinois College in Jacksonville, Ill., and his master’s degree in experimental pathology from

the University of Cincinnati. Haynes is the author of

more than 50 publications. His research interests include evaluation of non-invasive bioimpedance cardiac output devices in pediatric cath labs and perioperative surgical and electroconvulsive therapy procedures.

John P. Long, D.V.M., has been named chairman of the department of comparative medicine. Prior to this appointment, Long was associate professor of comparative medicine and vice chairman of the department. He also is the attending veterinarian at the medical school.

Long received his bach-elor’s of science degree from Southern Illinois University in 1991 and his doctor of veterinary medicine degree from Louisiana State Univer-sity in 1997. He completed his residency and postdoc-toral fellowship in laboratory animal medicine at Wash-ington University School of Medicine in 2000.

Long was a research instructor in the division of orthopedic surgery at Wash-ington University.

A Diplomate of the American College of Labora-tory Animal Medicine, Long is a board member of the Academy of Surgical Re-search and program chair of the American Association

of Laboratory Animal Sci-ence. He is a member of the American Veterinary Medical Association and the American Society of Laboratory Animal Practitioners.

Long succeeds Richard Doyle, D.V.M. who retired from the position.

Robotic Dog Makes Nursing Home Residents Less Lonely | A SLU study suggests that a sophisticated robotic dog could be a good companion for your dog-loving grandmother who can’t care for a living pet.

The researchers compared how residents of three nurs-ing homes interacted with Sparky, a living, medium-sized gentle mutt, and Aibo, a dog-gie robot once manufactured by Sony that looks like a three-dimensional cartoon.

“The most surprising thing is they worked almost equally well in terms of alleviating loneliness and causing residents to form attachments,” said William

Philip O. Alderson, M.D., dean of the school of medicine, has announced the appointment of three new department chairs whom he described as being “committed to excellence in patient care, education and research.”

F. David Schneider, M.D., M.S.P.H., has been named chairman of the department of family and community medicine.

Schneider came to the SOM from the Texas Health Science Center of San Antonio, where he was profes-

sor of family and community medicine and vice chairman of the department.

Schneider received his M.D. from Boston University School of Medicine in 1987. He completed his internship and residency training at the Duke Family Practice Resi-dency Program in Fayetteville, N.C. He also completed a fellowship in academic family medicine at the University of Missouri-Columbia, during which he earned an M.S.P.H. in epidemiology.

Schneider is nationally recognized for his work with the Academy on Violence and Abuse. He is one of the founders of the academy and serves on its nominating committee, board of directors and executive committee.

Schneider is the author of numerous book chapters,

Researchers Find Smallpox Drug May Also Target Adenovirus | SOM scientists have made two key

discoveries that could lead to the first-ever human testing of a drug

to target the adenovirus.

There are no drugs approved specifically to treat adenovirus

infections in large part because there has been no animal model in

which to test drug candidates. SLU researchers and their collabo-

rators, however, have made two breakthrough findings: an animal

model suitable for adenovirus testing — the Syrian hamster — and

a drug that successfully attacks the adenovirus in those animals.

The drug, hexadecyloxypropyl-cidofovir or CMX001, is under

development by Chimerix Inc. as a biodefense agent to meet the

threat of smallpox or monkeypox viruses and as an antiviral agent

in transplant patients.

“This is exciting news and a major step forward in finding a drug

to treat adenovirus infections in humans,” said William Wold, Ph.D.,

professor and chairman of the department of molecular microbiol-

ogy and immunology and the study’s lead author.

CMX001 is an oral pro-drug of cidofovir, a drug developed by

Gilead Sciences Inc. to treat a type of retinitis in AIDS patients.

Chimerix licensed from Gilead the rights to develop CMX001.

Cidofovir has long been a possible candidate to treat a number

of virus infections, including the herpes virus, poxvirus and adeno-

virus infections in humans. The drug, however, is quite toxic to

the liver and kidneys and is not available in oral form, which limits

widespread use.

Using the new animal model, the SLU researchers found that

CMX001 provided protection from the adenovirus when it was ad-

ministered prophylactically or therapeutically. The scientists found

that the drug worked by greatly reducing the ability of the virus to

replicate in key organs, mostly notably the liver.

The SLU team also found that CMX001 was much less toxic and

far more powerful than cidofovir. In addition, scientists discovered,

two weeks after infection with the virus, CMX001 had reduced the

viral load in the liver and blood to undetectable levels.

The SLU research was published in a May edition of the

Proceedings of the National Academy of Sciences.

A. Banks, M.D., professor of geriatric medicine.

To test whether residents connected better with Sparky or Aibo, researchers divided a total of 38 nursing home residents into three groups. All were asked questions to assess their level of loneliness.

One group saw Sparky once a week for 30 minutes, another group had similar visits with Aibo, and a control group saw neither furry nor mechanical critter.

After seven weeks, all resi-dents were asked questions about how lonely they felt and how attached they were to Sparky or Aibo.

The residents who re-ceived visits from real and ar-tificial pooches felt less lonely and more attached to their canine attention-givers than those who got visits from nei-ther. There was no statistical difference between whether the real or robotic dog did a better job easing loneliness and fostering attachments.

The research was pub-lished in the March issue of the Journal of the American Medical Directors Association.

Researchers Test Oral Medication for MS | Researchers at SLU are testing an investigational pill to treat relapsing-remitting multiple sclerosis.

There are various medica-tions to slow or modify the progression of the disease, but all must be injected into the skin, muscle or veins, making the search for an oral medication a top priority.

SLU will be one of several dozen sites around the world where researchers will study how patients with relapsing-

remitting MS respond to the experimental drug laquini-mod, which is taken in tablet form once a day. About 1,000 patients

will be enrolled worldwide. “Laquinimod seems to

modulate how the immune system works,” said Florian P. Thomas, M.D., Ph.D., profes-sor of neurology and the study’s principal investigator. “In smaller, earlier trials, the drug reduced the likelihood of relapses in patients, as well as the number of MS lesions seen on MRI tests.”

3 GrandRoundsSaintLouisUniversitySchoolofMedicine

I would love to have some clinical image friom Dr.

Wold to run here.

CMX001 decreases adeno-virus-induced lesions in the

liver. Livers of adenovirus-infected hamsters were

subjected to histopathological and immunohistochemi-

cal evaluation, in which an antibody directed against

an adenoviral protein stains infected cells brown. Animals infected with adenovirus and not treated with CMX001 ex-hibited extensive coagulation necrosis throughout the liver

(A) and widespread replication of adenovirus, demonstrated by staining for the adenoviral

fiber protein (B). Treatment of Ad5-infected hamsters with CMX001 resulted in a significant reduction in

hepatocellular injury (C) and greatly reduced staining for

fiber (D). The arrows indicate intranuclear inclusion bodies. The scale bars represent 200 μm for the larger pictures and

50 μm for the insets. N: necrosis

haynes

thomas

Schneider

Adenovirus +

CP

Adenovirus+

CP+

CMX001

A B

C

N

D

Gladys Moore, a resident of NHC Healthcare of

Maryland Heights, Mo., plays with Aibo, a robotic

dog used in a study of companionship.

Varvares Holds the Donald and Marlene Jerome Endowed Chair | Mark Varvares,

M.D. (’86), chairman of the

department of otolaryngology–

head and neck surgery,

has been appointed as the

inaugural holder of the Donald

and Marlene Jerome Endowed

Chair in Otolaryngology–Head

and Neck Surgery.

The chair is named for Don-

ald Lee Jerome, M.D. (‘61),

of Swansea, Ill., and his wife,

Marlene. Jerome, an alumnus

and strong

supporter of

the SLU School

of Medicine,

was in private

practice as an

otolaryngologist

in Belleville for

33 years before retiring.

For many years, Jerome

was the only ear, nose and

throat doctor in town and

drew patients from as far as

Evansville, Ind. He had served

as a Medical Service Corps of-

ficer in the U.S. Army between

1966 and 1968, spending

much time in Japan and hospi-

tals in southeast Asia.

“Not only has Dr. Jerome

directly touched the lives of his

patients, but through his gener-

osity he will expand his circle

of influence to touch countless

others he has not even met,”

said Varvares.

Jerome had high praise for

Vavares.

“Dr. Varvares came from

Harvard and he is involved not

only in the practice of medicine

but also with some research

projects, too,” Jerome said.

“He really put SLU on the map

as an excellent ENT program.”

Labovitz Invested as Jack Ford Shelby Endowed Professor | Arthur Labovitz, M.D., director

of the division of cardiology

has been named the Jack Ford

Shelby Endowed Professor in

Cardiology.

The profes-

sorship is

named for Jack

Ford Shelby,

chairman

emeritus of

Camie-Campbell

Inc., former

chairman of the board of the

St. Louis Heart Association

and a long-time benefactor of

the medical school.

“My father always told me

that joy is in giving. Now that

I’m older, I realize how wise my

dad was,” Shelby said.

“I love the University and

have tremendous regard for

the medical facility, particular-

ly. I am so blessed in my life,

with my family, my partners,

my company and my friends

at SLU. I’m honored that Dr.

Labovitz will hold the professor-

ship that bears my name.”

Labovitz has been affiliated

with SLU since he began his

cardiology fellowship in 1981.

“I feel delighted, honored

and greatly humbled by this

recognition. I am going to be

very proud to include this label

in all of my correspondence,

at all my meetings and during

my professional interactions,”

Labovitz said.

Former Faculty Member Endows Ophthalmology Chair | In June, the School

of Medicine celebrated the

establishment of a chair

in ophthalmology, which is

endowed by Anwar Shah,

M.D., a longtime benefactor

and member of the University

family.

“Through the Anwar Shah

Endowed Chair in Ophthalmolo-

gy, Dr. Shah will leave a legacy

forever linking his name with

Saint Louis University’s,” said

Oscar A. Cruz, M.D., chairman

of the department of ophthal-

mology.

Shah began his relation-

ship with SLU as an intern and

resident in ophthalmology after

coming to the United States

from Pakistan as a Fulbright

Scholar in 1955.

“I’ve been part of Saint

Louis University for a very long

time. It’s been getting better

and bigger and more known

nationally,” said Shah, who

now lives in California.

Shah was a member of the

SLU faculty for years, training

numerous ophthalmology resi-

dents in retinal disease. He

also created a two-year retinal

fellowship program at SLU,

among the few in the country

to provide this advanced,

specialized training to ophthal-

mologists.

He built the St. Louis Eye

Hospital, a $5 million nonprofit

project, which was inaugurated

with a benefit performance by

legendary comedian Bob Hope

in December 1980. The facil-

ity was later acquired by St.

Mary’s Hospital.

Pelvic Organ Prolapse Runs in Families | A SLU study has found that pelvic organ prolapse runs in families.

Women with a family history of hernia or prolapse were at 1.4 times greater risk of prolapse than those without a close relative with the problem.

SLU researchers studied 458 women who came into a gynecologist’s office for care. Nearly half had a family member — a grandparent, parent or sibling — with a hernia or prolapse. Of these, more than half had prolapse.

Of the women without a relative who had a hernia or prolapse, about 29 percent had prolapse, significantly

fewer than those with a direct family connection.

“If your father has had a hernia, and your mother has prolapse, you already have a risk of prolapse and should look at changing the things you can control to reduce your risk,” said Mary McLen-nan, M.D., director of the division of urogynecology and lead study author.

“Women with a family his-tory should not take a job that requires them to do heavy lift-ing. They should watch their weight. They should avoid becoming constipated so they don’t strain during bowel movements,” she said.

The research was pub-lished in an online edition of International Urogynecology Journal.

Researchers Study an Alzheimer’s Vaccination | Researchers are studying whether an investigational intravenous drug given to patients who have been diagnosed with mild to moderate Alzheimer’s disease can enhance the body’s own immune response in fighting the disease.

“This therapy is the first treatment of its kind and holds great potential,” said George Grossberg, M.D., Samuel W. Fordyce professor of psychiatry, director of the division of geriatric psychia-try and principal investigator for the clinical trial.

“Immune therapy has promise for being able to modify the course of Al-zheimer’s disease rather than simply treat the symptoms of the disease as current FDA-approved therapies do.”

Grossberg called the treatment a “vaccination” ap-proach because it introduces into the body an antibody to attack the plaque that forms inside the brain of those who have Alzheimer’s disease.

Patients who participate in the research will receive an intravenous infusion of an antibody to the beta amyloid protein. Scientists believe beta amyloid protein triggers the death of brain cells in pa-tients who have Alzheimer’s disease.

Study participants will be randomly assigned to one of three groups: two receive different doses of the study drug, and one will receive a placebo. About 2,050 participants are sought at ap-proximately 200 study sites in the United States and Canada. SLU is the only study site in St. Louis.

Endowed

professorships

help the medical

school attract

high-caliber faculty

and provide the

resources needed to

conduct research,

educate physicians

and provide patient

care. In the last few

months, SLU School

of Medicine has been

proud to announce

the creation and

installation of four

new chairs.

Labovitz

VitalSignsSaintLouisUniversitySchoolofMedicineGrandRounds4

In May, SLU dedicated the building at 1438 S. Grand Blvd., as Monteleone Hall in honor of Patricia Monteleone, M.D., dean emerita of the School of Medicine. The building houses the department of neurology and psychiatry, and is used for academic offices, patient treatment and clinical research.

“Pat may have left SLU as a faculty member and administrator, but thanks to the stellar graduates she has shepherded through the School of Medicine, her legacy will live on during the decades to come,” University President Lawrence Biondi, S.J., said at the dedication ceremony.

Varvares

Endowed Professorship Named for Dr. Slavin | An

endowed professorship in

allergy and immunology

named for long-time faculty

member Raymond Slavin, M.D.

(’56), and his wife, Alberta,

recognizes Slavin as one of the

giants in the field of allergy.

Slavin has conducted

research, treated patients and

educated students, residents

and allergy fellows at SLU for

nearly 43 years.

The lead donors in endow-

ing the professorship are

Bob Fox, founder and CEO of

NewSpace Inc. and a University

trustee, and his wife Maxine

Clark, founder and chairwoman

of Build-A-Bear Workshop.

“We are delighted to have

participated in this way of

honoring Ray. He’s done great

work at the University, and we

want to encourage that kind of

commitment to go on forever,”

Fox said.

Slavin and Fox first met

about 30 years ago, running

through Forest Park, and

became friends who supported

each other professionally.

“Our families’ friendship

goes back many years, which

is why I’m so deeply touched

by Bob and Maxine’s generos-

ity,” Slavin said. “The endowed

professorship creates a legacy

that means what I’ve built for

the last 43 years is going to

continue.”

Other donors have joined in

recognizing the contributions of

the Slavins by contributing to

the endowed professorship.

Within48hoursofopeningthedoortohisnewoffice,PhilipO.Alderson,M.D.,wasun-packed.HehadhisPendaflexfilefoldersinalphabeticalorderandhisprofessionaljournalsneatlystackedontheshelves.WithinthefirstweekoftakingoverasdeanofSaintLouisUniversitySchoolofMedicine,AldersonhadmetwithnearlyeverySOMdepartmentchairandwentonawalkaboutintheDoisyResearchCenter,poppinginonresearcherstoaskabouttheirwork.Withinthefirstmonthonthejob,Aldersonhadheldtown-hall-stylemeetingswithfacultyandstudents.Healsohadgonetotheotherendofcampustointroducehimselftodeans,departmentchairsandadministratorsthere.

WASTING NO TIMEThe School of Medicine’s 12th dean begins his tenure and lays out his plans for the school’s future.

Clearly,Aldersonhitthegroundrunningwhen he started his new job on April 1, and he has no intention of slowing down.

The internationally recognized radiologist said he plans to keep this pace to take the School of Medicine to the next level of scholarship, education and patient care. In this interview with Grand Rounds, Alderson talked about why he wanted the job and how he hopes to achieve his goals.

GR:Whatattractedyoutothisjob?My wife and I grew up in St. Louis, and we liked the city.

But my work kept us away for a long time. Then our daughter moved back here with her husband about four years ago, and they have two young children. We began visiting on a regular basis — three or four times a year — and we were reminded of how vibrant the city is. Our daughter did her cardiology training at SLU, and when we’d pick her up on campus we’d see how much SLU had changed. It was impressive. But all of this was theoretical, just impressions. We weren’t thinking of moving back until I learned the school was looking for a dean. I thought becoming a dean would be a natural step forward in my career as a department chair at a large research-oriented medical school, so I applied and, eight months later, here I am.

I also saw tremendous potential in the job. The school of medicine now has the tangible assets and resources, such as the Doisy Research Center, to make a move up. It’s not to say the school isn’t doing well. It’s a solid, mid-level school ranked number 56 in the county (U.S. News and World Report). Let’s get into the top 50, and once we’re there, let’s get into the top 40. We have to leverage our resources to enhance the visibility and reputation of the school, and I want to help do that.

GR:Whatotherassetsorstrengthsdoyouseeintheschool?I think the commitments to service and education are strengths. A lot of schools talk about the importance of education and service, but it isn’t really their main goal. Profit through research and clinical work is a major part of their business operation. Service is not as essential to their mission as it is here at SLU.

I also think the clinical simulation center we’re designing will be a huge asset and will be another way to enhance our profile. It’s the future of clinical education.

GR:Whatareasoftheschoolneedimprovement?

The school is expensive for our students. The scholarship support is not as strong as it should be. It’s getting stronger, but we can do better.

GR:Howdoyouplantobuildthatsupport?We have to generate outside money to support scholarship,

and I’m eager to meet with donors who can help us do that. As I see it, my job as dean is to provide the resources for other people so they can do great work — whether that means money for scholarships, research, endowed chairs or new facilities. That’s why fundraising is a major goal. Many people believe that if we are a giving, caring community of physicians and scientists and if we are about the business of doing things for the greater good, we shouldn’t be constrained by worries about money. Unfortunately, that’s not a recipe for success. Like every other organization in the real world, this medical school has to balance its budget. We have to pay for the things we get regardless of how lofty our goals might be. So the loftier our goals, the harder we need to work to convince other people who have the where-withal to help us meet the goals.

GR:Howdoyouplantoconvincedonorsandalumni?

I’ll meet with them, face to face whenever possible. In fact, after I accepted the job as dean but before I left New York, I met with some SLU alumni living in New York to talk about how we can help our school and our students. I’ve met with alumni in San Francisco and this winter I’ll meet with alumni in Chicago and Florida. I want their advice, their leadership and, yes, ultimately their financial support. For every graduate I engage, he or she should convince a classmate or friend to get engaged. I want our donors to know they can be a part of our future in a number of ways. I would hope our fundraising team keeps me moving in such a way that we can create a margin for excellence here.

GR:Howwouldyoudescribeyourleadershipstyle?

I like to believe that I’m enthusiastic, committed and open-minded. I like to work with people who enjoy what they’re doing. I don’t like to second guess or micromanage. I’d much rather delegate to capable people.

6 GrandRounds 7

8 GrandRounds

GR:Howhasyourbackgroundpreparedyouforthisnewchallenge?

Being a department chair at Columbia University in New York City for 20 years I had to navigate a lot of cross currents. I’ve also had other leadership positions at Columbia, including five years as chairman of the board of Columbia’s midtown private practice group, a 17-department practice in Manhattan. I was president of the Columbia Campus Medical Board for two years, and for one year I was president of the medical board that spanned the New York Presbyterian health care system. It was a great experience that I enjoyed very much, and I think it prepared me well for my new adventure.

GR:Howdifficultisittofollowadeanwhohadsuchalongtenureandsuccessfultrackrecord?

Dean (Patricia) Monteleone laid a great foundation for me. The challenge now is to take what she started into some new, exciting directions.

GR:Whatdoyoufindexcitingonthehorizon?I’m excited about the idea of growing the University Medical

Group so that it reaches beyond the campus and further into the St. Louis area. I also think there’s no question that a new ambulatory care center is on the horizon. An architectural group is putting together a feasibility study to tell us how large and how expensive the project will be. The new center would be a huge asset to our community. And, as I mentioned earlier, I think expansion of the clinical simulation center next year will be amazing. I also get enthused seeing our researchers utilizing

the Doisy Research Center to its full advantage. Walking around that building, talking to our scientists and seeing their discover-ies is very exciting. I’m eager to increase the support they need to continue their excellent work.

GR:HowwasyourtransitionfromNewYorktoSt.Louis?

It went well. I tell my friends that my wife has gone from seeing our grandchildren three times a year to three times a week. I see them at least twice a week. And we still know our way around the city. It’s very manageable.

GR:Whatwasthefirstthingyouunpacked?I’m pragmatic. At home I unpacked whatever box was in

front of me. Here in the office I think I unpacked my Pendaflex files first. I live by my Pendaflex files. I spend time every day taking materials off my desk and putting them in the files so when an issue comes up, I know right where to find the relevant materials.

GR:Whatdoyoudooutsideofwork?I spend time with my family and I exercise — somewhat

compulsively. My commitment to exercise is an outgrowth of the fact that when I was younger I was involved, at the amateur level, in competitive athletics. I played football and baseball in high school and football in college, and as a young adult I played a lot of men’s fast-pitch softball around St. Louis. One team, L&P Sales, won two St. Louis city championships, one MUNI championship and went to the regional championships twice in

Received his undergraduate and medical degrees from Washington University in St. Louis.

Completed his residency in radiology and nuclear medicine at the Mallinckrodt Institute of Radiology at Washington University.

Spent more than 25 years at the College of Physicians and Surgeons of Columbia University in New York City.

Most recently was chairman of the department of radiology and director of the radiology service at New York-Presbyterian Hospital/Columbia.

Spent four years as a faculty member at Johns Hopkins Medical Institutions before joining Columbia.

Specializes in nuclear medicine, with special interests in disorders of the pulmonary vasculature.

Has published more than 150 journal articles, 40 book chapters and four books.

Recently was appointed by the NIH to serve on its national advisory council for the National Institute of Biomedical Imaging and Bioengineer-ing — 2008 - 2012

Increasing scholarships to make medical education more affordable

Combining all of the School of Medicine’s simulation and robotics equipment into one organized center that becomes an important part of the SOM curriculum

Improving patient-care facilities at SLU’s urban medical practice

Using the Doisy Research Center as a starting point to enhance the medical school’s research profile

PROFESSIONAL STATSPhiLiP o. ALdErSon, M.d.

ALdErSon’S GOALS

9

five years. I’m way too old to be good at competitive sports now, but my dedication to exercise stems from that. I work out four days a week, usually before work. I don’t have time for much more, and honestly, I’d rather toss a wiffle ball to my five-year-old granddaughter than play golf or any other sport.

GR:Whatdoyouliketoread?I read history and biographies, rarely novels. One of my

favorite books is Robert Kaplan’s Warrior Politics. I also enjoyed Blood and Thunder by Hampton Sides. It’s a great story about Kit Carson and westward expansion. I also like Civil War history and have read several books by Stephen Ambrose.

GR:What’syourfavoritemovie?It’s hard to pick one. My wife and I enjoy sumptuous period

pieces. I wish it weren’t quite so violent, but I do like Braveheart. I also like Cider House Rules. It has a great soundtrack. I saw Jane Eyre, the version with William Hurt, in New York with my wife and daughters. That’s a beautiful film. We traveled to England for a conference sometime later and visited the Brontë parsonage, which is in a small Yorkshire village on the moors. It’s amazing to think that at a time in history when there were so few women writers and those who did write had to do so under a pen name, that this family turned out three women who were successful at the craft. I have the Laurence Olivier/Merle Oberon movie of Emily Brontë’s novel Wuthering Heights in my collection. I also have some of Errol Flynn’s movies on my shelf, including Robin Hood of course.

Daniel F. Hoft, M.D., Ph.D., delivers the bad news first. Despite the advent of the bacillus Calmette-Guérin (BCG) vaccine to prevent tuberculosis disease nearly 80 years ago, the vaccine has not managed to reduce disease prevalence — especially in the developing world. A third of the world’s population is infected with TB, and approximately 1.5 million people die of the disease each year.

Now, the good news. Hoft is leading efforts to find new vaccines, and his discoveries are showing promise.

In The Lancet, he provides details of the immune responses thought to be important for TB immunity, various mycobacterial antigens that seem to be promising targets for vaccine-induced immunity and different vaccination approaches being developed for use in people.

Hoft said BCG is most helpful when given to infants within the first two months of life. BCG protection is more variable in adults.

“Sometimes, later in life when the immune system is weak-ened or when it’s compromised by malnutrition and/or disease, BCG vaccine immunity wanes, and the TB bug can start growing again,” Hoft said.

Target PracticeAt the bench, Hoft and his team are working to identify the

specific mycobacterial antigens that induce protective responses. Their work has provided the first evidence that human γδ T cells might have an important role in vaccine immunity and need to be considered as possible new targets for vaccination. Their work also has identified specific mycobacterial antigens that can induce T cells inhibitory for intracellular myco-bacterial growth.

In the clinic, Hoft has conducted 10 human BCG vaccine trials designed to investigate, among other things, booster vaccinations with BCG or other new vaccines could enhance the levels of protective immunity — pre and post infection. Hoft said they suspect a vaccine still could be

effective even if mutations in the organism have resulted in drug resistance.

In one clinical trial, Hoft and his team found that a new vac-cine, known as rBCG30, safely provided a significantly better immune response than the original vaccine. His findings are published in The Journal of Infectious Diseases.

Hoft not only is investigating new vaccines, but new delivery systems.

Given that TB is transmitted through mucosal surfaces, we might get a different, and hopefully better, immune response if, rather than injecting BCG, we deliver it directly to those surfaces through an oral vaccine or a nasal spray, for example.

GrandRounds 11 10 GrandRounds

SLU Researcher Responds to Global Alarms Set Off by New Tuberculosis Strains

In a review article in the July 12 issue of The Lancet, Hoft said important contributing factors fueling the continued TB pandemic include the lack of access to proper TB diagnosis and treatments, the lack of treatment compliance, the diversity of BCG strains and overattenuation of presently used strains.

To make matters worse, during the last 15 years the TB organism has become more resistant to the combination drug therapy regimens that were considered a breakthrough in the 1950s. Cases of multidrug-resistant (MDR) TB and, more recently, extensively drug-resistant (XDR) TB are increasing.

“Usually when an organism becomes drug resistant it doesn’t grow inside people as well,” said Hoft, a professor and infectious disease specialist in the department of internal medicine, and director of the division of immunobiology. “It accumulates mutations and is weakened. That’s not the case with some strains of XDR-TB. It can retain full virulence and be highly aggressive.”

Border CrossingHoft demonstrates how aggressive by citing an epidemic

in South Africa. Two years ago, 52 of 53 infected patients in a rural hospital were killed by extensively drug-resistant TB, and experts believe the disease could spread to neighboring countries.

“If that strain circulates throughout the world, we’re at square zero. We have no practical ways to treat it, especially in the developing world. All of our systems will become es-sentially useless.”

Hoft concludes his article with an urgent call for new TB vaccines.

“These developments have intensified the need for new TB treatments and for vaccines or vaccine strategies to protect against a disease that remains a scourge of the human race,” he said.

“ Maybe we don’t need a new vaccine. Maybe we just need to deliver the old one in a better way.”

| hoft

left | In vitro stimulation with mycobacterial lysate results in marked expansion in γδ T cells. Shown are two-parameter dot plots of flow analyses indicating the subsets of T cells present in cultures of PBMC from one representative BCG responder after in vitro expansion with tetanus toxoid and M.tuberculosis whole lysate. A Presents the results of dual staining for CD3 and CD4 sur-face markers. B Presents the results of dual staining for CD3 and CD8 surface markers. C Presents the results of dual staining for CD3 and γδ TCR surface markers.

above | Immune mechanisms potentially protect against tuberculosis infection of mucosal surfaces

Tetanus Mt b Isysate

A

58%

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The Money Trail: Hoft is collaborating with other investigators from throughout the world, NIH, industrial partners and the Aeras Global TB Vaccine Foundation, which receives substantial funding from the Bill and Melinda Gates Foundation.“One of the exciting things about TB research is the fusion of both government and private money,” Hoft said. “The NIH spends more money than any other govern-ment in the world on TB vaccine research. That said, TB still is considered an orphan disease by most pharmaceutical companies. Many people are less concerned about TB because it’s not as much of problem in this country as it is in developing countries, but that may change as we travel more. So you can see we’re never going to eradicate TB until we’ve done a better job worldwide of protecting against infection and disease.”

CD8

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Patient with tuberculosis Susceptible non-infected person

Tuberculosis cavity with surrounding granuloma

CD4+ T cell CD8+ T cellγδ T cellSurface IgASurface IgG

GrandRounds 13

Poised for Discovery

12 GrandRounds

Although election season is upon us with the usual bombardment of political ads and debates, a poll shows many Americans feel uninformed about the views of their elected officials on scientific, medical and health research.

The poll, conducted by Research!America, found that a vast majority of people in the United States believe that scientific discovery is very important to our health (86 percent) and competitiveness (78 percent) as a nation and barely 25 percent feel they know where their leaders stand on research issues.

Ninety-one percent believe that research is essential in eliminating diseases, such as cancer, and 83 percent said they were more likely to vote for a candidate who supported increased government funding to find cures for and to prevent disease.

In spite of public support for funding, however, government money for scientific research has been declining over the last several years. Saint Louis University demonstrated faith in its researchers to compete for those dwindling dollars by constructing the Edward A. Doisy Research Center. Even with the dry spell, many School of Medicine researchers continue to find government funding for their work, including the three profiled in this issue of Grand Rounds.

role in the development of morphine tolerance. Repeated doses of morphine cause peroxynitrite to develop in the spinal cord, which in turn causes inflammation and damage to proteins and DNA in that area. Her research in animal models has shown that researchers could prevent morphine tolerance from oc-curring by blocking formation of this molecule or eliminat-ing it once it forms.

“The benefits of our findings are potentially quite huge.” Salvemini said. “Re-searchers can use our work to develop therapies that will al-low patients to take morphine without becoming tolerant of its benefits. For instance, when morphine is admin-istered, another drug could be given simultaneously that prevents peroxynitrite from working — and thus prevents tolerance.”

Together with her col-laborators at Duke University, Salvemini is synthesizing novel chemical entities that

For the past 30 years, Chinnadurai has been explor-ing why cancer cells do not follow the rules of normal cell proliferation and why they are able to evade the body’s defense mechanisms.

His groundbreaking dis-coveries are helping scientists and clinicians at the SOM and throughout the world develop drugs to fight the more than 100 different types of cancers diagnosed today, including cancers of the breast and lung.

By using two adenovirus genes — E1A and E1B-19K — Chinnadurai has discov-ered several cellular genes that are implicated in cancer cell proliferation and apoptosis. He discovered that a mutation in E1A, in cooperation with a cellular cancer gene known as Ras, induces highly aggressive and metastatic cancer cells.

While searching for cellu-lar proteins that are involved in controlling the tumor-causing activity of E1A, Chinnadurai also discovered the cellular protein, CtBP, which plays an important role in the spread of cancer cells. Chinnadurai hopes to design anti-cancer agents that target CtBP.

“If we could find a way to disrupt the interaction between E1A and CtBP, perhaps we can disrupt tumor growth,” said Chinnadurai, who is considered the nation’s

Someone once told Salvemini that patients don’t die of pain, they die in pain. She knew this was true after watching her mother’s friend die from breast cancer.

“She was taking opiates like crazy,” Salvemini recalled. “The doctors kept upping her dose, but the pain wasn’t getting better and the side ef-fects were tremendous. Seeing what pain did to her and to her family was devastating.”

The experience was a turning point in Salvemini’s professional life. She de-cided to dedicate herself to identifying novel ways to manage pain. In particular, she focuses on understanding the molecular, biochemical and pharmacological actions of reactive oxygen/nitrogen species in the development of the tolerance associated with the use of opiates, such as morphine.

Through this research, she and her colleagues discovered that a molecule known as peroxynitrite plays a critical

expressed at the right level, and a fly’s wings and other body parts do not develop properly.

When other clinicians and researchers learned of Dorsett’s work with Nipped-B they began calling. They suspected that changes in the human Nipped-B gene NIPBL were responsible for CdLS but were unsure of the mechanism. By comparing his fly data with data from CdLS patients, Dorsett found strik-ing similarities suggesting that human NIPBL controls de-velopment of human infants in much the same way that Nipped-B controls develop-ment of flies.

Although Dorsett contin-ues to study various aspects of the fruit fly’s develop-ment, his lab’s primary focus is determining exactly how Nipped-B functions and why even the smallest change in Nipped-B can have such a major impact on develop-ment. His work is laying the foundation for the creation of new methods of screening for CdLS and for designing drugs that could counteract the gene’s misbehavior.

“The challenge with many genetic diseases is that by the time a child is born, some damage is done already,” he said. “But an infant still has a lot of growing to do. If we can counteract the problems with NIPBL as soon as CdLS is diagnosed, we might be able to avoid or minimize some of the downstream ef-fects of the disease.”

Dorsett’s work has been consistently funded by the NIH. In addition to his investigator-initiated research grants, he has program proj-ect grants with researchers at Children’s Hospital of Phila-delphia and the University of California-Irvine.

block the effects of peroxyni-trite.

Salvemini has been work-ing in the area of pain and inflammation for more than 20 years. She worked in the private sector until 2005 when she came to the SOM full time. She was an adjunct pro-fessor at the SOM for more than a decade before becom-ing full-time faculty.

In the mid 1990s when Dorsett began exploring the factors that facilitated gene expres-sion in fruit flies, he wasn’t directing his research toward any human disease. His only goal was to understand how genes turn off and on to control development. What he discovered, however, shed light on the molecular mechanisms of a very human disease — Cornelia de Lange Syndrome (CdLS).

The syndrome is charac-terized by slow growth before and after birth, mental retar-dation, heart and other organ

leading expert on the protein. Chinnadurai and his team

also are credited with discov-ering important cell death regulatory genes, known as BH3-only members, during their work with E1B-19K, a gene that suppresses cell death.

“Chemotherapy drugs can’t kill some cancer cells because the cells express high levels of anti-cell death proteins,” he said. “Under-standing E1B-19K will help us determine how these genes protect cells from death.”

Two of the BH3-only members discovered by Chin-nadurai’s group are inacti-vated in a number of human cancers. He hopes that a new generation of drugs that ef-ficiently activates these genes would be more effective anticancer agents than are available now.

The NIH consistently has funded his research for the past three decades.

Salvemini recently received her first NIH award — a five-year, $1.7 million grant — to further elucidate the mechanisms and pathways in which peroxynitrite nega-tively impacts opioid-induced analgesia.

“NIH is looking for researchers who have the capacity to collaborate, which is what I do best,” Salvemini said.

deficits, and, in acute cases, limb abnormalities. In the United States, approximately one of every 10,000 infants is born with CdLS, and Dorsett is one of the nation’s leading experts on the disease.

His rise to prominence in the field began when he discovered Nipped-B, a gene in fruit flies that has multiple functions during develop-ment. Among other things, it promotes expression of the genes that control formation of a fly’s limbs and brain. If Nipped B is compromised in a fly, some genes are not

William A. Banks, M.D., professor of internal medicine and pharmacological

and physiological science, has received a $1.5 million grant from the NIH for the

project “Oxidative Dysfunction of LRP at the Blood-brain Barrier in Alzheimer’s

Disease.”

Richard D. Bucholz, M.D., professor and K.R. Smith Endowed Chair in Neurosur-

gery, has received a $5.3 million grant from the U.S. Department of Defense for

the project “Evidence Based Multimodal Neurodiagnostic Imaging of Traumatic

Brain Injury and Post-Traumatic Stress Disorder.”

Xiaofen Fan, M.D., associate research professor of internal medicine in the

division of gastroenterology and hepatology, has received a $1.4 million grant

from the National Institute of Diabetes and Digestive and Kidney Diseases for the

project “Hepatitis C. Virus Quasispecies in the Resistance to Antiviral Therapy.”

Jennifer K. Lodge, Ph.D., associate professor of biochemistry and molecular biol-

ogy and associate dean for research, has received two grants from the National

Institute of Allergy and Infectious Diseases — a $1.8 million grant for the project

“Signal Transduction and Cell Wall Integrity in Cryptococcus Neoformans,” and a

$1.3 million grant for the project “Chitin and Chitosan Production in Cryptococcus

Neoformans.”

John E. Tavis, Ph.D., professor of molecular microbiology and immunology, has

received a $1.3 million grant from the National Cancer Institute for the project

“HCV Genetic Variation and Hepatocellular Carcinoma.”

Daniel S. Zahm, Ph.D., professor of pharmacological and physiological science,

has received a $1.4 million grant from the National Institute of Neurological Disor-

ders and Stroke for the project, “Convergent Versus Parallel Striatal Afferents.”

G R A N T S at a Glance

Professor|InstituteforMolecularVirology

JoinedtheSchoolofMedicine

in1974

Govindaswamy Chinnadurai, Ph.D.

Daniela Salvemini, Ph.D.

ResearchProfessorDepartmentofInternalMedicineDivisionofPulmonary,CriticalCareandSleepMedicine

JoinedtheSchoolofMedicinein2005

Professor|DepartmentofBiochemistryandMolecularBiology

JoinedtheSchoolofMedicine

in2000

Dale Dorsett, Ph.D.

MATCH DAy 2008

EMErGEnCY MEdiCinEtodd Crum University of Nebraska Affiliated Hospital (Neb.)Chris dewar North Shore University Hospital Manhasset (N.Y.)Jared Jones Hennepin County Medical Center (Minn.)Matthew Larsen Advocate Christ Medical Center (Ill.)Gabriel Marsh University of Wisconsin Hospital and Clinics (Wis.)ryan Pohl Resurrection Medical Center (Ill.)Jeffrey Spencer Barnes-Jewish Hospital (Mo.)Anjali Srivastava University of Chicago Medical Center (Ill.)irena Vitkovitsky Barnes-Jewish Hospital (Mo.) Luke wilder University of Kentucky Medical Center (Ky.)Christopher williams University of Arizona Affiliated Hospitals (Ariz.)

FAMiLY MEdiCinEJennifer Bello West Suburban Medical Center (Ill.)Cory Bethmann University Hospitals-Columbia (Mo.)Amanda Bristol Saint Louis University School of Medicine (Mo.)Patricia Eusterbrock St. Johns Mercy Medical Center (Mo.)Amanda Gerber Cedar Rapids Medical Education Foundation (Iowa)Mark hooste Darnall Army Medical Center (Texas)Chrystal Jenkins University of Rochester/Strong Memorial Hospital (N.Y.)robert Konold Scott Air Force Base (Ill.)robert Myslin Camp Pendleton Naval Hospital (Calif.)

Matthew nelson Family Medicine Residency of Idaho (Idaho)Erika noonan Utah Valley Regional Medical Center (Utah)Lisa Phifer Allina Family Residency Program (Minn.)denise Pounds Swedish Medical Center (Wash.)Samuel recob Siouxland Medical Education Foundation (Iowa)Sara Schwager Saint Louis University School of Medicine (Mo.)richard Sheridan DeWitt Army Community Hospital (Va.)Susan Stephens Kaiser Permanente (Calif.)Bessevelyn tables St. Johns Mercy Medical Center (Mo.)Shawn usery Cox Medical Centers (Mo.)

intErnAL MEdiCinEPeter Anderson Mayo School of Graduate Medical Education (Minn.)timothy Brinker Saint Louis University School of Medicine (Mo.)Mihir Faldu University of Florida College of Medicine Shands Hospital (Fla.)olga Fortenko University of California Davis Medical Center (Calif.)Kathleen Gally Wright Patterson Medical Center (Ohio)Amanda Gomes University Hospitals Case Medical Center (Ohio)James Grigg Einstein/Montefiore Medical Center (N.Y.)Bryce haslem University of Iowa Hospitals and Clinics (Iowa)Estebes hernandez Johns Hopkins Hospital (Md.)Amelia Kasper Barnes-Jewish Hospital (Mo.)

oPhthALMoLoGYSonya Bamba Louisiana State University Ochsner (La.)Pooja Jamnadas Loyola University/Hines VA Hospital (Ill.)Christopher Pole Saint Louis University School of Medicine (Mo.)

orthoPAEdiCSAustin Crow University of Wisconsin Hospital and Clinics-WIMatthew dilisio Summa Health/Northeastern Ohio Universities, Colleges of Medicine and Pharmacy (Ohio)Bradley warlick Saint Louis University School of Medicine (Mo.)Kiley Ziegler University of Missouri/KC Programs (Mo.)

otoLArYnGoLoGYJennifer do Kaiser Permanente/Oakland (Calif.)Marsha Kadze University of California San Diego Medical Center (Calif.)

PAthoLoGYrichard Cantley Rush University Medical Center (Ill.)Jeanette Prante University of Kentucky Medical Center (Ky.)

PEdiAtriCSPatrick Basile Wright Patterson Medical Center (Ohio)Gregory Bross Phoenix Childrens Hospital (Ariz.)Karin Clauss Saint Louis University School of Medicine (Mo.)Kristen Covert Phoenix Childrens Hospital (Ariz.)Stacy dodt Naval Medical Center San Diego (Calif.)Matthew Fong Loma Linda University (Calif.)Susan Gage University of California Irvine Medi-cal Center (Calif.)tina Mathai Rush University Medical Center (Ill.)Sarah Meyer Childrens Hospital Boston (Mass.)Kevin Morgan Wright State University Boonshoft School of Medicine (Ohio)william Payne University Hospitals Case Medical Center (Ohio)Abigail ryan Saint Louis University School of Medicine (Mo.)Andrew Sherman University of Rochester/Strong Memorial (N.Y.)Allison Sterner University Hospitals Case Medical Center (Ohio)

rAdioLoGY ONCOLOGYKristin Kowalchik Mayo School of Graduate Medical Education (Fla.)Kiwhoon Lee University of Louisville School of Medicine (Ky.)Maria thomas Barnes-Jewish Hospital (Mo.)

RESEARCH PSYChiAtrYSarah Bowron Washington University (Mo.)

SurGErY GENERALAndrew hall Keesler Air Force Base Medical Center (Miss.)nicole Kellis Naval Medical Center (Calif.)Katherine Fu University of California San Francisco-Fresno (Calif.)Charles Kim Saint Louis University School of Medicine (Mo.)Carolyn Pinkerton Medical College of Wisconsin Affili-ated Hospitals (Wis.)Corey Stennes University of Tennessee College of Medicine (Tenn.)Jasmine wong Loma Linda University (Calif.)

SurGErY PRELIMINARYBlake hamby Saint Louis University School of Medicine (Mo.)Edward Kessler Saint Louis University School of Medicine (Mo.)Lorraine Levers UVM/Fletcher Allen (Vt.)

uroLoGYBrian Cross Emory University School of Medicine (Ga.)nilay Gandhi Saint Louis University School of Medicine (Mo.)Michael Gangel Akron General Medical/ Northeastern Ohio Universities Col-leges of Medicine and Pharmacy (Ohio)Gregory McLennan William Beaumont Hospital (Mich.)

AnESthESioLoGYChristopher Beuer Saint Louis University School of Medicine (Mo.)olatubosun dennis Saint Louis University School of Medicine (Mo.)John hille University of Utah Affiliated Hospitals (Utah)ryan hood Loyola University Medical Center (Ill.)nicholas hoskins Mayo School of Graduate Medical Education (Minn.)unhea Kim Brigham & Women’s Hospital (Mass.)nitin Malhotra University of Louisville School of Medicine (Ky.)ryan Meier University of Utah Affiliated Hospitals (Utah)Aaron rund University Hospitals Case Medical Center (Ohio)Palak Shah Northwestern McGaw/NMH/VA-ILSean Stoneking Saint Louis University School of Medicine (Mo.)robert wong Cedars-Sinai Medical Center (Calif.)

dErMAtoLoGYSofia Chaudhry Saint Louis University School of Medicine (Mo.)Sonya Jagwani University Hospitals-Columbia (Mo.)tricia Missall Saint Louis University School of Medicine (Mo.)Anthony nuara University of Texas Southwestern Medical School (Texas)

Lauren Sterner University of Tennessee College of Medicine (Tenn.)Joanna thomson Cincinnati Childrens Hospital Medical Center (Ohio)

PEdiAtriCS EMERGENCY MEDICINELauren rice University of Maryland Medical Center (Md.)

PhYSiCAL MEdiCinE And rEhABiLitAtionKatherine doerr Harvard/Spaulding (Mass.)william Filer University of North Carolina Hospitals (N.C.)Katherine Payne Case Western Metro Health Medical Center (Ohio)

PSYChiAtrYGayle Copeland University of Southern California (Calif.)Sarah Fayad University of Florida College of Medicine/Shands Hospital (Fla.)nicole Garber Emory University School of Medicine (Ga.)Lauren Kissner Loma Linda University (Calif.)Andrew Linsenmeyer Harvard Longwood Psychiatry (Mass.)Jacob Pounds University of Washington Affiliated Hospitals (Wash.)

rAdioLoGY DIAGNOSTICdouglas Adolphson Mayo School of Graduate Medical Education (Fla.)raymond Azab Saint Louis University School of Medicine (Mo.)Mark Barrett University Hospitals-Columbia (Mo.)Shandon hatch Rochester General Hospital (N.Y.)Conor Kain Tripler Army Medical Center (Hawaii)ivy Lawson Saint Louis University School of Medicine (Mo.)Luke Ledbetter University of Kansas School of Medicine (Kan.)dwight Lee Stony Brook Teaching Hospitals (N.Y.)Kendall Martin Harbor UCLA Medical Center (Calif.)John Stanfill Baptist Memorial Hospital (Tenn.)Colin thompson Barnes-Jewish Hospital (Mo.) Scott tyson Cleveland Clinic Foundation (Ohio)Sri Preethi Vagvala Advocate Illinois Masonic Medical Center (Ill.)

Phoebe King University of Texas Health Science Center (Texas)Jesse Matthews University of New Mexico School of Medicine (N.M.)Papiya ray National Naval Medical Center (Md.)Paul Schmidt University of Kansas School of Medicine (Kan.)david Stewart Rush University Medical Center (Ill.)Bithika thompson Barnes-Jewish Hospital (Mo.)Aaron Young University of Rochester/Strong Memorial (N.Y.)Malgorzata Zukowska Barnes-Jewish Hospital (Mo.)

intErnAL MEdiCinE PEDIATRICSolivia Giddings Vanderbilt University Medical Center (Tenn.)david niccum Medical College Wisconsin Affiliated Hospitals (Wis.)raegan Vanderput Banner Good Samaritan Medical Center (Ariz.)

intErnAL MEdiCinE PRIMARYryan westhoff Cook County Stroger Hospital (Ill.)

nEuroLoGYAustin hake Saint Louis University School of Medicine (Mo.)

nEuroLoGY CHILD thomas dye Cincinnati Childrens Hospital Medical Center (Ohio)Emily Gertsch Mayo School of Graduate Medical Education (Minn.)ivet hartonian UCLA Medical Center (Calif.)

nEuroSurGErYSonia teufack Thomas Jefferson University (Pa.)

oBStEtriCS And GYnECoLoGYShelly Agarwal Rush University Medical Center (Ill.)Angela dicarlo Naval Medical Center (Va.)Linda hong Loma Linda University (Calif.)Sukruthi reddy Loma Linda University (Calif.)Katherine Scolari Saint Louis University School of Medicine (Mo.)Sonyoung Seo Emory University School of Medicine (Ga.)Staci tanouye Mayo School of Graduate Medical Education (Minn.)Kelly Vo University of California San Francisco (Calif.)

Members of the Class of 2008 began their next stage of professional development this sum-mer as they entered their residency programs. Of the 149 students matching with residency positions throughout the country, 19 will continue to call St. Louis home while they complete their residencies at the SLU School of Medicine.

“The 2008 residency matching results again demonstrate the strength of our medical students,” said L. James Willmore, M.D., associ-ate dean of the School of Medicine. “Our newly graduated physicians will enter all fields of medi-cine and surgery and will be trained in pro-grams all over the United States. We on the faculty are quite proud of our students, and we wish them well in this next step of their education.”Students awaited word of their matches at a party in April held at Busch Stadium.

Here is the Saint Louis University School of Medicine match list by specialty:

Match Day 2008

more

med

scho

ol.sl

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/

GrandRounds 15

C STAR

GrandRounds 17

Col. Jeffrey Bailey, M.D. (’96), reminds them of this each time he brings a fresh group of U.S. Air Force medics through the hospital for two weeks of intensive trauma care training.

The training is designed to ensure that military medical teams are more fully prepared for the rigors of combat medicine be-fore they are deployed to potentially hostile environments.

“After the first Gulf War, the defense department realized a significant proportion of the physicians, nurses and medics sent to the war zone lacked experience in the field of trauma care,” said Bailey, an active duty Air Force trauma surgeon and an as-sociate professor of surgery in the medical school.

Bailey said this is partly because during peacetime most Air Force medical personnel are stationed in smaller hospi-tals and clinics on military bases. They perform physicals and treat minor ailments, but they do not experience the variety and sheer number of cases that doctors see at a trauma center such as the one at SLU Hospital — the only Level 1 Trauma Center certified for both Missouri and Illinois.

“Our ability to maintain our own competency in the care of criti-cally ill patients is just impos-sible in our facilities,” Bailey said. “To fill that gap, the military looked to where the trauma pa-tients are and where the expertise is. We found it in civilian trauma centers.”

The Air Force decided the best way

sistants, two nurses and two medics, all with extensive experience in combat medicine.

The students are physicians, nurses and medical technicians from active duty Air Force, Air National Guard and the Air Force Reserve Medical Service. All are fully trained, licensed health care professionals who rotate through the C-STARS program to refresh their skills. Most of the rotators, as they are called, are scheduled to deploy to Iraq or Afghanistan in the near future.

Overcoming barriersWhen the military initially approached the University in 2001

about permanently stationing the program within the School of Medicine, the immediate answer was yes, but there was a barrier.

The Air Force wanted its rotators to do more than observe. They wanted them to have hands-on training with patients. Air Force medics are indemnified by the government, but that protection does not apply to their civilian colleagues or civilian

to train its soldiers was to embed a military training unit within civilian trauma centers and have its medics work side-by-side with civilian health care providers. The result is the Center for Sustainment of Trauma and Readiness Skills (C-STARS). Bailey directs the program at Saint Louis University, which is one of only three in the nation.

“If we do things right here at SLU, not only will we be able to save lives on the battlefield, but quality of life as

well,” he said. Instructors are ac-

tive duty Air Force personnel. The team includes two trauma surgeons,

a neonatologist, two physician as-

institutions. If there were litigation, the Air Force medics would be covered, but the school and hospital would be vulnerable.

Robert M. Heaney, M.D., associate dean for graduate medical education and veterans affairs, worked closely with University administration, SLU Hospital, the School of Nursing and the Air Force to forge a memorandum of understanding that addressed the concerns.

The memorandum fully integrates the C-STARS staff into the medical faculty and grants them academic appointments. It allows the C-STARS curriculum to exist as a formal curriculum in the school. If C-STARS rotators are physicians, they function as residents or housestaff during their two weeks at SLU. They

ON THE FRONT LINESSLU physicians help prepare military medics for the battlefield.

| robert M. heaney, M.d.

“ We believe that graduates of C-STARS have helped save the lives of Iraqis, Afghanis, coalition forces and our friends and neighbors serving in armed conflict. We can only hope that in so doing, they bring us closer to a lasting peace.”

technical Sergeant tammy witt, a medic with the 136th Medical Group out of Fort Worth, Texas and Chief Master Sergeant Adam reading, a medic with the 182nd Airlift Wing out of Peoria, Ill. dress Nick Neeley’s head wound in the emergency room at Saint Louis University Hospital. Neeley, of Desloge, Mo, was hit on the fore-head with a crowbar.

above | technical Sergeant witt, Major Camille dema and Major Melanie Mcdonald with the 183rd Medical Group out of Springfield, Ill, in the middle of a simulation exercise inside mock field tent at the SOM. The “patient” they are treating suffered severe leg injuries when he stepped on a land mine.

Saint Louis University School of Medicine faculty working in the emergency department and in the intensive care unit at Saint Louis University Hospital may never go to Iraq — yet they are one degree of separation from treating the wounded soldiers there.

18 GrandRounds

notion, but it’s how we used to serve people in need and it worked — think back to the Good Samaritan,” Alieta Eck said. “We call it a first century solution to a 21st century need.”

With this idea in mind, the Ecks approached their congregation at the Zarephath Christian Church. They were given permission to open the clinic in a small building on church property that had been nearly destroyed by Hurricane Floyd in 1999. The now tidy tan and brick building holds three exam rooms, a waiting area, a counselor’s office and a small pharmacy.

Although the Ecks need to support their family of five children through their private practice — he’s a family practitioner and she’s an internist — they find time to keep the clinic open 10 hours a week.

With the help of volunteer nurses and staff, the Ecks make the most of those 10 hours. On average, the ZHC serves 200 patients and provides approximately $50,000 in medical care per month. Supplies and equipment are donated by individuals, businesses and area churches.

“This is a non-denominational endeavor,” John Eck said. “We have Muslims, Jews, Baptists — you name it — who want to make a difference.”

The Ecks estimate the ZHC saves the state of New Jersey at least a half-million dollars a year by keeping patients out of hospital

emergency rooms and by providing preventative care, such as prenatal exams.

“If we see a patient, it costs us maybe $10,” Alieta Eck said. “If they go to the ER, that visit will cost $1,000.”

A donation box sits on a table in the waiting room with a few scrunched up dollar bills, some coins and the occasional $20 bill, but no one is required to pay.

“Seeing the look on a patient’s face when we tell them we’re not going to charge them a penny — that never gets tiresome,” said John Eck.

The Ecks hope to see their clinic expand its hours and services. They recently recruited a cardiologist to run a monthly cardiology clinic

and an ultrasound technician who comes in monthly to perform prenatal exams on the new ultrasound machine donated to the ZHC.

All volunteers are given free medical malpractice coverage from the federal government through the Federal Tort Claims Act. The act allows practicing and retired physicians to donate their time without having to buy expensive insurance coverage.

In addition to the clinic in New Jersey, John Eck extends his charity overseas. He continues to go on international medical missions every other year or so — sometimes with his children. He works among the lepers in India and the indigent in Peru.

Living the Mission Faith in Motion | Alieta Eck, M.D. (’80) and her husband, John Eck, M.D. (’80), founded a clinic that provides free health care to the poor and uninsured in central New Jersey. They make certain, however, their patients feel like anything but charity cases.

“I tell them I’m honored I can love God through them,” John Eck said. “I thank them for coming and for giving me the opportunity to give back. I’ve had some patients, even some of our toughest tattooed Vietnam veterans break down and cry when I say this, but it’s my privilege to serve them.”

The Ecks’ established the Zarephath Health Care Center (ZHC) in Somerset, N.J., in 2003. Alieta Eck said the idea was born out of their increasing frustration with the lack of health care access for the poor and the government’s ineffective programs to provide care.

“Medicaid is an extremely wasteful and bureaucratic system, and everybody games it,” she said. “The administrative overhead is too high, and as a result, quality goes down. The system is unjust. We wanted a better model.”

The Ecks feel they found that model — charity-based health care in which churches meet the medical care needs of the poor, uninsured or underinsured.

“Faith-based charity care may seem like an outdated

Alumni Pulse

SaintLouisUniversitySchoolofMedicineGrandRounds19

are put on the trauma team and take calls. Nurses and medical technicians work shifts in the E.R. and I.C.U.

Heaney said integrating the program was the right thing to do. It not only benefits the military medics, it benefits the medi-cal school.

“We had the training venue,” he said. “The Air Force had a cadre of committed health care providers who needed real-world experience in trauma care and could learn by helping us take care of patients.”

Immersion therapyThe 14-day trauma immersion experience begins with an

orientation lecture for the 18 to 20 rotators and quickly picks up speed.

Rotators are re-familiarized with the medical equipment used in expeditionary medical care, including special types of ventila-tors, suction machines and IV infusers small enough to fit into a backpack if need be.

They begin working shifts in the hospital almost immediately and spend time at St. John’s Mercy Medical Center in the burn unit. Air Force medics also ride along as pre-hospital first re-sponders in association with the St. Louis Fire Department and the Air Rescue Consortium of Hospitals.

Other than spending time with patients at their bedsides, Bailey said perhaps the most powerful learning experience for the rotators takes place in a simulation lab in the lower level of the Learning Resources Center.

A usually non-descript exam room is draped in canvas and stocked to look exactly like a military field hospital. Three times throughout the course, rotators will enter the tent and practice

their skills on artificial computerized patients who have injuries medics might see in war zones.

Instructors sit behind two-way glass and score the team’s performance based on trauma care guidelines established by the American College of Surgeons.

C-STARS Instructor, Maj. Rance Bryan, R.N., sets the scene: “You have a 21-year old male soldier shot in the right femur. No intervention in the field. Go.”

Five rotators quickly remove the drape over the mannequin and begin assessing their patient. To make the experience more realistic, the instructors use computers to control the manne-quin’s vital signs. If treatment is correct, the mannequin’s condi-tion improves. If incorrect, the patient gets worse. In this case, the patient died.

Bryan meets with the rotators after the exercise and reviews a video recording of the simulation with them. He stops the tape several times to offer constructive criticism.

“This is where you started losing him,” he tells the rotators. “You spent so much time worrying about his airway that you neglected to get him fluids. But don’t be too hard on yourself. This is a learning process.”

“I guess it’s better we make these mistakes here rather than out in the theater,” said MSgt. Doug Coons, a medic from the 139th Aeromedical Evacuation Squadron in Scotia, N.Y. “This was our first simulation. I think we’ll get on a roll after we do it a couple more times, and we’ll be more confident when we get over there.”

Preparing for the worstConfidence is key according to Bailey. He said the rotators,

without exception, have higher simulation scores by the end of their second week of training and are more confident in their skills. This is important given that many of the medics who come through the C-STARS program at SLU are headed to Balad Air Base Theater Hospital in Iraq, reportedly the busiest defense department trauma center since Vietnam.

While the C-STARS training is designed to produce the best outcomes in the battlefield, Bailey said the training also can pre-pare soldiers for the worst.

“You take a young airman who went through training to be a medical technician and you assign him to a clinic or base to do physical exams,” Bailey said. “He’s never seen someone die be-fore. Then they come here for training, and it happens. They’re out on an ambulance ride or in the E.R., and it can be traumatic for anybody.

“We’re exposing our medics to death and dying in a setting where there’s support and understanding. We hope the experi-ence gives them some resilience for what they’ll have to face in the war zone because there’s no question in my mind that they will encounter death.”

Measuring successSince C-STARS was launched at SLU in 2002, more than

1,000 Air Force medics from bases in the United States and overseas have gone through the training. Many of the rotators send feedback to Bailey and his team, thanking them for the training and offering suggestions on how to adapt the curricu-lum to reflect what they are seeing in the field.

Bailey’s most cherished note of appreciation hangs on the wall in one of the simulation labs. It is a framed American flag and an engraved plaque. The plaque reads: Let it be known this American flag bears witness to the destruction of terrorist forces threatening the freedom of the United States of America. It was flown in honor of C-STARS through the enemy skies in Iraq. Please know the knowledge we gained has made our deployment smoother. The 33th Fighter Squadron.

“ When you get deployed, that isn’t the time to be learning your job. That’s the time to know your job.”

| Col. Jeffrey Bailey, M.d.

“ The concept of service is crucial to medicine. If we lose that, we lose our soul.”

| John Eck, M.d. (’80)

For more information about the Ecks and their clinic, go to zhcenter.org or contact the Ecks at zhcenter@aol.com.

Show your school colorswww.clubcolors.com/slu

Travel with alumniwww.slu.edu/alumni/travel

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Honoring Educators | During precommencement ceremonies in May, the Class of 2008 honored the educators who helped them through medical school and prepared them for the next phase of their training. This year’s winners were:

Robert J. Blaskiewicz, M.D. (’75), professor and director of general obstetrics, and gynecology in the department of obstetrics, gynecology and women’s health, and Carole A. Vogler, M.D., professor and interim chairwoman of the department of pathology, won “Golden Apple Awards” (best teacher).

Juan-Carlos Correa, M.D., won the “Top Banana Award” (favorite resident).

William C. Mootz, M.D., professor of internal medicine and assistant dean for curricular affairs, won the “Education Facilitator Award.”

Stuart J. Slavin, M.D., M.Ed., professor of pediatrics and associate dean for curricular affairs, won the “Father James McKelvey Tobin Award.”

Beloved Pediatrician Dies | Richard Barry, M.D. (’71), professor of pediatrics at the School of Medicine and a pediatric emergency medicine physician at SSM Cardinal Glennon Children’s Medical Center, died unexpectedly in April. He was 63.

Barry was director of emergency care services at Cardinal Glennon for 29 years and co-director of the pediatrics residency program at SLU for 30 years.

“The last day of his life was spent doing what he loved most — taking care of children and teaching others how to,” said Faye Doerhoff, M.D., assistant professor of pediatrics and a colleague for 26 years in Cardinal Glennon’s ER.

Robert Wilmott, M.D., chairman of the department of pediatrics and pediatrician-in-chief at Cardinal Glennon, described Barry as a warm and humble colleague.

“He would never boast or take credit for his achievements,” Wilmott said. “He was a warm person, very sociable and very loyal to Saint Louis University and Cardinal Glennon.”

Barry, who was not married and had no children, volunteered to work every Thanksgiving, Christmas Eve and Christmas Day so those who had families in town could spend holidays with their loved ones.

Alumni Receptions

Dec. 2 Meet the Dean Alumni Reception – Chicago area (This event will be held in conjunction with the Radiological Society of North America Annual Meeting)

Jan. 26 Society of Thoracic Surgeons – San Francisco

Feb. 27 American Academy of Orthopaedic Surgeons – Las Vegas

March 6 American Academy of Dermatology – San Francisco

April 3 Missouri State Medical Convention – Kansas City

April 25-May 2 American Academy of Neurology – Seattle

May 2-5 Pediatric Academic Societies

May 5 American College of Obstetricians and Gynecologists – Chicago

May 16-21 American Psychiatric Association – San Francisco

University Events

Dec. 14 Breakfast with Santa – SLU campus

CME programs

Dec. 6 Best of the American Association for the Study of Liver Diseases

Dec. 6-7 Craniofacial Surgery and Transfa- cial Approaches to the Skull Base

Jan. 5-9 Medicolegal Death Investigator Training Course

Jan. 8-11 2nd World Congress on Cerebral Revascularization

Jan. 23-25 Cosmetic Blepharoplasty

March 2-6 Microsurgery of Aneurysms: Recent Advances

For information on the CME programs, please call the SLU School of Medicine continuing medical education office at 314 | 977-7401 See updates and details about Practical Anatomy Workshop programs at pa.slu.edu.

For any other events, please contact the Alumni Relations Office at 314 | 977-8335.

In MemoriamHarry Staman, M.D. (’33)Walter Miner, M.D. (’36)Charles Stehly, M.D. (’37)Augustine Sperrazza, M.D. (’38)John Beare, M.D. (’39)Courand Rothe, M.D. (’39)William Escovitz, M.D. (’40)Jerome Janson, M.D. (’40)Drew Petersen, M.D. (’40)Charles Pitegoff, M.D. (’40)Harold Broady, M.D. (’41)James Coughlin, M.D. (’41)Adolph Surtshin, M.D. (’41)Raymond Huger, M.D. (’42)Richard Noda, M.D. (’42)John Brennan, M.D. (’43)David Brody, M.D. (’43)Carl Dreyer, M.D. (’43)John Hale, M.D. (’43)Francis Marino, M.D. (’43)Vincent Muscat, M.D. (’43)Normal Blackman, M.D. (’44)Edward DeFeo, M.D. (’44)William Galeno, M.D. (’44)Nelson Klamm, M.D. (’44)James McFadden, M.D. (’44)James McGlew, M.D. (’44)James Morrison, M.D. (’44)John Connors, M.D. (’45)Henry Drake, M.D. (’45)Gerald Lammers, M.D. (’45)Frank Winters, M.D. (’46)Donald Dockry, M.D. (’47)Harold Hagan, M.D. (’47)James O’Malley, M.D. (’47)Edward Wirthlin, M.D. (’48)Cyril Bruno, M.D. (’50)Douglas Cardozo, M.D. (’51)Thomas Culkin, M.D. (’51)William Sammis, M.D. (’51)Cornelius Derrick, M.D. (’52)Francis Skopec, M.D. (’52)Peter Tobin, M.D. (’52)Leo Furr, M.D. (’53)Harry Helling, M.D. (’53)Thomas O’Hern, M.D. (’53)Rose Papac, M.D. (’53)John Kanda, M.D. (’54)Herbert Luke, M.D. (’54)Thomas Maxwell, M.D. (’55)Richard Bealka, M.D. (’56)Edward Galla, M.D. (’56)James Smiggen, M.D. (‘56)Theodore Christian Baiz, M.D. (’58)Emory Beechwood, M.D. (’59) John Joyce, M.D. (’59)James Clark, M.D. (’61)George Dent, M.D. (’62)Raymond Muzzarelli, M.D. (’64)William Scaring, M.D. (’64)Paul Shuff, M.D. (’69)Richard Barry, M.D. (’71)Douglas Johnston, M.D. (’74)Gregory Mantych, M.D. (’82)Edward Bullock, M.D. (’85)

Do You Remember?Grand Rounds would like

you to submit your favorite

stories about two of the

school’s most memorable

educators: C. Rollins

Hanlon, M.D., chairman

of the surgery department

for nearly 20 years,

and his successor,

Vallee Willman, M.D.

You can send your stories

to grandrounds@slu.edu. Submissions will be

published in an upcoming

issue of Grand Rounds.

Some of your

professors may have

inspired you, some

may have intimidated

you, and some may

have entertained

you. Whatever their

style, they helped you

become the physician

you are today.

SaintLouisUniversitySchoolofMedicineGrandRounds21

Golden Apple Award recipient robert J. Blaskiewicz, M.d. (’75), celebrates during precommencement ceremonies with graduate Austin Crow.

221 N. Grand Blvd., SON 539

St. Louis, MO 63103

Address Service Requested

Non-Profit Org.U.S. Postage

PAIDSt. Louis, MOPermit No. 134

Catherine Beal, M.D. (’82), and her husband, Eugene

Beal Jr., M.D. (MR ’86) have multiple family members

who attended Saint Louis University, and the tradition

continues with their two sons — Brandon and Michael,

both of whom are pre-med students at SLU.

“We have longstanding ties to the University, and

those ties are very strong,” said Catherine Beal, a neu-

roradiologist at St. Anthony’s Medical Center in St. Louis

County.

“SLU has done a lot for us and

our family,” said Eugene Beal Jr.,

chairman of radiology at Lincoln

County Medical Center in Troy,

Mo. “The University provided

us with the opportunity to learn

and gave us excellent training

and the skills we needed to be

successful.”

To show their appreciation, the Beals have become

generous supporters of the School of Medicine. Their

contributions to the Medical School Dean’s Education

and Research Fund are helping the school fulfill its mis-

sion of education, service and research. Their contribu-

tions support student scholarship and faculty develop-

ment as the medical school continues its upward trend.

“We see the significant improvements on both

campuses, including the Doisy

Research Center and the new

Chaifetz Arena,” said Eugene

Beal Jr. “We are proud to be a

part of SLU’s commitment to

excellence.”

“Giving back is a personal

choice,” Catherine Beal said.

“But it’s a natural choice for us.”

P R O F I L E O F P H I L A N T H R O P Y

T O L E A R N M O R E about giving opportunities and tax benefits that may be associated with your gift,

contact the office of development at the School of Medicine at (314) 977-8317 or mdalumni@slu.edu.

the Beal Family: Brandon, Eugene, Catherine and Michael.