CLINICAL UPDATE - Wake Forest Baptist Health · Advanced Endoscopy Unit with ... monitoring, and patients ... collaboration,” Fleischer said. “This benefits the patient because

the hepatobiliary and pancreatic (hbp) disorders service, one of the most active in the state, sees more than 1,000 outpatients a year and currently performs approximately 800 mainly therapeutic Endoscopic Retro-grade Cholangiopancreatography (ERCP) procedures annually. ERCP provides access for diagnosis and, increasingly, therapy for problems involving the bile ducts, gallbladder and pancreas. The service is led by John Baillie, M.B., Ch.B., F.R.C.P., F.A.C.G., F.A.S.G.E., an internationally rec-

mately one-third of cases provides an answer (e.g. gallbladder sludge) that renders ERCP unnecessary. ERCP is performed in the Advanced Endoscopy Unit with the support of Anesthesiology and a team of outstanding Certified Registered Nurse Anesthetists (CRNAs). A full range of diagnostic and therapeutic ERCP procedures are offered, including sphincter of Oddi manometry (SOM), me-chanical and contact lithotripsy for large biliary and pancreatic stones, stenting for benign and malignant conditions (e.g. leaks, strictures) and a variety of pancreatic endo-therapies. The HBP Disorders Service works collaboratively with the Anesthesiology Pre-Operative Assessment Clinic, ensuring that elderly, sick patients with multiple comorbidities are adequately prepared for anesthesia. The Day Hospital is available for patients needing extended post-procedure monitoring, and patients requiring hospitalization are admitted to a newly revamped Internal Medicine Hospitalist Service. The HBP service boasts a nation-ally recognized team of specialists. John Baillie has been recognized by the American Society for Gastro-intestinal Endoscopy (ASGE) as a Master Endoscopist (2001) and

ognized expert in the investigation and management of HBP disorders. Working closely with the HBP ser-vice is the Endoscopic Ultrasound Service (EUS), comprised of Girish Mishra, M.D., director, and Jason Conway, M.D. Among the unique services of-fered are combined EUS and ERCP under a single sedation. Many HBP conditions require one or both of these procedures, which historical-ly have been performed on different days, requiring repeated sedation. Typically, the EUS examination is performed first and in approxi-

The Wake Forest Baptist Hepatobiliary team: Drs. John Baillie (L), Jason Conway (C), Girish Mishra (R). John Gilliam, M.D., and Lisa Hammon, R.N., are not pictured.

The Hepatobiliary and Pancreatic (HBP) Disorders Service Unique Services from a Growing Team of Experts

a Distinguished Educator (2007). He is the author of six textbooks and over 400 peer-reviewed publi-cations. Baillie is a regular speaker at regional, national and interna-tional gastroenterology meetings. He co-authored the American Gastroenterological Association Institute’s 2007 Guidelines for the Management of Acute Pancreatitis, and is the American College of Gastroenterology’s representative (“Governor”) for North Carolina. Prior to joining Wake Forest Baptist, Baillie directed the Duke University Medical Center’s HBP Disorders continued on page 2 / HBP

JUNE 2008

wfubmc.edu

For Physicians and Health Care Providers

inside ThiS iSSuE

The Hepatobiliary and Pancreatic (HBP) Disorders Service 1

Dermatology Overview 2

Deep Brain Stimulation Program 3

New Clinical Faculty Listing 3

Treating Scoliosis 4

Physician’s Access Line

PAL 1-800-277-7654

wfubmc.edu

CLINICAL UPDATE

®

Patients may be referred to the HBP Service by a variety of meth-ods: for urgent attention, including requests for hospital transfer, call the Physician’s Access Line, PAL®

. For less urgent referrals, call the Biliary Coordinator at 336-713-7315 or fax a request to 336-713-7322.

advanced endoscopy fellowship at the University of Pennsylvania, and performs both ERCP and EUS. Lisa Hammon, R.N., is nurse coordinator of the HBP Disorders Service. Ham-mon has an extensive background in coordinating clinical services at the Medical Center.

HBP continued from cover

For example, a lupus patient might need both dermatology and rheumatology. A patient with melanomas might need dermatol-ogy as well as surgical and medical oncology. Research trials currently under way include non-melanoma skin cancer, cutaneous lymphoma, psoriasis, atopic dermatitis and lichen planus, Fleischer said. “One of the leading fields of research is on the relationship between patients’ compliance with their treatment and the outcome. We monitor them and their compliance. It’s helpful to understand the fac-tors that contribute to noncompli-ance. It helps us to understand the factors that influence ways to have better outcomes.” The dermatology department

dermatologist alan fleischer, m.d., plays a video on his computer of a man asleep in bed, tearing and scratching furiously at his skin. The man has eczema and will wake up with scraped and bloodied skin — and daily misery. “You might call dermatology a quality-of-life specialty,” said Fleischer, chair of the Department of Dermatology at Wake Forest University Baptist Medical Center.

“We see patients with difficult to treat auto-immune diseases, often with conditions like atopic eczema and psoriasis that are incurable, but treatable.” With eight physician experts, the department treats a wide range of dermatologic problems, from the simplest to rare dermatologic disorders, at all ages. The group offers life-changing therapies for people with diseases related to skin, hair and nails. “We recognize that conditions like psoriasis or eczema, which may initially appear as a simple problem, can affect every aspect of your life. These patients need proper diagnosis and treatment.” The dermatology department treats psoriasis, hair and scalp dis-orders, acne and rosacea, eczema and itch, skin cancers and lesions, ethnic and pigmented skin disor-ders. They also offer laser rejuvena-tion, vascular and hair laser, and cosmetic dermatology. “Our department offers state-of-the-art diagnosis and clinic re-

search using the latest therapeutic tools,” Fleischer said. “For example, right now we are developing gene rearrangement studies for T-cell lymphomas of the skin. It allows earlier and more definite diagno-sis. It’s a molecular fingerprint of cancer.” In addition, he said, the research includes special histopathology approaches designed to more accurately diagnose inflammatory hair loss conditions. “We work intimately with pathology, medi-cal oncology, surgical oncology, plastic surgery, otolaryngology and radiation oncology — it is a true collaboration,” Fleischer said. “This benefits the patient because of the opportunity for immediate input from allied specialty fields.”

strives to improve not only the patient’s conditions, but quality of life, Fleischer said. “We want to help people live as full a life as they possibly can.” To refer a patient or for information, call PAL®

.

The dermaTology Physician Team

Alan B. Fleischer Jr., M.D.Chair, Skin Diseases and Cancer

Joseph L. Jorizzo, M.D.Founder, Rheumatologic and Immunologic/ Dermatologic Disorders

Steven R. Feldman, M.D., Ph.D.Director, Center for Dermatology Research

Phillip M. Williford, M.D., F.A.C.P.Director, Dermatologic Surgery

Amy J. McMichael, M.D.Director, Hair Disorders Clinic

Gil Yosipovitch, M.D.Director, Skin Physiology Laboratory

Rita Pichardo-Geisinger, M.D.Pigmented Lesions, Skin, Hair and Scalp Disease

Omar P. Sangueza, M.D.Director, Dermatopathology

The Wake Forest Baptist dermatology group includes (L-R): Dr. Omar Sangueza, Debra Copeland-Sizemore, PA, Drs. Steve Feldman, Rita Pichardo-Geisinger, Gil Yosipovitch, Alan Fleischer, Joseph Jorizzo, Amy McMichael, and Adele Clark, PA. Dr. Phillip Williford is not pictured.

Service from 1994-2005. The team includes John Gilliam, M.D., director of endoscopy and a longstanding faculty member of the Gastroenterology Division. In July, the group will add Jerry Evans, M.D., from Duke University Medi-cal Center. Evans completed an

Dermatology Overview Life-changing Therapies, Research

New on the

Live SurgerieS Archive

Computer-Assisted Total Knee

Replacement Surgery performed by

orthopaedic surgeon Jason E. Lang,

M.D., and narrated by orthopaedic

surgeon William G. Ward Sr., M.D.

To view webcast: www.Or-Live.com

or wfubmc.edu/webcasts

CLINICAL UPDATE is published by Wake Forest University Baptist Medical Center for community physicians.

William B. Applegate, M.D., M.P.H., F.A.C.P. Interim President, Wake Forest University Health Sciences

Dean, Wake Forest University School of Medicine

Donny C. Lambeth Interim President, Chief Operating Officer North Carolina Baptist Hospital

Please direct comments and suggestions for CLINICAL UPDATE to:

Editor: Annette Porter email: [email protected]

Contributing Writers: Rae Bush, Ann Hopkins, Claudia Nielson, Jonnie Rohrer

PAL Physician’s Access Line 1-800-277-7654 ®

wake forest baptist has offered deep brain stimulation (dbs) to treat medically refractory patients with Parkinson’s disease, essential tremor and generalized dystonia (humanitarian device exemption) for more than 10 years. “Our patients have enjoyed increased quality of life and have experienced marked improve-ments in the symptoms of their illness,” said Mustafa Siddiqui, M.D., director of the Parkinson’s and Movement Disorders Center and co-director of the Deep Brain Stimulation program. The multidisciplinary program offers patients the expertise of two surgeons, a movement disorders neurologist with specialized training in deep brain stimulation, a neuropsychiatrist, neuropsy-chologist, and speech and physical therapists. “This team works closely to care-fully select the right candidate for surgery,” said Siddiqui. “Our neuro-physiologist is available to provide microelectrode recording during DBS surgeries, which allows us to further refine our target within one millimeter of accuracy. The two most important factors in the success of DBS surgery are careful selection of the patient and correct placement of the brain electrodes.” When a patient with Parkinson’s

the medications, the stimulation settings and the device for each patient. The process typically ends four to six months after the second surgery phase. “Once the patient has completed this process, we usually begin to work with their neurologist in their home community for follow-up care,” said Siddiqui. The main advantages of DBS over other types of surgery are its ability to be reversed, to be pro-grammed and to perform bilateral procedures without serious side effects. Most Parkinson’s patients with motor symptoms such as rigidity, tremor, bradykinesia, dys-tonia, motor fluctuations (including dyskinesias, dose wearing off and dose failures), respond very well to deep brain stimulation. Symptoms unlikely to respond include speech,

disease, tremor or dystonia is referred, the movement disorder specialist confirms the diagnosis, quantifies the severity of the symp-toms and response to medications. The prolonged evaluation re-quires patients to come in without taking their medications. They are evaluated, asked to take their medi-cations and then re-evaluated. Sid-diqui explained that “this ensures that the symptoms are severe enough to justify surgery and that they cannot be treated satisfacto-rily with medication. If dementia is suspected, patients undergo ad-ditional testing. Dementia patients are poor candidates for surgery.” Currently, Parkinson’s patients comprise about 60 percent of the DBS program at Wake Forest Bap-tist, with essential tremor patients comprising approximately 30 per-cent and dystonia patients about 5 percent of the program. About one in three referred patients will be suitable surgery candidates. The DBS procedure involves three phases. First, the electrodes are surgically implanted. About three weeks later, the patient returns for phase two, which involves implanting the stimulator in the chest and connecting it to the electrodes. After completion of these two surgeries, Siddiqui and his team work to optimize

Dr. Siddiqui (center) monitors the progress of a DBS procedure. About 60 percent of DBS procedures at Wake Forest Baptist are performed on patients with Parkinson’s disease.

Deep Brain Stimulation Program More Than a Decade of Experience

cognition, gait, autonomic symp-toms and mood/behavior, accord-ing to Siddiqui. For more information about DBS at Wake Forest Baptist or to refer a

patient, call PAL®.

The dBs Team

Mustafa Siddiqui, M.D.DBS-trained Movement Disorder Neurologist and Intraoperative Micro Electrode Recording Neurophysiologist

Thomas Ellis, M.D. Neurosurgeon and Co-Director of the DBS Program

Stephen Tatter, M.D. Neurosurgeon

Stephen Kramer, M.D.Neuropsychiatrist

Veronica Abbott, RNP DBS-trained Nurse Practitioner

Allen NewtonDBS Technician

Kimberly SladeDBS Program Coordinator

The following physicians have joined the Wake Forest University Baptist Medical Center faculty recently. To refer patients, call PAL®. For a complete listing of clinical faculty, please check our online Physician Referral Directory atwfubmc.edu/oprd.

Hematology and Oncology KELLiE E. RizziERi, M.D. Assistant Professor | Clinical Interests: Breast Cancer, General Hematology and Oncology Postgraduate Degree: University of Rochester | Residency: Strong Memorial Hospital | Fellowship: Duke University Medical Center Board Certification: American Board of Internal Medicine (Hematology, Medical Oncology)

Orthopaedic Surgery ALLSTON J. STUBBS, M.D. Assistant Professor | Clinical Interests: Sports Medicine, Arthroscopic Surgery, Orthopaedics (general), Pediatric Orthopaedic Surgery, Arthroscopy of the shoulder and knee, Adolescent Sports Medicine | Postgraduate Degree: Duke University School of Medicine | Residency: Duke University Medical Center | Fellowship: Steadman Hawkins Clinic, Vail, Colorado; Children’s Hospital, Harvard Medical School

Radiology WENDELL STEPHEN MyERS, M.D. Assistant Professor | Clinical Interests: Pediatric Radiology, General Radiology, Breast Imaging, Chest CT, Radiology | Postgraduate Degree: Bowman Gray School of Medicine | Residency: Wake Forest University School of Medicine Board Certification: American Board of Radiology; National Board of Medical Examiners

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curvature of more than 50 percent often require surgery. “The surgery is extensive and requires a five-day hospital stay and a six-week re-covery period. This is why I always encourage my patients to wear the back brace if possible,” Frino said. However, patients who undergo surgery often are walking within 24 hours without a back brace or cast.

“We have dramatically improved this surgery over the years,” Frino said. “Forty years ago, patients who required this surgery often spent six-to-nine months in a body cast and were barely functional. Today, patients are walking on their own within 24 hours and have no restrictions after six months. The surgical hardware we use today also dramatically improves the cor-

john frino, m.d., treats many young patients with scoliosis and has the rewarding experience of helping them regain normal appearance and function through bracing or surgery. Scoliosis is a curvature of the spine which can worsen during periods of rapid growth. Patients with scoliosis often appear de-formed (for example one hip or shoulder might appear higher than the other). Bracing is the best option for pa-tients with a curvature of less than 40 degrees and growth remain-ing, said Frino. “We really strive to make braces functional and easily wearable by patients. Teenagers usually must remain in a back brace until their growth periods have ceased, which is typically by age 14 for girls and 16 for boys.” Teenagers or adults with a

rection of the spine. “It is very rewarding to see patients who were struggling with this problem regain their positive mental attitude and outlook about their appearance and their life,” Frino said. “The teenagers just feel better about themselves and that translates into their schoolwork and their after-school activities.” For more information, or to refer a patient, call the BrennerPal®.

Treating Scoliosis

Brenner Physician’s Access Line

1-877-716-1999

www.brennerchildrens.org

®

Bracing is the best option for growing teens with a curvature of less than 40 degrees, says Dr. Frino, adjusting patient Hannah Clark’s brace (above).

To receive CLINICAL UPDATE online, visit wfubmc.edu/CU

PEDIATRIC ORThOPAEDIC SuRgERy

Pediatric orthopaedic surgeons John Frino, M.D., and Andrew Koman, M.D., provide state-of-the-art treatment for scoliosis and spinal deformity, spina bifida, cerebral palsy, pediatric trauma, congenital deformities and sports medicine. Multidisciplinary clinics combine the expertise of surgeons, rehabilitation specialists and other pediatric sub-specialists to map out the best treatment plans for each child.

The pediatric orthopaedics team sees patients with hip dysplasia requiring pelvic and femoral osteotomies, congenital hand deformities, brachial plexus injuries and spasticity associated with cerebral palsy.

Special capabilities include limb-lengthening, such as self-lengthening intramedullary nail devices and com-puter-driven external fixators to correct congenital deformities or traumatic injuries of extremities, and computer-assisted surgery to enhance accuracy.

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