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St. Louis
Specialists with Worldwide Appeal
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Local
physicians are leading the way in advancing medical treatment and
technology—drawing patients from afar.
By Pam McGrath
More than 50 hospitals are located in metropolitan St. Louis, which
is one reason the area is considered a leading medical center in
the country. Another reason is that among those hospitals are two
adult and two pediatric hospitals affiliated with nationally recognized
medical schools at Saint Louis University and Washington University.
But in fact any reputation for excellence is only as good as the
individuals behind it. St. Louis’ real treasures are the physicians
whose research is leading the way in advancing medical treatment
and technology—and whose expertise is drawing patients from across
the country and around the world.
Presented here is a sampling of those St. Louis physicians. Although
they may not be the only prominent St. Louis-based physicians in
their specialties, they represent the community of medical professionals
who together provide their city with a stellar reputation for excellence
in health care.
Bruce R. Bacon, MD
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James F. King MD Endowed Chair in Gastroenterology
Professor of Internal Medicine, Director of Gastroenterology and
Hepatology
Saint Louis University School of Medicine/Saint Louis University
Hospital
Hepatitis C
Long before he encountered his most famous patient with hepatitis
C, Dr. Bacon was internationally known for his research and treatment
of the virus, as well as for his work in liver iron metabolism.
But his successful course of therapy for country music star Naomi
Judd brought his expertise to the attention of a broader audience.
Dr. Bacon’s help is now sought by people with hepatitis C living
throughout the United States—including a man from the East Coast
who, even after seeing three doctors, was not receiving adequate
treatment.
“There’s an estimated four million people in the U.S. with hepatitis
C, and probably 40,000 of them live in the metropolitan St. Louis
area. The virus, which is spread through blood-to-blood contact,
is like many other liver diseases—people often aren’t aware they
have it until serious liver damage has occurred,” Dr. Bacon says.
“That’s why it’s so important for those at high risk to be tested.”
He adds, “About 70 to 80 percent of people with hepatitis C develop
a chronic form of it. People need to know there are effective treatments
for about 40 percent of those patients.”
Richard D. Bucholz, MD
Professor of Surgery, Division of Neurosurgery
Director, Jean H. Bakewell Section of Image Guided Surgery
Saint Louis University School of Medicine
Attending Physician, Saint Louis University Hospital
Image Guided Surgery
On a recent episode of the television program, “ER,” a neurosurgeon
used a three-dimensional computer image, generated with the help
of a specially marked preoperative MRI scan, to map the anatomy
of a patient’s brain. He then used the map as a guide to removing
a brain tumor. The technology being showcased is called the StealthStation,
an image guided surgical navigational system developed by Dr. Bucholz.
The episode showed the StealthStation being used while the patient
was awake. In this way, the surgeon could stimulate the brain and,
with feedback from the patient, determine where functions such as
movement, speech and memory were located in relation to the brain
tumor. In reality, Dr. Bucholz has already developed the next level
of this technology, which allows the patient to remain asleep during
the operation.
“Prior to the surgery, we propose to use magnetoencephalography
(MEG), a means of measuring electrical activity in the brain, to
determine where these functions are stored. The magnetic activity
recorded by this extremely sensitive device is a result of the patient’s
brain responding to a variety of stimuli,” says Dr. Bucholz. “We’ve
developed new technology that allows us to fuse the MEG results
with the MRI scan. This provides neurosurgeons with the functional
brain maps they need and allows patients to undergo general anesthesia
during these major surgeries.”
William J.
Catalona, MD
Professor of Urology, Washington University School of Medicine
Attending Physician at Barnes-Jewish Hospital
Prostate Cancer
When Dr. Catalona began his career, he was interested in refining
nerve sparing prostatectomy, the surgical treatment for early-stage
prostate cancer. During this delicate operation, the surgeon removes
the prostate but spares nerves that control continence and potency.
Unfortunately, early-stage prostate cancer is hard to detect. At
the time Dr. Catalona began his practice, the only way to find the
cancer was through physical examination. The result was that seven
out of 10 patients he saw were not candidates for surgery because
their cancer had already spread beyond the prostate. Dr. Catalona
suspected a screening tool called the PSA blood test could be used
to detect prostate cancer in its early stages. In 1991, his favorable
study findings were published in the New England Journal of Medicine.
Today, the PSA blood test is used worldwide for early detection,
and Dr. Catalona has performed 2,800 nerve sparing prostatectomies,
with patients coming from across the United States, Central and
South America, Europe, the Middle East and Asia.
“The biggest fear of a man diagnosed with prostate cancer is that
he will become incontinent and impotent as a result of surgery,”
Dr. Catalona says. “The ability to diagnose the cancer in its earliest
stages has given me an excellent opportunity of assuring that doesn’t
happen.”
Joel D. Cooper, MD
Evarts A. Graham Professor of Surgery, Washington University School
of Medicine
Chief of the Division of Cardiothoracic Surgery at Barnes-Jewish
Hospital
Lung Volume Reduction Surgery
To understand how a patient with severe emphysema feels, Dr. Cooper
suggests breathing in as deeply as possible and then for one minute
taking small breaths while keeping the chest fully inflated. The
discomfort is enormous.
For people with emphysema, the inability to take deep breaths results
from their lungs losing their elasticity. They breathe in, but the
air doesn’t come out. Over the years, their lungs get larger and
larger, until there’s barely room for them to take any breaths but
rapid, shallow ones. The result is they become severely disabled
and limited in their activities.
People at this stage of the disease under age 65 may become candidates
for lung transplantation, although for many the shortage of donor
lungs limits that option. A remaining choice for them and older
adults may be lung volume reduction surgery, a procedure pioneered
by Dr. Cooper in the early 1990s.
“The basic idea is that by taking out the most diseased parts of
the lungs, the remaining portions are better able to expand. Patients’
oxygen levels increase, but more importantly a lot of their breathlessness
is gone, enabling them to exert themselves and remain reasonably
comfortable,” Dr. Cooper says. “Most feel like the procedure turns
their time clock back five years, allowing them to visit their grandkids,
shop, get dressed in under an hour—all without a pervasive sense
of being out of breath.”
Ralph J. Damiano Jr., MD
John M. Shoenberg Professor of Surgery, Washington University School
of Medicine
Chief of Cardiac Surgery at Barnes-Jewish Hospital
Beating Heart Surgery
Dr. Damiano describes the process of performing coronary bypass
surgery as sewing two strands of linguine together with fine thread.
Add to that the difficulty of trying to perform the procedure on
a moving, beating heart, and the task becomes very difficult.
In the early days of coronary surgery, the problem was solved with
a heart-lung machine, which reroutes blood outside the body and
allows the heart to be stopped during surgery. Dr. Damiano is recognized
as one of the pioneers of a new surgical technique called beating
heart surgery. During the procedure, a heart stabilizer immobilizes
the artery just where the surgeon needs to sew, but leaves the rest
of the heart beating. For multiple bypasses, the stabilizer is simply
moved from one artery to another.
“We’re about to begin a clinical trial to investigate the benefits
of beating heart surgery. However, I’ve found that patients experience
fewer complications when this procedure is used,” Dr. Damiano says.
“This is an exciting development, especially for elderly patients
or those with other medical complications who would be at high risk
if placed on a heart-lung machine.”
Lawrence G. Lenke, MD
Professor of Orthopedic Surgery, Washington University School of
Medicine
Chief of Spine Surgery at Shriners Hospital for Children
Attending Physician, St. Louis Children’s Hospital
Spinal Fusion
Scoliosis and kyphosis are conditions that cause the spine to curve.
Correcting the curvature involves surgically straightening the spine
by fusing vertebrae together and inserting thin rods so the spine
will heal in the new position.
Dr. Lenke is one of about 10 orthopedic surgeons in the country
skilled in video-assisted thoracoscopy, a procedure that does not
require large, invasive incisions to reach the spine. Rather, Dr.
Lenke makes several small incisions through which he inserts an
endoscope—a device consisting of a tube and optical system—that
allows him to perform the corrective surgery.
Thoracoscopy has been used for spinal fusion since the mid-1990s.
Two years ago, Dr. Lenke was the first to use it to insert the rods
as well.
“Depending on the type of curvature, sometimes we can do both the
fusion and rod insertion, sometimes only the fusion—and sometimes
children simply need the more invasive surgery,” Dr. Lenke says.
“But our option of doing this surgery less invasively means children
experience a lot less pain, recover more quickly and are on their
way to an active life that much sooner.”
Paul R. Manske, MD
Professor of Orthopedic Surgery, Washington University School of
Medicine Chief of Hand Surgery at Shriners Hospital for Children
Attending Physician, St. Louis Children’s Hospital, Barnes-Jewish
Hospital
Hand Surgery
For the past 25 years, Dr. Manske has given children born without
thumbs the ability to grasp objects, hold a pencil, toss a football—in
other words, gain full use of their hands. Dr. Manske is an expert
on pollicization, a procedure in which the index finger is surgically
moved to the thumb’s position. An important modification Dr. Manske
has made to the surgery seems an obvious one—making the moved finger
look like a thumb. But most surgeons don’t have extensive experience
with pollicization, perhaps performing a half dozen in a lifetime;
to date, Dr. Manske has performed more than 200.
“If you are a hand surgeon, it is reasonably easy to rotate the
index finger around to the thumb position. The problem is, it often
looks like a finger sticking out of the palm of the hand rather
than a thumb,” Dr. Manske says. “You can make the finger look like
a thumb by shortening it and having it join the hand at the middle
knuckle rather than at the third. Going that extra step often means
a lot to these children.”
T. S. Park, MD
Shi H. Huang Professor of Neurosurgery, Washington University School
of Medicine
Neurosurgeon-in-Chief at St. Louis Children’s Hospital
Selective Dorsal Rhizotomy
Cerebral palsy (CP) is caused by damage to the brain around the
time of birth. This damage often results in abnormal activity in
the brain and spinal cord that can lead to increased muscle stiffness
known as spasticity. For many years, the spasticity experienced
by children and adults with CP was primarily treated with leg braces,
physical therapy and orthopedic surgery.
Dr. Park, one of the nation’s leading pediatric neurosurgeons, performs
a surgery called selective dorsal rhizotomy (SDR) that can permanently
reduce stiffness in the muscles of the lower extremities. During
the procedure, Dr. Park exposes the lower end of the spinal cord
and cuts the nerve fibers causing the spasticity. In the past 14
years, he has performed more than 760 procedures; all of his patients
have experienced at least some improvement in their ability to walk,
stand, sit or control other movement.
“All children with cerebral palsy and stiffness primarily in their
legs should undergo SDR as the first option in managing their problems,”
Dr. Park says. “When performed at an early age, the rhizotomy can
not only help develop motor skills but also reduce the number of
orthopedic surgeries patients might otherwise require. It can also
improve speech, visual perception and upper extremity function in
some patients.”
Pediatric
Lung Transplant Team
St. Louis Children’s Hospital
Pediatric Lung Transplantation
Two transplant surgeons, four transplant pulmonary physicians, a
pediatric cardiologist and four nurse coordinators are a few of
the team members supporting the most active pediatric lung transplantation
program in the world. Nearly 40 percent of all pediatric lung transplants
ever done in the world have occurred at St. Louis Children’s Hospital.
“Our lung transplant program took off like a meteor when it was
established in 1990,” says Charles B. Huddleston, MD, surgical director
for the hospital’s heart and lung transplant programs. “No one else
was doing this procedure, and there was an obvious need to take
on the task.” In recent years, the lack of available donor organs
for children has brought the hospital to the forefront of another
aspect of lung transplantation, that of living-donor transplants.
The procedure involves removing a lower lobe from each of two living
donors and transplanting them as whole lungs into the child. Over
the past two years, 30 to 35 percent of the hospital’s lung transplants
have been living donor. According to Stuart C. Sweet, MD, PhD, medical
director for the program, that number will continue to comprise
a significant percentage of the hospital’s lung transplant activity,
and it will increase unless the availability of cadaveric organs
improves.
“For children who become very ill, or whose diseases progress rapidly—so
that they will not survive until a cadaveric organ donor becomes
available—living-donor transplants become their safety net,” he
says.
P. Syamasundar Rao, MD
Professor of Pediatrics, Saint Louis University School of Medicine
Cardiologist, SSM Cardinal Glennon Children’s Hospital
Transcatheter Closure
Before birth, a duct remains open between the two great arteries
of a fetus’ heart to help the flow of oxygen from the mother to
the baby. After birth, the duct usually closes permanently within
a day or two. But in about 3,000 babies born in the United States
annually, the duct does not close, resulting in the congenital defect
called patent ductus arteriosus.
Surgery was once the only treatment for this defect. But in 1988
Dr. Rao became one of the first cardiologists in the United States
to use a technique called transcatheter buttoned device closure.
This technique uses tiny, umbrella-like devices inserted into the
patient’s body through a catheter. Mounted on tiny, flexible wires,
these are directed to the heart, where they spring open to form
a square-shaped patch. After positioning, they are buttoned together
against tissues surrounding the hole. Within a few weeks, normal
tissue grows over the components to close the defect permanently.
At the present time, a small patent ductus arteriosus may be closed
using a procedure known as coil occlusion, but a large defect requires
the transcatheter buttoned device closure. This procedure is also
sometimes used for two other heart defects, atrial septal defect
and ventricular septal defect.
“There are cases where open heart surgery is called for. But patients
need to spend four to five days in the hospital to recover,” Dr.
Rao says. “With transcatheter closure, patients are able to leave
the hospital the day after the procedure is performed.”
Eric W. Sargent, MD
Assistant Professor of Otolaryngology-Head and Neck Surgery
Saint Louis University School of Medicine
Attending Physician, Saint Louis University Hospital
Otolaryngology
Because of his experience with cochlear implants, Dr. Sargent was
selected to be among the first physicians in the nation—and the
only doctor in St. Louis—to begin implanting a new hearing device
called the Vibrant Soundbridge. Developed and tested by Symphonix
Devices, Inc., this new technology is designed to improve the hearing
of people with moderate-to-severe sensorineural (nerve) hearing
losses, the most common form of hearing loss.
Classified as a medical prosthesis rather than a hearing aid, the
Soundbridge is divided into an external and internal component.
The external portion, called the audio processor, remains outside
the body and is held onto the head with a magnet. It contains the
technology that converts sound to a signal transmitted to the internal
portion, which is implanted behind the ear.
“Hearing aids take sound and make it louder. The Soundbridge converts
sound to mechanical vibrations inside the middle ear, vibrating
the bones like the diaphragm of a speaker,” Dr. Sargent says. “This
is elegant technology that reduces the feedback people often experience
with hearing aids and eliminates the discomfort some people feel
having something in their ear canals.”
J. David Thompson, MD
Associate Professor of Pediatrics, Saint Louis University School
of Medicine
Director of Pediatric Orthopedic Surgery, SSM Cardinal Glennon Children’s
Hospital
Scapulothoracic Fusion
Most people are familiar with the type of muscular dystrophy (MD)
that causes progressive atrophy and wasting of muscles in young
boys. There are several forms of MD, however, among them facioscapulohumeral
muscular dystrophy (FSH). This hereditary form of MD affects both
men and women. Its most severe consequence is weakness in the shoulder
muscles, which causes shoulder blades to “wing” or protrude at angles
up to 90 degrees. People with FSH are often unable to lift their
arms above their shoulders, making everyday actions like getting
a plate down from a cabinet, washing their hair or throwing a baseball
almost impossible.
Twelve years ago, Dr. Thompson became interested in scapulothoracic
fusion, the surgical procedure that helps remedy the muscle weakness.
Today, he has performed more of the surgeries than anyone else in
the world.
“Fusing the shoulder blades to the ribs underneath them prevents
them from winging and provides stability,” Dr. Thompson says. “My
patients have ranged in age from late teens to people in their ’60s.
Routinely they are people who have led active lives in the past;
thanks to the surgery, they are able to resume those lives.”
Dionysios K. Veronikis, MD
Chief, Division of Gynecology
Director, Urogynecology and Reconstructive Pelvic Surgery
St. John’s Mercy Medical Center
Urogynecology and Reconstructive Pelvic Surgery
Dr. Veronikis describes his patients as the most grateful in the
world. That’s because more often than not he is able to bring them
relief from sensitive problems such as urinary incontinence, rectal
and small bowel hernias, and prolapse of the genitals, vagina and
uterus. He describes these conditions as becoming epidemic, as women
live longer and demand treatment that allows them normal, active
lives free of embarrassment. An emphasis of his clinical practice
is reoperative gynecologic surgery in cases where these problems
persist or recur.
“The important aspect of treating these conditions is the ability
to take the standard operations and modify them to best fit the
individual patient,” Dr. Veronikis says. “It’s a privilege for me
to use my skills in such a way that makes a tremendous difference
in people’s lives.”
Another group of women for whom Dr. Veronikis makes a difference
is those born with congenital anomalies. In one out of every 5,000
live births, a female child is born without a vagina. Dr. Veronikis’
ability to correct that anomaly through laparoscopic surgery has
brought peace of mind to women searching for someone with the skill
and compassion to help.
Michael P. Whyte, MD
Professor of Medicine, Pediatrics and Genetics, Washington University
School of Medicine
Director, Center for Metabolic Bone Disease and Molecular Research,
Shriners Hospital for Children
Attending Physician, St. Louis Children’s Hospital and Barnes-Jewish
Hospital
Metabolic Bone Diseases
Children with metabolic bone diseases have problems growing bone
because their bodies don’t process bone-building nutrients properly.
According to Dr. Whyte, the individual kinds of metabolic bone diseases
are not common. But considering that many of these rare diseases
exist, the cumulative patient population is substantial.
The rarity of these diseases often makes it difficult for any one
medical center to develop a large patient population from which
an in-depth understanding of the disease may develop. For that reason,
children from across the United States come to the Research Center
at Shriners to benefit from Dr. Whyte’s work in metabolic bone diseases.
“We have a broad range of interest in these diseases, from diagnosis
and treatment to research concerning the molecular bases of the
heritable disorders. And our ability to treat these children is
enhanced by the subspecialties available to us at Shriners, such
as orthopedic surgery and physical therapy,” Dr. Whyte says. “These
factors make us an important resource for children with metabolic
bone disease and their families.”
Pam McGrath is a St. Louis-based free-lance writer.
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