TAG: "Surgery"

On the road to recovery

UC Irvine spinal experts help patient get back on his feet after motorcycle accident.

Ruben Barajas remembers the accident in snapshots: Riding his motorcycle to class at Cal State Fullerton. An inattentive driver veering into his lane. Lying on the freeway, unable to move or breathe. Finally, paramedics giving him a lifesaving rush of oxygen.

“That first taste of air after struggling to breathe was absolutely beautiful,” he says. He also remembers the ambulance ride to UC Irvine Medical Center in Orange, his anxious family, neurological tests and learning at age 25 he might never walk again.

His neurosurgeon, Dr. Daniel Yanni, explains: “Ruben had two shattered vertebrae in his neck — a severe injury that paralyzed his arms and legs. His chances of regaining movement were small, but we tried to ensure the best possible outcome by treating him quickly and aggressively.”

That night, Yanni removed the bone fragments that were compressing Barajas’ spinal cord, replacing the broken bones with a metal cage, plate and screws.

The next day, he excised more bone from the back of Barajas’ spine and anchored the cage in place with metal rods and screws. Both surgeries required tremendous surgical skill and precision.

Barajas was treated for other injuries, too — a broken right arm, fractured ankle and mangled right toe. The neurosurgical and neurocritical care team did everything possible to aid his recovery, even maintaining artificially high blood pressure to improve blood flow to the spinal cord.

Heavily sedated for two weeks, Barajas has no memory of the surgery. But he does remember beginning physical therapy at UC Irvine Health. “My right leg was in a brace and my right arm in a sling,” he says. “It was the hardest work I’ve ever done.” After three weeks at UC Irvine Health, he was transferred to a rehabilitation hospital, where he continued to regain the use of his arms and legs.

The hard work and intensive medical care paid off. In January 2013, six months after the accident, Barajas took his first steps. “Just standing up was a shock,” he says. “I’d forgotten how different the world looks when you’re upright.”

He left the rehabilitation hospital in March using only a walker. By October, he was driving and working at a gym part time. In August 2014, two years after the accident, Barajas returned to college with a new career in mind. “I want to help people when they’re at their most vulnerable,” he says. “I can do that best as a doctor specializing in rehabilitation medicine.”

Yanni describes Barajas’ recovery as “truly spectacular.” Barajas credits Yanni: “I’m truly blessed that he had the expertise to put me back together,” he says. “I’m blessed beyond belief.”

To learn more about UC Irvine Health neurosurgical spine services, visit ucirvinehealth.org/spine.

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UCLA offers pioneering surgery for phrenic nerve damage

West Coast’s only medical center with surgery for the rare condition.

By Amy Albin, UCLA

David Powell could not catch his breath.

The 35-year-old from San Diego got winded walking up the stairs, exercising or even just bending over to tie his shoes. His favorite pastime, hiking, became impossible. But doctors, unable to diagnose his condition, told Powell that he would just have to live with it.

Frustrated, he turned to the Internet and discovered that his symptoms could be the result of phrenic nerve damage. The phrenic nerves — there is one on each side of the body — send messages from the brain to the diaphragm telling the body to breathe. Powell also learned that the damage could possibly be repaired through surgery.

Injuries to the phrenic nerve can occur in a variety of ways, including injections of medicine in the neck prior to shoulder surgery or to treat pain, chiropractic adjustments of the neck, or neck, chest or vascular surgery. In addition, scar tissue can form in the neck and compress the nerve. Patients are often misdiagnosed because the symptoms are similar to those of pneumonia or asthma. Doctors typically diagnose phrenic nerve injury by conducting a physical exam, asking the patient about previous medical treatments that may have affected the neck or chest, and considering whether the patient has severe shortness of breath and is unable to perform simple day-to-day activities.

“If we suspect that it is a phrenic nerve injury, there are a couple of tests that can help us make a definitive diagnosis,” said Dr. Reza Jarrahy, an associate clinical professor of plastic and reconstructive surgery at UCLA.

Jarrahy said surgery for the disorder aims to identify the exact location of the injury and then repair it by removing the scar tissue and freeing up the nerve. In some cases, surgeons take a small piece of nerve from the person’s leg and use it as a bypass around the injured nerve, creating a clean route for the nerve signal from the brain to the diaphragm.

Although many people notice an improvement immediately following surgery, it may take a year or more for the new nerve to regrow and form new connections in the body. Also, the diaphragm muscle must be retrained and strengthened again.

“Even though diaphragm paralysis impacts the respiratory system, the underlying pathology is focused on nerves and muscles,” said Dr. Matthew Kaufman, a voluntary assistant clinical professor at the David Geffen School of Medicine at UCLA. “As a result, many medical professionals are unaware of phrenic nerve surgery.”

In 2007, Kaufman began specializing in the procedure at his plastic and reconstructive surgery practice in Shrewsbury, New Jersey. In 2013, he teamed up with Jarrahy to offer the surgery at UCLA. Together, the two centers have treated more than 100 patients, up to 80 percent of whom have made a partial or complete recovery.

“These patients suffer tremendously and yet have very few options,” Jarrahy said. “This surgery offers hope to patients who previously had none and were resigned to dealing with this debilitating condition for life.”

Powell underwent the procedure in August 2013, and is no longer sidelined by his condition. He can once again enjoy all of his favorite activities.

“It’s so much better,” he said. “Before, I pretty much couldn’t do anything, but now I can do exercise—hike, ride my bike and swim.”

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Caring for the child’s brain

Pediatric Brain Center provides holistic care for patients’ full range of brain-related needs.

Audrey Price

By Kathleen Masterson, UC San Francisco

Fifteen-year-old Audrey Price slowly reaches for an orange plastic cup sitting on the counter. In a concerted effort, her fingers close around it, and she lifts it to chest height, shaking ever so slightly.

For Audrey, this simple act marks a tremendous journey from diagnosis to brain surgery to therapy and slow healing.

Just 11 months ago, she was living a typical middle-schooler’s life in a Bay Area suburb, hanging out with friends, playing tennis and obsessing over the British boy band, One Direction.

Then Audrey began developing weakness in her right side. After a series of doctor’s appointments, she ended up visiting a neurologist, who ordered scans of her brain that showed an aneurysm the size of a golf ball pressing on her brain stem.

That’s when her neurologist called UC San Francisco.

Audrey was brought into the newly formed Pediatric Brain Center at the UCSF Benioff Children’s Hospital San Francisco, which integrates neurology, neurosurgery, physical and occupational therapy, speech, social work and neuro-psychology to provide seamless holistic care for patients’ full range of brain-related needs. It’s one of just a few specialized pediatric brain centers in the U.S.

The center’s unique structure and specializations ended up being an ideal match for Audrey’s rare and complex condition.

Heather Fullerton and Nalin Gupta lead UC San Francisco's Pediatric Brain Center, which opens a new, centralized location at the new UCSF Benioff Children's Hospital at Mission Bay on Feb. 1. (Photo by Cindy Chew)

Bringing the doctors to the patient

The Pediatric Brain Center was founded about two years ago, spearheaded by Heather Fullerton, M.D., and Nalin Gupta, M.D. The center brings together a diverse range of UCSF experts from across multiple departments to treat patients together, as a team.

Rather than the typical experience in which a patient may see one doctor and then be referred to another specialist, and then another, chasing multiple appointments over weeks, at the Pediatric Brain Center the physicians, nurses and other key staff coordinate the care around the patient. One coordinator books all the patient’s appointments, from check-ups to arranging tests to surgery, and each patient is treated by a team assembled specifically to meet his or her unique medical needs.

“The goal was to make not only the patient experience, but also the problem solving and treatment, more rational. We wanted to be able to design our care around the patient’s medical issue, as opposed to simply following the organizational structure of the institution,” said Gupta.

Initially the center existed mainly as an organization change, with all the experts still located in separate offices at Parnassus. With the Feb. 1 opening of the UCSF Medical Center at Mission Bay, the Pediatric Brain Center will soon have it’s own central location to further streamline the patient experience.

“It’s so much easier for the family to have one place to go for all their child’s care, all the way from the initial treatment to rehabilitation,” said Fullerton.

Unique expertise in research and care

Having a centralized space will help make the patient experience smoother, but the crux of the Pediatric Brain Center is its network of highly specialized researchers, clinicians and surgeons.

“Having clinicians and researchers together helps inform what we study,” said Fullerton, a practicing neurologist who also researches pediatric strokes. “So many of our clinicians are also researchers, so when a question comes up in clinic, we can use our own local expertise to start the search for an answer. For example if I keep seeing this strange-looking blood vessel, I can turn around and start a study to investigate what’s happening.”

That’s a distinct advantage of an academic medical center. Private practices couldn’t afford the freedom to develop deep expertise in narrow areas, said Gupta. Furthermore, a child’s brain isn’t like the adult brain; treating a growing brain requires specialized neurology expertise.

“With the Pediatric Brain Center, we’re explicitly trying to leverage the strengths of the institution,” said Gupta. “We have people that have lot of expertise in narrow areas, and by definition those are often rare things.”

Building a specialized team

The Pediatric Brain Center brings all these diverse experts together, forming a unique treatment team made up of specialists relevant to each patient’s needs.

That’s vital for patients like Audrey, said Gupta.

“What Audrey had was very rare and complex. She’s an example of type of patient that there isn’t a list of 500 patients like that,” he said. “It’s not like other conditions where we could simply look to see what did we do for last 500.”

So Audrey’s doctors assembled a team of neurologists and neurosurgeons to develop a plan to remove the brain aneurysm.

“Audrey’s surgical team in consultation was so calm, they really explained things really well in terms we understood,” said her mother, Barbara Price. “We left there feeling very relieved this was treatable, that we were not in emergency situation and we had one of best surgical teams in the world that would treat her.”

Audrey’s surgery went well, and the team was able to remove the brain aneurism safely.

However, when she came out of surgery, she could hardly move the right side of her body. Her doctors quickly called in another team member, Jonathan Bixby, M.D., who specializes in physical rehabilitation.

“Unlike some other aspects of medicine, rehabilitation is dependent on how much effort the patient puts in,” said Bixby.

“Audrey was great. With any patient dealing with significant changes to the body, there can be issues adjusting. Audrey adjusted quickly, and was very willing to work with a therapist.”

Ongoing team care

Audrey is continuing to get stronger every day. She does her physical therapy daily at home, has learned to do nearly everything with her left hand and was able to start high school last fall.

She got there after spending six weeks living at the hospital after her surgery; she practiced physical therapy six hours a day, six days a week. It’s exhausting work, but her therapists strived to incorporate Audrey’s interests into her exercises to make it more fun, including using therapy dogs and playing One Direction’s music during sessions.

“The hardest part is not knowing when my body is going to be back to the way it was,” she said. “The doctors said, ‘all brains are different,’ and that was the most frustrating part.”

Throughout her hospital stay, her bed was covered in a fleece blanket with the One Direction’s faces on it, including her favorite singer, Niall.

Barbara Price recalled that one day Audrey came back to her room to find a note atop her One Direction blanket that read something like: “‘Dear Audrey, I’m really proud of all the hard work you’re doing’ then the note quoted lyrics from one of the songs. It was signed,  ‘Love, Niall,” she said with a laugh. One of the doctors had scripted this joking note of encouragement.

“The team was so funny and thoughtful, so we had a lot of laughs that got us through some tough times.”

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UC Davis heart surgeon publishes his model for medical humanitarian aid

J. Nilas Young details a quarter century of establishing cardiac surgery sites in Russia.

J. Nilas Young, UC Davis

By Karen Finney, UC Davis

J. Nilas Young, UC Davis chief of cardiothoracic surgery, has published a landmark article on medical humanitarian aid, detailing his 25 years of experience establishing six cardiac surgery sites in Russia.

The article appears in the December 2014 issue of the prestigious Journal of Thoracic and Cardiovascular Surgery and is also available online.

Young’s UC Davis co-authors were pediatric cardiac surgeon Gary Raff and pediatric critical care physician James Marcin, and his collaborators included colleagues at the Mayo Clinic, Emory University, Childrens Hospital of Wisconsin, Nationwide Childrens Hospital and the Siberian Branch of the Russian Academy of Medical Science.

The article emphasizes the approach of Heart to Heart International Children’s Medical Alliance in developing sustainable medical aid programs with high-quality outcomes, scalability and efficacy. Although focused on a specific class of diseases (congenital heart diseases), the authors believe the model is applicable to other medical humanitarian projects, particularly those that involve complex surgical interventions.

In 2012, Young received the the World of Children Health Award — hailed as the “Nobel Prize for child advocates” — for his international humanitarian efforts to improve pediatric heart care (read the press release).

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First real-time MRI-guided brain surgery for Parkinson’s in SoCal

Deep brain stimulator also can be used to treat other movement disorders.

By Jackie Carr, UC San Diego

Neurosurgeons at UC San Diego Health System are the first in Southern California to implant a deep brain stimulator (DBS) in a patient with Parkinson’s disease using real-time 3-D magnetic resonance image (MRI) guidance.

Parkinson’s disease is a progressive disorder of the nervous system that affects movement. Symptoms include shaking, slowness of movement and difficulty walking. These unpredictable movements are caused by abnormal nerve cell activity in the brain. DBS therapy, like a heart pacemaker, transmits electrical signals to help restore normal activity.

Traditionally, DBS surgery is conducted while the patient is awake, and under pain management. This approach allows surgeons to continuously monitor the patient’s brain function and to ensure accurate placement of the device.

“Now, for some patients, this surgery can be performed in the MRI suite under general anesthesia so that a patient can sleep during the placement of the DBS electrodes,” David Barba, M.D., director of functional neurosurgery, UC San Diego Health System. “Within a few days of DBS therapy, many patients can resume life’s everyday activities.”

“Placing a DBS device while a patient is awake can be exhausting for the patient due to the length of the procedure and the need to perform neurologic testing in the operating room,” added Clark Chen, M.D., Ph.D., director of stereotactic and radiosurgery, UC San Diego Health System. “Fortunately, with continuous real-time MRI monitoring, we can now place the electrode in a safe location that provides maximal neurological benefit while the patient is under the comfort of general anesthesia.”

Bob S. Carter, M.D., Ph.D., professor and chief of neurosurgery and co-director of the UC San Diego Neurological Institute, said the collaborative endeavor introduces a new technology strategy to improve the care of patients with Parkinson’s and other diseases.

“Our capacity to perform these procedures will be further enhanced in the new A. Vassiliadis Family Hospital for Advanced Surgery at Jacobs Medical Center, which opens in 2016,” said Carter.

DBS also can be used to treat other movement disorders, including dystonia, essential tremor and obsessive compulsive disorder. It is in clinical trial testing as treatment for depression.

UC San Diego Health System is an internationally recognized leader in functional neurosurgery. Barba is a pioneer in the neurosurgical treatment of patients affected with movement disorders. Chen is an expert in MRI guided neurosurgery.

To learn more about MRI-guided DBS placement, please visit: health.ucsd.edu.

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Robotic surgery technique developed to treat head and neck cancer

Pioneering method, developed at UCLA, gives patients new hope to live cancer-free lives.

By Peter Bracke, UCLA

In a groundbreaking new study, UCLA researchers have advanced a robotic surgical technique to successfully access a previously unreachable area of the head and neck.

This pioneering method can now be used safely and efficiently in patients to remove tumors that many times were previously considered inoperable, or that necessitated the use of highly invasive surgical techniques in combination with chemotherapy or radiation therapy.

Abie Mendelsohn, UCLA

Developed by Dr. Abie Mendelsohn, UCLA Jonsson Comprehensive Cancer Center member and director of head and neck robotic surgery at UCLA, this new approach provides the surgical community with a leading-edge technology roadmap to treat patients who had little or no hope of living cancer-free lives.

“This is a revolutionary new approach that uses highly advanced technology to reach the deepest areas of the head and neck,” said Mendelsohn, lead author of the study. “Patients can now be treated in a manner equivalent to that of a straightforward dental procedure and go back to leading normal, healthy lives in a matter of days with few or even no side effects.”

The parapharyngeal space is pyramid-shaped area that lies near the base of the human skull and connects several deep compartments of the head and neck. It is lined with many large blood vessels, nerves and complex facial muscles, making access to the space via traditional surgical options often impossible or highly invasive.

Current surgical techniques can necessitate external incisions be made to the patient’s neck, or the splitting of their jaw bone or areas close to the voice box. Chemotherapy and radiation therapy are also often required, further complicating recovery and potentially putting patients at risk for serious (or even lethal) side effects.

Approved by the U.S. Food and Drug Administration in 2009, Trans Oral Robotic Surgery (or TORS) utilizes the Da Vinci robotic surgical system, the state-of-the-art technology that was developed at UCLA by the specialized surgical program for the head and neck. TORS uses a minimally invasive procedure in which a surgical robot, under the full control of a specially trained physician, operates with a three-dimensional, high-definition video camera and robotic arms.

These miniature “arms” can navigate through the small, tight and delicate areas of a person’s mouth without the need for external incisions. A retraction system allows the surgeon to see the entire surgical area at once. While working at an operating console just steps away from the patient’s bed, every movement of the surgeon’s wrists and fingers are transformed into movements of the surgical instruments.

Over the course of the robotic program’s development, Mendelsohn refined, adapted and advanced the TORS techniques to allow surgical instruments and the 3-D imaging tools to at last reach and operate safely within the parapharyngeal space and other recessed areas of the head and neck.

Currently, Mendelsohn’s new procedure largely benefits patients with tumors located in the throat near the tonsils and tongue, but it continues to be adapted and expanded in scope and impact.

“We are tremendously excited about the possibilities for the surgical community with this new advancement of TORS,” said Mendelsohn. “Now patients have options they never had before, and we can even develop potential applications for the procedure beyond the surface of the head and neck.”

The study was published online ahead of print in the journal Head and Neck.

David Alpern: one patient’s story

UCLA patient David Alpern and son. Alpern is now cancer-free after his throat tumor was removed using Dr. Abie Mendelsohn’s breakthrough robotic surgery technique.

In 2012, David Alpern received devastating news. He was diagnosed with throat cancer, and the treatment options given to him by his doctors sounded worse than the disease.

“They described a procedure where your face is split in half and it’s basically reconstructive surgery. I was completely freaked out,” said Alpern, a husband and father of two.

After careful examination and imaging at UCLA, Mendelsohn determined that Alpern was a perfect candidate for TORS. Alpern was up and about just days after the procedure. Like the more than 100 similar TORS surgeries performed with Mendelsohn at the controls, Aplern’s tumor was removed and he’s now cancer free.

“I try not to get too cocky or excited that I beat cancer, but I think I did,” Alpern said. “There are no side effects at this point. My hopes are just to watch my kids grow up and enjoy my family and my life.”

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Healing the human instrument

When words fail, a highly specialized center at UCLA helps patients find their voice.

Dr. Dinesh Chherti is an otolaryngologist who specializes in swallowing disorders at UCLA's Voice Center for Medicine and the Arts. Among those who have sought help with their vocal instruments have been Celine Dion and John Mayer. (Photo by Ann Johansson/U Magazine)

By Joan Voight, U Magazine

When Erik Laurence transferred in 2009 to Shanghai, China, as vice president of a software company, he thought his biggest challenge would be improving his Mandarin-language skills and learning the nuances of the Chinese business scene. But his vocal cords, not the foreign nation, turned out to be his undoing.

Laurence, who was in his mid-40s at the time, had struggled for about 20 years with a mild case of spasmodic dysphonia (SD), intermittently losing his voice at odd times. It’s a neurological disorder that involves spasms of the vocal cords, which cause the voice to break up or have a strained or strangled  quality.

“Work demands and trying to speak a new language aggravated all my vocal problems,” Laurence said. “It came to a head at a meeting where I was called on to speak to about 250 people. My voice was horrible, cracking and missing words. I wanted to crawl away and hide.”

Laurence, who was trained as an engineer, methodically scoured the latest medical research and took a week’s vacation in New York to confer with specialists. That’s when he learned about otolaryngologist Dr. Gerald Berke, chair of the Department of Head and Neck Surgery and founder of UCLA’s Voice Center for Medicine and the Arts. He performs a specialized surgery that severs the nerve pathway between the brain and vocal cord and grafts a new nerve from the neck. It essentially rewires the larynx.

For patients who have baffling problems with talking, breathing, singing or swallowing, the UCLA Voice Center for Medicine and the Arts can be an oasis in a desert of inconclusive tests, endless doctors’ appointments and despair. “Your voice is how you express yourself to others,” said Berke, an international authority on the physiology of the larynx. “If it’s compromised, it impairs your personality and how you interact with the world, which can be overwhelmingly frustrating.”

In addition to patients like Laurence, world-class singers such as Celine Dion and John Mayer have asked Dr. Berke for help with their ailing vocal instruments and then gone public in support of his work. “Through his medical care, I learned that the voice is an instrument … and nobody sees that as delicately and carefully as Dr. Berke and his colleagues at UCLA,” Mayer told an audience last January  at a fundraising gala for the Department of Head and Neck Surgery.

The Voice Center for Medicine and the Arts is known for novel treatments for such disorders as vocal-cord paralysis, airway stenosis and the SD surgery that Laurence underwent. In-office laser therapy, digital-video endoscopes and minimally invasive approaches are used to treat myriad complex and common disorders of the larynx and trachea.Berke started the center in 2004 with Bruce Gerratt, a speech and language pathologist, and Dr. Dinesh Chhetri, an otolaryngologist who specializes in swallowing disorders. The younger generation of physicians at the center now includes otolaryngologists Dr. Jennifer Long and Dr. Abie Mendelsohn.

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Grant will aid patients suffering from severe pulmonary hypertension

$7.6M grant helps launch a nationwide patient registry to improve CTEPH practices.

Imagine trying to take a deep breath, but feeling like you’re sucking air through a straw. That’s how some patients with chronic thromboembolic pulmonary hypertension (CTEPH) describe living with the condition, which is estimated to affect several thousand Americans yearly but is commonly misdiagnosed. UC San Diego Health System is a world leader in CTEPH, and now with a $7.6 million grant, has helped launch the first national CTEPH registry to improve best practices and patient care.

The United States CTEPH registry, funded by Bayer Healthcare Pharmaceuticals, is a centralized electronic database that will involve 30 sites across the nation. UC San Diego Health System will manage the registry with the goal of enrolling 750 newly diagnosed patients over the next six years. It will allow physicians to follow the short- and long-term outcomes of patients and learn more about CTEPH.

CTEPH is believed to be a complication of a common blood clot condition called pulmonary embolism. It has been reported that as much as 3.8 percent of individuals with first-time pulmonary embolism may develop CTEPH. This suggests there may be thousands of new cases of CTEPH in the United States annually.

“Currently, the number of patients in the United States with CTEPH is unknown. Because the symptom of shortness of breath is nonspecific, many CTEPH patients may be misdiagnosed as having more common diseases like asthma or COPD,” said Kim Kerr, M.D., principal investigator and pulmonologist at UC San Diego Health System. “Using data collected from the registry, we will identify barriers to patients receiving the correct diagnosis and treatment of their CTEPH. This registry will also allow us to assess the effectiveness of established and evolving therapies of this disease.”

UC San Diego Health System is the pioneer of pulmonary thromboendarterectomy (PTE) surgery, a life-saving procedure that removes the blood clots from the lungs’ arteries that rob patients of their ability to breathe.

“The registry will serve as an educational tool for physicians and centers to learn more about the disease and its prognosis and outcomes, especially as it relates to surgical techniques used for PTE and the benefits to the patient,” said Michael Madani, M.D., co-investigator and cardiac surgeon, chief of cardiothoracic surgery and director of UC San Diego Sulpizio Cardiovascular Center – Surgery. “People from around the US suffering from CTEPH are referred to UC San Diego Health System for PTE but usually after discharge we do not have the resources to follow up long-term. Another critical part of the registry is that it will give us a more thorough understanding of how PTE truly improves a patient’s overall quality of life, even if they live 2,000 miles away.”

Nick Kim, M.D., pulmonologist and director of pulmonary vascular medicine at UC San Diego Health System, adds that the registry will enrich physicians’ understanding of all aspects of CTEPH in the U.S., including the subset of patients deemed not operable and treated with medical therapy instead.

“Centers across the nation working as a team will not only help health providers improve their approach to CTEPH, it will ultimately give patients more options, knowledge and empowerment in how their disease is managed,” said Kim.

For more information on pulmonary vascular medicine at UC San Diego Health System, please visit heartcenter.ucsd.edu.

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Building the future of health care

More than 1,000 donors give $131M in support of UC San Diego Jacobs Medical Center.

By Judy Piercey and Jade Griffin, UC San Diego

Committed to fostering the future of health care in San Diego, more than 1,000 donors have contributed $131 million to UC San Diego’s Jacobs Medical Center. Included in the total are gifts that matched a donation of $25 million, meeting the Challenge goal of the initiative.

Today (Nov. 20), the campus announced that the Challenge donation, originally anonymous, was made by Joan and Irwin Jacobs. They provided a $75 million lead gift for the new facility in 2010; with the Challenge gift, that brings their contributions to the Jacobs Medical Center to a total of $100 million. Continued private support will help fund the completion of the new medical center, which is the largest hospital project currently underway in Southern California.

Under construction and projected to open in 2016, Jacobs Medical Center is a $839 million, 10-story facility on the university’s La Jolla campus, which will include three new clinical care units in one location: The A. Vassiliadis Family Hospital for Advanced Surgery, The Pauline and Stanley Foster Hospital for Cancer Care and the Hospital for Women and Infants.

“We are deeply grateful to Joan and Irwin Jacobs for their generosity, including the recent $25 million match challenge,” said UC San Diego Chancellor Pradeep K. Khosla. “We also thank Carol Vassiliadis and Pauline Foster, who made leadership gifts, as well as all of the other donors who participated in meeting this challenge. These visionaries support UC San Diego’s commitment and vision to create a healthier world through new science, new medicine and new cures.”

“Jacobs Medical Center is part of a multibillion dollar university investment in the future of health care for the region,” said Dr. David A. Brenner, vice chancellor for Health Sciences and dean of the UC San Diego School of Medicine. “I want to thank all of the donors who have helped make this extraordinary medical center a reality.”

Irwin and Joan Jacobs

“When we came here in 1966, the medical school was just starting,” said Irwin Jacobs, co-founder, former chairman and CEO of Qualcomm Inc. and UC San Diego founding faculty member, who served as a professor in electrical and computer engineering from 1966 to 1972. “There was no hospital, just a school. So it’s very exciting to make Jacobs Medical Center possible. More and more, we’re learning how to bring results from basic research in biology and engineering to medicine, and to the clinic. I think this medical center is going to show how effective that can be. The innovations will spread out from San Diego, and go all around the world.”

The 509,500-square-foot facility will house 245 patient beds and be connected on multiple floors with the existing John M. and Sally B. Thornton Hospital on UC San Diego’s La Jolla campus, in the heart of the area’s nexus of biomedical research centers. Jacobs Medical Center has been designed with the patient in mind. From spacious private rooms to soothing color schemes and artwork, to next-generation medical equipment, the vision and needs of patients, doctors and nurses, all aspects of the Jacobs Medical Center have been fully integrated. Each floor will combine all the necessary healing elements while achieving optimal safety and efficient delivery of care.

“Soon we will have the largest, most technologically advanced hospital in the region, dedicated to offering specialized care for every kind of patient, in every phase of life,” said Paul Viviano, CEO of UC San Diego Health System.

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New approach proposed to heart surgery for infants

Would potentially reduce the number of surgeries single-ventricle patients have to undergo.

A computer simulation showing how a clipped shunt would connect an artery off the aorta to the superior vena cava.

Engineers at the UC San Diego are proposing a new surgical intervention for children born with a single ventricle in their heart — instead of the usual two. The new approach would potentially reduce the number of surgeries the patients have to undergo in the first six months of life from two to just one. If successful, it would also create a more stable circuit for blood to flow from the heart to the lungs and the rest of the body within the first days and months of life.

Engineers ran computer simulations of the surgery and found it would reduce the workload on the patient’s heart by as much as half. It would also increase blood flow to the lungs and increase the amount of oxygen the body receives.

The surgery would introduce a radical change in the way infants with a single ventricle are treated. Currently, they undergo three surgeries by age three. Babies born with a single ventricle are severely deprived of oxygen, which makes their skin turn blue, and requires immediate medical intervention.

The research group, led by Alison Marsden, a professor of mechanical engineering, is working in collaboration with cardiothoracic surgeon Tain-Yen Hsia, of the Great Ormond Street Hospital for Children and UCL Institute of Cardiovascular Science in London.  They reported their findings in an October issue of the Journal of Thoracic and Cardiovascular Surgery.

“Even when surgeries are successful, these babies live with a circulation that is very taxing on the one heart pump they have,” Dr. Hsia said.  “So there is a need to find a better solution.”

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Perioperative surgical homes improving results for patients, hospitals

UC Irvine Health anesthesiologists spearhead effort.

UC Irvine Health physicians continue to be leaders for a model of surgical care that may drive down hospital costs and, more importantly for patients, results in better outcomes and fewer complications.

At the recent annual meeting of the American Society of Anesthesiologists, Dr. Zeev Kain discussed the perioperative surgical home concept and UC Irvine’s experience in front of more than 5,000 participants during the meeting’s opening session.

“The perioperative surgical home delivers better patient outcomes, enhances safety and reduces costs,” said Kain, M.D., M.B.A., chairman of the UC Irvine Department of Anesthesiology & Perioperative Care and Chancellor’s Professor of Anesthesiology, Pediatrics and Psychiatry. “That’s not wishful thinking, it’s hard data.”

“Readmission rates are between 8 and 12 percent for the U.S. Our readmission rate from the [perioperative surgical home] is 0.5 percent,” he said.

Noting that half of all hospital costs occur in the postoperative period, Kain said avoidable complications such as pneumonia, urinary tract infections or the delirium some patients experience as they emerge from anesthesia can add $10,000 to the cost of treatment.

In addition, UC Irvine Health anesthesiologists made more than two dozen presentations, including Minimizing Postoperative ICU Complications with Drs. Trung Q. Vu and William Wilson, Optimization of the High-Risk Surgery Patient in the Era of Enhanced Recovery After Surgery and Perioperative Surgical Home with Dr. Maxime Cannesson and Kain, and Total Joint Perioperative Surgical Home at UC Irvine Health: A Cost Analysis with Drs. Darren R. Raphael, Cannesson, Leslie M. Garson, Shermeen B. Vakharia, Kain, Ran Schwarzkopf and Ranjan Gupta.

This perioperative care model, which refers to the period before, during and after surgery, spans the patient’s entire surgical experience, starting with the decision to have surgery through 30 to 90 days after hospital discharge. The care pathway is a mapped out by a clinical team that includes surgeons, anesthesiologists, nurses and to the medical device specialists to the rehabilitation therapists, such that there is complete continuity of care as well as standardization of practices to enhance patient safety.

Kain and Cannesson summed up the reasons for their surgical home efforts in the May issue of the journal Anesthesia & Analgesia:

Interestingly, with the recent changes occurring in the health care system in the United States, the American Society of Anesthesiologists has endorsed the concept of the Perioperative Surgical Home (PSH) and has recommended including it as part of affordable care organizations and hospitals. It is widely recognized that our current perioperative system in the United States is costly, fragmented, and often driven by focus on hospital reimbursement as well as culture and tradition rather than on quality and service. …  Because it has been shown that most perioperative complications are related to a lack of coordination of care and a wide variability in the way care is delivered, a model such as the PSH is much needed.

UC Irvine Health physicians published several other articles about the perioperative surgical home in the May Anesthesia & Analgesia, including a review of the university’s experience with orthopaedic surgeon Schwarzkopf and the model’s implementation for total hip and total knee replacement surgeries.

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Carol Vassiliaidis names hospital with $8.5M to Jacobs Medical Center

New UC San Diego facility to be home to A. Vassiliadis Family Hospital for Advanced Surgery.

Carol Vassiliadis surveys the construction site of Jacobs Medical Center, which will be home to the A. Vassiliadis Family Hospital for Advanced Surgery. (Photo by Paul Turang)

People give to UC San Diego for many different reasons, but for local philanthropist Carol Vassiliadis, her reason is simple. “It’s the people,” she said. “The people at UC San Diego truly believe in what they are doing. And if, with the Jacobs Medical Center, we are helping people survive, we are doing something very important.”

That is why Vassiliadis has designated gifts totaling $8.5 million to the future UC San Diego Jacobs Medical Center. In honor of her support, the new facility — to be opened in 2016 — will be home to the “A. Vassiliadis Family Hospital for Advanced Surgery.” A portion of Vassiliadis’ support was also matched by an anonymous donor as part of a Jacobs Medical Center Challenge grant, for a total of $12 million in gifts.

Vassiliadis, like so many others, has faced the loss of a loved one from disease. Her husband, Alkiviadis or “Laki,” passed away from colon cancer in 2002. Carol began her tradition of philanthropy at UC San Diego initially to honor her late husband’s legacy with a fellowship for cancer prevention, followed by support for the Healthy Eating and Living Program at UC San Diego Moores Cancer Center. Now, she has chosen to name the A. Vassiliadis Family Hospital for Advanced Surgery, housed on the second and third floors of the Jacobs Medical Center, for her husband and family.

“Thanks to Carol Vassiliadis’s visionary support, the A. Vassiliadis Family Hospital for Advanced Surgery will be among the most technologically advanced surgical facilities in the nation,” said UC San Diego Chancellor Pradeep K. Khosla. “UC San Diego is proud to offer state-of-the-art health care options for patients who need them. Together, with generous donors like Carol, we are creating a healthier world, one patient at a time.”

“We express our sincere gratitude to Carol for this transformative gift to UC San Diego,” said David Brenner, M.D., vice chancellor for health sciences and dean of the UC San Diego School of Medicine. “This investment in Jacobs Medical Center will also help accelerate translational research so that discoveries can be delivered to patients in real time. With Jacobs Medical Center, the Altman Clinical and Translational Research Institute, Shiley Eye Center, Sulpizio Cardiovascular Center, and Moores Cancer Center, we will have one place where the strengths of academic medicine – excellent patient care, cutting-edge research and teaching – come together in one location to best serve patients.”

The A. Vassiliadis Family Hospital for Advanced Surgery will offer patients access to more than 200 surgeons who specialize in complex procedures for all medical conditions. Examples of surgeries to be offered include MRI-guided gene therapy for brain cancer, heated intraperitoneal chemotherapy for abdominal cancers, and complex spine and joint reconstruction. A robust robotics program will continue to treat thyroid, esophageal, prostate, colon, kidney and bladder cancers. Delicate microsurgery to restore voice and hearing and reanimation of the paralyzed face and extremities will also be performed. Minimally invasive surgical options will be available to treat cancer, obesity and a range of other conditions.

“We are deeply grateful to Carol for her extraordinary generosity in naming the Hospital for Advanced Surgery at UC San Diego Jacobs Medical Center,” said Paul Viviano, CEO, UC San Diego Health System. “With her gift, we will be able to invest in the kind of lifesaving surgical techniques, technologies, devices and therapies that are only available inside the nation’s leading academic health systems.”

The A. Vassiliadis Hospital for Advanced Surgery will house the region’s only intraoperative magnetic resonance imaging (MRI) machines. With this technology, surgeons will be able to image tumors in real-time during surgery to be certain that malignancies, such as glioblastoma in the brain, have been removed — without ever having to leave the operating room. Repeat MRIs can be performed throughout the surgery, which is critical to removing malignant tissue while sparing healthy tissue. MRI guidance can also be used for more accurate biopsies, for laser therapy to destroy tumors and to deliver gene therapy as a potential treatment for brain tumors.

“This hospital will help support patients so that cancer, as well as other diseases and ailments, are things patients can live through,” said Vassiliadis. “Great advancements are being made quickly so that fewer and fewer cancers will be fatal.”

Additionally, the hospital will be the only hospital in the United States using a proprietary MRI technique called Restriction Spectrum Imaging (RSI) to create color coded maps of the brain, fiber by fiber, for accurate surgery planning.

The hospital will also have 14 new, 650-square-foot operating rooms. These rooms are larger than a standard OR and the ideal size to accommodate rapid changes in technology. The operating room designs incorporate input from the UC San Diego Center for the Future of Surgery, which was established to research, design and teach the most safe and effective surgeries.

“UC San Diego’s surgical care is not only recognized as among the most innovative and technically advanced but also among the safest in the country,” said Christopher Kane, M.D., professor and interim chair of the Department of Surgery. “Our new surgical hospital is designed to enhance efficiency, quality and outcomes for patients. Surgeons were involved in every step of the design process so we are thrilled with the enhancements in surgical care that this new facility will enable us to deliver to the San Diego community.”

In addition to supporting Jacobs Medical Center and Moores Cancer Center at UC San Diego, Vassiliadis has supported a wide range of areas on campus. She established the Alkiviadis Vassiliadis Chair in Byzantine Greek History and helped garner support for two other Greek history chairs at UC San Diego, in honor of her husband’s strong ties to his ancestral heritage. She still plays an active role in San Diego’s Greek Orthodox community. Vassiliadis is also a trustee of the UC San Diego Foundation Board and member of the UC San Diego Moores Cancer Center Advisory Board.

“My hope is to leave the world a slightly better place than it was when I was born,” said Vassiliadis. “I think this hospital is going to change lives.”

The Jacobs Medical Center, currently under construction and projected to open in 2016, is a 10-story facility that will include three important clinical care units in one location: the A. Vassiliadis Family Hospital for Advanced Surgery; The Pauline and Stanley Foster Hospital for Cancer Care; and the Hospital for Women and Infants. There are still numerous naming opportunities in the center, ranging from nurses stations and a family lounge to the main courtyard and more. Visit jmc.ucsd.edu for more information.

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