UCSF School of Nursing partners on resource to improve comfort and speed recovery.

Linda Franck, UCSF

When a young child has surgery, parents rely on doctors and nurses for advice on how to prepare and support children during the procedure and immediately afterwards. But once that child gets home, parents are left with little guidance on how to best help their children cope with pain.

A new website aims to fill that information gap and give parents the framework for how to be more effective caregivers for children after surgery.

Created with Linda Franck, R.N., Ph.D., chair of Family Health Care Nursing in UC San Francisco’s School of Nursing, the website My Child is in Pain targets parents of children between the ages of 2 and 6 who want to know how to help manage their child’s post-operative pain.

“There are very few formal resources for parents to learn how to tell if their child is in pain and what they can do to relieve it,” said Franck.

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UCSF work shows brain exerts symphony-like control of vocal tract during the act of speaking.

Edward Chang, UC San Francisco

A team of researchers at UC San Francisco has uncovered the neurological basis of speech motor control, the complex coordinated activity of tiny brain regions that controls our lips, jaw, tongue and larynx as we speak.

Described this week in the journal Nature, the work has potential implications for developing computer-brain interfaces for artificial speech communication and for the treatment of speech disorders. It also sheds light on an ability that is unique to humans among living creatures but poorly understood.

“Speaking is so fundamental to who we are as humans – nearly all of us learn to speak,” said senior author Edward Chang, M.D., a neurosurgeon at the UCSF Epilepsy Center and a faculty member in the UCSF Center for Integrative Neuroscience. “But it’s probably the most complex motor activity we do.”

The complexity comes from the fact that spoken words require the coordinated efforts of numerous “articulators” in the vocal tract – the lips, tongue, jaw and larynx – but scientists have not understood how the movements of these distinct articulators are precisely coordinated in the brain.

To understand how speech articulation works, Chang and his colleagues recorded electrical activity directly from the brains of three people undergoing brain surgery at UCSF, and used this information to determine the spatial organization of the “speech sensorimotor cortex,” which controls the lips, tongue, jaw, larynx as a person speaks. This gave them a map of which parts of the brain control which parts of the vocal tract.

They then applied a sophisticated new method called “state-space” analysis to observe the complex spatial and temporal patterns of neural activity in the speech sensorimotor cortex that play out as someone speaks. This revealed a surprising sophistication in how the brain’s speech sensorimotor cortex works.

They found that this cortical area has a hierarchical and cyclical structure that exerts a split-second, symphony-like control over the tongue, jaw, larynx and lips.

“These properties may reflect cortical strategies to greatly simplify the complex coordination of articulators in fluent speech,” said Kristofer Bouchard, Ph.D., a postdoctoral fellow in the Chang lab who was the first author on the paper.

In the same way that a symphony relies upon all the players to coordinate their plucks, beats or blows to make music, speaking demands well-timed action of several various brain regions within the speech sensorimotor cortex.

The patients involved in the study were all at UCSF undergoing surgery for severe, untreatable epilepsy. Brain surgery is a powerful way to halt epilepsy in its tracks, potentially completely stopping seizures overnight, and its success is directly related to the accuracy with which a medical team can map the brain, identifying the exact pieces of tissue responsible for an individual’s seizures and removing them.

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Minimally invasive surgery may benefit patients previously deemed hopeless.

Paul Vespa, UCLA

A new endoscopic surgical procedure has been shown to be safer and to result in better outcomes than the current standard medical treatment for patients who suffer strokes as a result of brain hemorrhages, UCLA neurosurgeons have announced.

The findings from their potentially groundbreaking, randomized, controlled phase 2 clinical trial, which was conducted at multiple medical centers, were presented last week at the International Stroke Conference in Honolulu.

“These exciting results offer a glimmer of hope for a condition that most doctors have traditionally considered hopeless,” said principal investigator Dr. Paul Vespa, professor of neurosurgery at the David Geffen School of Medicine at UCLA and director of the neurocritical care program at Ronald Reagan UCLA Medical Center. “That is a big deal in medicine.”

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Only 15% of joint replacement specialists in nation capable of muscle-saving approach.

Francis Gonzales, UC San Diego

UC San Diego Health System is one of only a few hospitals in the nation to offer computer-assisted navigation technology with the direct anterior hip replacement technique, potentially resulting in less pain, faster recovery and fewer dislocations for patients with osteoarthritis and other forms of degenerative joint disease.

Only 15 percent of the top joint centers in the United States have the expertise and technological capability to perform an anterior hip replacement, where the incision is made in the front (anterior) of the hip as opposed to the side (lateral) or back (posterior). The anterior approach allows the surgeon to work in between a natural muscle plane without detaching muscles or tendons from the hip or thigh bone, avoiding undue trauma to the muscle and surrounding tissue.

“With traditional hip replacements, we have to cut muscle to do the surgery, which affects the recovery process and may limit immediate hip movement in the early post-operative period,” said Francis Gonzales, M.D., orthopedic surgeon specializing in adult joint reconstruction at UC San Diego Health System. “The muscle-sparing approach is performed in between muscle groups, gently pushing the muscle aside during the hip replacement instead of cutting through it.”

UC San Diego Health System performs a high volume of anterior hip replacements annually, making it a leader in the region on the technique.

Gonzales, who is fellowship-trained in anterior hip replacements, is the only surgeon in San Diego performing the technique using computer-assisted navigation on a specialized surgical table from Mizuh OSI, which allows for live imaging guidance and manipulation in real time to confirm the hip replacement implants are precisely placed.

“The specialized surgical table used during an anterior hip replacement is a vital instrument used during the procedure.  It enables the surgeon to perform the surgery with ease and decreases the complication rate,” said Gonzales. “The table allows for safe leg placement not possible with a traditional surgery table.”

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“If a patient is very obese, he bears a lot of risks and complications.”

Suitulaga “Sugi” Hunkin has been overweight most of his life. He attributes that to his love of food and his Samoan ancestry.

Because of his size, he also had trouble breathing and experienced irregular heartbeat – symptoms his doctors diagnosed as heart disease called cardiomyopathy, which usually leads to heart failure.

“Here I am thinking I’m on top of the world at the age of 27 and all of a sudden I ran into a brick wall,” said Hunkin, who tipped the scale at 350 pounds by his mid-20s. “I couldn’t believe it. I was in denial.”

He needed heart transplantation surgery to replace his failing heart, but before that could happen, he needed to lose at least 100 pounds.

“If a patient is very obese, he bears a lot of risks and complications, inter-operatively as well as post-operatively,” said Georg Wieselthaler, M.D., professor of surgery of UC San Francisco’s Division of Adult Cardiothoracic Surgery, and director and surgical chief of the UCSF Cardiac Transplantation and Mechanical Circulatory Support. “And therefore it’s absolutely favorable for patients to try and have a body mass index of below 35 before going into a complex operation.”

Body mass index (BMI) measures a person’s body fat based on height and weight. Normal BMI is between 18.5 and 24.9; overweight is 25-29.9; and obesity is BMI of 30 or greater.

Hunkin chose UCSF to help him with his heart failure. Its pioneering cardiothoracic surgery program was established 50 years ago by chair Leon Goldman, M.D., and Benson Roe, M.D.. The Heart and Lung Transplant Program has historically had high one-year survival outcomes among academic surgery programs nationally.

To help Hunkin stay alive, Wieselthaler installed a ventricular assist device (VAD), a mechanical device that helps a failing heart pump blood. The VAD allowed Hunkin stay alive, but it did not help him lose weight.

“A switch clicked in my head,” he said. “I need to get on the ball. It’s not fair to my wife and my kids, and it’s not fair to myself. It’s not fair to the doctors that are treating me. Everybody’s doing so much. It comes down to me.”

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UC Davis surgeon receives knit-worthy recognition.

UC Davis cardiothoracic surgeon David Cooke and his famly with the Jacksons.

Quilts are often given to celebrate a life change such as a marriage or the birth of a baby. Marilyn Jackson’s latest quilt celebrates much more: a life saved.

On Jan. 30, she presented UC Davis cardiothoracic surgeon David Cooke with a quilt she made for his 3½ year old daughter, Audrey.

“Dr. Cooke saved my husband’s life,” said Marilyn. “I know it is impossible to truly thank him for that, but sharing my talent with someone he loves as much I love my husband is one way to try.”

Last year, Marilyn’s husband, Jim Jackson, had two procedures known as lung volume reduction surgery (LVRS) to treat his emphysema. The progressive disease, which is most often attributed to smoking, causes walls of air sacs to break down, reducing lung function and oxygen throughout the body. Those with emphysema experience continuously reduced breathing capacity and mobility.

“I was in denial for a long time, so the disease was diagnosed for me in its later stage,” said Jim, a retired railroad foreman. “On good days, I felt like there was a paper bag on my head. On bad days, it felt like a plastic bag. I mostly sat and watched television with an oxygen tank.”

During LVRS, damaged lung tissue is removed, helping the remaining lung tissue work more efficiently and increasing the amount of oxygen in the blood.

Even though there are few other effective treatments for emphysema and no cure, LVRS is not recommended for every patient. Those whose disease is concentrated in the upper parts of their lungs and who participate in pulmonary rehabilitation, stick with a strict medication regimen and do not smoke are considered the best candidates.

“Jim was a poster child for the surgery, and we’ve both been really pleased with his outcomes,” said Cooke, a specialist in surgical treatments for lung disease. “Today, I see him less in my clinic and more at community events, speaking about his experiences and the importance of lung health.”

Cooke cautioned that even for good candidates, LVRS has post-surgical risks. One of Jim’s lungs collapsed due to an air leak following his second surgery, requiring a longer hospital stay and recovery time than expected.

“Air leaks are common with lung surgery, but our excellent nursing, surgical and critical-care teams anticipated and rescued him from that complication while preventing others,” said Cooke.

Today, the Jacksons say that the surgeries were worth it.

“Dr. Cooke not only gave me back my life, he gave me back my life as I knew it,” said Jim, who watched his mother’s health deteriorate until her death from emphysema in the 1980s. “I figured that would be me, too. Instead, here I am, more active than I was before the surgery. I still need oxygen, but not as much. And I never feel anymore like I have a bag on my head.”

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UC Davis cardiac surgeon brings life-saving operations to Russian children.

UC Davis cardiac surgeon Nilas Young spends time with a patient in Russia being considered for heart surgery.

The doctors in Moscow said her daughter’s heart defect was inoperable, but she clung to the hope they were wrong.

A few days after Christmas in 1988, the mother brought her dying 7 year old to the San Francisco Bay Area. She placed her in the care of cardiac surgeon Nilas Young at Children’s Hospital in Oakland and prayed.

Young, now chief of cardiothoracic surgery at UC Davis Medical Center, performed open heart surgery on the girl. Born with a congenital heart defect that obstructs blood flow to the lungs and deprives the body of sufficient oxygen, the child had been too weak to move and often had to be carried from one place to another.

The surgery was successful.

“I thought it would be a one-time thing that was a nice thing to do,” Young said.

Instead it became the catalyst that would take Young to the USSR, where he and other American surgeons would train Russian medical teams to perform life-saving surgery on children with similar heart defects. Over the next two decades, they helped launch pediatric cardiac units in four major cities; a fifth is in the works.

Young’s decades-long effort to improve pediatric care internationally earned him the 2012 World of Children Health Award. He is quick to say he didn’t do it alone.

“It seems unfair for me to get an award for something that took so many to get started — so many unselfish people who were in it for the good of the cause, who gave up vacation time, and worked in sometimes very difficult situations,” said Young, who joined the UC Davis Health System in 2001.

Nearly 15,000 Russian children have undergone successful heart surgery since 1989 when Young co-founded the nonprofit Heart to Heart International Children’s Medical Alliance.

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UCSF study finds dramatic results.

Two heads are better than one, as the saying goes – and a new study by a duo at UC San Francisco demonstrates how having two attending surgeons in the operating room during spinal surgeries can benefit patients in multiple ways.

Most spinal surgeries in the United States are performed by teams led by a single attending surgeon – one top-level doctor who has completed medical school, residency and other specialized training.

In 2007, two spinal surgeons in the Departments of Neurological Surgery and Orthopedic Surgery joined forces and began doing certain complex, high-risk procedures together, and now they have published their findings on the benefits of having them both in the operating room.

“We found very dramatic results,” said UCSF neurosurgeon Christopher Ames, M.D., who led the study with his co-senior author, orthopedic surgeon Vedat Deviren, M.D.

Published this month in the inaugural issue of  Spine Deformity, the official journal of the Scoliosis Research Society, the data show that surgeries with two attending physicians tended to be much shorter, averaging five hours instead of eight. Patients also suffered less blood loss, had fewer major complications and enjoyed shorter hospital stays – all of which should help lower health care costs, though the UCSF team did not specifically model how much money this approach would save if widely implemented.

The major benefit to patients is more favorable outcomes, said Deviren. “There is no way we would go back to how we used to perform these surgeries with single surgeons,” he said.

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It could help avoid unnecessary removal of healthy lymph nodes.

Quyen Nguyen, UC San Diego

One of the greatest challenges faced by cancer surgeons is to know exactly which tissue to remove, or not, while the patient is under anesthesia. A team of surgeons and scientists at UC San Diego School of Medicine have developed a new technique that will allow surgeons to identify during surgery which lymph nodes are cancerous so that healthy tissue can be saved. The findings will be published in the Jan. 15 print edition of Cancer Research.

“This research is significant because it shows real-time intraoperative detection of cancer metastases in mice,” said Quyen T. Nguyen, M.D., PhD, associate professor of head and neck durgery at UC San Diego School of Medicine. “In the future, surgeons will be better able to detect and stage cancer that has spread to the patient’s lymph nodes using molecules that were designed and developed at UC San Diego.”

Lymph nodes, located throughout the body, serve as filters that contain immune cells to fight infection and clean the blood. When cancer cells break away from a tumor, the cells can travel through the lymph system and hide in these tiny organs. Surgeons remove the nodes to determine if a cancer has spread. However, human nodes, only half a centimeter in size, are difficult to discern among the surrounding tissue during surgery. Furthermore, even when surgeons are able to map the location of the nodes, there is no current technique that indicates whether or not the lymph nodes contain cancer, requiring removal of more lymph nodes than necessary.

“With molecular-targeted imaging, surgeons can avoid unnecessary removal of healthy lymph nodes which is better long-term for patients,” said Nguyen, director of the facial nerve clinic at UC San Diego Health System. “The range of the surgeon’s visual field is greatly enhanced by a molecular tool that can help achieve accurate surgical margins and detection of metastases so that no tumor is left behind.”

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First such pediatric patient in western U.S.

Leonidas Hill

Leonidas Hill recently made history at Mattel Children’s Hospital UCLA, when the 5-year-old became the first pediatric patient in the western United States to undergo transoral robotic surgery (TORS) — a minimally invasive surgery performed with the help of a robot — to repair a rare congenital condition known as a laryngeal cleft.

Mattel Children’s Hospital UCLA is one of only a handful of medical centers in the country offering this type of surgery, which is rarely done on pediatric patients. The technology allows surgeons to perform the operation through the mouth of the patient, rather than in the traditional manner, which requires external incisions and the splitting of the patient’s voice box.

Hill was born with both a laryngeal cleft and a cleft lip/palate, defects that occur during embryonic development. The cleft is an extremely rare airway defect in the laryngo-tracheal wall, which results in an abnormal opening between the larynx and the esophagus. This allows food to get into the airways and even the lungs.

Hill’s cleft, which was classified as Type 3 (Type 4 is the most severe), extended beyond his voice box and into his trachea, leading to tracheomalacia, a condition that occurs in newborns in which the cartilage of the trachea, or windpipe, has not developed properly. Because of this, the trachea walls, instead of being rigid, are floppy and collapse, resulting in breathing difficulties.

Hill’s breathing difficulties began soon after birth, and he underwent a tracheotomy-tube placement as an infant to help with his airway issues. Due to his chronic aspirating, he also had a gastrostomy tube placed in his stomach to minimize respiratory infections such as pneumonia and bronchitis.

Dr. Nina Shapiro, director of pediatric otolaryngology at Mattel Children’s Hospital UCLA and an associate professor of surgery at the David Geffen School of Medicine at UCLA, diagnosed Hill’s cleft and recommended him for the TORS procedure.

“The benefit of the surgical robot is that it gives more access to the pediatric airway using minimally invasive techniques,” she said. “For Leonidas, this surgery repaired his cleft, which will greatly improve his airway issues and put him in a better position for removing the tracheotomy tube.”

The Da Vinci robotic surgical system, the state-of-the-art technology used at UCLA, is 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 the mouth without the need for external incisions. A retraction system allows the surgeon to see the entire surgical area at once. While working from an operating console, every movement of the surgeon’s wrists and fingers are transformed into movement of the surgical instruments.

Dr. Abie Mendelsohn, an assistant professor of surgery at UCLA, developed the TORS program at the UCLA Department of Head and Neck Surgery. Mendelsohn operated on Hill and repaired the cleft in the back of his larynx.

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Surgery tasks among those to be studied.

UC Berkeley professors Ken Goldberg, center, and Pieter Abbeel, right, work on the RAVEN surgical robot in a Soda Hall lab, with an assist from graduate student Animesh Garg, left.

What if robots and humans, working together, were able to perform tasks in surgery and manufacturing that neither can do alone?

That’s the question driving new research by UC Berkeley robotics experts Ken Goldberg and Pieter Abbeel and colleagues from four other universities, who were awarded a $3.5 million grant from the National Science Foundation.

Their work is part of the first $50 million in funding for the National Robotics Initiative, announced in 2011 with the goal of exploring how robots can enhance the work of humans rather than replacing them.

“The emerging generation of robots are more aware than oblivious, more social than solitary, and more like companions than tools,” says Goldberg, a professor in the departments of Industrial Engineering and Operations Research and  Electrical Engineering and Computer Sciences.

The four-year project, a collaboration of experts at Berkeley, Stanford, Johns Hopkins, UC Santa Cruz and the University of Washington, will focus on ways that robots can be trained by humans to perform “multilateral manipulation,” with one or more humans providing perception and adaptability and robots providing speed, precision, accuracy and dexterity, as the researchers described it in their grant application.

In surgery, for example, a human-robot system could mean an extra set of “hands” for retraction or suturing for a doctor focusing on more complex procedures. The concept envisions something quite different from telesurgery, where a remote surgeon controls robotic equipment directly; the next generation of robots would function autonomously, but with training and supervision by humans and reliance on algorithms and data libraries compiled by humans.

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Portable power supply allows patient to go home while he awaits new heart.

Chad Washington with total artificial heart and pump device

Imagine living without a heart. It is possible — if you have a new artificial heart pumping blood through your body. You can even go to the supermarket, watch your kid’s soccer game or go on a hike.

Ronald Reagan UCLA Medical Center has performed its first procedure to remove a patient’s diseased heart and replace it with a SynCardia Temporary Total Artificial Heart.

Chad Washington, 35, underwent the seven-hour transplant surgery at UCLA on Oct. 29, led by Dr. Murray Kwon, an assistant professor of cardiothoracic surgery.

The temporary pump will act as a “bridge” until Washington receives a new donor heart.

“Historically, patients with a total artificial heart had to remain hospitalized while they waited for a transplant because they were tethered to a large machine to power the device,” Kwon said. “Today, however, this device can be powered by advanced technology small enough to fit in a backpack.”

“It sounds like a loud grandfather clock going ‘tick-tock’ in my chest, but it doesn’t feel foreign. It’s there to help,” Washington said of the artificial heart. “I’m so glad to be living in an age where technology is moving so fast.”

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