March is Colorectal Cancer Awareness Month - Surgery

March 2003
March is Colorectal Cancer Awareness Month
Each year over 150,000 Americans are diagnosed
with cancer of the colon or rectum, and over onethird
will die from the disease. March has been
designated as Colorectal Cancer Awareness
month in an effort to educate patients, physicians,
and the media about the incredible opportunity
we have to impact upon this deadly disease.
Educating patients about their risk for developing
colorectal cancer, and need for screening and surveillance,
is part of our mission in the Division of
Colon and Rectal Surgery. We follow the guidelines
established by the American Society of
Colon and Rectal Surgeons, the AGA, and others.
Screening of asymptomatic patients of average
risk should take place at the age of 50 years.
Colonoscopy can detect and treat most polyps and
even some early cancers. Flexible sigmoidoscopy,
which examines only the lower 60 cm of large
intestine, is best when combined with a barium
enema to evaluate the right and transverse colon.
Digital rectal exam is crucial to detect tumors of
the distal rectum. Fecal occult blood tests are useful
to determine the presence of blood in the stool,
but fairly vague in locating the source of blood
loss. The "camera in a pill" technology is useful in
certain situations as well, and even virtual
colonoscopy has its proponents. It is critical to
tailor the examination to the individual patient.
Patients should bring symptoms of colorectal cancer
to the attention of their health care providers.
Blood in the stool is never normal and should
always be evaluated. A change in caliber of stool,
new and persistent constipation, diarrhea or
incontinence, abdominal bloating and pelvic pain
can all be symptoms of malignancy and should
not be ignored.
State-of-the-art surgical treatment of colorectal
cancer is available in the Division of Colon and
Rectal Surgery. Laparoscopic resection is utilized
for patients with polypoid lesions and certain
malignant conditions. Transrectal ultrasound to
accurately stage rectal cancer allows us to make
the best recommendation for treatment of each
unique rectal tumor. Multidisciplinary neoadjuvant
therapy, coordinated by our faculty, results in
a high rate of sphincter preservation, even for very
low rectal cancers. Sharp total mesorectal excision
(TME) is routinely used during surgical
resection of rectal cancer, leading to the lowest
possible rate of local recurrence. Advanced techniques
for improved post-operative rectal reservoir
function are also used in certain patients.
Careful and close follow-up of patients with colorectal
cancer is coordinated by our staff.
March is the month for us to remove the stigma
and embarrassment from routine screening for
colorectal cancer. Take this opportunity to provide
a lifesaving service for your patients, your family,
and yourself!
For further information, please contact Janice F.
Rafferty, M.D., Chief of the Division of Colon
and Rectal Surgery, at (513) 929-0104.
Janice F. Rafferty, M.D.
Dr. Rafferty completed a Fellowship in Colon
and Rectal Surgery at Washington University
Medical Center, St. Louis, and is Board Certified
by the American Board of Surgery and the
American Board of Colon and Rectal Surgery.
* * * * * *
Dr. Rafferty recently implanted another artificial
anal sphincter for the treatment of devastating
fecal incontinence. This procedure is performed
at only a few centers in the country.
* * * * * *

UC Surgeons Prominent at National Meeting
UC surgeons were everywhere at the recent annual meeting of the
prestigious Society of University Surgeons (SUS) held in Houston
on February 12-15, 2003. Jeffrey Matthews, M.D. (Chair,
Department of Surgery) gave his Presidential Address entitled
"Relativity: Societies, Universities, and Surgeons," then passed
the gavel to Brad Warner, M.D. (Professor, Division of Pediatric
Surgery), who became the new President of the SUS. This marked
the first time that a Presidency was passed on from one member of
a department to another member of the same department, and is a
great credit to the academic and clinical strengths of our department.
Jeffrey B. Matthews, M.D. Brad W. Warner, M.D.
Andrew Lowy, M.D. (Chief, Division of Surgical Oncology) was
named to the Program Committee of the SUS.
On Saturday morning, Joseph Solomkin, M.D. (Director of
Research) presided over a clinical symposium on "New
Developments in Surgical Infections."
Andrew M. Lowy, M.D. Joseph S. Solomkin, M.D.
Joseph Cuschieri, M.D. (Division of Trauma/Critical Care) presented
a paper entitled "Modulation of Macrophage Responsiveness
to LPS by Manipulation of IRAK-1."
Amod Sarnaik, M.D., surgical resident, won the resident research
award at the meeting for his paper entitled "A Novel Function of
the Tumor Suppressor Gene Adenomatous Polyposis Coli:
Transcriptional-Independent Inhibition of DNA Replication."
Amod will represent the SUS at the upcoming meetings of the
British and European surgical research societies.
Joseph Cuschieri, M.D. Amod Sarnaik, M.D.
Other surgical residents presenting abstracts were:
Grace Mak, M.D. - "Differential Expression of Laminin-5 in
Kidney Epithelial Cell Growth."
Joshua Mammen, M.D. - "Ischemic Stress Induces Distinct
Membrane and Cytoskeletal Targeting of PKC in Intestinal
Epithelia."
Kuojen Tsao, M.D. - "VEGF Promotes the Expression of
Pro-angiongenic Hox D3 in Cultured Sinusoidal Endothelial
Cells."
Konstantin Umanskiy, M.D. - "ß1 Integrin Ligation
Mediates NADPH Oxidase Activation in Human Neutrophils."
Grace Mak, M.D.
Joshua Mammen, M.D.
Kuojen Tsao, M.D. Konstantin Umanskiy, M.D.
Such a strong presence at this prestigious meeting indicates the
high academic quality of the Department of Surgery, its dedication
to research, and the national reputation of its faculty.

Annual Meeting of Ohio
Valley Society of Colon and
Rectal Surgeons to be Held in
Cincinnati, April 2003
The Division of Colon and Rectal Surgery is sponsoring
the Annual Meeting of the Ohio Valley Society of
Colon and Rectal Surgeons (OVSCRS) scheduled for
Saturday, April 26, 2003, to be held in downtown
Cincinnati at the Cincinnatian Hotel, 601 Vine Street.
Reservations can be made by calling (513) 381-3000 or
toll free (800) 942-9000. A block of rooms is being
held at the discounted rate of $140/queen and
$160/king. Rooms are available on a limited space and
rate available basis, and registrants should call soon.
A reception is scheduled for Friday evening, April 25,
with the meeting on Saturday, April 26, and a casual
dinner is to be arranged on Saturday evening for interested
persons. The meeting will open with talks by
selected members, followed by resident presentations
and case management discussions. The annual business
meeting will occur after the day's educational
program. Please share this information with anyone
who might be interested in attending such as surgical
residents, colorectal fellows, and oncology or surgical
colleagues.
The Society is actively seeking new members. Any
general surgeon with an interest can be an affiliate
member of OVSCRS. If the physician's practice is primarily
devoted (>90%) to colorectal surgery, membership
can be complete with full voting rights. Consider
your colleagues and share this information with any
that you regard as potential members.
Please consider attending this year's meeting and share
this information with potentially interested colleagues.
If you have any questions regarding the meeting, or to
request an application for membership, please contact
Janice F. Rafferty, M.D., Chief of the Division of
Colon and Rectal Surgery, at (513) 558-4206.
Guest Lecturer in Colorectal Surgery
In observance of Colorectal Cancer Awareness Month,
the Division of Colon and Rectal Surgery is hosting a
Guest Speaker on March 26. Peter W. Marcello, M.D.,
Staff Surgeon, Department of Colon and Rectal Surgery,
The Lahey Clinic, Burlington, MA, will speak on
“Laparoscopic Colectomy: Where Do We Stand?”
Area physicians are invited to attend this lecture. Please
contact Gilda Young (513-558-4206) for more details.
J. Wesley Alexander, M.D.
Walter H. Merrill, M.D.
Henry W. Neale, M.D.
Michael F. Reed, M.D.
Roger T. Worrell, Ph.D.
Honors and Kudos
J. Wesley Alexander, M.D., Professor of
Surgery, Division of Transplantation, has
been honored in recognition of exceptional
achievement in transplantation medicine
by Baskent University and the Turkish
Transplantation Society, at which the “J.
Wesley Alexander Research Award” will
be presented every two years, with the first
presentation to be made this June. The
award will include $10,000 and a silver
commemorative medal emblazoned with
an image of Dr. Alexander.
Walter H. Merrill, M.D., Associate
Professor of Surgery and Chief, Section of
Cardiothoracic Surgery, was appointed
Chair of the Workforce on Graduate
Medical Education for the Society of
Thoracic Surgeons, and will serve on the
Education and Member Services Council
Operating Board. He was also appointed
to the Committee on Standards & Ethics.
Henry W. Neale, M.D., Professor of
Surgery and Chief of the Division of
Plastic, Reconstructive and Hand Surgery,
was Visiting Professor at the Beth Israel-
Deaconess Medical Center in Boston on
Feb. 18-20, 2003, where he gave lectures
on “Abdominal Wall Reconstruction” and
“The 5+2 (Independent) vs. the 3+3
(Integrated) Plastic Surgery Program.”
Michael F. Reed, M.D., Assistant
Professor of Surgery, Division of Thoracic
Surgery, presented a paper on “Surgical
Treatment of Esophageal High-Grade
Dysplasia” at the 39th Annual Meeting of
the Society of Thoracic Surgeons in San
Diego, February, 2003.
Roger T. Worrell, Ph.D., Research
Assistant Professor, was named Presidentelect
of the Ohio Physiological Society.
Dr. Worrell was also an invited seminar
speaker for the Department of Physiology
and Biophysics at Wright State University
College of Medicine, where he presented a
lecture on “Ammonium Inhibition of
Colonic Chloride Secretion: Anomalous
Mole Fraction Behavior.”

Physician Assistants Aid UC Surgeons
According to the American College of Surgeons, many positions in
general surgery residency programs went unfilled in 2001 and 2002.
In addition, the Accreditation Council for Graduate Medical
Education (ACGME) announced that effective July 1, 2003, more
than 100,000 residents (including surgical residents) in the United
States will be limited to a maximum of 24 hours per shift and no more
than 80 hours per week.
In an effort to meet these resident work hour restrictions, the
Department of Surgery has begun to utilize Physician Assistants.
While PA's are not intended to replace residents, when a resident is
unavailable the service will be covered by PA's or other mid-level
providers. The PA's are intended to augment the resident staff to help
reduce their work-loads and allow them additional quality education
time. Michael Bowen, MA, RN, PA-C, has joined the Department to
manage and oversee the development of the PA program. Michael has
been a practicing PA for 25 years with extensive experience in
Graduate Medical Education and PA education, and serves on the PA
Policy Committee to the State Medical Board of Ohio.
Several institutions have demonstrated that surgical PA's provide
high-quality, cost-effective care as house officers. In addition to
assisting in surgery, the surgical PA frequently takes the admitting
history and performs the physical examination, writes orders, interprets
preoperative tests, educates the patient and obtains informed
consent, dictates the operative report, manages patient care on the
wards, handles discharge planning, and performs follow-up care.
There are 132 accredited physician assistant educational programs in
the United States, located at medical colleges and universities, teaching
hospitals, and the Armed Forces. All PA educational programs are
accredited by the Commission on Accreditation of Allied Health
Education Programs (CAAHEP). Prior to admission, the typical PA
student has a bachelor's degree and 45 months of health care experience.
PA education typically is 111 weeks in length. PA students will
spend 400 hours in basic sciences, 70 hours in pharmacology, 150
hours in behavioral sciences, and 550 hours in clinical medicine. In
addition, the PA student will spend over 2000 hours on clinical rotations,
with emphasis on primary care in ambulatory clinics, physicians'
offices, and acute/long-term care facilities.
To practice, the PA must pass a national certification examination
developed jointly with the National Board of Medical Examiners and
administered by the National Commission on Certification of
Physician Assistants (NCCPA). Following a successful certifying
examination, the PA must obtain an individual license from the state
medical board or PA regulatory committee.
The Department of Surgery currently has five PA’s: Doug Knight,
Trauma; Joseph Konys, Cardiothoracic; Susan Hatfield, Burns;
Glenda Updyke, Transplant; and Michael Bowen. We anticipate
additional PA's for Trauma/Critical Care, Vascular, General Surgery,
Cardiothoracic, and Transplantation.
For additional information, please contact Michael Bowen at (513)-
558-1759; e-mail: Michael.Bowen@UC.EDU.
Left to right: Susan Hatfield, PA-C; Doug Knight, PA-C; Joseph Konys, PA-C; Michael Bowen, PA-C; and Glenda Updyke, PA-C.

New Clinical Trials
J. Wesley Alexander, M.D., Division of Transplantation:
NIH-funded study at University Hospital and Christ Hospital: “A
randomized trial of immunomodulating diets with arginine and
omega-3 fatty acids in renal transplant recipients.” This study will
evaluate the plasma and blood cell membrane absorption levels of
amino acids and fatty acids in renal transplant patients receiving
special transplant dietary supplements and will determine potential
beneficial effects of decreased rejection episodes, decreased incidence
of acute rejection, improved long-term allograft survival,
reduced cardiac and vascular complications, reduced infectious
complications, and improved quality of life.
Internally funded study at University Hospital and Christ Hospital:
“A pilot study of relationships of gastrointestinal hormones and
appetite following gastric bypass.” This study will measure hormones
which may be associated with loss of appetite following
gastrointestinal bypass. Changes in the hormones after the procedure
will be correlated with changes in appetite, the amount of
weight loss and technical features of the operation, such as the size
of the remaining gastric pouch and the lengths of the intestinal
limbs that are a normal part of the operation.
NIH-funded grant for the development of new technologies for
studying the mechanisms of graft acceptance or dysfunction following
renal transplantation. The study, approved by the IRBs at
University Hospital and Christ Hospital, is currently underway.
For further information, please call (513)-558-6006.
Recent Publications
Cuschieri J, Gourlay D, Garcia I, Jelacic S, Maier RV. Modulation
of endotoxin-induced endothelial activity by microtubule depolymerization.
J Trauma 54:104-112, 2003.
Giglia JS, J Ollerenshaw, P Dawson, K Black, WM Abbott.
Cryopreservation prevents arterial allograft dilation. Ann Vasc
Surg 16:762-767, 2002.
Johannigman JA, Miller SL, Davis BR, Davis K, Campbell RS,
Branson RD. Influence of low tidal volumes on gas exchange in
acute respiratory distress syndrome and the role of recruitment
maneuvers. J Trauma 54:320-325, 2003.
Kitzmiller J. Non-invasive skin measurements after CO 2 and
Erbium laser resurfacing. Aesthetic Surgery Journal 23:20-27,
2003.
Song JC, Rangachari PK, Matthews JB. Opposing effects of PKCalpha
and PKC-epsilon on basolateral membrane dynamics in
intestinal epithelia. Am J Physiol (Cell) 283(5):C1548-C1556,
2002.
Yoo J, Nichols A, Song JC, Mammen J, Calvo I, Worrell R,
Cuppoletti J, Matlin K, Matthews JB. Bryostatin-1 attenuates TNFinduced
epithelial barrier dysfunction: Role of novel PKC
isozymes. Am J Physiol (GI/Liver), Dec. 27, 2002.
Visiting Professors
Dr. Jeffrey L. Ponsky to Visit as John
and Elizabeth McDonough Visiting
Professor on April 8-9
The Section of General Surgery will
sponsor a visit by Jeffrey L. Ponsky,
M.D., Professor of Surgery and the
Director of Endoscopic Surgery at
The Cleveland Clinic Foundation.
Dr. Ponsky will speak at Surgical
Grand Rounds on Wednesday, April
9, on “Therapeutic Pancreatico-
Biliary Endoscopy: A Surgical Viewpoint.”
At the Cincinnati Surgical
Society that evening, Dr. Ponsky will
speak on “New Horizons in Surgical
Endoscopy.”
Jeffrey L. Ponsky, M.D.
******
Dr. Gerald Buckberg to Lecture as
Visiting Professor on May 13-14
In honor of John B. Flege Jr., M.D.,
Professor of Surgery, and establishment
of the Flege Chair in Surgery,
the Section of Cardiothoracic Surgery
will host Gerald D. Buckberg, M.D.,
Professor of Surgery, Division of
Thoracic and Cardiovascular Surgery,
at UCLA. Dr. Buckberg's visit will
include teaching activities as well as
two lectures: “The Helix and the
Heart” at Surgical Grand Rounds and
“New Geometric Surgical Approaches
Gerald D. Buckberg, M.D.
to Congestive Heart Failure” at the
Cincinnati Surgical Society.
Upcoming Guest Speakers:
May 21, 2003 - Frame Lectureship (Trauma/Critical Care): Rao
R. Ivatury, M.D., Professor of Surgery, Medical College of
Virginia - “Towards Optimal Resuscitation After Trauma”
June 4, 2003 - Barrows Visiting Professor (Surgical Oncology):
Douglas Evans, M.D., Professor of Surgical Oncology, MD
Anderson Cancer Center - Topic to be announced
Area physicians are invited to attend these lectures. Please contact
Gilda Young at 513-558-4206 for further information.
******

Surgical Grand Rounds Schedule
March 26, 2003 Visiting Professor (Colorectal Surgery): Peter W. Marcello, M.D., Staff Surgeon, Department of
Colon and Rectal Surgery, Lahey Clinic, Burlington, MA - “Laparoscopic Colectomy: Where
Do We Stand?”
April 2, 2003 Elizabeth Shaughnessy, M.D., Ph.D. (Surgical Oncology) - “HIPAA Regulations”
April 9, 2003 John and Elizabeth McDonough Visiting Professor (General Surgery): Jeffrey Ponsky, M.D.,
Director, Endoscopic Surgery and Professor of Surgery, The Cleveland Clinic Foundation -
“Therapeutic Pancreatico-Biliary Endoscopy: A Surgical Viewpoint”
April 16, 2003 Steven M. Rudich, M.D., Ph.D. (Transplant Surgery) - “Live Donor Liver Transplantation: Sum
of Parts is Greater Than the Whole”
April 23, 2003 Amy B. Reed, M.D. (Vascular Surgery) - “Carotid Artery Stenosis”
April 30, 2003 Christopher Gordon, M.D. (Plastic & Reconstructive Surgery) - “Craniofacial Surgery”
Upcoming Guest Speakers:
May 14, 2003 Visiting Professor (Cardiothoracic Surgery): Gerald Buckberg, M.D., Professor of Surgery,
UCLA Medical Center - “The Helix and the Heart”
May 21, 2003 Frame Lectureship (Trauma/Critical Care): Rao R. Ivatury, M.D., Professor of Surgery, Medical
College of Virginia - “Towards Optimal Resuscitation After Trauma”
June 4, 2003 Barrows Visiting Professor (Surgical Oncology): Douglas Evans, M.D., Professor of Surgical
Oncology, MD Anderson Cancer Center - TBA