Pediatric Focus Winter 05


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Pediatric Focus Winter 05

  1. 1. Focus P e d i a t r i c VO LU M E 3, I S S U E 1 Letter From the Chair providing services to children with special health care needs, so they don’t always have to make the trip to downtown Baltimore. The need for pediatric subspecialty care is growing much faster than fellowship pro- Dear Friends and Colleagues: grams can produce such experts. Our society is faced with a rapidly expanding proportion I hope the New Year finds you well, and of children with chronic health care needs, News, Information, and that 2005 will hold nothing but goodness for who often have multiple problems. Dealing Happenings from the you and your families. As I write this, the most with these problems can be difficult, and University of Mar yland recent world tragedy-the Asian tsunami, is still dealing with the system can sometimes be Hospital for Children and the a topic of concern to us all. Such devastation overwhelming for families as well as for University of Mar yland reminds us of the fleeting nature of life, and referring physicians. School of Medicine the seeming unfairness of nature. We, as pedia- While we continue to search for additional tricians, are particularly struck by the death of subspecialists to help meet the needs of these so many children, and the knowledge that so children, we also strive to help primary care many more are left homeless or orphaned, or physicians and families more easily access the both. Although it may be hard to make sense physicians who can provide the necessary care of such an event, this occurrence can also help right now. Although the University of Maryland give us perspective as to our role in the world. Hospital for Children has had a process in place As pediatricians, pediatric subspecialists, for the past several years to assist families and and as teachers of future pediatricians, our physicians navigate our system of subspecialty I N S I D E department at the University of Maryland care, we have recently made some changes to contributes in many ways to the lives of make the process simpler. We have developed New Faculty Profiles children in Maryland and around the world. a new program called Access for Special Kids Our researchers work to find answers to or ASK. Details and contact information are Spotlight on Research— problems that affect children and youth described inside this newsletter. Understanding Traumatic disproportionately. We develop new vaccines Inside you will also learn about some Brain Injury in the Pediatric and improve old ones; we fight HIV/AIDS of our programs in endocrinology, and you Population here in Baltimore as well as in the developing will be introduced to many physicians who world; we study mechanisms of disease in the have recently joined our faculty. As always, Endocrinology at the childhood population. One research program, I hope that you will give me a call with your University of Maryland focused on the impact of traumatic brain comments, questions, or concerns. I can be Hospital for Children injury on the developing nervous system, is reached at 410-328-6777 . described on the following pages. Addressing the Needs of We run clinics in underserved areas; Sincerely, Children with Chronic we provide critical care to children with Medical Conditions devastating diseases, and to neonates born prematurely. We treat all families with respect and care. While some of our faculty Alice D. Ackerman, M.D. travel around the world to make the biggest Interim Chair, Department of Pediatrics, and impact, others travel around the state, Associate Professor of Pediatrics
  2. 2. Endocrinology at the University of Maryland Hospital for Children It is no secret. Diabetes is a problem plaguing In addition to seeing patients at the down- the pediatric population. Not only are children town University of Maryland Medical Center, more frequently being diagnosed and treated the members of the team from endocrinology for type 1 diabetes, but they are also developing travel the state each week, visiting several type 2 diabetes, once referred to as adult-onset different counties. Outreach services are diabetes. Because of the growing demand for offered at Shipley’s Choice in Anne Arundel endocrinology services, the University of County, University Pediatric Specialists in Maryland Hospital for Children has expanded Bel Air, Montgomery County General, Mt. its services by hiring an additional physician Washington Pediatric Hospital, Peninsula and support staff to accommodate the increase Regional Medical Center in Salisbury, and at in patient volumes. the Pediatric Center of Frederick in Mt. Airy. At the University of Maryland Hospital In addition to the clinical practice, the for Children, the division of pediatric endocrinologists are also actively engaged in endocrinology recognizes the need for a conducting research. They are involved in strong, clinical program for diabetes. In part- several multi-center trails and independent nership with the Joslin Diabetes Center, the NIH funded studies. University of Maryland Hospital for Children Clinical research studies are ongoing offers a multidisciplinary approach to the for growth, prevention of type 1 diabetes, management of children with diabetes. Under The diabetes program, led by Dr. Debra prevention of obesity, and prevention of the leadership of Debra Counts, M.D., chief Counts, has expertise in intensive manage- diabetes complications. ment and insulin pump therapy. of pediatric endocrinology and associate For more information about the division or to schedule an professor of pediatrics at the University of Syndrome Center, located at Mt. Washington appointment, please call 410-328-3410. Maryland School of Medicine, the program Pediatric Hospital, has a multidisciplinary has expertise in intensive management and approach to management of children with The Pediatric Endocrinology Team: insulin pump therapy. As part of the multi- Prader Willi Syndrome. A metabolic clinic Debra Counts, M.D. disciplinary approach, they are developing has also recently been established, and offers Matthew Hebdon, M.D., Ph.D. a transition clinic for patients who are a multidisciplinary approach to the manage- Rachel Gafni, M.D. between the ages of 16 and 22 and have ment of children and adolescents with Yves Nordman, M.D., Fellow type 1 or type 2 diabetes. medical consequences of being overweight. Malinda Duke, C.P ., Certified .N.P Within the division of pediatric The emphasis of this program is prevention. Diabetes Educator endocrinology, there are several other The pediatric endocrinology program Mary Jane Grove, R.N., Certified programs. The Pediatric Metabolic Bone continues to offer diagnosis and management Diabetes Educator Disorder Center specializes in the diagnosis of growth problems, thyroid disease, precocious Mary Burr, C.P ., Diagnostic T .N.P esting Nurse and management of a broad range of bone and delayed puberty, adrenal diseases, and Sherry Johnsonbaugh, R.N., Study Coordinator diseases of children. The Prader Willi lipid disorders. Patricia Wrobel, C.M.A. Make the Connection... 800-373-4111... OneCall Call University Physicians Consultation and Referral Service 24 hours a day, 7 days a week to: • Arrange consultations with attending physicians. • Access University of Maryland Medicine services. • Schedule outpatient appointments. • Receive information and register for continuing medical education programs. • Obtain updates on a patient’s condition or follow-up reports. • Request ground or air critical care transportation through Maryland ExpressCare and Maryland ExpressCare for Kids. 2
  3. 3. New Faculty Profiles John F. Caccamese, Jr., D.M.D., training with a pediatric internship and Fernando V. Mena, M.D., has been appointed M.D. has been appointed assis- residency at Children’s Hospital of Los to the faculty of the University of Maryland tant professor of surgery, within Angeles and a fellowship in genetics at School of Medicine in the department of the division of oral-maxillofacial Stanford University School of Medicine. pediatrics as an assistant professor. surgery at the University of Dr. Greene can be reached at 410-328-3335. Most recently, Dr. Mena has been a pediatric Maryland School of Medicine. resident at the University of Maryland Medical Dr. Caccamese returns to Maryland from G. Matthew Hebdon, M.D., Center. Prior to that, he was an attending Pittsburgh where he completed a fellowship Ph.D., an endocrinologist, has neonatologist at Hospital San Jose in Chile in cleft, craniofacial and pediatric maxillofacial been appointed an assistant profes- after completing a fellowship in neonatology at surgery at the University of Pittsburgh sor of pediatrics at the University the University of Maryland. Medical Center/Children’s Hospital of of Maryland School of Medicine. Dr. Mena was educated at the University Pittsburgh. He completed a general surgery Dr. Hebdon comes to Baltimore from of Chile in Santiago. After receiving his internship and an oral and maxillofacial the University of Michigan where he has medical degree, he was a resident and chief surgery internship and residency at the spent the past eight years as a resident and resident in pediatrics at Robert del Rio University of Maryland Medical Center/ fellow. During a combined pediatric-adult Hospital, also in Santiago. R Adams Cowley Shock T rauma Center. He endocrinology fellowship, he participated in Dr. Mena can be reached at 410-328-6716. also served as chief resident of oral-maxillofacial both basic and clinical research in the area surgery at the University of Maryland. of obesity and diabetes. His primary basic Todd A. Milbrandt, M.D., In addition to trauma and craniofacial science interest is to understand how cells has joined the University of reconstruction, Dr. Caccamese maintains a are affected by circulating free fatty acids. Maryland School of Medicine clinical focus on the care of the pediatric A graduate of the University of North as an assistant professor of patient. This includes the reconstruction of Carolina School of Medicine in Chapel Hill, orthopaedics. He specializes congenital facial anomalies, cleft lip and Dr. Hebdon pursued medical school after in pediatric orthopaedic surgery. palate, pediatric trauma, pediatric pathology, 15 years working for Wellcome Research Most recently, Dr. Milbrandt was a fellow and orthognathic surgery. He serves on the Laboratories and Glaxo Research Laboratories. in pediatric orthopaedic surgery at T exas Kernan Cleft and Craniofacial team. During that time, he studied the inhibitors Scottish Rite Hospital for Children in Dallas. Dr. Caccamese can be reached at 410-328-6195. of multi-drug resistance and served as director After graduating with a medical degree from of the division of chemotherapy at Glaxo the University of Virginia (UVA) School of Carol L. Greene, M.D., has Labs in North Carolina. He received his Medicine, Dr. Milbrandt remained in been appointed a professor of Ph.D. in 1977 from the National Institute Charlottesville to complete an internship in pediatrics at the University of of Medical Research in his native home of general surgery at the University of Virginia Maryland School of Medicine the United Kingdom. Health Sciences Center. Following that, he in the division of genetics. Dr. Hebdon can be reached at 410-328-3410. was a post-doctoral research fellow within Most recently, Dr. Greene has been a policy the department of orthopaedic surgery at advisor in the Office of Science and Data Miriam K. Laufer, M.D., has been appointed UVA and then Dr. Milbrandt went on to Policy at the Department of Health and assistant professor of pediatrics at the University further train in orthopaedic surgery at the Human Services. Concurrently, she served as of Maryland School of Medicine. UVA Health Sciences Center. During this a staff physician in genetics and metabolism For the past two years, she has been a time, Dr. Milbrandt was also completing a at Children’s National Medical Center in research fellow at the University of Maryland’s masters of science degree at UVA. Washington and was on the faculty at George Center for Vaccine Development’s Malaria Dr. Milbrandt’s research interests include Washington University School of Medicine. Section. Concurrently, she was a clinical fellow the basic science applications of bone and Prior to that, Dr. Greene spent almost in the division of pediatric infectious diseases cartilage cell-based gene therapy and bone a decade at University of Colorado Health at Johns Hopkins. graft survival. Clinically, he is involved in Sciences Center where she was a professor Dr. Laufer received her medical degree research investigating scoliosis in Down’s of pediatrics, as well as on the faculty in the from the University of Pennsylvania School syndrome patients and the position of the department of biochemistry, biophysics and of Medicine. She continued her training with aorta in scoliosis patients. genetics. She was also the director of Inherited a pediatric residency at Babies and Children’s Dr. Milbrandt can be reached at 410-328-6040. Metabolic Diseases Clinic. In the past, Dr. Hospital at Columbia University in New York. Greene was as assistant professor at Tulane Dr. Laufer has done extensive research James T. Moore, M.D., a University School of Medicine and director outside the United States. In addition to pediatric surgeon, has been of the genetics clinic at Charity, Children’s malaria, her research interest is in drug- appointed an assistant professor and Ochsner Hospitals. resistance and HIV. of surgery at the University of Dr. Greene completed her undergraduate Dr. Laufer can be reached at 410-328-5328. Maryland School of Medicine. degree at Stanford University and her medical He comes to Baltimore from Memphis where degree from Albert Einstein College of he was a pediatric surgical fellow at Medicine in New York. She continued her the University of Tennessee, Le Bonheur 3
  4. 4. Children’s Hospital where he trained in Dr. Sundel comes to Baltimore from Florida also in Ethiopia. He completed another advanced laparoscopy and robotic surgery. where he spent a year as a pediatric hospitalist residency in pediatrics at Woodhull Medical Prior to that, Dr. Moore was a general surgery at Sarasota Memorial Hospital. Prior to that, Center in New York. resident at New York Presbyterian Hospital. he worked for over a decade as director of the His research interest includes orbital Dr. Moore received his medical degree pediatric hospitalist program at Bryn Mawr ceullulitis in children. from Columbia University College of Hospital in Pennsylvania. Dr. Sundel was also Dr. Teshome can be reached at 410-328-6335. Physicians and Surgeons. acting director of the pediatric intensive care His research interest is in clinical outcomes unit at Hahnemann University Hospital. Donald F. Van Wie, Jr., D.O., in pediatric surgery. After graduating from the combined has been appointed an assistant Dr. Moore can be reached at 410-328-5730. baccalaureate medical program at Boston professor of pediatrics at the University, Dr. Sundel completed a pediatric University of Maryland School Adora C. Okogbule-Wonodi, internship and residency at Babies and of Medicine, after five years at the M.B.B.S., has been appointed Children’s Hospital at Columbia Presbyterian University of Maryland completing a combined an assistant professor of pedi- Medical Center in New York. Following that, emergency medicine and pediatric residency. atrics within the division of he was a pediatric fellow with the Robert Wood In addition to spending the past year as chief neonatology at the University Johnson Clinical Scholars Program at Johns resident, Dr. Van Wie served as an overnight of Maryland School of Medicine. Hopkins and Sinai Hospital. The fellowship and weekend fellow in the pediatric intensive Dr. Okogbule-Wonodi was educated in focused on teaching and clinical research. care unit at the University of Maryland. Nigeria and received her medical degree from Dr. Sundel can be reached at 410-787-4917. Dr. Van Wie is a graduate of the Kirksville the College of Health Sciences at University of College of Osteopathic Medicine in Missouri. Port Harcourt. She continued her training with Milagritos D. T apia, M.D., He has been a pediatric phlebotomist at the an internship at University of Port Harcourt has joined the department of University of Maryland Hospital for Children Teaching Hospital. pediatrics at the University of and a medical technologist at Shock Trauma. After practicing medicine in Nigeria, Dr. Maryland School of Medicine Dr. Van Wie can be reached at 410-328-6335. Okogbule-Wonodi came to the United States as an assistant professor within as a post-doctoral research fellow at UCLA the division of infectious diseases. Teresa A. York, M.D., a pediatric Medical Center in California. Following that, A graduate of Cornell University Medical hematologist/oncologist, has been she was a pediatric intern and resident at D.C. College, Dr. T apia continued her training as appointed an assistant professor General Hospital. a resident at Case Western University and of pediatrics at the University of For the past four years, Dr. Okogbule-Wonodi Rainbow Babies and Children’s Hospital. Maryland School of Medicine. has been with the University of Maryland as a Following that she was a fellow in pediatric Dr. York comes to Baltimore from neonatal/perinatal medicine fellow and as a infectious diseases and a fellow in vaccinology Charleston, South Carolina where she was a research fellow. at the University of Maryland. Currently, Dr. fellow and clinical instructor of pediatric Her research interest is in the effects of Tapia is completing an M.P at Johns .H. hematology/oncology at Medical University Lactobacillus plantarum. Hopkins Bloomberg School of Public Health. of South Carolina. While there, she cared for Dr. Okogbule-Wonodi can be reached a 410-328-6003. She is board certified in pediatrics. patients with cancer and blood diseases. She Dr. T s research interest is in oral fluid apia’ also participated in autologous and allogeneic Donna J. Perlin, M.D., F.A.A.P ., as a non-invasive method to measure immune stem cell transplants at the Medical University has been appointed an assistant response to some vaccinations, such as measles of South Carolina, which was the only pedi- professor of pediatrics at the and tetanus. atric bone marrow transplant unit in the state. University of Maryland Medical Dr. Tapia can be reached at 410-706-5328. As part of her fellowship training, she gained School of Medicine. experience in bench research and how this Since 2001, Dr. Perlin has been an attending Getachew T eshome, M.D., relates to patient care in order to give cancer within the pediatric emergency department has been appointed an assistant patients the best chance of cure. at the University of Maryland Medical Center. professor of pediatrics at the A graduate of the West Virginia University At the same time, she was completing a University of Maryland School School of Medicine, Dr. York continued her fellowship in pediatric emergency medicine of Medicine. He works within training with a pediatric residency at West at Johns Hopkins. the pediatric emergency department at the Virginia University Children’s Hospital. A graduate of the Medical College of University of Maryland Hospital for Children. Her research interests include relapsed Virginia, Dr. Perlin completed an internship Dr. Teshome was most recently a pediatric leukemia and drug resistance as well as and residency there as well. emergency medicine fellow at Children’s monitoring cancer survivors for developing Dr. Perlin can be reached at 410-328-6335. Hospital of Michigan in Detroit. Concurrently, secondary malignancies after treatment with he was working on a masters in public health chemotherapy and/or radiation. Eric Sundel, M.D., has joined at Medical College of Wisconsin in Milwaukee. Dr. York can be reached at 410-328-2808. the faculty of the University After receiving his medical degree from of Maryland School of Medicine as Addis Ababa University in Ethiopia, Dr. an assistant professor of pediatrics. Teshome was part of a family medicine He has also been appointed as practice at Sodo Rural Hospital. He later head of the North Arundel Hospitalist Program. became a pediatric resident and chief resident 4
  5. 5. SPOTLIGHT ON RESE ARCH Understanding Traumatic Brain Injury in the Pediatric Population Head injuries among children are a common We have defined initial baseline In addition to the basic cellular function, problem. In the United States, more than features of trauma in this rat model and mitochondria are also important for trigger- half a million young people are hospitalized now we are moving forth to look at specific ing a process called apoptosis, which is a each year following a head injury, and unfor- interventions that go on in the clinical programmed cell death process. There are tunately, more than 3,000 of those children environment and how they might impact two ways cells can die after injury. They can die as a result of their injury. the young brain after injury. die quickly, basically disintegrating in Despite this, basic science research into a process called necrosis or they can die pediatric brain injury is rare. What results have you found? in a more delayed fashion in a process called At the University of Maryland School Courtney Robertson: We have isolated apoptosis. Mitochondria are involved in of Medicine, Dr. Courtney Robertson, an mitochondria from the brain of rats starting both types of cell death. We found after assistant professor of pediatrics and an at one hour after injury and are studying traumatic brain injury in immature rats that attending in the pediatric intensive care their function in vitro. We have looked at their mitochondria are very vulnerable to unit at the University of Maryland Hospital basic features of mitochondria function, pro-apoptotic signals. In response to these for Children, is studying the impact of like how they consume oxygen. Essentially, signals, mitochondria release a molecule traumatic brain injury on a child’s developing we have already seen that there are some called cytocrome c into the cytosol, and brain at the cellular level. abnormalities in the basic respiratory rates this triggers the apoptosis process. The Dr. Robertson’s interest in this area began of these mitochondria one-hour after injury. mitochondria we have isolated from young when she was completing a fellowship in This respiratory change is unique on the rat brains are doing this after traumatic critical care at the Children’s Hospital of traumatic injury side of the brain as com- brain injury, which is another mechanism Pittsburgh. While working with the director pared to the uninjured side of the brain. to explain why these cells might go on to of the Safar Center for Resuscitation die. So it can be explained by either a lack Research, Dr. Patrick Kochanek, a leading of energy production due to the poor investigator in the field of pediatric traumatic mitochondrial function or the release of brain injury, she was able to research the cytocrome c triggering delayed cell death. basic science side, as well as investigate the In the lab, we see evidence for both of clinical side of traumatic brain injury. these explanations an hour after traumatic brain injury. Dr. Robertson, explain the kind of research you are Where will you go from here? conducting. Courtney Robertson: Moving forward, Courtney Robertson: I am interested in we are going to look at interventions that studying mechanisms of neuronal cell death people might perform after a head injury. In or cell survival after traumatic brain injury one of our future studies, we plan to look at using a clinically relevant pediatric model Dr. Courtney Roberston is studying the high levels of oxygen in this pediatric model. of traumatic brain injury in rats. Specifically, impact of traumatic brain injury on a child's Traumatic brain injury patients are often developing brain at the cellular level. resuscitated with high levels of oxygen. I am studying how mitochondria—the powerhouse of the cell—may be responsible We’re currently investigating some That is standard protocol and it might be for determining cell survival after traumatic potential mechanisms to explain this mito- beneficial, but there is some pre-clinical injury in the developing brain. chondrial malfunction. It may relate to evidence that excessive levels of oxygen can I received a 5-year grant from the reactive oxygen species in the brain. It may be detrimental. Most of this work has come National Institutes of Health. We are about relate to high levels of calcium. We’re investi- from brain injury models in adult animals, half way through now. The grant is called gating the specific mechanisms that cause so we are going to be looking at that in the a KO8 and is designed for a junior clinician the mitochondria not to work properly. young brain and see what the effects of high scientist to work along with a mentor senior Mitochondria are responsible for producing versus normal oxygen might be. researcher. I am working with Dr. Gary ATP So when there is a malfunction at some . We also plan to test these rats to look Fiskum and his colleagues in the department level of the electron transport chain or the in specifically at what cognitive deficits they of anesthesiology. Dr. Fiskum has a back- the final enzyme producing ATP then the , have after traumatic brain injury. The main ground in biochemistry research, specifically cell does not have enough ATP to function. way we study that in the rat is using the mitochondrial aspects of brain injury. Mitochondrial dysfunction has been docu- behavioral test, the Morris water maze, a We have conducted a series of initial mented in many chronic neurodegenerative test of learning and memory. This will be investigations comparing injured rats to non- diseases as well as many types of acute brain important for understanding how these injured rats that underwent similar surgical injury. So if something occurs after an injury mitochondrial processes correlate with procedures and are defining the specific to cause the mitochondria to not function actual cognitive deficits in rats. mitochondrial mechanisms that are respon- properly, then the cell can really be in trou- The hope for this study is to use cutting- sible for some of the injury that occurs. ble and ultimately the cell can die. Please see Research on back page. 5
  6. 6. Focus P e d i a t r i c Non-Profit Org. U.S. Postage PAID Permit #2573 Baltimore, MD 22 S. Greene Street Baltimore, Maryland 21201 Check out our Web site at Pediatric Focus is published by the University of Maryland Hospital Advisory Board Peter Gilbert for Children. For more information, please contact the editor: Senior Administrator, Richard Armiger Department of Pediatrics President, University of University of Maryland School Alexandra Bessent Enright Alice D. Ackerman, M.D. Maryland Hospital for of Medicine Marketing Manager Interim Chair, Children Board of Visitors 22 South Greene Street Associate Professor, Vice President, Investments, James King, M.D. Salomon Smith Barney Division Chief of General Baltimore, MD 21201 Department of Pediatrics Pediatrics, Professor of Pediatrics, Phone: 410-328-9260 University of Maryland Alison Brown, M.P .H. University of Maryland School Fax: 410-328-6815 School of Medicine Senior Vice President of Business of Medicine E-mail: Development, Marketing and Planning, University of Maryland Roger Voigt, M.D. Medical Center Chief of Pediatric Surgery, Assistant Professor of Surgery University of Maryland School of Medicine Research from page 3. Addressing the Needs of Children with edge mitochondrial techniques to define the Chronic Medical Conditions sub-cellular pathways responsible for brain Many children today suffer from chronic medical conditions. Their families and doctors injury in a developing brain. It has really not often encounter difficulties in coordinating their care. At the University of Maryland been studied to this degree of detail at all. There Hospital for Children, Drs. Lindsay K. Grossman and Virginia Keane have developed is limited literature in pediatric animal models, the ASK Program (Access for Special Kids) to assist parents of these children and their especially related to traumatic brain injury. We primary care physicians by: then hope to use the mechanisms that we find • Assisting in making and coordinating appointments to plan future studies to look at neuroprotective • Locating resources right in the child’s community interventions. These could possibly lead to • Helping with school issues clinical interventions or drug treatments that • Supporting families as they deal with their child’s illness could improve outcomes in children after traumatic brain injuries. T connect with ASK, clinicians or parents may call Joyce Hylton, RN, at 410-328-6879. o T reach Dr. Robertson, please call 410-328-6957 o .