ROUNDS Magazine, Summer 2003 - Hartford Hospital

SUMMER
2003

ROUNDS

H A R T F O R D H O S P I T A L’ S W E L L N E S S M A G A Z I N E

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SimMan Does “We can make him talk. Students can ask questions and he
the Circuit replies. We use audio messages, such as screams of agony
or complaints of pain and shortness of breath, which add
Dr. Thomas Mort and Stephen to the realism of the training sessions.”
Donahue work with SimMan.
SimMan can become a woman, with the addition of a wig,
Hartford Hospital’s SimMan travels around the hospital, breasts and reproductive organs. Affectionately named
springing surprise scenarios on students and staff to “Witold” after the chief of the Department of Anesthesiol-
sharpen their clinical and decision-making skills. The blond, ogy, Witold Waberski, M.D., the realistic-looking simulator
handsome, plastic SimMan (short for simulated man) teaches anesthesia, medical, cardiac and intensive care
sometimes sports a bruised and bleeding face that makes teams how to collaborate in a crisis. “We can videotape the
him resemble a trauma victim. Other times he’s a heart- team to see how they handle a life-and-death situation,”
attack victim with a difficult airway lying unconscious in says Stephen Donahue, R.R.T., assistant director of Human
the ICU or the hallway leading to the parking garage. Crisis Simulation and a respiratory therapist who works with
SimMan at the hospital’s Center for Advanced Technology.
Powered by a laptop computer and an air compressor, the
patient simulator is controlled by computer chips and an Nurses, medical residents, doctors and trauma staff may
air hydraulics system. “He breathes, his chest rises and administer medications, intubate the airway, call for crash
falls, his tongue swells, he clenches his jaw, he has pulses carts, defibrillate or cardiovert any arrhythmias to resusci-
and heart sounds,” says Thomas C. Mort, M.D., an anesthe- tate the patient as SimMan’s condition rapidly worsens.
siologist who heads the Human Crisis Simulation program. “The focus of human crisis simulation is on individuals
working together in an rapid, efficient and competent
manner to optimize patient care,” says Dr. Mort.

SAFETYTIPS

ROUNDS Food
Fright
Hartford Hospital’s Wellness Magazine
More than one billion pounds of pesticides are sprayed in
Hartford Hospital the United States each year. Though long-term health
80 Seymour Street consequences of these chemicals—often used in combina-
Hartford, CT 06102-5037 tion—are unknown, several have been shown to disrupt the
(860) 545-5000 endocrine (hormonal) system. Fight back against pesticide-
Health Referral Service laden food to protect your health:
(860) 545-1888 or
(800) 545-7664 • Scrub fruits and vegetables thoroughly in running water,
www.harthosp.org or diluted dishwashing liquid (rinse thoroughly to
remove detergent).
Rounds Medical Advisory Board:
Adrienne Bentman, M.D. • Discard the outer leaves of leafy vegetables such as
David Crombie, M.D. lettuce and cabbage.
Joseph Klimek, M.D.
Andrew Salner, M.D. • Trim fat from meat (pesticide residues concentrate
Linda Taylor, M.D. there).

Editor: Lee Monroe • Remove fat and skin from poultry and fish.
Director of Public Relations
Designer: Clare Philips • Grow your own fruits and vegetables. (Avoid edging
Writer: Jane Bradley gardens with pressure-treated wood, which contains high
Photography: Pages 3, 4, 5, 8: Joy Miller levels of arsenic.)
Calendar
Coordinator: Luisa Machado • Eat a varied diet that contains lots of organic fruits and
vegetables.
ROUNDS is a quarterly publication of Hartford Hospital. It is
not intended to provide medical advice on individual health Pesticides that mimic the effects of estrogens may be
matters. Please consult your physician for any health concerns. implicated in breast cancer. Occupational and Environmental
Medicine reports that women with breast cancer were more
than five times as likely to have traces of the pesticide DDT
in their blood than women without breast cancer. Though
banned in 1972, DDT can remain active in tissues for years.

2

PHYSICIAN PROFILE

Andrew J. Ricci, M.D. Targeting
Tumors
Andrew J. Ricci, Jr.,
M.D., a senior surgical Herceptin Blocks
pathologist at Hartford Breast Cancer Receptors
Hospital, is Board-
certified in anatomic and Every three minutes a woman is diag- a clinical trials group supported by the
clinical pathology. nosed with breast cancer and every 12 National Cancer Institute (NCI).
Pathologists analyze minutes another woman dies. Nationally,
tissue from biopsies to breast cancer will strike more than 200,000 “Herceptin can be toxic to the heart,”
guide oncologists in times this year and take more than 40,000 warns Gregory J. Tsongalis, Ph.D., director
selecting the best course lives. Yet less than a third of the women of Hartford Hospital’s molecular pathology
of treatment, especially who develop the disease have any identifi- lab. “Metastatic breast cancer patients with
critical for breast cancer able risk factors, and fewer than ten strongly over-expressed growth factors—
patients who may have a percent have a family history of a specific said to be HER2-positive—are the only
variety of tumor types. breast cancer gene such as “BRCA-1.” ones who can be expected to derive benefit
He also analyzes biopsy from Herceptin. The marker must be
results from gastro- The decoding of the human genome is confirmed to assure that patients really are
intestinal, bone or soft bringing new understanding of how normal HER2-positive and that the potential
tissue tumors. genes go awry, spawning uncontrolled benefit of treatment with Herceptin
growth of abnormal proteins. The genome outweighs any risks.”
A graduate of New York comprises about 30,000 genes that code
Medical College, Dr. Ricci for a million or more different proteins— “Up to one-third of the patients we see
interned at Beth Israel the biochemical powerhouses of the body. have tumors that might make them
Hospital/Harvard, The study of proteins, in turn, is driving candidates for Herceptin,” says Dr. Ricci,
followed by a fellowship revolutionary research into targeted who so far has reviewed 15 HER2-positive
in tumor pathology at “designer drugs” for cancer. Now in its cases for the NSABP. “We were extremely
New York’s Memorial infancy, the new science of proteomics— pleased and gratified that their testing
Sloan Kettering Cancer the study of protein within cells—is center corroborated our HER2 results in
Center. An assistant shaping the chemotherapy of the future. every case.”
professor of pathology
at the University of The first proteomic-technology drug to be Connecticut ranks first in the country in
Connecticut, he is an approved for clinical use in the treatment rates of breast cancer, according to the
avid road cyclist who can of breast cancer, the monoclonal antibody American Cancer Society, though new
ride 100 miles in just Herceptin, blocks the HER-2/neu protein, chemotherapy regimens and estrogen-
over five hours. He also found in about 25-30 percent of metastatic blocking drugs like tamoxifen have saved
sings, writes songs and breast cancers. Metastases, with their far- many lives. “Herceptin is the newest of the
plays his guitar for flung colonies of invading cells, kill most ‘biomarker’ treatments,” explains Dr.
friends. of their victims by unleashing proteins that Tsongalis, who anticipates that the war
destroy normal tissue as the cancer grows against breast cancer will increasingly be
and spreads. fought on the molecular front. “More than
400 mutations have been identified so far
“Advances in molecular pathology are in the known breast cancer genes, but we
bringing new approaches to diagnosis and know other genes must also be involved.”
treatment of breast cancer,” explains
Andrew Ricci, Jr., M.D., a senior surgical
pathologist at Hartford Hospital and a
participating pathologist in the National
Surgical Adjuvant Breast Project (NSABP),

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PIONEERING

Hartford Hospital “Dives” into Advanced Wound Care Therapies

Hartford Hospital’s “Center for Wound Healing and healing by increasing the content of oxygen within the
Hyperbaric Medicine” will open this summer on the wound tissue and aids in the restorative process.

ground floor of the Conklin Building. The Center will bring Once inside the chamber, the patients breathe 100%
together multidisciplinary resources to provide state-of- oxygen, which has been compressed by the pressure inside
the-art treatments for chronic, the chamber to one and a half to 3 times normal pressure.
hard-to-heal wounds, such as
diabetic foot ulcers, venous leg This results in tissue oxygen that is up
ulcers, pressure sores and to 300 times greater than normal.
radiation-induced tissue injuries. Patients remain in the chamber for a
A state-of-the-art 10-person 90-minute “dive” (a term carried over
hyperbaric oxygen chamber will from the days when hyperbaric
be part of the new wound-healing chambers were used to treat “the
program. bends” caused by resurfacing too fast
in scuba diving accidents). The 90-

“Our patient population reflects the minute treatment is usually repeated

demographic trend towards an aging 20-40 times. “Over time, this therapy

population along with increasing can create new blood vessel formation

incidences of diabetes and obesity,” within the wound, thus improving

explains George Perdrizet, M.D., wound healing,” explains Dr. Perdrizet.

Ph.D., a staff surgeon with expertise Patients will receive a comprehensive

in immunology who serves as the evaluation and appropriate treatment

medical director for the new pro- Dr. George Predizet and (inset) Hartford
Hospital’s new room-sized hyperbaric chamber. or a combination of treatments will be
gram. He combines his surgical prescribed. It is anticipated that

background with laboratory research
into cellular responses related to wound healing. “We are approximately 25% of patients with non-healing wounds
will meet criteria for Hyperbaric Oxygen Therapy.
seeing an increasing number of people with poor blood

flow with wounds that are difficult to heal.” The chamber will operate on a 24 hour/7 days a week

The centerpiece of this new hospital service will be a 10- schedule, is part of the Divers Alert Network, and is ready

person hyperbaric chamber that will provide hyperbaric to respond to diving accidents, acute traumatic injuries and

oxygen to patients in the Wound Center. Unlike claustro- carbon monoxide poisoning. “You can read a magazine

phobic, single-person chambers that are found elsewhere or watch TV with several other patients and a trained

in the state, Hartford Hospital’s room-sized multi-person attendant within the chamber while you are having your

chamber can seat up to 10 individuals in a comfortable treatment,” says Dr. Perdrizet. “It is similar to going for a

open environment. Hyperbaric Oxygen Therapy aids wound plane ride.”

What’s going around...News & Breakthroughs

Cold Comfort Mighty Mouse Parkinson’s Potential Super-Bug Drug

A daily dose of the experi- Researchers at Wake Forest An experimental Parkinson’s Antibiotic-resistant bacteria
mental drug pleconaril University have created a disease treatment eases pose a greater public health
reduced colds by as much a colony of 700 cancer- tremors and helps preserve threat than the SARS virus,
half in healthy adults over a resistant mice, according brain function, reports warn infectious disease
six-week period, according to the Proceedings of the Nature Medicine. Research- experts at the University of
to research presented at the National Academy of ers infused naturally Pennsylvania Medical Center.
International Conference on Sciences. One male mouse produced growth factor Pneumonia, meningitis, and
Antiviral Research in that did not develop (glial cell line-derived once easily treated bacterial
Georgia. The drug, which disease despite repeated neurotrophic factor) directly diseases have grown deadly
prevents as well as treats transplants of cancer cells into the brain. More than a from overuse of powerful,
the common cold, attacks was bred with other mice. million Americans suffer broad-spectrum antibiotics.
picornaviruses believed to About half the offspring from the progressive Researchers are seeking
account for about two- inherited the cancer disease, which results from drugs for “super bugs”
thirds of all colds. resistance, indicating a low levels of the neuro- responsible for an estimated
genetic basis for the trait. chemical dopamine. 19,000 U.S. deaths annually.

4

THE NEW MEDICINE

Drug-Coated Stents Keep Arteries Open

Since 1977, interventional cardiologists have used blockage recurs and symptoms return. Restenosis is our
“balloon angioplasty” to open blocked coronary arteries. Achille’s heel.”
Approximately one million Americans undergo angioplasty
each year. A balloon-tipped catheter is inserted through the At the annual meeting of the American College of Cardiol-
groin up to the site of the arterial blockage, and once in ogy, physicians reported early success in keeping newly
place, the balloon is inflated to compress fatty deposits opened heart arteries from closing again with drug-coated
into the artery wall and stretch the artery open to increase versions of conventional stents. In the clinical trial in
blood flow to the heart. which Hartford Hospital participated, drug-coated stents
proved especially effective in women, who tend to be
Although minimally invasive techniques to remove coronary vulnerable to restenosis because of their smaller vessels.
artery blockages have revolutionized the treatment of
occluded vessels, the downside has been re-narrowing, or “Sirolimus and rapamycin are drugs used to prevent
restenosis, of the artery. “Although immediate results are rejection in organ transplants, while chemotherapy drugs
excellent, more than 40 percent of patients experience like Taxol are also being tested,” says Dr. Kiernan. “The
restenosis at the site of the original blockage,” explains drug is mixed with a polymer topcoat applied to the stent
cardiologist Francis J. Kiernan, M.D., F.A.C.C., director of and medication leaches out of the polymer during the first
the cardiac catheterization few days, when scarring is most likely to occur at the site
laboratory at Hartford Hospital.
“As a result, stainless steel ‘stents’ of injury.” The drug coating
were introduced to enlarge the interrupts the normal proliferation
channel and reduce the chances of of scar tissue cells, allowing the
re-narrowing.” stent to be covered with a layer of
smooth cells that normally line
blood vessels.

Stents are tiny metal mesh tubes Dr. Fran Kiernan is using drug-coated stents to Recently the Food and Drug
placed in the artery at the time of help prevent restenosis in angioplasty patients. Administration recommended the
angioplasty to keep arteries use of drug-coated stents. “Last
propped open. Restenosis, however, year, nearly 1,400 balloon
afflicts up to 20 to 30 percent of angioplasties were performed at
patients within six to nine months Hartford Hospital,” says Dr. Kiernan.
after placement of the stent. “Scar “We expect drug-coated stents will
tissue creates a different sort of now be used even for diabetics or
blockage that may require local other patients at high risk for
radiation,” says Dr. Kiernan. restenosis, who formerly would have
“Patients come back because had to undergo bypass surgery.”

Redheads Have More… Family Strokes Smoke Signals Take Two…

While testing the painkiller Stroke patients 65 or Though sudden cardiac Women can cut their
pentazocine, researchers at younger are nearly three death can be the first sign breast cancer risk in half
Montreal’s McGill University times more likely to have a of heart disease, nearly all by regularly taking aspirin
discovered that the gene parent or sibling who had women who die suddenly or ibuprofen at least three
that gives women red hair an early stroke or heart have at least one risk times a week, while
and fair skin also helps attack, reports the American factor—smoking, high acetaminophen confers no
boost their natural Heart Association journal blood pressure, high benefit, according to the
defenses against pain. The Stroke. A study at London’s cholesterol, diabetes or federally funded Women’s
same is not true for male St. George’s Hospital obesity. Harvard Medical Health Initiative study.
carrot-tops. Redheaded Medical School linked the School researchers found Some over-the-counter
women tolerate pain better genetic predisposition most that women who smoked 25 pain relievers block an
than both men and women often to strokes caused by or more cigarettes a day had enzyme (COX-2), which
of any other hair color, and blockages of carotid arteries a four-fold increased risk of triggers inflammation that
respond better to painkill- or vessels within the brain. sudden cardiac death. may contribute to cancer’s
ing drugs. growth and spread.

5

Fat Chance Not only does being overweight raise your risk of heart
disease and diabetes, but it also increases your chances
Obesity Raises Cancer Risk of dying of cancer. An estimated 90,000 Americans die each
year of cancer caused primarily by excess weight.
Pyramid Slant
In a widely publicized American Cancer Society study of
900,000 people over a 16-year period, deaths from almost
every type of cancer were linked to obesity. “This is the
first time such a large cadre of well people has been
studied prospectively to gauge the impact of lifestyle
choices on cancer risk,” says Andrew Salner, M.D., director
of the cancer program at Hartford Hospital. “Obesity was
shown to increase the risk of dying of cancer by as much as
one and a half times. The risk of cancer death was shown
to rise gradually as body mass increases from ideal body
weight to obesity. Changes in metabolism appear to be an
independent risk factor for cancer.”

The more overweight you are, the greater the risk. Main-
taining body weight, exercising regularly, giving up
smoking and regular cancer screening can cut your cancer
chances dramatically. Since physical activity appears to be
protective against cancer, especially breast and colon
cancer, experts recommend at least 30 minutes or more of
moderate exercise five or more days a week.

Cancer society guidelines released last year call for at least
five servings a day of fruits and vegetables, which provide
a rich source of antioxidants, vitamins and compounds
known to be protective against cancer. Whole grains, oats,
brown rice and fiber-rich foods have been shown to stave
off colon cancer, while high-fat diets containing lots of red
meat have been linked to cancers of the rectum, colon and
prostate.

“We’re not sure that it’s diet—saturated fats, for example—
that cause cancer,” explains Dr. Salner. “It seems to be
caused just by being obese. The mechanism may be
abnormalities in body metabolism, insulin overproduction
or growth factors that speed the growth of cancer cells.”

Now that 60 percent of Americans are overweight, the lower coronary risk. Blood levels of triglycerides, high-
federal government is rethinking its dietary advice in the density lipoprotein (“good”) cholesterol, amino acids,
Food Guide Pyramid. clotting factors, blood pressure, cardiac rhythms and
blood sugar all play a role in coronary artery disease.
The food pyramid introduced in 1992 by the United
States Department of Agriculture (USDA) recommended a The diet of people living along the Mediterranean Sea
diet rich in complex carbohydrates, including bread, has proven to be the heart-healthiest, according to a
cereal, rice and pasta. The goal was to lower cholesterol recent Harvard School of Public Health study published
levels by reducing saturated fat intake. in the Journal of the American Medical Association. The
diet is rich in vegetables and fruits, whole grains, nuts,
In an effort to avoid artery-clogging fats, many people unsaturated vegetable oils, and protein derived from
substituted carbohydrates, which can pile on the pounds. fish, beans and chicken, not red meat.

Carbohydrate-laden foods containing refined sugar and Also to be avoided are the so-called “trans fats” that
white flour trigger a rise in blood lipids, adding to the form when vegetable oils are hardened to make most
risk of diabetes and heart disease. Excess pounds in turn margarines and the shortenings widely used in processed
raise the risk of hypertension, stroke, arthritis, gall or fast foods. Foods labeled with the words “partially
bladder disease and cancer. hydrogenated vegetable oil” almost always contain trans
fats. Because they raise blood levels of triglycerides and
Now it seems earlier advice was overly simplistic, since harmful lipoproteins, trans fats appear to increase the
calculating the risk of coronary heart disease involves risk of type 2 diabetes.
more than the sum of total serum cholesterol. Research-
ers have found that small amounts of certain fats actually

6

Adult Though learning disabilities Brain scans that point to
ADD? or dyslexia often exist dysfunction in the frontal
concurrently with ADD, lobes of the brain and
Although impulsive boys Though behavioral rating bright kids may compensate abnormalities in the neu-
are often labeled ADHD scales for children and with tremendous powers of rotransmitters dopamine and
(for Attention Deficit teens are helpful in identi- memory or the ability to norepinephrine are driving
Hyperactivity Disorder) fying ADHD, adults may hyper-focus on tasks of new research. Cognitive
when their behavior veers have difficulty acknowledg- interest to them. At least behavioral therapy, medica-
out of control, new diagnos- ing their inattention and two genetic defects have tion and a reward-and-
tic criteria have extended impulsivity problems. “We been linked to the disorder, punishment plan can help
the reach of the disorder to used to think that about a which tends to run in inhibit impulsivity and allow
adults. third of kids outgrew the families. other areas of the brain to
disorder as they moved into compensate for biochemical
Children with ADHD com- adolescence,” says Dr. Sahl. Stimulant medications like deficits.
prise approximately five to “We now know that as many Ritalin or Dexedrine have
six percent of the school- as one half of teens carry it long been used successfully “The frontal and prefrontal
age population. While it has into adulthood.” in children, and the areas of the brain regulate
long been thought that boys availability of newer long- conduct and inhibitory
with the disorder outnumber It is conservatively esti- acting forms of the drug responses,” says Dr. Sahl.
girls by up to five-to-one, mated that two to four eliminate the stigma of “By developing master
new research reveals that percent of adults are daily trips to the school control over the ‘executive’
actual numbers may be affected by ADHD. “It nurse. A non-stimulating functions of the brain,
nearly equal. becomes a chronic condi- medication called Strattera, people with ADD can live
tion,” says Dr. Sahl. “Over recently arrived on the more typical lives.”
Adults may not suffer the time, fidgety and squirming market, is designed to
hyperactivity that is the children become adults who target behaviors without
hallmark of the child’s constantly need to keep affecting appetite or sleep.
inability to sit still, but may busy. They may have
experience relationship difficulty organizing their wa r n i ng s i gn s
problems, job loss or work or be passed over for
difficulty concentrating. “We promotion because they Over-the-Counter Overdose
start off taking the patient’s forget appointments.”
behavioral history,” explains The Food and Drug Administration (FDA) is responding
Robert A. Sahl, M.D., a child Though subtle sorts of to calls for stricter warnings about the risks of common
and adolescent psychiatrist behavior may point to adult over-the-counter pain relievers. Consumers, particularly
at The Institute of Living. ADD, thinking patterns have the elderly, should be aware of the possibility of
“Then we explore what other probably persisted since stomach bleeding or kidney failure associated with non-
conditions—anxiety, childhood. “Some kids, steroidal anti-inflammatory drugs (NSAIDs) such as
depression, learning issues, especially girls, quietly aspirin, ibuprofen (Motrin or Advil) and naproxen
substance abuse, aggressive blend into the background,” (Aleve).
behavior—may be present, he explains. “As they grow
along with past treatments.” older, they are likely to be Warning signs of excess ibuprofen or naproxen include
overlooked.” stomach cramps, diarrhea, nausea or vomiting; head-
ache, dizziness or drowsiness; problems with urination;
and hearing, vision or cognitive impairments.

Unintentional overdose of acetaminophen (the main
ingredient in Tylenol) results in 100 deaths from liver
failure each year. Ask your doctor before combining
over-the-counter pain relievers with any prescription
drugs.

Warning signs of aspirin overuse include ringing in
the ears or temporary deafness, headache, heartburn,
excessive bruising, and internal bleeding and liver
damage (especially in people who consume more than
three alcoholic drinks daily). Never use aspirin for flu-
like conditions or chickenpox in children or teenagers
because of the risk of a fatal illness called Reye’s
Syndrome.

7

Cook’s

Circle Scallop (or Shrimp) Ceviche
Ingredients

Table runner and 11/2 lbs bay scallops (or shrimp)
matching napkins 1 small onion, chopped
are available in the 1 hot pepper, diced
Hartford Hospital 1 glove garlic, minced
Auxiliary Gift Shop. 1/4 tsp. oregano
1 Tbs. vinegar
Try this trendy summer dish being served at restaurants 2 Tbs. olive oil
around the state. 2 tbs. ketchup
1/2 cup lime juice or lemon juice
Charlotte Meucci, D.T.R., a registered dietetic technician, 1/4 cup chopped cilantro
obtained the recipe from her neighbor at the shore and salt and pepper to taste
made a few changes to suit her taste. “It’s easy to make
before guests arrive and always makes a hit,” says Ms. Rinse scallops throughly in colander, pour
Meucci, who works in the Outpatient Congestive Heart boiling water over them and let them
Disease Center at Hartford Hospital. drain. While the scallops are draining, stir
together onion, pepper, garlic, oregano
and vinegar. Toss with scallops and let
flavors blend for 30 minutes. Whisk
together olive oil, ketchup, lime juice and
cilantro. Pour over scallops, making sure
that all are covered. Refrigerate 24 hours.

To serve, place in a glass dish inside a
larger dish filled with ice. Garnish with
additional cilantro and serve with crackers.

Ceviche is safe to serve because the scallops are scalded Recipe serves 6.
by the boiling water, while the acid in the lime juice kills
any bacteria. It is important to make sure all the scallops Per serving
are coated and that they soak for adequate time. Lemon
juice may be substituted, but lime is preferable. Calories: 125 calories Cholesterol: 8 mg

This is a low-fat, low-cholesterol recipe. Substituting Protein: 21 g Vitamin A: 921 IU
shrimp for the scallops raises the cholesterol slightly,
though it should not be of concern. There are no saturated Carbohydrates: 8 g Vitamin C: 29 mg
fats that increase blood cholesterol levels, while the
Omega 3 oils are beneficial to heart health. Dietary Fiber: 0 g Calcium: 37 mg

Total Fat: 6 g Potassium: 459 mg

Saturated Fat: 0.5 g Sodium: 246 mg

Unsaturated Fat: 1 g

This analysis is based on recipe without added salt.

Recipe analyzed by Charlotte Meucci, D.T.R.

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