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PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY March 2013 | Archived Issues

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Grand Rounds

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Surgery Scheduling

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Risk of Potentially Fatal Heart Rhythms with Azithromycin (Zithromax or Zmax)

Pharmacy Focus

The U.S. Food and Drug Administration has strengthened a previous warning regarding a small but significant increased risk of fatal arrhythmias associated with azithromycin (marketed as Zithromax® or Zmax®). Also, the FDA is evaluating unpublished findings by a group of academic researchers that suggest an increased risk of pancreatitis and pre-cancerous cellular changes in patients with type 2 diabetes treated with a class of drugs called incretin mimetics.

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Surgeon Gives Girl a Reason – and the Ability – to Smile

Hayley Brang can smile, after a pair of surgeries performed by Randy Sherman, MD.

During three decades as a plastic and reconstructive surgeon, Randy Sherman, MD, has faced plenty of tough cases. He has transplanted severed limbs, and reconstructed jaws, breasts and other vital structures ravaged by cancer, trauma or infections. He also has treated children born with cleft lips and other congenital abnormalities.

One of his most fulfilling cases, however, has involved one of his youngest patients – 8-year-old Hayley Brang, who suffers from Moebius syndrome, a congenital disorder that paralyzes facial muscles, compromising her ability to eat, talk and smile.

Sherman, vice chair of the Department of Surgery, is among a handful of doctors who treat the rare condition.

Hayley's mother, Heather, says the surgeries have changed her daughter's life, enabling her to make more friends at school.

He began treating Hayley when she was only 5. To correct her problem, Sherman performed two identical surgeries, separated by eight months. In each one, he transplanted a portion of a small muscle from Hayley's inner thigh, along with its accompanying blood vessels and motor nerve, into one side of her face, allowing her to smile whenever she would bite down.

After the transplanted muscle reacquired function through the growth of new nerve fibers, Sherman and his team asked Hayley to use a mirror to practice smiling every day, giving her something most others take for granted. And that smile has in turn given Sherman one of his greatest gifts.

"That's all that I need," he said.

Hayley's mother, Heather, said the surgeries have changed her daughter's life, enabling her to make more friends at school.

"Whenever I see Hayley smile, I am beyond excited that she finally has that ability to express her enthusiasm and show the world how happy she really is," said Brang.

Sherman has devoted much of his career to helping children. He is chief medical officer of Operation Smile, a global medical charity concerned with the reconstructive surgery of children with congenital and acquired deformities. He has spent years traveling the globe to perform surgeries on children born with cleft lips, cleft palates and other facial irregularities, performing this volunteer work in dozens of countries, including Cambodia, India and Brazil.

But he has never forgotten his commitment to young patients – like Hayley Brang – back home in Los Angeles. Every time Sherman thinks of Hayley, he breaks into a smile of his own.

"I feel awesome," he said. "Just awesome."