sutures newsletter

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

Mark Your Calendar


Surgery Grand Rounds

Click the "read more" to see information about upcoming Surgery Grand Rounds.

» Read more


Grand Rounds

Click here to view a schedule of all upcoming grand rounds.


Surgery Scheduling

Click the "read more" for hours and contact information for surgery scheduling.

» Read more

Inspiring Presentations at Vascular Surgery Lectureship

Benjamin Starnes, MD, chief of Vascular Surgery at the University of Washington, was the visiting professor for this year's Sanford Rosenbaum Lectureship in Vascular Surgery on Wednesday, Nov. 13.

» Read more

Follow Universal Protocol for Patient Safety

This is a reminder that closely following our Universal Protocol before beginning procedures is the only reliable way to prevent mistakes in providing the correct care to the correct patient.

» Read more

Slattery, Azizzadeh Complete Book on Facial Nerve

Two Cedars-Sinai otolaryngologists have completed a book on the pathology, diagnosis and treatment of facial nerve disorders. "The Facial Nerve," edited by William H. Slattery, MD, and Babak Azizzadeh, MD, addresses facial nerve problems such as congenital disorders and Bell's palsy.
 

» Read more

Honors for Reich, Steiner

Physician News

Heidi Reich, MD, has been named the recipient of a 2014 Sports Spectacular Endowed Fellowship, and Jerrold H. Steiner, MD, has received the Tower of Spirit award from the Tower Cancer Research Foundation.

» Read more

Formulary Expanded; FDA Issues Warnings, Changes Labels for Several Drugs

Pharmacy Focus

The Pharmacy and Therapeutics Committee added ticagrelor (Brilinta®) to the formulary and took other actions Oct. 1. The U.S. Food and Drug Administration has cautioned about human immune globulin products, the use of spinal catheters in certain patients and two cardiac stress test agents. Sales of the drug Iclusig have been halted, and the FDA has changed the labels for Potiga and Incivek. Also, the federal agency has removed some restrictions on diabetes drugs containing rosiglitazone.

» Read more

Circle of Friends Honorees for October

The Circle of Friends program honored 149 people in October. Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai.

» Read more

Inspiring Presentations at Vascular Surgery Lectureship

By Willis H. Wagner, MD
Clinical Chief, Division of Vascular Surgery

Benjamin Starnes, MD, chief of Vascular Surgery at the University of Washington, was the visiting professor for this year's Sanford Rosenbaum Lectureship in Vascular Surgery on Wednesday, Nov. 13.

Starnes began the day with a captivating lecture on the management of extremity vascular trauma gleaned from three tours of duty as a military surgeon in Kosovo and Iraq. His tremendous experience both in the military and at one of the pre-eminent vascular surgery programs enlivened the discussion of cases scrutinized at the surgical morbidity and mortality conference.

The surgical residents also presented a series of unusual and challenging patient problems that Starnes expertly analyzed, to the benefit of our patients. His thoughtful commentary was consistently focused on maximizing the educational aspect of each case for all levels of the house staff.

The high point of the day was Starnes' presentation at the combined Medicine-Surgery Noon Conference of his pioneering work in the management of ruptured abdominal aortic aneurysms. During his tenure in Seattle, he has established Harborview Medical Center as the premier referral center for the endovascular management of this profoundly challenging condition from an area that includes Washington, Alaska, Montana, Wyoming, Idaho and northern Oregon.

Traditional open aneurysm repair has been associated with mortality rates of 50 to 70 percent. Starnes was one of the first practitioners in the U.S. to treat this condition with minimally invasive technology. His many advances in this arena have led to significant declines in the mortality of patients who undergo both endovascular and open repairs. This is the second time that Starnes has shared his evolving techniques with the Cedars-Sinai community in the past five years.

All of the attendees were impressed by Starnes' courage both in the military arena and in civilian practice, tackling some of the most vexing problems that surgeons encounter.

The Division of Vascular Surgery is indebted to the Rosenbaum-Katz family for endowing a lectureship that advances both the clinical science of our specialty and the education of our residents, the next generation.

Follow Universal Protocol for Patient Safety

This is a reminder that closely following our Universal Protocol before beginning procedures is the only reliable way to prevent mistakes in providing the correct care to the correct patient.

I ask you to recommit to uniform adherence to the protocols outlined below before performing any procedure in our institution, both outpatient and inpatient.

  • Checking and confirming two patient identifiers before performing all procedures.
  • Completing a meaningful and thorough Time Out before all procedures in inpatient and outpatient settings where ALL team members participate and each step is performed.
  • Ensuring that a pre-procedural assessment by a licensed practitioner (RN, NP, PA, resident, fellow, attending, pharmacist and therapist) has been performed.

Bruce L. Gewertz, MD
Surgeon-in-Chief
Chair, Department of Surgery
Vice President, Interventional Services
Vice Dean, Academic Affairs

Slattery, Azizzadeh Complete Book on Facial Nerve

Two Cedars-Sinai otolaryngologists have completed a book on the pathology, diagnosis and treatment of facial nerve disorders.

"The Facial Nerve," edited by William H. Slattery, MD, and Babak Azizzadeh, MD, addresses facial nerve problems such as congenital disorders and Bell's palsy. The text provides physicians with the most up-to-date medical and surgical treatment recommendations.

Honors for Reich, Steiner

Physician News

Heidi Reich, MD, Wins Sports Spectacular Fellowship

Heidi Reich, MD, has been named the recipient of a 2014 Sports Spectacular Endowed Fellowship. The $1,000 award will be used to fund the surgical resident's training.

The Sports Spectacular Fellowship Endowment supports the training of research fellows in various medical fields at Cedars-Sinai. It is backed by the Sports Spectacular, an annual event to raise awareness and money to fight genetic disorders.

Jerrold H. Steiner, MD, speaks at the Tower Cancer Research Foundation event Nov. 4.

Jerrold H. Steiner, MD, Honored by Tower Cancer Research Foundation

Jerrold H. Steiner, MD, has received the Tower of Spirit award from the Tower Cancer Research Foundation. The award was presented at the foundation's Spirit of Hope event Nov. 4 at the Beverly Hills Hotel.

Steiner's speech before the 575 people at the event was introduced by Edward Phillips, MD.

The Tower Cancer Research Foundation, located in Beverly Hills, provides grants for clinical trials, research, patient support and community education to promote more effective treatments for cancer and blood disorders.

Formulary Expanded; FDA Issues Warnings, Changes Labels for Several Drugs

Pharmacy Focus

The Pharmacy and Therapeutics Committee added ticagrelor (Brilinta®) to the formulary, along with other actions at its Oct. 1 meeting. The committee's actions are summarized in the PDF link below.

Also, the U.S. Food and Drug Administration has added a warning to human immune globulin products, has made recommendations regarding the use of spinal catheters in patients taking anticoagulant drugs, has issued warnings about two cardiac stress test agents, and has removed some restrictions on diabetes drugs containing rosiglitazone.

P and T Committee Actions - Oct. 1, 2013 (PDF)

FDA Revises Warning for Immune Globulin Products

The U.S. Food and Drug Administration has approved changes to the prescribing information for human immune globulin products to add a new boxed warning about the risk of thrombosis. The revised labels also include underlying risk factors for thrombosis, and recommendations for monitoring and managing patients on these products to mitigate the risk of thrombosis.

The FDA has analyzed recent data that has strengthened the association between the use of intravenous, subcutaneous and intramuscular human immune globulin products and the risk of thrombosis. Additional caution regarding the use of these products is warranted.

Human immune globulin products are used in a variety of conditions, both on- and off-label, by healthcare professionals who may not be aware of the thrombosis risk and measures that could be taken to mitigate this risk.

The information on thrombosis in the final approved boxed warning states:

  • Thrombosis may occur with immune globulin products.
  • Risk factors may include: advanced age, prolonged immobilization, hypercoagulable conditions, history of venous or arterial thrombosis, use of estrogens, indwelling central vascular catheters, hyperviscosity and cardiovascular risk factors.
  • Thrombosis may occur in the absence of known risk factors.
  • For patients at risk of thrombosis, administer immune globulin products at the minimum dose and infusion rate practicable.
  • Ensure adequate hydration in patients before administration.
  • Monitor for signs and symptoms of thrombosis and assess blood viscosity in patients at risk for hyperviscosity.

Learn more at this FDA Web page.

Use Extra Care With Spinal Catheters in Patients on Anticoagulants, FDA Says

The U.S. Food and Drug Administration is recommending that healthcare professionals carefully consider the timing of spinal catheter placement and removal in patients taking anticoagulant drugs, such as enoxaparin, and delay dosing of anticoagulant medications after catheter removal to decrease the risk of spinal column bleeding and subsequent paralysis after spinal injections, including epidural procedures and lumbar punctures.

These new timing recommendations, which can decrease the risk of epidural or spinal hematoma, will be added to the labels of anticoagulant drugs known as low molecular weight heparins, including Lovenox, generic enoxaparin products and similar products.

Epidural or spinal hematomas are a known risk of enoxaparin in the setting of spinal procedures and are already described in the boxed warning and in the warnings and precautions sections of the labels for Lovenox and generic enoxaparin products. However, these serious adverse events continue to occur, so the FDA updated the warnings.

Learn more at this FDA Web page.

FDA Warns of Risks With Lexiscan, Adenoscan

Due to recent reports of serious adverse events, the U.S. Food and Drug Administration has approved changes to the drug labels for the cardiac stress test agents regadenoson (Lexiscan®) and adenosine (Adenoscan®), including a warning regarding the rare but serious risk of heart attack and death, as well as recommendations for use:

  • Screen all nuclear stress test candidates for suitability to receive Lexiscan or Adenoscan
  • Avoid use in patients with signs or symptoms of unstable angina or cardiovascular instability
  • Cardiac resuscitation equipment and trained staff should be available prior to administration

Learn more at this FDA Web page.

Sales of Iclusig Halted

The U.S. Food and Drug Administration has asked the manufacturer of the leukemia chemotherapy drug Iclusig (ponatinib) to suspend marketing and sales of Iclusig because of the risk of life-threatening blood clots and severe narrowing of blood vessels.

The drug manufacturer, Ariad Pharmaceuticals, has agreed to FDA’s request to suspend marketing and sales of Iclusig while the FDA continues to evaluate the safety of the drug.

The FDA will continue to evaluate the drug to further understand its risks and potential patient populations in which the benefits of the drug may outweigh the risks. Patients currently receiving Iclusig should discuss with their healthcare professionals the risks and benefits of continuing treatment with the drug.

Learn more at this FDA Web page.

FDA Changes Potiga's Label, Citing Risks to Eyes, Skin

The U.S. Food and Drug Administration has approved changes to the label of the anti-seizure drug Potiga (ezogabine), underscoring risks of abnormalities to the retina in the eye, potential vision loss, and skin discoloration, all of which may become permanent.

The revised label includes a new boxed warning because of the risk of abnormalities to the retina, a part of the eye that is needed for vision. The FDA advises that Potiga use be limited to patients who have not responded adequately to several alternative therapies to decrease the frequency of seizures, or epilepsy, and for whom the benefits of treatment outweigh the risks.

The FDA recommends that patients have eye exams by an ophthalmic professional before starting Potiga and every six months during treatment. These exams should include visual acuity and dilated fundus photography, with additional vision testing as necessary. Patients whose vision cannot be monitored should generally not take Potiga.

Also included in the updated label are warnings regarding the risk for discoloration of the skin, nail, mucous membrane and white of the eye. The updated drug label states that if a patient develops skin discoloration, an alternate medication should be considered.

Learn more at this FDA Web page.

Changes Made to Incivek Labeling

The U.S. Food and Drug Administration has approved changes to labeling of the hepatitis drug Incivek (telaprevir) to include results from trial C211 (Optimize) to support a twice-daily dosing regimen. In addition, new contraindications were added for anticonvulsant medications (carbamazepine, phenobarbital and phenytoin). Below is a summary of the changes.

  • Dosage and administration of telaprevir were updated throughout the label: from 750 mg three times a day to 1125 mg twice daily.
  • The anticonvulsant medications carbamazepine, phenobarbital and phenytoin were moved from the drug interaction section (Section 7, Table 5) to the contraindications section (Section 4, Table 3).
  • The section on adverse reactions was updated.

Learn more at this FDA Web page.

FDA Removes Some Restrictions on Drugs Containing Rosiglitazone

The U.S. Food and Drug Administration has determined that recent data for rosiglitazone-containing drugs, such as Avandia, Avandamet, Avandaryl and generics, do not show an increased risk of heart attack compared to the standard type 2 diabetes medicines metformin and sulfonylurea. As a result, FDA is requiring removal of the prescribing and dispensing restrictions for rosiglitazone medicines that were put in place in 2010.

This decision is based on FDA review of data from a large, long-term clinical trial and is supported by a comprehensive, expert re-evaluation of the data conducted by the Duke Clinical Research Institute.

Previous data from a large, combined analysis of mostly short-term, randomized clinical trials of rosiglitazone had suggested an elevated risk of heart attack, so the FDA required a Risk Evaluation and Mitigation Strategy (REMS), called the Rosiglitazone REMS program. The Rosiglitazone REMS program restricted the use of rosiglitazone medicines to help ensure that their benefits outweighed the risks.

Although some scientific uncertainty about the cardiovascular safety of rosiglitazone medicines remains, in light of the new re-evaluation, the FDA's concern is substantially reduced, and the rosiglitazone REMS program requirements will be modified.

Learn more at this FDA Web page.

Circle of Friends Honorees for October

The Circle of Friends program honored 149 people in October.

Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai. When a gift is made, the person being honored receives a custom lapel pin and a letter of acknowledgement.

Click here for more information about the program and for a list of past honorees.

  • Daniel C. Allison, MD
  • Farin Amersi, MD
  • Neel A. Anand, MD
  • C. Noel Bairey Merz, MD
  • Rowena S. Bascon-Abdon, RN, BSN, MSN
  • Marites G. Bautista
  • Leon I. Bender, MD
  • Valerie Betley
  • Keith L. Black, MD
  • Swaraj Bose, MD
  • Darina Brezhnev, PharmD
  • William W. Brien, MD
  • Wendy Briggs
  • Barry J. Brock, MD
  • Philip G. Brooks, MD
  • Barbara Brown
  • Eileen G. Brown, OCN, RN
  • Neil A. Buchbinder, MD
  • Mathew H. Bui, MD
  • Christiane Michele J. Burnison, MD
  • Michael A. Bush, MD
  • Neyra Cannon, CNA
  • John D. Carmichael, MD
  • Ilana Cass, MD
  • Christopher Chang, MD, PhD
  • Kirk Y. Chang, MD
  • Piyaporn Chantravat, RN
  • George Chaux, MD
  • Ray M. Chu, MD
  • Alice P. Chung, MD
  • Michelle Chung, RN
  • Ruth Cousineau, MD
  • Arlene Curry
  • Hal C. Danzer, MD
  • Robert M. Davidson, MD
  • Todd Davis
  • Michael T. Duffy, MD
  • Julie A. Dunhill, MD
  • Matthew R. Eng, MD
  • Fardad Esmailian, MD
  • Richard Essner, MD
  • Jeremy A. Falk, MD
  • Robert A. Figlin, MD
  • David Finke, MD
  • Lindsy J. Forbess, MD
  • Stuart Friedman, MD
  • Larry Froch, MD
  • Erwin Peter Gabor, MD
  • Donna Gallik, MD
  • Elayne K. Garber, MD
  • Francine J. Gates
  • Sara Ghandehari, MD
  • Mitch Gheorghiu, MD
  • Diana Gilker, RN
  • Eli Ginsburg, MD
  • Armando E. Giuliano, MD
  • Julian A. Gold, MD
  • Richard N. Gold, MD
  • Neil J. Goldberg, MD
  • Crystal F. Gonzalez, RN
  • Aimee Goseland, RN
  • Jeffrey R. Gramer, MD
  • Leland M. Green, MD
  • Antoine Hage, MD
  • Behrooz Hakimian, MD
  • Solomon I. Hamburg, MD
  • Michele A. Hamilton, MD   
  • David D. Hopp, MD
  • Kevin W. Hopwood, RN
  • Arash A. Horizon, MD
  • Gabriel E. Hunt Jr., MD
  • Andrew F. Ippoliti, MD
  • Michelle Israel, MD
  • Laith H. Jamil, MD
  • Omar Kabba
  • Beth Y. Karlan, MD
  • Robert M. Kass, MD
  • David Kawashiri, MD
  • Dong U. Kim, MD
  • Hyung L. Kim, MD
  • Robert Klapper, MD
  • Jon A. Kobashigawa, MD
  • Lyle D. Kurtz, MD
  • Michael M. Levine, MD
  • Andrew J. Li, MD
  • Michael C. Lill, MD
  • Stephen W. Lim, MD
  • Simon K. Lo, MD
  • Joanne Lutman, RN
  • Cleofe F. Macasias, RN
  • Rajendra Makkar, MD
  • Adam N. Mamelak, MD
  • Edmund J. Martinez
  • Bryan M. May, RN
  • Philomena McAndrew, MD
  • Mary Katharine McCormick, RN
  • Robert J. McKenna Jr., MD
  • Shlomo Melmed, MD
  • Anne Meyer, MD
  • Amin Joseph Mirhadi, MD
  • Monica M. Mita, MD, MDSc
  • Joel D. Mittleman, MD
  • Alejandro Molina
  • Doris S. Moradzadeh, MD
  • Arpine Nahabedian, RN
  • Dan I. Naim, MD
  • Ronald B. Natale, MD
  • Christopher S. Ng, MD
  • David G. Ng, MD
  • Victoria K. Nigro, RN-BC
  • Veronica Palacios, LVN
  • Shi-Hui Pan, PharmD
  • Edward H. Phillips Jr., MD
  • Joann Porter
  • Edwin M. Posadas, MD
  • Danny Ramzy, MD, PhD
  • Rebeca Raymundo
  • Joseph R. Recinos
  • Rafael Rodriguez
  • Jay S. Rudin, MD
  • Jeremy D. Rudnick, MD
  • Stephen A. Sacks, MD
  • Gregory P. Sarna, MD
  • Jay N. Schapira, MD
  • Wouter I. Schievink, MD
  • Prediman K. Shah, MD
  • Jeffrey H. Sherman, MD
  • Nancy L. Sicotte, MD
  • Robert J. Siegel, MD
  • Allan W. Silberman, MD, PhD
  • Steven M. Simons, MD
  • Christina J. Soto
  • Jerrold H. Steiner, MD
  • Martin Stern, PhD, MPH
  • Ronald Sue, MD
  • Rae D. Syms, RN
  • Esperanza Tercero
  • William C. To, MD
  • Alfredo Trento, MD
  • Serkan Tusu
  • Michael B. Van Scoy-Mosher, MD
  • Billy O. Villao
  • Mary Jane Vos, RN, BSN, CDE
  • Bethany Wendel
  • Paula J. Whiteman, MD
  • Donald A. Wiss, MD
  • Edward M. Wolin, MD
  • Arthur Wu, MD
  • Michael C. Yang, MD