> Spring 2013


Message from the Chairman – Dr. Robert Hromas

Robert HromasAbout 150 years ago, Rudolf Virchow was the first to use the microscope extensively to understand human disease. He could count TB bacilli in a sputum macrophage sample, and based on their presence and number, diagnose the disease and provide a prognosis. For this he is considered the father of modern pathology. His principle was, “As the cell goes, so goes the disease, so goes the patient.” We live in the era of molecular medicine, where we have taken Virchow’s postulate one step further, “As the gene goes, so goes the cell, so goes the disease.” We know the defective genes behind many human diseases, and the mutated genes that cause drug-resistant infections. For those of you who think the world is falling apart, consider the case of TB. In 1650 it was the most common cause of death in Europe. Now, an internist can go years between cases. Still, before we forget TB, and think it a vanquished foe, realize that it is slowly mutating to a dangerous species that is totally drug resistant. We may yet face a time when the most common cause of death is TB. The world has a greater chance of ending in the tuberculous wheeze of the last living human before it ends in a nuclear holocaust. But we are internists, we never give up, we never give in, we take the patients no one else will take, we fight the diseases no one else cares about. George Drusano and his team here are not ceding the world just yet to TB. They are taking the extended version of Virchow’s postulate, and dissecting the mutated genes in TB to define new classes of anti-mycobacterials. In the world we live in, our own health interventions alter the macro- and micro-environment of disease, and we cannot afford not to use every tool at our disposal, from gene to cell to organ, to meet the challenges before us.

The Institute for Therapeutic Innovation

The University of Florida Research and Academic Center at Lake Nona brings to the Orlando area vital research on new therapies for infectious disease, increased Lake Nona College of Pharmacyopportunities for participation in clinical research and enhanced access to professional and graduate pharmacy education.

The $53 million roughly 106,000-square-foot facility extends UF’s presence into the greater Orlando area through a number of colleges, institutes and centers, including the Department of Medicine.

The institute, led by director Dr. George L. Drusano, focuses on developing and testing new treatments and cures for a variety of infectious diseases caused by drug-resistant pathogens. The work in basic biomedical research and clinical trials dovetails with efforts by the Infectious Diseases Society of America to have 10 new anti-infectious disease drugs on the market by 2020. The work has far-reaching implications for the practice of medicine, notably with respect to organ transplantation, procedures that rely heavily on infection control, and MICU care.

“The ability to treat hospital-acquired infections supports the ability to do all those things,” said Drusano. “That’s the impact of having these new drugs.”

Supported by more than $40 million in funding, primarily from the National Institutes of Health’s National Institute of Allergy and Infectious Diseases, the Institute for Therapeutic Innovation has created more than 30 new well-paying jobs in the region through faculty and technical positions.

“Our economic footprint in the area is going to be substantial, and so will our scientific stamp,” Drusano said.

For more information on the Institute for Therapeutic Innovation, please call (352) 265-0655.

Advanced Colorectal Cancer Clinical Trial

Dr. Thomas GeorgeColorectal cancer (CRC) remains the second leading cause of cancer deaths in the US despite reductions in mortality through improved adherence to screening guidelines. Molecular knowledge obtained in the past decade has provided evidence that further advances in CRC clinical management will come from the strategic use of select cellular pathway inhibitors that interfere with the specific dysfunction responsible for an individual patient’s cancer – in other words, highly targeted and personalized oncology care.

Dr. Thomas J. George, an associate professor of medicine in the division of hematology & oncology and director of the UF GI oncology program, and his research team have recently been selected as one of the charter clinical/academic sites for a new multi-institutional Phase I/II consortium through the NCI-sponsored cooperative group clinical trials program.  This program is specifically for patients with advanced CRC. Through selection to this elite group (which includes the University of Pittsburgh, Washington University, Thomas Jefferson University, Yale University, and the Helen F. Graham Cancer Center), nearly every patient diagnosed with advanced CRC will have the opportunity to have a thorough molecular interrogation of their tumor.  Based on review of this molecular tumor “signature”, access to novel biologic targeted therapeutics will be personalized as part of a series of innovative clinical trials.  Not only do patients obtain cutting edge molecular interrogation of their tumors, but they also have access to novel therapeutics that are not available elsewhere.  Collaboration in developing this program with our affiliate colleagues at Orlando Health is ongoing to expand this opportunity to more of our patients across the region.  A major thrust of the UF GI Oncology Program is the development of personalized diagnostics and therapeutic treatment while simultaneously advancing scientific knowledge.

For more information or to refer a patient, please contact the UF&Shands Cancer Center Clinical Trial Office (Alison Ivey, RN) at (352) 265-0680 x 88411.

Multidisciplinary Team Care for Hepatocellular Carcinoma Treatment

Liver Team

Hepatocellular carcinoma (HCC) is the most common complication for patients with cirrhosis and is currently considered the most rapidly rising cancer.  The presence of cirrhosis in the majority of patients with HCC makes the disease medically complex to evaluate and treat. UF&Shands has a unique multidisciplinary approach to the evaluation of patients with primary liver tumors and chronic liver disease.

The UF HCC Clinic, established in 2007, has a single-point of entry to streamline evaluation and individualize treatment plans. The clinic provides patients with HCC immediate access to physicians from multiple disciplines through multidisciplinary team conferences, which include hepatobiliary and transplant surgeons, diagnostic and interventional radiologists, hepatologists, gastroenterologists, pathologists and oncologists.  Each meeting focuses on the evaluation of liver tumors and determining personalized treatment decisions by group consensus.

Following formulation, each treatment plan is then immediately implemented by highly trained physician extenders staffing the HCC Clinic, who also provide patients further education on the comprehensive plan of care with telemedicine and/or during a face-to-face clinical visit.

Patients are followed throughout treatment in our dedicated HCC Clinic to ensure optimized outcomes by managing both the underlying cirrhosis and HCC therapies in order to delicately balance treatment of cancer with the liver disease, which can worsen as a results of the cancer treatment. This also serves as a platform for clinical and translational research studies that include developing new biomarkers and novel treatments for HCC.

Our goal with this approach is to improve patient care and communication, and to streamline evaluation and treatment decisions for each individual.

To refer a patient to the UF HCC Clinic, please visit www.gastroliver.medicine.ufl.edu or call (352) 265-0139.

Quick Look: UF&Shands Sleep Disorders Center at Magnolia Parke

Sleep CenterThe UF&Shands Sleep Disorders Center at Magnolia Parke (UF&Shands Sleep Center) provides patients with diagnosis and treatment for the full spectrum of sleep disorders, including obstructive and central sleep apnea, insomnia, restless leg syndrome, disorders of excessive sleepiness (narcolepsy and others), parasomnias and circadian rhythm disorders.

The center takes a multidisciplinary approach, collaborating with a variety of skilled polysomnographic technologists and sleep board certified physicians, including adult and pediatric pulmonologists, neurologists, surgeons and sleep psychologists, to diagnose and treat sleep disorders in both adults and children. Under the oversight of Dr. Richard Berry, medical director of the sleep center and professor of medicine in the division of pulmonary medicine, critical care and sleep medicine, the team consists of a number of talented physicians  including; Dr. Mary Wagner, director of the pediatric sleep disorders program, Dr. Stephan Eisenschenk, one of only a few physicians nationally board certified in clinical neurophysiology and sleep medicine, and Dr. Khurshid A. Khurshid, a diplomat in psychiatry and internal medicine.

The more than 12,000 square-foot, 12-bed facility has spacious private rooms, operates six nights per week and allows patients to bring loved ones with them for their overnight stay. The UF&Shands Sleep Center features state-of-the-art monitoring equipment and is the only center in North Central Florida that utilizes End Tidal CO2 and TC monitoring as a gold standard for pediatric patients to rule out certain sleep disorders. Additionally, the center can accommodate bariatric patient needs, as well as non-ambulatory patients that require special equipment for bed transfer.  The dedicated team works with each patient to overcome sleep issues and choose the right treatment options to fit their specific needs.

For more information or refer a patient, please call (352) 265-5240.