A Wayne State University School of Medicine researcher has published a clinical practice guideline in the journal Neurology stating that there is scientific evidence to support that carotid endarterectomy is useful in preventing future strokes. The guideline, which appears in the Sept. 27, 2005, issue of the scientific journal of the American Academy of Neurology, updates a 1990 statement on carotid endarterectomy.

Stroke affects more than 700,000 people in the United States per year. A blockage of a blood vessel is responsible for about 80 percent of strokes. Carotid endarterectomy is the most frequently performed operation to prevent stroke with about 150,000 to 200,000 procedures taking place each year.

“The evidence of this guideline points out an effective method of stroke prevention in certain people,” said Seemant Chaturvedi, M.D., guideline author and director of the Wayne State University Stroke Program. “Carotid endarterectomy is beneficial for those with severe to moderate narrowing in their carotid artery.”

Carotid endarterectomy is a surgical procedure that removes plaque and fatty deposits from blocking the carotid arteries which are the main suppliers of blood for the brain. There is strong evidence recommending carotid endarterectomy to prevent stroke in people who have severe (70 percent to 99 percent) blockage in their carotid artery. Nearly 25 percent of people who recover from their first stroke will have another stroke within five years. The guideline authors reviewed all of the scientific evidence on carotid endarterectomy.

The guideline found that carotid endarterectomy is effective for patients with severe stenosis (narrowing in a carotid artery) and recent symptoms of stroke or transient ischemic attack (TIA or mini-stroke). Carotid endarterectomy may also be considered for patients with moderate (50 percent to 69 percent) stenosis and recent symptoms of stroke.

For people between the ages of 40 and 75 with moderate to severe narrowing, but presenting with no symptoms of stroke or disease, carotid endarterectomy may be considered if the patient has at least a five-year life expectancy and if the surgery can be done with a low complication rate.

For patients with less than 50 percent stenosis, medical treatment is preferred over carotid endarterectomy.

People who undergo carotid endarterectomy should receive low-dose aspirin therapy (81 to 325 mg per day) prior to surgery and for at least three months following surgery, according to the guideline.

There is not enough evidence for or against having a carotid endarterectomy within four to six weeks of a moderate to severe stroke.

“We recommend further high-quality studies to evaluate the evidence/practice gap in the future,” said Dr. Chaturvedi, an associate professor in the WSU Department of Neurology.

The guideline has been endorsed by the American Stroke Association and is available online at www.aan.com/professionals/practice/guideline/index.cfm.

Michigan Gov. Jennifer Granholm will be among the honorees at the Wayne State University School of Medicine's Pathfinders in Medicine Awards, Saturday, October 8, at 6 p.m. at Ford Field.

Gov. Granholm plays a key role in ensuring that the state's vital health-care safety net remains viable despite economic hardships that threaten access to quality care. In 2004, she played a leading role in guiding the establishment of the Detroit Wayne County Health Authority. She also was instrumental in forming a temporary oversight committee that provided a $50 million infusion to bolster the Detroit Medical Center .

Established in 2000, the black-tie dinner honors outstanding vision and leadership in medicine, progressive scientific research and efforts that promote the availability of quality health care within the community. Amyre Makupson, a longtime Detroit anchor on UPN-50 and CBS-62, is mistress of ceremonies.

In addition to Gov. Granholm, This year's honorees include:

• Larry Fleischmann, M.D. , is past president of Children's Hospital of Michigan and a WSU professor of pediatrics and a pediatric nephrologist. Dr. Fleischmann founded Children's Hospital's Renal Dialysis and Transplant Program and was director of the Nephrology Service. A native of Saginaw who currently resides in St. Clair Shores , Dr. Fleischmann has received the March of Dimes Humanitarian of the Year Award and the National Kidney Foundation of Michigan Champion of Hope Award.
• Henry McKinnell, Ph.D., is chairman and CEO of Pfizer Inc., the world's largest research-based pharmaceutical company. He was appointed to the Presidential Advisory Council on HIV/AIDS by President George Bush and is the recipient of the United Nations Association of the United States of America 's Global Leadership Award and the Woodrow Wilson Institute for International Scholars Corporate Service Award.
• Tina Kelley, M.D. , (posthumously), a WSU School of Medicine resident dedicated to serving children who was killed in a car accident Feb. 4, excelled both academically and spiritually. She received her undergraduate degree from Michigan State University and her medical degree from Wayne State University School of Medicine. Dr. Kelley shared her many gifts with others through her volunteer endeavors. She was a youth interpreter for I Zandla, Hartford Memorial Baptist Church 's deaf ministry. This dedicated young woman was also a member of the Michigan State University Gospel Choir and the Just for Christ campus ministry, through which Dr. Kelley traveled on a mission to Jamaica .
• Roberto Romero, M.D. , leads the National Institutes of Health's Perinatology Research Branch at the WSU School of Medicine, which conducts studies into maternal and infant health and disease. A world renowned lecturer, Dr. Romero is one of the most prominent intellectual leaders in modern obstetrics. During the past 20 years, his work has focused on the prenatal diagnosis of congenital anomalies and the study of the mechanisms responsible for the onset of premature labor. Dr. Romero lives in Grosse Pointe.
• Ebony Rucker , a fourth-year student at the WSU School of Medicine, was born and raised in Detroit . She attended Detroit public schools until she received a scholarship to Cranbrook Kingswood in Bloomfield Hills which motivated her to attend college on the East Coast. Awaiting the arrival of twin siblings in the labor and delivery suite ignited her interest in a medical career. After receiving her bachelor's degree from Vassar College in Poughkeepsie , N.Y. , Ms. Rucker spent three years studying genetics at Harvard Medical School before applying to medical school. Since returning home, Ms. Rucker has been involved with numerous community endeavors including serving as a co-coordinator at the Cass Clinic and being involved with the Black Medical Association.
• Sophie Womack, M.D. , a Detroit resident, is the division chief of neonatology for Sinai-Grace Hospital , an assistant professor in the WSU Department of Pediatrics and a member of the Detroit Medical Center 's board of trustees. This physician and humanitarian tirelessly promotes children's health and safety through her volunteer efforts, including The Coalition Inc. – Circle of Hope, which she formed with her husband, Rev. Dr. Jimmy Womack. Dr. Womack has been honored with the “Caring for Children Angel Award” from Blue Cross and Blue Shield of Michigan and the “Image Award in Medicine” from the Women's Justice Center .

Proceeds from the event support the Pathfinders in Medicine Scholarship Fund, the Black Medical Association of Wayne State University Endowed Grant Fund and the Charles F. Whitten, M.D., Post-Baccalaureate Fund.

Previous Pathfinders in Medicine Award recipients include Barbara Anderson, M.D.; Thomas Batchelor, M.D.; Waldo Cain, M.D.; Julius Combs, M.D.; Ethelene Jones Crockett, M.D.; Walter Douglas; Mary Fisher; Cynthia Ford; Robert N. Frank, M.D.; Adnan Hammad, M.D.; Peter Karmanos, Jr.; Mark Kelley, M.D.; Kamran Moghissi, M.D.; Marjorie Peebles-Meyers, M.D.; Arthur Porter, M.D.; Altha Stewart, M.D.; Joan Stryker, M.D.; Natalia Tanner, M.D.; Vainutis Vaitkevicius, M.D.; Charles Vincent, M.D.; John Waller, Jr., Dr.P.H.; Charles Whitten, M.D.; and Charles Wright, M.D.

Tickets are $200 per person, of which $80 is tax deductible. For more information or to make a reservation, please contact Sue Helderop at (313) 993-4179 or sheldero@med.wayne.edu .

A conference on health-care disparities sponsored by the WSU Office of the President will be Oct. 10 and 11, in the McGregor Memorial Conference Center .

"The Wayne State University President's Conference on Health Disparities" will explore the underlying causes of the disparities in health outcomes, particularly those related to chronic diseases among medically underserved and ethnic minority populations living in an urban environment. 

Pre-registration for this event is required.  Registration is $25; students are free if they submit a letter from their department or advisor verifying their full-time status. For more information about the conference including registration, please visit http://www.med.wayne.edu/news_media/prognosis/events/cme.asp#cuaah or http://www.cuaah.com. 

Attorney Geoffrey Fieger and Philip Howard, founder of Common Good, met in Scott Hall's Blue Auditorium yesterday to argue the merit of establishing special courts to handle medical liability cases. WSU School of Medicine Dean Robert Frank moderated the debate, which was sponsored by the Federalist Society for Law and Public Policy Studies.

In kicking off the debate, Dean Frank said that it was important to remember that medical malpractice is "directly the responsibility of the profession itself."

Mr. Howard argued that health courts could provide a more reliable system of justice because cases would be handled by judges with dedicated experience in medical malpractice. Neutral experts could be engaged by the courts to provide fair opinions, allowing cases to be decided on their merits rather than on the emotional subtext of the facts presented.

"The fundamental principal of the rule of law is that like cases be treated alike," Mr. Howard said.

Although malpractice awards amount to less than 1 percent of health-care expenditures in this country, Mr. Howard said that the cost of practicing defensive medicine to ward off potential lawsuits would be enough to provide health insurance to the nation's 45 million uninsured.

Mr. Fieger countered that establishing health courts is another attempt at tort reform, which he characterized as "a campaign to undermine every single one of your fundamental rights." He said that in states that have enacted tort reform, health-care costs remain as high as in other states without tort reform.

"If you eliminated all the lawsuits, the impact would be zero (on health-care costs)," Mr. Fieger said. "You wouldn't notice at all."

He also told the audience that the best thing a physician could do in a malpractice case is to apologize.

"If you want to do one thing, say you're sorry," he said. "Patients don't want to sue doctors. They idolize them. That's why the placebo effect works; you touch 'em, they're healed."

To view the debate in full, please visit http://www.med.wayne.edu/news_media/streamingmedia/somevents/index.asp.

OHEP Scholars return from New Orleans
Brittney Van Buren (left) and Shahaan Smith were inspired by WSU and the OHEP Scholars program to pursue careers in medicine. They were both enrolled at Xavier University in New Orleans when Hurricane Katrina hit. They have since moved back to Detroit, are enrolled at WSU and plan to continue their pre-med education. David Pieper, Ph.D., WSU assistant dean and executive director of the Southeast Michigan Center for Medical Education, coordinated a fundraising effort to buy Mr. Smith and Ms. Van Buren laptops.

Graduate Student Research Day, a daylong, student-organized event intended to promote interactions among WSU departments and students within the biomedical research field, will be tomorrow, Sept. 23. The public is welcome to attend student presentations, which will be ongoing from 8:30 p.m. to 4:15 p.m. in Scott Hall's cafeteria and Green Auditorium.

In addition, Dr. Arthur L. Horwich, professor of genetics and pediatrics at Yale University School of Medicine, will present a public keynote address, "Chaperonin Mediated Protein Folding" at 4:30 p.m., in Scott Hall's Green Auditorium. Dr. Horwich is also a Howard Hughes medical investigator and a member of the National Academy of Sciences.

Student presentations will be judged by WSU faculty. Prizes will be awarded for the top three posters and oral presentations based on scientific content, visual design and layout, clarity, ability to address questions and scientific significance. Awards will be presented at a dinner for alumni and award recipients beginning at 5:30 p.m.

Nitric oxide, a signaling molecule in the nervous system, appears to slow or reverse the aging of eggs in mouse ovaries. This important discovery may improve assisted reproduction techniques and allow women's eggs to remain healthy and viable, and increase their chances for fertility and having healthy babies into their 30s and 40s. The finding was published by Wayne State researchers in the Aug. 30 issue of the American Chemical Society's journal Biochemistry. (vol. 44, pages 11361-11368)

Mammalian oocytes, or eggs, have a limited window of opportunity for optimal fertilization. Eggs removed from the ovaries begin to age rapidly without fertilization. If not fertilized within about six hours, the eggs are more prone to abnormal or insufficient fertilization and have a greater likelihood of chromosomal abnormalities. Exposing these eggs to nitric oxide protects them and may significantly increase their viability for in vitro fertilization, intracytoplasmic sperm injection (ICSI) and nuclear transfer.

“In addition to possibly extending fertility in women, our results suggest that nitric oxide could help prevent chromosome errors during early embryonic development,” said first author Anuradha Goud, Ph.D., research associate in the Department of Obstetrics and Gynecology and at the C.S. Mott Center for Human Growth and Development. Specifically, nitric oxide slowed the hardening of the eggs' outer shells, halted cortical granule loss, and diminished ooplasmic microtubule dynamics. “These phenomena significantly delay the process of postovulatory aging and improve the quality and health of the egg, leading to better outcomes for reproduction,” Dr. Goud said.

“Eggs from older women may be particularly sensitive to aging after they are released from the ovaries,” said Husam Abu-Soud, Ph.D., associate professor of OB-GYN, and co-author on the study. “As a result, the time available for optimal fertilization of these women's eggs may be quite a bit shorter than the time frame in younger women. But exposing the eggs to appropriate levels of nitric oxide would extend this fertilizable time window in both old and young women,” he said.

Additional co-authors on the study include Drs. Pravin Goud M.D., Ph.D., and Michael Diamond M.D., who note that although it is unclear how nitric oxide produces these effects exactly, nitric oxide shares phosphodiesterase inhibition and antioxidant properties similar to those of caffeine. An earlier study also suggested that caffeine can delay the aging process of eggs and plays a contributory role as an antioxidant molecule.

Incidentally, Dr Anuradha Goud won a Young Investigator Award for this work when she presented at the Gordon Research Conference in Italy earlier this year. At the meeting, she was congratulated by 1998 Nobel Prize winners Drs. Ferid Murad and Louis Ignarro, who are the experts on the therapeutic effects of nitric oxide. Dr. Pravin Goud, has also received eight national awards including the first place award at the 2005 American College of Obstetricians and Gynecologists annual junior fellow meeting for related work.

More than 100 members of the WSU School of Medicine community responded to a call for volunteers to assist victims of Hurricane Katrina who migrated to Detroit. The Region 2 South Medical Bio-Defense Network established an evacuee processing station at Detroit City Airport, where faculty, students and staff affiliated with the School of Medicine have provided medical assistance.

"I would like to say thanks to Dr. Herbert Smitherman who eloquently offered the support of the university under the direction of Dean Robert Frank in a manner that would have been hard to refuse, to Dr. John Malone Jr., identified as the principle contact for Wayne State University and facilitated efforts to identify resources within the University and, finally, to those of you who, without hesitation, responded to the call to lend a helping hand," wrote Dr. James Blessman, medical director for the city of Detroit and a faculty member in the WSU Department of Family Medicine. "Your generosity is truly inspiring."

Please watch med.wayne.edu for continuing developments in how the WSU School of Medicine is helping to make a difference in this matter.

Dean Robert Frank will kick off the school year with a presentation at tomorrow's Faculty Senate meeting on several ongoing issues affecting the School of Medicine. The meeting will be from 3:30 p.m. to 5 p.m., in Room 2268, Scott Hall; a special reception for full-time and voluntary faculty will follow at 5:30 p.m., in the Detroit Public Library's Strohm Hall.

Dean Frank will discuss the school's vision for facilities, including the Medical Education Commons as well as a potential new research building; the status of the dean search; and faculty development issues, including funding for basic scientists, leadership training and release time for clinical faculty.

For more information on the reception, please contact Sue Helderop at sheldero@med.wayne.edu or (313) 933-4179.

Dean Robert Frank will moderate a debate on Tuesday, Sept. 20, on health courts between trial attorney Geoffrey Fieger and Philip Howard, founder of Common Good. The topic at hand will be whether special courts created to handle medical liability cases will create a more reliable system of justice. The event, presented by the Federalist Society for Law and Public Policy Studies, will be at 6 p.m., in Scott Hall.

pathfinder, n: a person who or thing which opens up new ways; esp. a person who seeks out or disseminates new ideas or ways; a trailblazer, a trendsetter

-- Oxford English Dictionary

The Wayne State University School of Medicine will honor six people who have worked to make a difference in the health -care field at its annual Pathfinders in Medicine Awards, Saturday, October 8, at 6 p.m. at Ford Field.

Established in 2000, the black-tie dinner honors outstanding vision and leadership in medicine, progressive scientific research and the availability quality health care within the community. Amyre Makupson, a longtime Detroit anchor on UPN-50 and CBS-62, is mistress of ceremonies.

This year's honorees include:

• Larry Fleischmann, M.D. , is past president of Children's Hospital of Michigan and a WSU professor of pediatrics and a pediatric nephrologist. Dr. Fleischmann founded Children's Hospital's Renal Dialysis and Transplant Program and was director of the Nephrology Service. A native of Saginaw who currently resides in St. Clair Shores , Dr. Fleischmann has received the March of Dimes Humanitarian of the Year Award and the National Kidney Foundation of Michigan Champion of Hope Award.
• Henry McKinnell, Ph.D., is chairman and CEO of Pfizer Inc., the world's largest research-based pharmaceutical company. He was appointed to the Presidential Advisory Council on HIV/AIDS by President George Bush and is the recipient of the United Nations Association of the United States of America 's Global Leadership Award and the Woodrow Wilson Institute for International Scholars Corporate Service Award.
• Tina Kelley, M.D. , (posthumously), a WSU School of Medicine resident dedicated to serving children who was killed in a car accident Feb. 4, excelled both academically and spiritually. She received her undergraduate degree from Michigan State University and her medical degree from Wayne State University School of Medicine. Dr. Kelley shared her many gifts with others through her volunteer endeavors. She was a youth interpreter for I Zandla, Hartford Memorial Baptist Church 's deaf ministry. This dedicated young woman was also a member of the Michigan State University Gospel Choir and the Just for Christ campus ministry, through which Dr. Kelley traveled on a mission to Jamaica .
• Roberto Romero, M.D. , leads the National Institutes of Health's Perinatology Research Branch at the WSU School of Medicine, which conducts studies into maternal and infant health and disease. A world renowned lecturer, Dr. Romero is one of the most prominent intellectual leaders in modern obstetrics. During the past 20 years, his work has focused on the prenatal diagnosis of congenital anomalies and the study of the mechanisms responsible for the onset of premature labor. Dr. Romero lives in Grosse Pointe.
• Ebony Rucker , a fourth-year student at the WSU School of Medicine, was born and raised in Detroit . She attended Detroit public schools until she received a scholarship to Cranbrook Kingswood in Bloomfield Hills which motivated her to attend college on the East Coast. Awaiting the arrival of twin siblings in the labor and delivery suite ignited her interest in a medical career. After receiving her bachelor's degree from Vassar College in Poughkeepsie , N.Y. , Ms. Rucker spent three years studying genetics at Harvard Medical School before applying to medical school. Since returning home, Ms. Rucker has been involved with numerous community endeavors including serving as a co-coordinator at the Cass Clinic and being involved with the Black Medical Association.
• Sophie Womack, M.D. , a Detroit resident, is the division chief of neonatology for Sinai-Grace Hospital , an assistant professor in the WSU Department of Pediatrics and a member of the Detroit Medical Center 's board of trustees. This physician and humanitarian tirelessly promotes children's health and safety through her volunteer efforts, including The Coalition Inc. – Circle of Hope, which she formed with her husband, Rev. Dr. Jimmy Womack. Dr. Womack has been honored with the “Caring for Children Angel Award” from Blue Cross and Blue Shield of Michigan and the “Image Award in Medicine” from the Women's Justice Center .

Proceeds from the event support the Pathfinders in Medicine Scholarship Fund, the Black Medical Association of Wayne State University Endowed Grant Fund and the Charles F. Whitten, M.D., Post-Baccalaureate Fund.

Previous Pathfinders in Medicine Award recipients include Barbara Anderson, M.D.; Thomas Batchelor, M.D.; Waldo Cain, M.D.; Julius Combs, M.D.; Ethelene Jones Crockett, M.D.; Walter Douglas; Mary Fisher; Cynthia Ford; Robert N. Frank, M.D.; Adnan Hammad, M.D.; Peter Karmanos, Jr.; Mark Kelley, M.D.; Kamran Moghissi, M.D.; Marjorie Peebles-Meyers, M.D.; Arthur Porter, M.D.; Altha Stewart, M.D.; Joan Stryker, M.D.; Natalia Tanner, M.D.; Vainutis Vaitkevicius, M.D.; Charles Vincent, M.D.; John Waller, Jr., Dr.P.H.; Charles Whitten, M.D.; and Charles Wright, M.D.

Tickets are $200 per person, of which $80 is tax deductible. For more information or to make a reservation, please contact Sue Helderop at (313) 993-4179 or sheldero@med.wayne.edu .

The Wayne State University School of Medicine is working with the Association of American Medical Colleges, the National Institutes of Health, the Detroit Medical Center and state and local officials to coordinate health care for Hurricane Katrina evacuees as well as services and supplies for Gulf Coast-area medical students.

Dr. John Malone, Jr., professor and chairman of the WSU Department of Obstetrics & Gynecology, has agreed to serve as the school's point person for coordinating efforts. For more information and to volunteer your services, please contact Dr. Malone at jmalone@med.wayne.edu or (313) 993-4513.

Please watch Prognosis and the School of Medicine's homepage for further developments.