1981 Autumn Faculty Journal

FACULTY JOURNAL UNIVERSITY OF UTAH SCHOOL OF MEDICINE Vol. 4 No. 2 Autumn 1981New angiographic technique aids diagnosis and treatment of atherosclerosis University of Utah radiologists have developed an alternative to the most commonly used type of angiogra-phy which appears to be safer, more accurate, less expensive and easier to implement than any technique cur-rently available to study the anatomy of arteries. Called " time domain filtering," or " continuous recursive filtering," the technique is an extension of the sub-traction imaging concepts that recently have made intravenous angiography a clinical reality. " It's been used on 40 patients and the results are extremely promising," says Robert A. Kruger, Ph. D., research assistant professor of radiology who conceived the instrumentation. " Filter-ing is an especially valuable tool in the diagnosis and treatment of atheroscle-rosis, and it can also be used to assess and diagnose cardiac illness and to monitor patients who've had heart problems." Dr. Kruger, a physicist, says this filtering technique is very similar to " Time domain filtering" conceived by Dr. Kruger is similar to conventional digital subtraction angiography. conventional digital subtraction angi-ography, but has fewer drawbacks and is simpler and potentially less expensive to implement. " In digital subtraction angiography, the image of a body part is first ' masked' and stored as a series of numbers. Con-trast materials then are injected, after which time a series of images is stored and sequentially subtracted from the ' mask,' " explains Dr. Kruger. " For the procedure to be successful, the patient must remain absolutely still, and there must be an intense enough beam of x- rays so that there's little noise inter-ference, i. e., the same dosage as a regular x- ray would require." Subtraction angiography is effective if the patient doesn't move between the time the mask is taken and the time the contrast material reaches the artery ( 10- 20 seconds). In the difference be-tween the two images, bones, organs and other extraneous structures are eliminated, leaving a very dim image of the arteries, which can then be con-trast enhanced ( made brighter) by computer. " Our instrumentation does not subtract the two images, but the filter-ing makes it look as if it had. Filter-ing isolates the flow of contrast material by virtue of a priori knowledge of its probable variation with time," says Dr. Kruger. " This continuous recursive filtering can be ' tuned' to isolate cardio-vascular dynamics which vary at known rates. Such processing does not require taking an explicit mask image in order to isolate and enhance contrast material flowing through the arteries. " For example, filtering angiography can isolate image variation that changes every five seconds or so," explains Dr. Kruger. " It removes events that vary more slowly, such as stationary ana-tomical parts, or faster, such as cardiac motion." The Utah physicist says filtering has several advantages over subtraction angiography. " It uses a lower dose of radiation. Filtering angiography costs only half as much, requires a far less sophisticated fluoroscopy system, and the necessary equipment ( the prototype was produced by Thompson- CFS Broadcast, Inc., manufacturers of video processing equipment) can be retrofitted to existing equipment," says Dr. Kruger. When filtering angi-ography equipment is manufactured it will be portable, eliminating the need for a special purpose x- ray room. Video tape studies can be performed, or the video image can be made into a trans-parency that looks like an x- ray. Another advantage, according to Dr. Kruger is that technicians can see the finished product as the procedure evolves - x- rays can be left on con-tinuously to create a moving picture of changes going on inside the artery. " Intravenous angiography using filtering techniques is most successful on the head, neck and peripheral ar-teries," says Dr. Kruger. " It is some-what less effective in areas where there's a greater chance of unwanted motion, such as the lung, or the abdomen, where even a small amount of bowel gas can cause motion artifacts." Stevens to head research effort in new administrative post Walter Stevens, Jr., Ph. D., profes-sor of anatomy, has been named assistant dean for research, effective immediately. Dr. Stevens' major charge in the half- time position is to facilitate and foster research in the School of Medi-cine. " We'll look at changes in Federal funding patterns, new programs and contracts and recent changes in the tax laws that make it more advantageous for private industry to sponsor univer-sity- based research," says Dr. Stevens. " We'll also ferret out research oppor-tunities that match the talents of our faculty - all of these things with an eye toward increasing research monies coming to the school. Dr. Stevens will be responsible for the Vivarium, Animal Care Committee, Dean's Research Advisory Committee ( which manages the biomedical research support grant and provides starting grants for faculty and students), M. D./ Ph. D. program, Graduate Programs Committee, the Central Electron Micro-scope Facility on the second floor of the Maxwell M. Wintrobe Research and Education Building, and other institu-tional research equipment. Dr. Stevens The new assistant dean earned his B. S. degree in 1956 and Ph. D. degree in 1962 from the University of Utah. He has been a professor in the Depart-ment of Pharmacology since 1979 and director of graduate studies in the De-partment of Anatomy since 1967. Dr. Stevens served on the Dean's Research Advisory Committee from 1972- 76 and was chairman of the Com-mittee on Graduate Programs from 1973- 76. His current research activities in-clude the mechanism of action of gluco-corticoids in target organs, the deposi-tion of transuranic elements in large animals and health risk analysis in oil shale development. FACULTY JOURNAL UNIVERSITY OF UTAH SCHOOL OF MEDICINE Vol. 4, No. 2 Autumn, 1981 Published quarterly by University of Utah Medical Center, Office of Development and Community Relations, 50 North Medical Drive, Salt Lake City, UT 84132, under the auspices of G. Richard Lee, M. D., Dean, School of Medicine. Faculty Journal is published exclusively for School of Medicine faculty and alumni. Article suggestions, guest commentaries and correspondence are welcomed. Articles may be reprinted with permis-sion. Copyright 1981 by the University of Utah School of Medicine. Photographs by Medical Illustration Service, University of Utah School of Medicine. Editor: Anne Brillinger Contributing Editors: Erin Basta, Robert Glass, Shery Harris Dr. Gottfredson explains true- false testing procedure to a patient in the VAMC's Psychiatric Assessment Unit. Computerized psychiatric tests at VAMC aid diagnosis, triage and treatment v An elaborate computer system used to test and track the progress of psychi-atric patients at Veterans Administra-tion Medical Center has vastly enhanced psychiatric diagnosis and triage / admis-sions decisions. The system - the only one of its kind in the country - compiles, inter-prets and stores voluminous data on psychiatric patients - information ranging from demographic and medical histories to mental status diagnoses and psychological test results. After a clinician determines that a patient is capable of completing the computer- administered tests, the pa-tient sits down at the keyboard and answers questions at the computer con-sole. " We found that our patients actually prefer computer testing to a paper and pencil test or a face- to- face interview," explains Douglas K. Gottfredson, Ph. D., chief of the VAMC's Psychiatric Assessment Unit. " There's never any embarrassment connected to answering questions posed by a computer." w The computer, a DEC 11/ 70, allows the VAMC staff to administer, score and interpret some 70 psychological tests, including the commonly used MMPI, Shipley- Hartford, Beck Depres-sion Scale and Strong- Campbell Interest Inventory. The computer also is programmed with 20 interviews and questionnaires on such subjects as alcohol, anger and pain. Test results can be reviewed on a CRT terminal or be printed for inclu-sion in the medical record. After re-viewing tests and interview results, the clinician makes an admission or referral decision. " One big advantage of computer testing is the time it saves," says Dr. Gottfredson. " It takes 60- 90 minutes to complete the 556 questions on the MMPI, for example. To score and interpret this test manually would take nearly five hours of skilled staff time with the number of special scales we are using. But in just 90 seconds the computer gives clinicians a print- out of 13 clinical scales, 86 special scales and interpretive paragraphs." Time saved also converts to cost savings. Administration of the tests and getting test results are supervised by one of VAMC's four health techni-cians, leaving physicians, psychologists and crisis nurses free for other work, and to review results once tests are completed. Leonard J. Schmidt, M. D., chief of the Mental Health Treatment Service at the VAMC and associate professor of psychiatry in the University of Utah medical school, says some 10,000 patients have been tested by computer since the system was launched in 1979. " In addition to doing psychological testing on veterans applying for treat-ment or on consultation from other ser-vices at our VAMC - this is about 40 percent of our total patient popula-tion - we also provide automated test-ing services to other veterans' centers around the country," says Dr. Schmidt. " Personnel at Long Beach, Palo Alto, St. Louis and Ft. Mead, S. D. and other veterans centers use a quick entry pro-cedure to input test answers from locally printed answer sheets, and then imme-diately get a computer- scored printout. University of Utah Medical Center, state and federal vocational rehabilita-tion offices and other agencies also use the service. " One of the significant clinical applications is the crisis notes feature," says Dr. Schmidt. " Current clinical and/ or crisis information about a patient is displayed on the CRT when-ever a user calls up that patient's name, any time of the day or night." Computer security allows access to test results only to psychologists or mental health professionals directly supervised by psychologists. It also prevents anyone from changing an existing diagnosis on a patient, although diagnostic disagreements can be entered as progress notes. The computer stores information on patient participation in individual and group therapy and vocational and educational programs. The number and dates of hospital visits also can be instantaneously retrieved, and the computer keeps track of all laboratory test results, as well as psychiatric data. " The Mental Health Treatment Computer System has greatly improved information gathering for clinicians, administrators and researchers," says Dr. Schmidt. " Researchers can easily study the effectiveness of assessment, diagnosis and treatment and recom-mend program improvements; admin-istrators receive information vital for decisions and Federal reporting; and, most importantly, the computer gives clinicians information valuable for assessment, treatment, and establishing care- after- discharge plans." Twelve advance to full professor rank Editor's Note: 79 percent of School of Medicine departmental recommenda-tions for promotions and tenure and 83 percent of the recommendations for retention were approved by University administration in action early this year. 50.1 percent of the medical school faculty are now tenured, compared with 47.7 percent three years ago. Twelve School of Medicine faculty members were promoted to full profes-sorships this year in action by the Uni-versity's Institutional Council. The new professors, 11 associate professors and eight assistant professors were recommended for promotion following careful analysis of their past performance and promise for the future, based on evaluations from department chairmen, colleagues and the Student Advisory Committee. The group includes two men who were promoted in more than one de-partment. Harry R. Hill, M. D., was promoted to professor of pathology and pediatrics; and William N. Rom, M. D., was promoted to associate pro-fessor of family and community medi-cine and internal medicine. In addition to Dr. Hill, those ap-pointed to the rank of professor include: Robert E. Dustman, Ph. D., neurology; SalvatoreJ. Fidone, Ph. D., physiology; Michael R. Franklin, Ph. D., pharma-cology; John B. Hibbs, Jr., M. D., inter-nal medicine; William S. Jordan, M. D., anesthesiology; Carl R. Kjeldsberg, M. D., pathology; Timothy G. Lee, M. D., radiology; James L. Parkin, M. D., surgery; Gerald Rothstein, M. D., internal medicine; Larry J. Stensaas, Ph. D., physiology; Fred A. Ziter, M. D., pediatrics. Dr. Robert E. Dustman is a neuro-psychologist whose pioneering assess-ments of brain activity in children, the elderly and Down's syndrome indi-viduals have provided insights into the utilization of evoked potentials as techniques for the determination of genetic influences on brain activity and as measures of intellectual functioning. He has been lauded for his contribu-tions to improved diagnosis and patient care through refined electrophysiologi-cal methods. Dr. Dustman is research psycholo-gist ( experimental and physiological) and director of the neuropsychology Dr. Dustman laboratories at the Veterans Adminis-tration Medical Center. He heads the Department of Neu-rology's Division of Medical Psychology and is a research professor in the Department of Psychology. Dr. Dustman earned his Ph. D. degree in psychology from the Univer-sity of Utah in 1963. Dr. Fidone Salvatore J. Fidone is a neuroscien-tist who has received international recognition for his research on the mechanisms of arterial chemoreception. In recent years, he has edited two monographs on this subject, and has been an invited speaker at nearly a dozen symposia and international workshops, including the recent Inter-national Congress of Physiological Sciences. His research on chemical transmission in sensory receptors has received long- term support from the NIH, in the form of two grants which were recently renewed through their eleventh and sixteenth years. Dr. Fidone currently serves as a regular member of the Neurology " A" Study Section at the NIH. He has also served on the Dean's Research Advisory Committee of the School of Medicine, both as a member ( 1977- 81) and chair-man ( 1980- 81) of this committee. The neuroscientist is co- author of the widely- used textbook, Physiology of the Nervous System ( Yearbook Dr. Franklin Medical Publishers), which has been translated in three languages and is now in preparation for a third edition. Dr. Fidone received an Outstanding Teacher Award from the medical class of 1976, and has served on the Admis-sions Committee of the School of Medicine. He received his Ph. D. degree in physiology from the State University of New York ( Upstate Medical Center) in 1967, and after a two- year NIH Post-doctoral Fellowship, he joined the U faculty in 1969. Michael R. Franklin's research on the cytochrome P- 450' s, which are key enzymes in the metabolism of drugs by the liver microsomal enzyme system, has helped to enlarge scientific under-standing of variations in drug responses among individuals. Dr. Franklin has an international reputation in the field of drug metabolism and is an authority in the field of mixed function oxidases. Dr. Franklin earned his Ph. D. degree in 1969 from the University of Dr. Hibbs London, after which he completed a postdoctoral fellowship in the Depart-ment of Biochemistry at the University of Texas Southwestern Medical School. He served one year on the faculty at the University of Texas before joining the Utah pharmacology faculty in 1972. In the U of U College of Pharmacy, Dr. Franklin serves as professor in the department of biochemical pharma-cology and toxicology. John B. Hibbs, Jr. is internationally recognized for his knowledge of the role of the macrophage in immune reactions, particularly in resistance to tumor cell growth. His research has virtually defined the cell biology of Dr. Hill macrophage- tumor cell interactions. Dr. Hibbs received his M. D. degree in 1962 from the University of Pitts-burgh. He did his internship and resi-dency at the University of Oregon and was an NIH Special Fellow in infectious diseases and immunology at Stanford University from 1969- 71, when he joined the Utah faculty. He was elected to membership in the American Society for Clinical Investigation in 1978. Dr. Hibbs serves as chief of infec-tious diseases at the Veterans Adminis-tration Medical Center in Salt Lake City. He also holds the rank of adjunct associate professor of materials science and engineering. Harry R. Hill has made lasting contributions to our knowledge of Group B streptococcal infections, to Dr. Jordan our understanding of the mechanisms of compromised host resistance and to the elucidation of neutrophil func-tion. The board- certified pediatrician directs the School of Medicine's Clini-cal Immunology and Allergy program, which he developed upon joining the faculty in 1974. Considered one of the top such programs in the area of host resistance to infection, it spans the departments of pediatrics, pathology and internal medicine. Hill also directs the Clinical Immunology Laboratory for the Department of Pathology. Dr. Hill is on the editorial board of the Journal of Clinical Microbiology and is a reviewer for 15 other journals. He serves on the Bacteriology and Mycology Study Section of the NIH. In 1980 he received the Ross Research Award for Outstanding Young Investi-gator from the Western Society for Pediatrics Research. Dr. Hill received his M. D. degree from Baylor University in 1966, fol-lowed by an internship at Grady Memorial Hospital / Emory University School of Medicine in Atlanta. He subsequently served as an Epidemic Intelligence Service Officer with the U. S. Public Health Service, then com-pleted a residency in pediatrics at the University of Washington. Dr. Hill also did postdoctoral fellowships in immunology at the University of Washington and in pediatric infectious disease and host resistance at the Uni-versity of Minnesota, where he served as an instructor for one year. William S. Jordan has earned world acclaim for his pioneering efforts in the application of computers and other aspects of bioengineering to the anes-thesiology problems of critically ill infants and children. He is considered an important force in helping pediatric anesthesia achieve recognition as a legitimate scientific subspecialty. After receiving his M. D. degree from Temple University in 1955, Dr. Jordan entered an internship and resi-dency program at San Bernardino County Hospital and a residency at the Air Force Hospital in Lackland, Texas. He also has had special training in Dr. Kjeldsberg anesthesia for thoracic surgery and in geriatric anesthesia. Dr. Jordan joined the U Medical School faculty in 1968, following one year in the University's Department of Bioengineering. He holds a secondary appointment as assistant professor of pediatrics. Dr. Jordan served as acting chair-man of the Department of Anesthesi-ology from 1974- 76. He is chief of the Department of Anesthesia at Shriner's Hospital. Carl Kjeldsberg has won wide recognition both as a consultant in the area of service hematopathology and as a researcher in the areas of leukemias and lymphomas. A skilled diagnostician, Dr. Kjelds-berg is currently the director of the hematopathology section and clinical hematology in the Department of Pathology, and his lab is one of the leaders in the nation. He is board certi-fied in anatomic and clinical pathology with a subspecialty in hematology. Dr. Kjeldsberg received his M. D. degree from the University of Edinburg in 1966. He completed an internship and residency program at General Rose Memorial Hospital in Denver. From 1974- 79, Dr. Kjeldsberg served as chief of the Department of Pathology at the Veterans Administra-tion Medical Center. Timothy G. Lee, one of the most widely respected ultrasonography ex-perts in the nation, has earned wide respect for his work in prenatal diag-nosis of congenital defects. Dr. Lee received his M. D. degree in 1965 from the University of Illinois. He did an internship at Illinois Masonic Hospital and residencies in radiology at West Suburban Hospital in Chicago, Chicago Wesley Memorial Hospital and the University of Oregon. He taught at Oregon from 1973- 78, when he joined the Utah faculty. He currently directs the Department of Radiology's Ultrasound Division. Dr. Lee is board- certified in radi-ology. James Parkin is a board- certified, nationally recognized otolaryngologist with diversified expertise in all areas of the specialty - facial plastic surgery, otology and neurotology, head and neck surgery, endoscopy and general otolaryngology. He assumed the chair of the Utah Division of Otolaryngology in 1974 and has developed an outstanding graduate program that has received national recognition. Dr. Parkin earned his M. D. degree from the University of Utah in 1966. He received a master's degree in physi-ology and biophysics from the Univer-sity of Washington in 1970, where he also completed an internship, residency and fellowship in otolaryngology Dr. Parkin before joining the U of U faculty in 1972. Gerald Rothstein, a hematologist / oncologist, is recognized as a world leader in the area of white blood cell regulation. His research on blood granulocyte kinetics in neutropenic states and the effects of lithium on granulocyte production and kinetics is highly acclai