All three bariatric surgery faculty members (Drs. Curet, Morton and Safadi) and both fellows have been very involved in a number of clinical research projects which have focused mostly on the outcomes of our bariatric surgery program. We currently have a prospective randomized trial evaluating the use of preoperative weight loss prior to bariatric surgery. In addition, we have looked at our results evaluating the learning curve of the operation when the surgeon's training differs and when the assistant's training differs. We are currently implementing a study to evaluate hand sewn versus stapled anastomosis.
Colorectal Surgery
The colorectal surgery program is actively engaged in sectional, departmental institutional and national clinical trials and basic science research projects.
Dr. Shelton is the institutional PI for an NSABP trial looking at chemoprevention of colorectal cancers with COX-2 inhibitors. He is also the institutional PI for two NSABP trial evaluating the role of neoadjuvant radiation and chemotherapy of stage II and stage III rectal cancers and chemotherapy of stage II and III colon cancers He is a co-investigator with Teresa Desser comparing three dimensional reconstruction CT scans to ultrasound in the staging of rectal cancers. He is a co-investigator assessing the response of rectal cancers to various combinations of chemotherapy with radiation in the preoperative setting. Dr. Shelton is also reviewing the use of capsule endoscopy in Crohn's disease and the current status of treatment of low rectal cancers.
Dr. Welton is the institutional PI for national clinical trials as well including the ACOSOG trial evaluating colon cancers in patients under the age of 50 and the NIH trial evaluating the timing of surgery after chemoradiation therapy for rectal cancer. He is the national PI for a multi-institutional trial that is assessing the need for bowel preparation in elective colorectal surgery. He is co-PI for a clinical trial defining the frequency of colonoscopy and quantity of biopsies obtained at colonoscopy during surveillance for colorectal cancer in patients with ulcerative colitis. He is also a co-PI in a basic science project with Hanlee Ji and Ronald Davis assessing the molecular, genetic & pathologic changes in anal cancers and dysplasias using molecular inversion probe genomic technology. Finally, Dr. Welton is the surgical leader of a multidisciplinary group actively involved with a group assessing the surgical prevention of anal cancer is patients at high risk for anal cancer.
Trauma/Critical Care
Dr. Susan Brundage is conducting active laboratory research into the investigation of sepsis and trauma and on the initiation of the inflammatory cascade following hemorrhagic shock. Her clinical interests are in patient outcomes following trauma.
Dr. Rochelle Dicker 's current research focus is on two areas of clinical research: Manifestations of Adult Respiratory Distress Syndrome (ARDS) in the trauma patient and injury prevention.
In ARDS, we have found through a prospectively collected database of ARDS patients at San Francisco General Hospital that many trauma patients manifest a mild form of ARDS and may not benefit from ARDS protocols as defined by the North American/European Consensus Definition of Adult Respiratory Distress Syndrome (ARDS) established in 1994. The practical consequences of these protocols arising from this broad and perhaps over simplified definition may even prolong patients' time on the ventilator by subjecting them to higher levels of sedation.
In the area of injury prevention she is endeavoring to transplant her successful violence prevention program at San Francisco General Hospital , The Wraparound Project to the greater Stanford area. This program uses a screening instrument to uncover common "risk factors" that contribute to recidivism (i.e. repeat victims of interpersonal violence) rate, which preliminary studies indicate is about 30-40%.
Surgical Oncology
Dr. Ralph Greco , in collaboration with Mechanical Engineering and
the Stanford Rapid Prototyping facility, is studying methods to use nanoscale technology to fabricate new biomaterials for drug delivery and tissue engineering.
Dr. Stefanie Jeffrey continues her nationally recognized work into the molecular genetics of breast cancer and is co-investigator of an NIH grant.
Dr. Jeffrey Norton was just awarded an NIH grant to study tumor immunology. The grant is looking at methods to potentiate the immune response against murine tumors, specifically by inhibiting STAT6 and administering interleukin-12.
Dr. Irene Wapnir is the Principal Investigator for the National Surgical Adjuvant Breast and Bowel Project sponsored clinical trials at Stanford and is study chair of a new national protocol seeking to define the optimal treatment for women with locally recurrent breast cancer (NSABP B-37) http://www.nsabp.org . The pursuit of new strategies and novel therapies through advances in molecular biology will contribute to the goal of achieving lasting cures in breast cancer. A decade ago the protein responsible for the transport of iodine in the thyroid gland was finally cloned. Dr Wapnir and her colleagues went on to discover that many breast cancers express the sodium iodide symporter ( NIS ). Moreover, they have now shown for the first time that some breast cancers, like thyroid cancers, could be treated with radioactive iodine. Studies are under way at Stanford to test the feasibility of this approach and determine its clinical usefulness. In addition to her role in the NSABP clinical trials, has been funded to continue her creative research into the role of the sodium iodide transporter in breast cancer and potential treatment strategies that may evolve from this work.
Dr. George Yang 's research has a primary emphasis on research into tissue engineering. He was recently awarded a 5 yr KO8 training grant to pursue this topic.
