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  A P U B L I C AT I O N F O R R E F E R R I N G P H Y S I C I A N S                                            FALL 2003


  Gwen      Rohrer     knew       almost     centers in the nation specializing in
immediately that there was something         Marfan syndrome. It brings together
unique about her newborn son, Dylan.         many physicians and disciplines to treat
“The doctors were measuring his              every aspect of pediatric and adult
head, and looking at his fingers,” she       Marfan cases.
says. Rohrer spent 17 months watching        A DIFFICULT DIAGNOSIS
and worrying before an eye examination          Although Marfan syndrome affects
and an echocardiograph cemented              about one in 5,000 people, many don’t
the diagnosis: Dylan had Marfan              know they have the disorder. The severity
syndrome, a connective tissue disorder       and number of physical symptoms of
caused by mutations in the fibrillin         Marfan syndrome can vary wildly,
1 gene.                                      making accurate diagnosis difficult,
  Dylan, now 12 years old, came to           particularly in children. People with
Lucile Packard Children’s Hospital in        Marfan syndrome are frequently tall,
1991 to consult with pediatric specialists   with loose joints and disproportionately
at the Stanford University Center for        long arms, legs and fingers. They may
Marfan Syndrome and Related                  have long narrow faces with deeply set
Connective Tissue Disorders. Founded in      eyes and sunken or protruding chests.
1988 by cardiovascular surgeon               Many also experience lens dislocations,
D. Craig Miller, MD, the center is           which can cause blindness, and painfully
one of only about five comprehensive         flat feet.
                                                Although some people with Marfan
                                             syndrome are clearly affected, the             DANIEL MURPHY, MD,
   The severity and number                                                                  Pediatric Cardiologist at
                                             relatively mild signs exhibited by many
   of physical symptoms of                                                                  LPCH and
                                             can be passed off as intriguing, but not
                                                                                            DAVID LIANG, MD, PHD,
   Marfan syndrome can vary                  alarming, quirks of nature. A rapidly          Cardiologist at Stanford
                                             growing adolescent might appear thin           Hospital & Clinics
   wildly, making accurate                   and gangly but not have Marfan
   diagnosis difficult,                      syndrome. Dismissing warning signs
                                             is a high-stakes game, however; if left
   particularly in children.                 undiagnosed, the weakened connective         large fibrillin 1 gene, genetic testing is
                                             tissue of the aorta can rupture, causing a   often not a practical means of diagnosing
                                             life-threatening aortic dissection.          the condition.
                                                “There is no single diagnostic test for      “We rely on careful clinical evaluation
IN THIS ISSUE:                               Marfan,” says Dan Murphy, MD,                by a group of physicians with extensive
                                             pediatric cardiologist at Packard            experience,” Murphy says. “Kids are
New Director of CVICU                 3
                                             Children’s Hospital. Because Marfan
Improving Quality in Perinatal Care   4      syndrome can be caused by more than
                                             100 different mutations in the very                           Continued on next page
Weekend Births Not More Risky         5

Research Identifies Types of Rejection 6


Continued from cover
                                                MARFAN QUICK FACTS:                           MARFAN TIP-OFFS:
sometimes referred after a visit to an          s   Affects one in 5000 people                s    Disproportionately long arms,
ophthalmologist or orthopedist, but                                                                legs and fingers
some of the signs can be very subtle. The       s   Can be difficult to diagnose
center allows us to provide the children                                                      s    Loose joints
                                                s   Often fatal in early adulthood
with a uniform medical evaluation, with             if not treated                            s    Scoliosis
all of the experts in one place,
communicating with one another.”                s   Caused by more than 100 different         s    Sunken or protruding chest
                                                    mutations in a single gene                s    Long, narrow face with deeply set
   “We can’t always tell with 100 percent
certainty after looking at a patient,”          s   Patients can live a normal lifespan            eyes and shallow cheekbones
agrees Stanford Hospital & Clinics                  with proper monitoring                    s    Flat feet and long toes
cardiologist David Liang, MD, PhD.              s   Children of affected parents have a
“Diagnosis still is a little bit of an art.”                                                  s    Lens dislocations or nearsightedness
                                                    50 percent chance of inheriting
Because an affected parent has a 50-                Marfan syndrome                           Not all symptoms are necessary for a diagnosis.
percent chance of passing Marfan
syndrome to a child, Liang and Murphy
also consider a patient’s family history.
                                               as well as physicians specializing in               The Center for Marfan Syndrome
But a spotless background doesn’t
                                               obstetrics,      gynecology,       urology,         and Related Connective Tissue
guarantee a clean bill of health: the
                                               neurology, endocrinology, rheumatology              Disorders brings together many
mutations that cause the syndrome can
                                               and thoracic surgery, to help both the              disciplines to provide a uniform
also arise spontaneously within the egg or
                                               children and their families.                        evaluation and address all aspects
the sperm of an unaffected parent.
                                                  As children with Marfan syndrome                 of clinical care:
                                               grow older, they may rebel against the              s   Cardiovascular medicine
   A generation ago, the life expectancy       disease that prevents them from playing
for a person with Marfan syndrome              contact sports and leaves them looking              s   Cardiothoracic surgery
hovered in the 30s. However, early             different from their peers. Some might              s   Genetics
diagnosis, coupled with the use of beta        even stop taking their heart medication
blockers to reduce blood pressure and          in an effort to just be normal.                     s   Ophthalmology
surgery to replace an expanding aortic            “In the last 12 years I’ve seen two              s   Orthopedics
root with tougher man-made materials,          teenagers who came in with much larger
allow many Marfan patients to live into                                                            s   Obstetrics
                                               aortas than the year before,” says
their 70s and beyond. After diagnosis, a       Murphy. “In both cases the kids had                 s   Gynecology
child returns regularly to the center for      stopped taking their medicine. We can
ongoing monitoring of the size of the                                                              s   Urology
                                               do things to keep the patient’s lifestyle as
aorta and other medical problems that          normal as possible and improve the                  s   Neurology
are caused by Marfan syndrome.                 survival, but it relies on teamwork with            s   Endocrinology
   “One thing about Marfan syndrome is         the patient. Most would not consider
that everybody is different,” says             themselves to be particularly limited.”             s   Rheumatology
Murphy. “We want the kid to see the               Over the years, Packard physicians
ophthalmologist to get their eyes taken        worked together to correct Dylan’s
care of. We may want them to see the           scoliosis and sunken chest, monitor his            For more information about Marfan
orthopedist, because scoliosis and foot        heart function and repair his failing              syndrome contact the National Marfan
deformities can cause serious disability.      mitral valve. They now expect Dylan to             Foundation at To
It’s also very important to teach the          live a normal life span, thanks to ongoing         contact the Stanford Center for
family about the syndrome and the              management that requires the expertise             Marfan Syndrome and Related
importance of the medication.”                 and coordination of many different                 Connective Tissue Disorders, call
    The center brings together pediatric       disciplines. “It used to be you just had to        patient coordinator Sunny Pellone at
and adult experts from cardiovascular          wait for the person to die,” says Rohrer.          650-725-8246 or visit the center’s
medicine,     cardiothoracic     surgery,      “Nowadays, doctors fix them. They do               website at
genetics, ophthalmology and orthopedics,       miracles.”

2 PHYSICIAN Update                                                                                                 

   Stephen J. Roth, MD, MPH, a
nationally recognized cardiac intensivist
and researcher at Children’s Hospital
Boston, has been named director of the
cardiovascular intensive care unit at
Lucile Packard Children’s Hospital at
Stanford, effective October 1.                                                                           STEPHEN ROTH, MD, MPH
   “Dr. Roth is a wonderful addition to                                                                  Director of LPCH
our team,” says Frank L. Hanley, MD,                                                                     Cardiovascular Intensive
director of the Children’s Heart Center at                                                               Care Unit
Packard. “His exceptional experience and
leadership skills will further enhance our
ability to treat children needing this
very special care.”
   Besides overseeing patient care in the
CVICU, Roth will be developing new
hospital programs focusing on clinical           clinical research. He was also associate        cardiologists and cardiology trainees in
care, research and training in the               chief of the division of intensive care         the critical care of children with both
subspecialty of pediatric cardiac intensive      cardiology and an assistant professor of        congenital and acquired heart disease.
care. Roth will also be appointed an             pediatrics at Harvard Medical School.           He plans to continue this role in building
associate professor of pediatrics at the            “This is a great opportunity for me,”        a major training program in this specialty
Stanford University School of Medicine.          says Roth. “The Children’s Heart Center         at Packard.
   Daniel Bernstein, MD, Packard’s               at Packard is bringing together an                 Roth received his MD at the Yale
chief of pediatric cardiology and                outstanding group of cardiologists,             University School of Medicine and his
co-director of the Children’s Heart              surgeons, anesthesiologists and nurses          MPH at the Harvard School of Public
Center, lauded Roth’s “national                  who are dedicated to the care of children       Health. His undergraduate degree in
reputation as a splendid teacher,                with heart disease. As director of the          biochemical sciences is also from
researcher, clinician and team builder.          CVICU, I look forward to collaborating          Harvard. He has been published
Best of all, he’s a first-rate physician who’s   with this multi-disciplinary group to           extensively in peer-reviewed medical
a proven and compassionate leader in the         manage these children.”                         journals, has lectured internationally
post-surgical care of children with                                                              about pediatric cardiovascular health and
                                                 RESEARCH INTERESTS
congenital heart defects.”                                                                       disease and has been listed by the group
                                                    Roth’s research, teaching and patient        Best Doctors in America as one of the
   At Children’s Hospital Boston, Roth           care contributions are extensive. His
was the associate director of the cardiac                                                        nation’s leading physicians.
                                                 research leadership has been primarily
intensive care unit and the director of          focused on the reduction of postoperative          To Packard’s chief of pediatric
                                                 morbidity and mortality of children             intensive care, Lorry Frankel, MD, “Dr.
                                                 who require major cardiac surgery. Roth         Roth’s background, experience and
   “Packard has developed                        has been a co-principal investigator            reputation for innovation will play an
                                                 in several clinical trials of both              important role in helping us achieve
   a high degree of                              groundbreaking surgical techniques and          our vision.”
                                                 investigational drugs.                             Roth called his move to Packard
   momentum, and this is                            His current research focus is on the         Children’s Hospital “exciting,” adding
                                                 design and execution of prospective             that, “among children’s hospitals in the
   especially the case within                    clinical trials in pediatric cardiac patients   country, Packard has developed a high
                                                 and includes participation as a co-             degree of momentum, and this is
   the Children’s Heart                          principal investigator and steering             especially the case within the Children’s
                                                 committee member in the NIH-                    Heart Center. It’s very appealing to be a
                                                 sponsored Pediatric Heart Network. As a         part of a team that is focused on
   Center,” Roth says.                           member of Harvard’s faculty, Roth               developing innovative therapies for
                                                 played a leading role in educating              children with congenital heart defects.”

                                                                                                                PHYSICIAN Update 3


                                               disease in babies of various weights.          determine how to modify teaching
                                               Significant deviations from benchmark          programs and care improvement efforts
                 JEFFREY GOULD,                goals set by the group’s Perinatal Quality     to be more useful to rural hospitals.”
                 MD, MPH                       Improvement Panel can highlight practices      A PERINATAL DATA CENTER
                 LPCH Neonatalogist            that may need to be changed. More than
                                                                                                 In addition to providing member
                                               60 hospitals in the state are members of the
                                                                                              hospitals throughout the state with up-
                                               group, accounting for nearly all of the
                                                                                              to-date assessment of their performances,
                                               major neonatal intensive care units.
                                                                                              the CPQCC data center, managed by
   Peer pressure can be a good thing. That        Another unique aspect of the effort is      Gould, is a gold mine of statistics about
is, if it’s used to ensure that everyone       the number of different organizations          neonatal health in California. Gould and
benefits equally from proven medical           involved. The California Department of         his colleagues at Packard Children’s
techniques. Lucile Packard Children’s          Health Services, the Office of Statewide       Hospital will use the information to
Hospital neonatologist Jeffrey Gould,          Health Planning and Development, the           catalogue neonatal illnesses and
MD, MPH, has a lot invested in the idea        Regional Perinatal Programs of                 outcomes in order to identify previously
that hospitals around the state can            California, the Pacific Business Group on      unseen associations between social,
improve the quality of their care simply       Health and the David and Lucile Packard        biological and healthcare factors.
by comparing themselves to their peers.        Foundation are just a few that are                “We want to understand why some
   “Our goal is to improve the health of       working to meet the challenge of               infants in difficult health situations get
pregnant women and newborns by                 providing better care for newborns.            through fine, while others, subjected to
making sure that approaches to illness            “When states do initiate widespread         the same stresses, end up with chronic
that have been demonstrated to be              quality improvement programs,” says            respiratory problems and brain damage,”
effective are actually being carried out,”     Gould, “it’s usually from top down. In         says Gould. “Is it something that we are
says Gould, a professor of pediatrics and      this case, the California Association of       missing clinically, or is there a biological
director of the perinatal epidemiology         Neonatologists has been instrumental in        basis that we have just not learned about
and health outcomes research unit at           establishing CPQCC. We have a                  yet? We are in a very good position to
Packard Children’s Hospital and the            tremendous base of neonatal and                finally understand some of these issues.”
Stanford University School of Medicine.        obstetric experts to prepare toolkits for
He is the principal investigator of the                                                          The combination of many different
                                               member hospitals, and we prepare               disciplines and experts at Packard
California Perinatal Quality Care              databases to allow them to know how
Collaborative, or CPQCC, conceived to                                                         Children’s Hospital and Stanford
                                               they’re doing.”                                University School of Medicine make the
provide a better way to evaluate neonatal
care provided by specific hospitals.              The toolkits, which can be freely           hospital an excellent place to tackle
                                               downloaded from the group’s website,           such questions.
DEVELOPING NEW METRICS                         include evidence for particular clinical          “There are world leaders in perinatal
   Neonatal health has been steadily           approaches and information about               medicine, genetics, infant development,
improving over the past several years,         how to implement best practices. Four          social sciences and health services research
thanks to medical advances that allow          toolkits now available address common          at Stanford and Packard Children’s
physicians to keep smaller and smaller         issues and decisions facing many               Hospital,” says Gould. “Having a vision
babies alive. From a statistical standpoint,   obstetricians      and       neonatologists:   that combines these things is extremely
however, such good news is a mixed blessing.   antenatal steroid treatment, postnatal         important. Given an appropriate research
   “We have always used mortality as an        steroid administration, nosocomial             platform, these experts will be able to
index for quality of care,” says Gould,        infection prevention and improving             advance our understanding of perinatal
“but it is becoming difficult to judge a       initial lung function. A toolkit focusing      illness and to design special interventions
hospital on that basis, because mortality      on feeding practices in premature infants      to prevent and cure these conditions.”
is becoming such an uncommon event.            is planned for future distribution.
Fortunately, very few infants die.”               “Another thing on the drawing board is       For more information about the
   CPQCC provides interactive web-             an effort to address the unique needs of        California Perinatal Quality Care
based databases that allow individual          California’s very rural hospitals,” says        Collaborative, or to download specific
member hospitals to assess their               Gould. “While most of the databases             toolkits, visit or call
performance in scores of neonatal              available today are centered around the         650-723-5763. Dr. Gould can be
outcomes, such as their relative rates of      major cities, a huge part of the state is       reached at 650-723-5711.
nosocomial infection and chronic lung          quite isolated. No one has ever tried to

4 PHYSICIAN Update                                                                                            

   The California Perinatal Quality Care         “We’ve found that weekends are not          healthy enough for delivery during the
Collaborative strives to correlate neonatal   an inherently more dangerous time to be        week, when ample support staff is
outcomes with quality of care in more         born,” said senior author and                  available. The same is true of cesarean
than 60 neonatal intensive care units         neonatologist Jeffrey Gould, MD, MPH.          sections, which were used to deliver about
throughout the state (see accompanying        “Instead, the fact that there is a             20 percent of the infants in the study.
story). Recently CPQCC researchers at         proportionally higher percentage of very          But while jump-starting labor
Lucile Packard Children’s Hospital, the       tiny babies—who are more likely to             or performing a cesarean is a reliable
University of California, Berkeley and        die—born on weekends than during the           way to get a baby out, it is much
the State Department of Health Services       week inflates the observed mortality.”         harder to thwart premature labor to keep
used data from the effort to debunk long-        Weekend deliveries have been saddled        a small, underdeveloped baby in the
standing concerns about higher mortality      with a seemingly deadly reputation after       uterus. The battle to prevent delivery of
rates associated with weekend vs.             studies published in the 1970s and ’80s        these sickest fetuses can as easily be lost
weekday births.                               suggested that infants born on weekends        on the weekend as during the week. The
                                              are more likely to die than those born         researchers found that 0.95 percent
                                              during the week. “One thing these              of infants born during the week could
                                              studies didn’t do, however,” says Gould,       be classified as “very low birth weight.”
                                              who is also a professor of pediatrics at the   In contrast, infants of very low birth
                                              Stanford University School of Medicine,        weight made up 1.1 percent of all
                                              “was control for the fact that there           weekend births.
                                              might have been more emergency births
                                                                                                When the researchers correlated
                                              on the weekend.”
                                                                                             mortality rates with birth weight, the
                                                 Gould and his colleagues at CPQCC           difference between weekday and weekend
                                              pooled data from more than 1.5 million         birth vanished, confirming their theory:
                                              births throughout California from 1995         Fewer deliveries of more acutely ill
                                              to 1997 to confirm that overall neonatal       newborns create the perception that all
                                              mortality increased on Saturdays and           weekend births are more dangerous. The
                                              Sundays. However, they also found that         finding, which was published in the
                                              weekends accounted for 17.5 percent            June 11 issue of the Journal of the
                                              fewer births than would be expected had        American Medical Association, should
                                              the births been distributed randomly.          relieve concerns that the higher death
                                              When they homed in on the birth                rates are due to inadequacies in hospital
                                              weights of this subset of newborns, they       staffing or experience and allay the
                                              discovered why.                                fears of women with uncomplicated,
                                                 Many physicians prefer to induce labor      full-term pregnancies who begin labor on
                                              in women whose fetuses are at risk but         the weekend.


    A flu shot in the fall can prevent a nasty bout of illness in the winter. Lucile Packard Children’s Hospital researchers are
  seeking healthy children between the ages of three and nine who received the flu vaccine last season to participate in a study
  of children’s immune response to influenza.
    Just in case potential volunteers aren’t won over by altruism, the researchers are offering $30 per visit to kids willing to
  donate blood samples three times: twice before receiving the vaccine and once one month later. A numbing cream will be
  used to minimize this discomfort to the child, and the flu shot is free.
    “We’re finding that people in the medical field are volunteering their own kids,” says study coordinator Nancy Bouvier,
  PNP. “Parents are using the hook ‘Well, you’re going to get the flu vaccine anyway, so here’s a chance to make some money’.”
  For more information or to enroll in the study, call Bouvier at 650-498-7284.

                                                                                                             PHYSICIAN Update 5


                                                unique human genes, allowed lead author              “We may waste two to three days giving
                                                Sarwal and her colleagues to divide episodes      high doses of steroids only to find the
                                                of acute rejection into at least three distinct   rejection episode is steroid-resistant,” says
                                                subgroups based on their global gene-             Sarwal. “Even when we then try antibody
                                                expression profiles.                              therapy, many of these patients will fail to
                                                   Surprisingly, one of the three subgroups       get all their kidney function back, and are
                                                associated with particularly poor outcomes        more likely to lose their kidney over time.”
                                                expressed many genes specific to B cells,         Indiscriminate use of anti-rejection drugs
                                                which had previously been cleared of              can also cause other problems, including
                                                significant wrongdoing in transplant              growth inhibition and an increased risk of
                                                rejection. Further research pinpointed            infection and cancer.
                                                clumps of B cells within slices of the               The researchers are now experimenting
                                                transplant tissue. The presence of the cells      with ways to allow noninvasive monitoring
   MINNIE SARWAL, MD                            suggested a way for physicians to better          of transplant function from blood or urine
   LPCH Nephrologist and                        employ anti-rejection drugs.                      samples, eliminating the need for a biopsy.
   Molecular Immunologist                          “Although physicians realize that clinical     Eventually, they hope physicians will be able
                                                responses to treatment for acute rejection        to identify possible rejection episodes early
                                                range from complete response to no                by monitoring the expression of a few
                                                response, we currently have very few clues        key genes.
   A simple test may pinpoint children at       to target the high-risk patient group or to          “We need to begin using drugs in a
high risk of rejecting newly transplanted       individualize treatment,” says Sarwal, who        more educated manner,” says Sarwal.
kidneys, say researchers at Lucile Packard      is also an assistant professor of pediatrics at   “Ideally, we will be able to avoid over-
Children’s Hospital and the Stanford            the Stanford School of Medicine. “If we can       immunosuppressing our patients with
University School of Medicine. The              now figure out which of the more serious          drugs that are clearly not working and that
research, which also identifies more than       rejections are due to these B cells, we can       increase their risk of cancer and infection
one type of acute rejection, may increase the   treat them completely differently, perhaps        and inhibit growth in children.”
long-term survival of transplant patients       by using antibodies to specifically wipe out         Sarwal’s colleagues include co-author
and reduce the severe side effects caused by    B cells in these patients.”                       Oscar Salvatierra, MD, professor of
common anti-rejection drugs.                       T cells traditionally have been pegged as      pediatrics and of surgery and director of the
   Acute rejection affects 15 percent to        primary troublemakers for transplant              pediatric kidney transplantation program,
40 percent of kidney transplant recipients      recipients. While anti-rejection drugs such       and Patrick Brown, MD, PhD, professor of
nationwide and is a leading cause of            as steroids do a good job mollifying agitated     biochemistry and a Howard Hughes
retransplantation or death in these patients.   T cells marshalling for an attack, B cells        Medical Institute investigator.
Although the tissue inflammation and cell       have mostly been ignored because they
damage that spell trouble for a transplanted    make up a relatively small proportion of
organ are easily diagnosed with a light         host cells in the transplanted tissue. The
microscope, this technique can’t identify the   researchers found, however, that when
molecular rabble-rousers at the root of the     kidneys became peppered with B cells after
problem. As a result, physicians have           transplantation, steroid treatment was less
wondered whether patients experience            successful in treating the rejection.
more than one type of acute rejection.             “What’s happened is we’ve failed to
A CELLULAR VIEW OF REJECTION                    realize that the immune system is very
   In a new study published in the July 10      clever and redundant,” says Sarwal. “It may
issue of the New England Journal of             have developed a mechanism to assist the T
Medicine, Packard Children’s Hospital           cells to attack the transplanted kidney by
pediatric nephrologist and molecular            recruiting the B cells, which rev up the T
immunologist Minnie Sarwal, MD, PhD,            cells and increase their efficiency.”                   OSCAR SALVATIERRA, MD
used microarray technology to peek behind          Although a simple laboratory test can                Director of Kidney
the scenes in more than 60 pediatric kidney     identify congregations of B cells, most                 Transplantation Program
transplant patients. The technique, which       episodes of acute rejection are currently
simultaneously examines more than 12,000        treated in a hit-or-miss fashion.

6 PHYSICIAN Update                                                                                                

MOSHFEGHI NAMED HEAD OF                              During his tenure as a medical student at        PUBLICATIONS
OPHTHALMIC ONCOLOGY                               the University of Virginia’s School of              Pediatric cardiology and adult congenital
                                                  Medicine, Kim completed a clinical rotation           heart disease. Murphy. Journal of the
                                                  at Yonsei University Severance Hospital in            American College of Cardiology 2003
                     DARIUS M.
                                                  Seoul, where he developed lasting professional        Jul 16;42(2):380–1
                     MOSHFEGHI, MD                ties with many Korean physicians.                   Molecular heterogeneity in acute renal
                                                     After completing a surgical residency at           allograft rejection identified by DNA
                                                  the University of Chicago Hospital, he                microarray profiling. Sarwal, Chua,
                                                  studied cellular transplantation and tissue           Kambham, Hsieh, Satterwhite, Masek,
                                                  engineering of the small intestine and                Salvatierra. New England Journal of
   Darius M. Moshfeghi, MD, has been              liver as a research fellow at the Children’s          Medicine 2003 Jul 10;349(2):125–38
appointed assistant professor at the              Hospital of Boston, Harvard Medical                 Neonatal mortality in weekend vs weekday
Stanford University School of Medicine            School. Most recently, Kim completed a                births. Gould, Qin, Marks, Chavez.
department of ophthalmology, where he             fellowship in pediatric surgery at the                Journal of the American Medical Association
leads the pediatric vitreoretinal surgery         Children’s Hospital and Regional                      2003 Jun 11;289(22):2958–62
service and is head of ophthalmic oncology.       Medical Center in Seattle, Washington.              Decreased N-Acetylaspartate in children
   He is the author of more than 40 peer-         KAY ELECTED TO LEADERSHIP                             with familial bipolar disorder. Chang,
reviewed articles and 10 book chapters and        ROLE AT AMERICAN SOCIETY OF                           Adleman, Dienes, Barnea-Goraly, Reiss,
has been invited to speak at national             GENE THERAPY                                          Ketter. Biological Psychiatry 2003
meetings on topics of pediatric vitreoretinal                                                           Jun 1;53(11):1059–65.
surgery, ophthalmic oncology, photo-                                                                  Perinatal outcomes in two dissimilar
dynamic therapy, and quantitative angio-                                                                immigrant populations in the United
graphy. He has an interest in adult and                                                                 States: a dual epidemiologic paradox.
pediatric eye tumors, and, in particular, their                         MARK KAY, MD, PhD               Gould, Madan, Qin, Chavez. Pediatrics
imaging characteristics.                                                                                2003 Jun;111(6 Pt 1):e676–82
   Moshfeghi has received awards from                                                                 Circadian and sleep development in preterm
the Heed Ophthalmic Foundation, the                                                                     infants occurs independently from the
Ronald G. Michels Fellowship Foundation                                                                 influences of environmental lighting.
                                                     Mark Kay, MD, PhD, professor of                    Mirmiran, Baldwin, Ariagno. Pediatric
and the National Eye Institute and has been
                                                  pediatrics, has been elected to a three-year          Research 2003 Jun;53(6):933–8
named a Paul Kayser International
                                                  term to serve successively as vice president,       NGF signaling in sensory neurons: evidence
Scholar. Practice locations include Palo
                                                  president-elect and president of the American         that early endosomes carry NGF
Alto, Menlo Park, Santa Clara and Salinas.
                                                  Society of Gene Therapy. The ASGT is the              retrograde signals. Delcroix, Valletta, Wu,
KIM JOINS DIVISION OF                             preeminent international association for gene         Hunt, Kowal, Mobley. Neuron 2003 Jul
GENERAL SURGERY                                   therapists and has more than 3,000 members.           3;39(1):69–84
                                                  Dr. Kay’s election to this position signifies his   Measles and mumps vaccination as a
                                                  international reputation for excellence in the        model to investigate the developing
                                                  study of human gene therapy.                          immune system: passive and active
                     STEPHEN KIM, MD                 Kay received his PhD in developmental              immunity during the first year of life.
                                                  genetics in 1986 and his MD in 1987,                  Gans, DeHovitz, Forghani, Beeler,
                                                  both from Case Western Reserve                        Maldonado, Arvin. Vaccine 2003 Jul 28;
                                                  University. He completed a pediatrics                 21(24):3398–405
                                                  residency and a three-year fellowship in            AAV serotype 2 vectors preferentially
                                                  medical genetics at Baylor College of                 integrate into active genes in mice. Nakai,
  Stephen Kim, MD, has joined the                 Medicine before joining the University                Montini, Fuess, Storm, Grompe, Kay.
division of pediatric general surgery at          of Washington faculty in 1993 as an                   Nature Genetics 2003 Jul;34(3):297–302
Lucile Packard Children’s Hospital. Kim,          assistant professor of medicine with                A gene deleted adenoviral vector results
who was born in Seoul, is an accomplished         adjunct appointments in pediatrics,                   in phenotypic correction of canine
and versatile minimal access surgeon              biochemistry and pathology. He joined                 hemophilia B without liver toxicity or
focused on the multidisciplinary care of          Lucile Packard Children’s Hospital as                 thrombo-cytopenia. Ehrhardt, Xu, Dillow,
children with intestinal disorders and            an associate professor of pediatrics at               Bellinger, Nichols, Kay. Blood 2003 Jun 12
short gut syndrome.                               Stanford’s School of Medicine in 1998.                [Epub ahead of print]

                                                                                                                      PHYSICIAN Update 7
IMPORTANT CONTACT                                 OTHER CONTACTS FOR              PHYSICIAN REFERRAL
INFORMATION                                       REFERRING PHYSICIANS            LIAISON SERVICE
                                                  Admissions                      Providing assistance and information to referring
Physician Hotline for Referral                    800-995-5724 / 650-497-8221     physicians and their staff.
& Consultation                                    Continuing Medical Education    Monday–Friday 8 am–5 pm
24-hour, immediate referral                       650-497-8554                    Tel. 800-756-5000
and consultation                                                                  Fax. 650-320-9443
                                                  Diagnostic Imaging    
Tel. 800-995-5724                                 650-497-8376
                                                                                  CME COURSES
Fax. 650-843-0136                                 Radiologist Consult                   650-497-8466                    Clinical Update in Pediatric & Perinatal Medicine
                                                                                  Nov. 3–5
                                                  Grand Rounds
                                                                                  Big Island of Hawaii, Mauna Lani Bay Hotel
Critical Care Consultation                        650-723-5168
& Transport                                                                       Innovations in Pediatric and Perinatal Medicine
                                                  Health Plan Services            Nov. 8
24-hour, immediate consultation for               650-736-1067                    Kapiolani Medical Center, Oahu, Hawaii
neonatal, pediatric and maternal critical         Medical Group Services          New Development In the Management of
care and transport issues                         650-736-1067                    Eating Disorders in Children and Adolescents
650-723-7342                                      Medical Staff Services          Jan. 23–24, 2004
                                                  650-497-8566                    Lucile Packard Children’s Hospital at Stanford,
                                                                                  Friedenrich Auditorium
Hospital Page Operator                            Professional Services Billing
24-hour access                                    for Physicians                  Pediatric Headache: a Guide for Every Practitioner
                                                  650-498-5785                    March 13, 2004
650-497-8000                                                                      Fairmont Sonoma Mission Inn & Spa
                                                                                  For More Information
                                                                                  650-497-8554 or visit

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                                                                                                                    Palo Alto, CA

725 Welch Road • Palo Alto, CA 94304

Physician Update is published as part of an
ongoing effort to serve the needs of physicians
who refer to Lucile Packard Children’s Hospital
at Stanford.To share comments or secure more
information, contact:
Terry O’Grady, RN, MS
Director, Community and Physician Relations
Lucile Packard Children’s Hospital
1520 Page Mill Road, Palo Alto, CA 94305

Erin Buford
Manager, Physician Referral Liaison Service
Lucile Packard Children’s Hospital
725 Welch Road, Palo Alto, CA 94304