"Inside Surgery", The Department of Surgery Newsletter, Summer 2012
UCSF Department of Surgery - August 22, 2012
This issue of Inside Surgery describes several exciting
developments that are advancing our ability to provide outstanding
care for a range of patients including the new Hepatobiliary
Service, under the direction of Carlos
Corvera, M.D., which provides comprehensive,
multidisciplinary care for patients with liver and bile duct
disease. Other topics include updates on Endocrine
Surgery, San Fancisco General Hospital's Wraparound Project, and
notable rankings of our surgeons within U.S. News & World
Report annual update.
UCSF/SFGH surgeon and trauma researcher, Mitchell J. Cohen, MD, has
teamed up with researchers around the globe to change the way acute
traumatic coagulopathy is treated. His work is leading to a
new understanding of the causes of and appropriate treatment for
uncontrolled bleeding after trauma.
"It seems that sometimes major injuries trigger a problem with
the blood-clotting process, causing blood to leak from the body
faster than it can be stemmed. This clotting disorder affects as
many as 1 in 4 major trauma victims. So Brohi and others have
developed a way of treating people that prioritises fixing their
blood over fixing their body. It's a radical departure from
standard procedures, and one that is by no means widely accepted,
but if they're right it could save thousands of lives every year
worldwide, and a whole chapter of trauma care will have to be
SFGH Trauma Surgeon Works to Prevent Injuries in San Francisco
UCSF News - August 08, 2011
"San Francisco General Hospital trauma surgeon Rochelle Dicker has treated many
pedestrians who ended up in the emergency room after being struck
by vehicles. She and her four-person research team have conducted
an unprecedented analysis of the direct medical costs of
auto-versus-pedestrian encounters in San Francisco. They also
looked at where the incidents occurred, so that they could identify
"high cost areas and high injury morbidity areas, or hot spots" and
work with city officials to consider countermeasures that could
save lives and money. The study, titled "Cost-Driver Injury
Prevention: Creating an Innovative Plan to Save Lives with Limited
Resources," was published in the Journal of Trauma in April."
Department of Surgery at SFGH Launches Cohen Lab Website
Department of Surgery at San Francisco General Hospital - June 28, 2011
The Department of Surgery at SFGH is pleased to
announce the launch of the Cohen Lab website. Led by Mitchell
J. Cohen, M.D., Associate Professor of Surgery
and Director of Acute Care Research at the San Francisco
Injury Center, the site will highlight the application of
translational discoveries to acute traumatic
coagulopathy. The Cohen lab is focused
on elucidating the biology of coagulation and
inflammation after injury. Incorporating clinical, in
vivo, in vitro, and in silico approaches,
the research embodies a truly translational
approach for investigating the causes of uncontrolled
hemorrhage, the leading cause of (potentially preventable)
death in both combat casualties and civilian
Walk Steady: Securing Safe and Walkable San Francisco Streets
KALW - May 23, 2011
At some point in our day, most of us are pedestrians walking the
7x7 swatch of land we know as San Francisco. The city's relatively
small size, temperate weather, and inviting neighborhoods make San
Francisco inherently walkable.
Yet statistics tell a very different story. San Francisco is one
of the most dangerous cities for pedestrians nationwide with over
800 people hit by cars here each year--that's between 2 and 3
pedestrians a day.
In one of his last acts as Mayor, Gavin Newsom signed an
executive directive setting ambitious goals for reductions in
pedestrian injuries and fatalities over the next decade. As a
result multiple city agencies have been tasked with coming up with
a unified and coordinated approach to improving pedestrian safety
that looks at re-engineering our streets, enforcing traffic laws
for motorists and pedestrians alike to gathering data and raising
We've gathered several of those individuals whose jobs it is to
make San Francisco safer for pedestrians as we ask:
What makes a city that appears so walkable so unsafe? Are some
neighborhoods more dangerous for pedestrians than others? What
measures can be put into place to improve safety and encourage
walking? How are local agencies responding to this issue?
Dr. Rajiv Bhatia, Director of Environmental Health with the San
Francisco Department of Public Health.
Dahianna Lopez, Prevention Director with the San
Francisco Injury Center at UCSF.
Timothy N. Papandreou, Deputy Director of The SFMTA Sustainable
Streets-Long Range planning and Policy.
Elizabeth Stampe, Executive Director of WalkSF, a member-based
pedestrian advocacy organization.
UCSF Chancellor Susan Desmond-Hellmann, MD, MPH, joined the UCSF
community for the 2011 Founders Day Luncheon when the University
recognizes faculty, staff and students for their extraordinary
contributions to advancing the mission of education, research and
The individuals, who celebrated the occasion with their friends,
family members and colleagues, delivered heart-felt speeches about
their work. San Francisco Injury Center Prevention
Director, Dahianna Lopez, received the Chancellor's Award for
Oakland Organization Offers Help for Young Gunshot Victims
KCBS - April 30, 2011
After Emergency Room doctors patch up a young gunshot victim,
the patient is given time to recover from the physical wound. While
time may heal, there is still the mental wound that lingers
according to Anne Marks, the executive director of Oakland-based
Youth Alive-an urban violence prevention organization.
Many young gunshot victims are experiencing Post Traumatic
Stress Disorder (PTSD), something that was initially linked to
soldiers. Violence prevention experts discussed ways to improve
mental health care for these victims at the two day National
Network of Hospital-based Violence Intervention Programs this week
Marks spoke about the problems of living in communities where
victims see violence on a regular basis.
"You get shot on your block, in front of your house, you get
treated and you go right back to that house in that same community.
You don't know if someone's coming back to get you." she said.
Marks said the victim will likely suffer from what she calls,
"Recurring Traumatic Stress Syndrome" Typically identified as Post
Traumatic Stress Disorder.
Dr. Rochelle Dicker, a trauma surgeon at San Francisco General,
runs a violence-prevention project that works directly with
patients who've been shot stabbed or in some way physically
Dicker said that PTSD is treatable, but that traditionally,
"this particular population" has not wanted to seek mental health
care because of the stigma attached. Now she's finding more youth
are opening up to the idea of once they hear how it can help them
cope with their trauma.
Two to three people are hit by cars every day on San Francisco's
dangerously motorized streets, and researchers are beginning to
paint a clearer picture of the economic toll. The more than 800
pedestrian crashes a year are racking up a $76 million bill for
injuries, reports the Pedestrian Safety Advisory Committee (PSAC),
and advocates say it's imperative the city invest in preventative
"It has a huge impact on the economic stability of our
residents," said PSAC member Dahianna Lopez of the San Francisco
Injury Center, who highlighted that pedestrian injuries in the city
cost $15 million per year in medical treatment alone and comprise a
quarter of all traumatic injuries. Professionals from the
Department of Public Health (DPH) and the University of California,
San Francisco presented their findings to city supervisors at two
hearings on pedestrian safety this past week.
At a community meeting last week at Mission Police Station,
Capt. Greg Corrales for the first time offered details on the fatal
shooting of Aldo "Trigger" Troncoso - the neighborhood's first
homicide of the year - and the aftermath.
Stories of violence averted are not often told, but that's the
story Corrales offered the assembled group, and repeated the
following evening while delivering a special report to the Police
Commission on gang violence in the Mission.
"Because of open communication," Corrales told the commission,
"we were able to prevent more violence from happening."
Still, there was more trouble ahead. A shootout on March 2 left
the intersection at 24th and Harrison littered with spent bullet
casings and sent the victim to San Francisco General Hospital.
Several people who attended the neighborhood meeting lived within a
few blocks of the shooting. A few gave eyewitness accounts. "I do
not," said one woman, "ever want to look out my window again and
see a man crawling behind a car with blood coming out of his
"We do know who the shooter was," Corrales told the group of
neighbors. "We may not get him for that. But we'll get him for
something." The victim, Corrales said, was a known Norteño,
and a victim in four previous shootings.
A few hours after the shooting at 24th and Harrison, Corrales
got word that a Sureño had just been shot in the Bayview.
When police realized that he too was headed for SF General, where
the waiting room had filled with angry Norteños, they asked
the Community Response Network for help.
Corrales credits Project Wraparound, a follow-up program for the
victims of violence run by SF General, for defusing the situation
at the hospital. "There was not violence," he told the commission,
"though there was huge potential. This is why there is such an
incentive for open communication with community groups."
Gun-related injuries and deaths have declined drastically,
saving taxpayers nearly half a million dollars in medical costs
San Francisco General Hospital officials released a report this
week showing that gunshot wounds dropped from 175 in 2005 to 134
last year. The number of gun-related deaths also sharply declined
from 45 in 2006 to 17 in 2009, according to the annual report.
"It's absolutely phenomenal," said Patti O'Connor, a trauma
program manager nurse at San Francisco General Hospital.
Officials are hoping the new trend remains, adding that in the
first six months of 2010, the hospital admitted 55 gunshot victims;
six of those were fatal.
The drop in gun violence doesn't only represent lives spared, it
is also money saved. Taxpayers shell out $60,000 for every gunshot
victim treated at San Francisco General Hospital, said Rochelle
Dicker, assistant professor of surgery at UCSF and a trauma surgeon
Sitting in her office at San Francisco General, Dr. Rochelle
Dicker remembers the young man who sparked the idea for the
Wraparound Project. The year was 1995 and Dicker was fresh from
medical school; armed with a white coat and pager, she set out to
meet the gurneys bearing the city's grievously wounded into San
Francisco General's emergency room. On one of her first days on the
job, a young man, just 16 years old, was wheeled through the
sliding doors with a gunshot wound to the abdomen.
As Dicker helped care for the young man through his recovery,
she came to know him. He told her stories of gang life and the
brutality of the drug trade, and Dicker grew concerned. He would
survive his injury, but how much time would that buy him before his
already marginal luck ran out again?
M. Margaret Knudson, M.D., F.A.C.S.,
noted trauma surgeon, Professor of Surgery, and Executive
Director of the San Francisco Injury Center
for Research and Prevention, travelled to
earthquake-ravaged Haiti to treat survivors
of the tragedy that struck the country on January 12,
Rochelle Dicker, Assistant Professor in the Department of
Surgery, was selected to receive the 2010 Chancellor's Award
for Public Service in the faculty/academic category. She
received the award in recognition of her work as Director and
Founder of the Wraparound Project for Comprehensive Rehabilitation,
an outstanding violence prevention program that has developed
a new approach to the care of the violently injured by instituting
a program, based on the public health model of injury prevention,
to reduce injury recidivism.