Department of Medicine Subspecialities

• Allergy/Clinical Immunology
• Cardiology
• Endocrinology
• Gastroenterology - Hepatology
• General Medicine and Geriatrics
• Hematology
• Infectious Diseases
• Nephrology and Hypertension
• Oncology
• Pulmonary/Critical Care
• Rheumatology

Allergy/Clinical Immunology
The Division of Allergy/Clinical Immunology has 2 full-time faculty members. The division has 4 clinical fellows who are engaged in patient care and research devoted to allergic and immunologically mediated diseases. The program consists of Allergy /Clinical Immunology and vector-borne infectious disease outpatient services, an inpatient service at University Medical Center, and an outpatient and consultative service at the VA Medical Center at Northport.

Medical students and residents may elect clinical or basic science research projects in the division.

Clinical fellows spend their first year performing consultations in allergic and immunologically mediated diseases, using elective time for research projects or independent study.

Elective research is available in the second year. Fellows become board eligible in Allergy/Clinical Immunology at the end of the second year.

Cardiology
The Cardiology Division, which includes13 full-time faculty members and 13 fellows, provides a full range of non-invasive and invasive procedures at University Medical Center and the VA Medical Center at Northport. At University Medical Center, the interventional cardiology section performs invasive procedures in two, newly upgraded, state-of-the-art, cardiac catheterization laboratories. These include diagnostic cardiac catheterization, percutaneous transluminal coronary angioplasty - both conventional and laser assisted - directional coronary atherectomy, coronary stent placement, balloon valvuloplasty and the insertion of intraaortic balloon pumps. Round-the-clock emergency angioplasty is performed. The Stony Brook Arrhythmia Study and Sudden Death Prevention Center is actively involved in the electrophysiological evaluation of arrhythmias and the treatment of patients with life-threatening or incapacitating arrhythmias. Cardiac imaging, using either echocardiography or nuclear-cardiographic techniques, is another important activity of the Cardiology Division.

Division faculty are involved in a number of basic and clinical research projects, including

• clinical studies addressing the efficacy of various pharmacologic agents used for treating angina, arrhythmias, congestive heart failure, and preventive cardiology.
• clinical studies of silent myocardial ischemia, including ambulatory electrocardiographic monitoring and ambulatory ventricular function monitoring
• clinical studies, using enhanced external counterpulsation in patients with coronary artery disease and congestive heart failure.
• clinical interventional cardiology studies to treat acute MI, unstable angina, and CAD.

A three-year cardiology fellowship program offers training in all aspects of noninvasive and invasive cardiology and opportunities for basic or clinical research.

Medical students and residents are encouraged to participate actively in cardiology elective programs designed to stimulate more advanced work.

Endocrinology
The Endocrinology Division provides ambulatory care and consultation services at University Medical Center and the VA Medical Center. Specialists care for patients with diabetes mellitus, thyroid disorders, neuroendocrine disturbances, metabolic bone disease and other endocrine problems. Close association is maintained with the pediatric and reproductive endocrinology, nuclear medicine, thyroid surgery and thyroid cytopathology services.

The division strongly supports clinical investigation and a faculty member directs the hospital's NIH-funded General Clinical Research Center. Ongoing divisional research projects include studies of lipodystrophy in HIV disease, male osteoporosis, treatment of Type 2 diabetes and the pathogenesis of gynecomastia.

Electives offer residents and students a broad exposure to clinical ambulatory endocrinology, which takes place at the outpatient endocrinology units of University Medical Center, as well as the diabetes and endocrinology clinics at the VA Medical Center at Northport. Residents may also participate in the inpatient consultation services at both institutions - evaluating patients and discussing their findings with the fellows and attendings.

Formal teaching occurs at weekly conferences, which include research conferences, clinical conferences, basic physiology conferences, journal club and bimonthly thyroid biopsy conference.

A fellowship program in endocrinology provides extensive clinical training in all facets of the subspecialty and involvement in an active investigative program. The division currently offers four fellowship positions for subspecialty training, leading to board eligibility in Endocrinology and Metabolism. The two-year program provides extensive experience in clinical endocrinology - particularly diabetes mellitus, neuro-endocrinology, thyroid disorders and metabolic bone disease - and exposure to pediatric endocrinology as well. A third-year research extension is offered where appropriate.

Participation in clinical or basic laboratory investigation is expected. A variety of projects, appropriate time, and well-equipped and adequately staffed facilities are available. Fellows are expected to spend about 60 percent of their time in clinical activities, with the remaining time devoted to research.

Gastroenterology - Hepatology
The Division of Gastroenterology-Hepatology has six full-time physicians at University Medical Center and four at the DVA Medical Center. The ten clinical faculty members actively participate in the teaching program.

Regularly scheduled conferences at each hospital include a Clinical Conference, which focuses on complex cases; a GI/Surgery Conference, where current patients of mutual interest are discussed; an Endoscopy Conference; a Research Conference; Journal Club, where recent important papers are analyzed. Students and residents, as well as fellows and attendings, participate in most conferences.

At the DVA Medical Center, gastrointestinal immunologists are investigating the effects of aging on GI immune function; the effects of prolactin on the GI immune system; and the gut's immune response to rotavirus.

At the Health Sciences Center, molecular research in GI has an Infectious Disease focus. Investigators research the mechanism of pathogenesis of Group A and B Rotaviruses; define neutralization, detection and pathogenic determinants of Hantaviruses; use in situ analysis of growth hormone on gut aging and immune responses to infectious agents; utilize Hepatitis C virus PRC based diagnostics; and define determinants of Helicobacter pylori mucosal adhesion and clearance. Clinical research in GI is investigating new ways to perform esophageal motility and pH; new therapies for chronic Hepatitis B and C and NASH, evaluating new modalities of Therapeutic Endoscopic Ultrasound, long term success of endocinch and factor influencing colonoscopy success and failure. Investigation is ongoing in the area of colorectal cancer screening. These include risk tumors of colorectal polyps, procedural challenges of colonoscopy, as well as the input of new technology on colorectal cancer screening. There are two NIH grants; one involving virtual colonoscopy with Dr. Mark Wax of Radiology and another with Dr. Dorothy Lane of Preventive Medicine examining barriers to colorectal screening.

A three-year fellowship program prepares fellows for an academic career. Two candidates are selected annually from a large applicant pool.

Fellows divide their time between clinical work and research. They practice a full range of endoscopic and other diagnostic procedures at both hospitals, gaining ample experience in the latest diagnostic and therapeutic techniques. Both the University Hospital ambulatory center and the DVA Medical Center's gastroenterology clinic, supervised by the full-time faculty, allows fellows to follow specific patients with chronic complex gastrointestinal problems over a three-year period. The division sponsors attendance and presentation at national meetings.

General Medicine and Geriatrics
Activities include primary care in outpatient and inpatient settings at both facilities. Residents participate in comprehensive care and preventive medicine activities, as well as consultative services in both general medicine and geriatrics. Division members make major contributions to the teaching of clinical medicine to medical students and house staff. The Long Island Geriatric Center offers faculty development in Geriatrics and Gerontology to full-time and community based preceptors.

An ACGME accredited fellowship in geriatrics is offered with involvement of the hospitals, geriatric clinics, teaching nursing homes, geriatric assessment units and home care teams. Clinical research projects for trainees are available under the tutelage of geriatric faculty.

Hematology
The Division of Hematology supervises the care of patients with hematologic disorders and conducts special clinical programs for patients with hematologic malignancies, coagulation disorders and platelet dysfunctions. Basic molecular and cellular research is conducted on cell proliferation, hematopoiesis, cellular ion transport, platelet physiology and hemostasis. Clinical studies include evaluation of new therapies in patients with thrombocytosis or thrombocypenia, molecular studies of genetic variants in patients with hypercoaguable states, protocol therapy of hematological malignancies, and tranlational research in hematologic neoplasia. The division trains graduate and postgraduate research trainees, clinical and research fellows, students and residents. Visiting scientists from around the world are often in residency in the division.

The Division of Hematology offers electives lasting a minimum of one month for fourth year medical residents. The elective provides a balance between the experiential and didactic approach. Each resident is provided with a brief, formal introduction to blood banking, the routine hematology laboratory (emphasizing blood cell counts), the special coagulation laboratory, the special hematology laboratory (emphasizing red blood cell hemoglobinopathy abnormalities), and radiation therapy. Throughout the elective, residents learn blood cell morphology under the guidance of attendings, fellows and laboratory personnel. Each resident receives an atlas of blood cell morphology. Residents are exposed to both outpatient and inpatient hematology. As a result of the division's reputation as a referral center for patients with unusual hemotologic disorders, residents see many such patients.

Faculty participate in organized weekly meetings, which include a review of all patients seen that week, and a major didactic conference on a single subject organized by the fellows. Under supervision, residents evaluate a select number of patients whose illnesses are most likely to illustrate the fundamental diagnostic and therapeutic approaches in hematology.

Individualized electives may be arranged in basic research or clinical projects.

The division offers a combined three-year fellowship in conjunction with oncology, leading to board eligibility in hematology and oncology. The fellowship is a combined University Hospital and Medical Center-VA Medical Center program. At both hospitals, the inpatient services are organized as teams with one or two fellows and an attending faculty physician assigned to the service each month. Both hospitals have active outpatient services where fellows take primary responsibility for managing a wide variety of cases. Radiotherapy, blood banking and special hematology laboratory rotations are included. An active bone marrow transplant program at University Hospital provides experience in transplantation care. Research laboratory experience is offered in the second and third year.

Infectious Diseases
The Division of Infectious Diseases has active clinical teaching services and outpatient clinics, recording approximately 75 inpatient and 200 outpatient visits per month at each hospital. The division supervises the New York State designated AIDS Center at University Medical Center, which includes an inpatient unit, an outpatient clinic and treatment area, and a staff of physicians, nurse practitioners, nurses and social workers.

Research is carried out in the following areas by the nine full-time members of the division.

Lyme Disease Research Group
Stony Brook is situated at the epicenter of Lyme disease in North America. Our University Medical Center sees several hundred patients per year. The Division of Infectious Diseases is at the forefront of an interdepartmental research program, using cutting edge molecular biological techniques to develop reliable diagnostic tests, multivalent vaccines and innovative therapies.

AIDS Center
The AIDS Center, a New York State designated program, encompasses a multidisciplinary approach to management of patients with HIV infection. The Comprehensive HIV/AIDS Center has a large clinical research program involved in the testing of new therapies for HIV treatment as well as development of a vaccine for HIV. These programs interrelate to basic investigations of HIV pathogenesis by examining immune reconstitution of people under therapy for HIV infections. New therapies for HIV based upon identification of target sites in HIV replication cycles are under study. The Center also includes the State-funded HIV Clinical Scholars Program, an educational program supported by the New York State Department of Health's AIDS Institute.

Other areas of investigation are

• studies of Toxoplasma gondii with the aim of identifying steps in replication that may be susceptible to chemotherapy
• studies of the molecular pathogenesis of Hantavirus which leads to Adult Respiratory Distress Syndrome (ARDS)
• in vitro, in vivo and clinical trials of investigational antibacterial and antiviral agents; epidemiology of antimicrobial use and abuse
• epidemiology and prevention of nosocomial infections, infections in patients with compromised host defenses and infection with resistant organisms
• host defense mechanisms for infectious organisms, such as Cryptosporidium, Leishmania donovani, Salmonella typhi, Borrelia burgdorferi, Toxoplasma gondii and HIV Trichinella spiralis
• molecular mechanism of microbial adherence to mucosal and endothelial surfaces

Medical students may take the clinical infectious diseases rotation. Students evaluate patients seen in consultation and discuss each patient with division fellows and faculty. Students also gain experience working with a modern clinical microbiology laboratory. Electives are available at both hospitals. Under attending supervision, residents see patients in consultation.

The division has an approved fellowship program in Infectious Diseases. The two-year program encompasses both clinical and research activity. Divisional conferences include a weekly Clinical Journal Club, a weekly Clinical Conference, periodic Research Conferences and Journal Clubs and a biweekly lecture series on core topics in infectious diseases. In addition to working with members of the Infectious Disease faculty in the Department of Medicine, arrangements can be made for postdoctoral fellows to work in laboratories of members of the basic science departments, such as Microbiology and Pharmacology, or the Infectious Disease Institute of the Center for Molecular Medicine.

Nephrology and Hypertension
The Division of Nephrology and Hypertension provides inpatient consultation and ambulatory care services for the evaluation and management of patients with fluid and electrolyte disorders, acid-base disturbances, metabolic bone or stone disease, glomerulonephritis, renal failure, complicated hypertension, management of hypertension, and renal transplantation. Emphasis is placed on a variety of ambulatory services; particularly management of diabetic nephropathy, evaluations of potential patients for transplantation and long term follow up of transplanted patients. In collaboration with the Departments of Radiology, Pathology, and Urology, the division offers the latest in sophisticated diagnostic techniques for the evaluation of patients. At both institutions, the division offers the full range of renal replacement therapies, including acute and chronic hemodialysis, acute and chronic peritoneal dialysis, continuous ambulatory peritoneal dialysis and continuous venous hemofiltration. An active and successful renal transplant program at University Medical Center complements these programs. A lithotripter for the treatment of stone disease and plasmapheresis unit for management of immuno-complex diseases exists at University Medical Center.

The clinical activities of the division are complemented by an active basic and clinical research program. Present areas of investigation include:

• role of integrins in the pathogenesis of acute renal failure.
• pathogenesis and pathophysiology of aminoglycoside-induced acute renal failure.
• role of viral infection in chronic interstitial nephritis.
• pathogenesis and pathophysiology of altered renal cortical phospholipid metabolism in diabetes mellitus.
• collagen metabolism in the pathogenesis of diabetic nephropathy.
• mechanisms of endothelin action on cells of the renal origin.
• role of nitrous oxide in renal cell signal transduction mechanisms.
• pathogenesis of cyclosporine-induced acute renal failure.
• exploration of drug detoxification mechanisms by proximal tubule cells.
• biocompatibility of hemodialysis membranes.
• effects of vasoactive agents on cultured mesangial cells.
• cellular mechanisms of urinary acidification.
• mechanisms of intracellular pH regulation.
• cellular mechanisms of PTH action on proximal tubular cell transport.
• role of oxidative stress in epithelial cell injury.
• evaluation of efficacy of new drugs in the therapy of essential hypertension.
• application of ambulatory blood pressure monitoring to the evaluation of essential hypertension.
• evaluation of new anti-rejection therapies for renal transplant recipients.
• evaluation of the management of the anemia of chronic renal failure.

The division sponsors weekly conferences including Clinical and Basic Science Journal Club, Renal Research Seminar, Nephrology Grand Rounds, Renal Physiology Seminar, as well as a monthly Renal Biopsy Conference.

The division offers a two-year fellowship program which emphasizes ambulatory care during the second year. Additional training is available for those who wish to pursue a career in academic nephrology.

The division also offers electives for second - and third - year medical residents and for fourth-year medical students.

Oncology
The Division of Oncology is actively involved in the evaluation of innovative treatment modalities for human cancer. The molecular biology and the biochemistry of tumor cell invasion constitutes the major emphasis of the division's laboratory investigative activity.

The major thrust of the division clinical investigations is the evaluation of Phase I and Phase II drugs for treatment of cancers in humans, with particular interest in the modulation of antimetabolites with other agents. Pharmacokinetic studies of drug levels in blood and tumors are actively pursued at University Medical Center in the clinical research center. Diagnostic imaging studies, employing biological agents, are also in progress.

We participate in nation-wide evaluations of high-dose chemotherapy with bone marrow and/or peripheral blood stem cell support. A chemoprevention program is also being introduced to the Division Oncology Clinical Trials.

The ex-vivo expansion of hematopoietic stem cells research program was started this year. We evaluate the effect of several cytokines on the growth of the stem cell.

The division is investigating cell and molecular biology activity concerning human carcinogenesis. A major effort may identify the genetic locus responsible for cancer susceptibility in the cancer family syndrome. Studies are under way to determine the mechanism of action of a number of oncogene products, including ras, src and the transforming proteins of the Epstein-Barr virus. Further, the proteolytic enzymes responsible for cancer cell invasion are being characterized in detail. The Division of Oncology has a joint training program with the Division of Hematology.

Pulmonary/Critical Care
The Pulmonary/Critical Care Division oversees critical care units and lung consultation services at the University Medical Center and the Northport VAMC. The division offers a three-year fellowship in preparation of a well-rounded pulmonary/critical care physicians. Clinical training is intense and trainees emerge with a comprehensive grasp of respiratory-hemadynamic physiology, diagnostic procedures, critical care, and scholarly thinking.

Fellows are exposed to research methods with a mandatory month research block during the second and third years, in parallel with clinical training. The trainees are prepared for the presentation and publication of investigative results at national conferences and in peer-reviewed journals.

Area of active faculty investigation include basic and clinical studies of acute lung injury and asthma, human studies of airway inflammation and nosocomial infection, asthma, pleural effusions, lung mechanics, aerosol physiology and mucociliary clearance, sleep disorders, and lung defense mechanisms.

Rheumatology
The Division of Rheumatology has six full-time faculty members and four fellowship positions for a two-year accredited program. The program consists of inpatient and outpatient clinical services at the University Medical Center at Stony Brook and at the VA Medical Center at Northport. Medical students and residents may elect clinical or basic science research projects in the division.

Clinical fellows spend their time performing consultations, attending conferences and using elective time for research projects or independent studies. Fellowship training leads to board eligibility in Rheumatology at the end of the second year.