Internal Medicine

Clinical Programs

Allergy and Clinical Immunology
The newest division in our department is the Division of Allergy & Clinical Immunology. Houston is often regarded as the "allergy capital of the world". Thus, there are many patients who need the services that this division can provide. The division shares the three pronged departmental mission of teaching, research and clinical service. The potential for clinical teaching is very broad, with clinics three days a week, active consult services at three different hospitals and plans to expand specialty services to two others. There are monthly specialty conferences at UT as well as Baylor. Our division works closely with other clinical groups at UT including the Pulmonary medicine division with asthmatics, Otolaryngology Department with upper airway diseases, Dermatology Department with allergic skin diseases and the Infectious Disease division with HIV disease. In addition, there are increasing referrals for evaluation and therapy of nonallergic immunological diseases. Finally, we have begun a collaborative effort with the Department of Pathology for a Diagnostic Immunology Laboratory that will offer specialized testing not currently available in our locale.

Cardiology
The faculty of the Division of Cardiology provide a balanced scope of services in both the inpatient and outpatient settings. At Hermann Hospital, the inpatient cardiology service is comprised of the Cardiac Care Unit (CCU), Cardiac Intermediate Care Unit (CIMU), and the Cardiovascular/Cardiac Care Unit (CV/CCU). The cardiology consultative team evaluates patients admitted to other services wh have cardiovascular diseases as a secondary aspect of their acute problem. On both the inpatient and consultative teams, teaching in cardiac patho- physiology and electrophysiology is emphasized. Teaching conferences are held regularly and include a cardiac catheterization conference, a cardiac graphics conference, a journal review club as well as an advanced cardiovascular medicine course. An interventional cardiology team is available 24 hours a day for routine and emergent diagnostic cardiac catheterization, thrombolytic therapy for myocardial ischemia and/or infarction, percutaneous transluminal coronary angioplasty, valvuloplasty, insertion of left ventricular assist devices, and coronary and peripheral atherectomy. The electrophysiology team performs diagnostic procedures, insertion of pacemakers, His bundle and accessory pathway ablations, and therapy for supraventricular and ventricular arrhythmias. The Hermann Heart Center provides routine electrocardiography, Holter monitors, 2D and M mode echocardiography with color flow doppler, exercise testing, thallium perfusion and gated ventricular studies, positron emission tomography and cardiac rehabilitation. At the Lyndon B. Johnson General Hospital, the Division of Cardiology provides inpatient and consultative services as well as Cardiac Care Unit teaching.Non-invasive testing is done at the Heart Station on site. There is an active outpatient cardiology clinic. Addional rotations have been established at the M. D. Anderson Cancer Center and at the Texas Heart Institute on their catdiac catheterization and transplant services. Cardiac Surgery at Hermann Hospital is provided by outstanding cardiac surgeons who work very closely with cardiologists in preoperative and ostoperative patient management. Heart transplantation is performed at Hermann Hospital and at the Texas Heart Institute.

Endocrinology
The Division of Endocrinology offers a comprehensive training program for medical students, residents and fellows. This includes extensive clinical experience in the areas of diabetes, reproductive endocrinology, thyroid disorders, calcium and bone metabolism, and other endocrine disorders. Medical students and residents rotate through the consultative services at Hermann Hospital and Lyndon B. Johnson General Hospital. Emphasis is placed on ambulatory teaching at the endocrine clinics located at the Houston Medical Center, LBJ General Hospital, and the M.D. Anderson Cancer Center. Weekly clinical conferences are conducted jointly with Pediatric Endocrinology and the Reproductive Endocrinology and Gynecology Divisions and includes Endocrinology Divisions from the M.D. Anderson Cancer Center and other Medical Center endocrinologists. Endocrine malignancies are seen at the M.D. Anderson outpatient clinic. One faculty member has a joint appointment in the Departments of Obstetrics and Gynecology and Medicine providing outpatient experience in reproductive problem management. The Lyndon B. Johnson Hospital provides clinical experience in seeing florid endocrine disease manifestations and hands on experience in management is gained.

Gastroenterology, Hepatology and Nutrition
The clinical program in gastroenterology is under the combined auspices of the Divisions of Gastroenterology at The University of Texas Medical School and the M.D. Anderson Cancer Center. A broad spectrum of clinical gastroenterology is encountered at Hermann Hospital and LBJ through the inpatient and consultative services. Gastroenterological procedures, including upper and lower diagnostic and therapeutic endoscopy, ERCP, papillotomy, polypectomy, small bowel enteroscopy, esophageal, small bowel, and ano-rectal motility, secretory studies, intestinal and liver biopsies are carried out in a fully equipped clinical gastroenterology suite with fluoroscopic capabilities at Hermann and LBJ. A state-of-the-art outpatient endoscopy suite will open in late 1991. A new ambulatory facility, The Hermann-UT Digestive Disease Center, is being built across the street in the Hermann Professional Building. At the M.D. Anderson Cancer Center, the consultative service evaluates patients with gastrointestinal and hepatic malignancies and infections, as well as problems encompassing the entire spectrum of gastroenterology, including manifestations of the Graft versus Host disease. Residents may gain outpatient experience in gastroenterology by staffing faculty and fellow clinics that are located in the Houston Medical Center building and at the Lyndon B. Johnson General Hospital while rotating on the consult service. The major teaching activities of the Division include a weekly clinical conference, a Radiology/Pathology conference, Journal Club and a research conference.

General Internal Medicine
The Division has ten full-time members and many private community-based physicians who hold clinical appointments. This division has the broadest range of patient care, education, clinical research, administration and quality assurance activities of any division. The largest number of patients in outpatient and inpatient settings are seen by or under the supervision of members of this division. Inpatient care duties include attending responsibilities at both Hermann Hospital and Lyndon Baines Johnson General Hospital (LBJGH). Members provide consultation expertise in management of hypertension, infections in immune compromised and transplant
patients, geriatrics, medical problems in obstetrical and gynecologic patients, peri-surgical medical assessment and management. Two division members are board certified in geriatrics. All house staff have one to two months per year on the ambulatory rotation taught by the division; many fourth year students rotate on this as well. This rotation provides opportunities to learn on general medicine consultation services and in outpatient clinics. Residents see general medicine consults at Hermann Hospital, LBJGH, Harris County Psychiatric Center (a 250 bed inpatient facility) and at the M.D. Anderson Cancer Center inpatient services and Ambulatory Center. Outpatient clinics included in this rotation are the LBJGH Medicine Clinic where the division faculty supervise house staff and students, Thomas Street Clinic and the Houston Medical Center, where the faculty s private patients are seen. Ambulatory teaching is formalized with a curriculum of core articles and lectures. Ambulatory care curriculum is covered at seminars two afternoons per week. The Division of General Medicine supervises house staff at their continuity clinic located in the Hermann Professional Building, just across the street from the medical school. Residents follow their collection of private patients for the duration of their residency and follow them when they require admission to Hermann Hospital. This is an integral part of the residency training program.

Hematology
The clinical program encompasses a comprehensive consultation service at Hermann Hospital, Lyndon Baines Johnson General Hospital (LBJGH), the M.D. Anderson Cancer Center (MDACC), and several specialized patient care services including a hemophilia treatment center and a hyperthermia cancer therapy program. The Division maintains outpatient clinics at Hermann Hospital and the LBJGH which provides care for a large number of patients with diversified hematologic and oncologic disorders. The Division sponsors several scheduled conferences, including a patient care conference, journal review club, interdepartmental cancer conference and specal research seminars given by invited speakers. The Center for Vascular and Thrombosis Research co-sponsors a joint blood conference attended by faculty, fellows, residents, and students. Furthermore, a number of outstanding conferences are offered on a regular basis at the MDACC

Infectious Diseases
Hermann Hospital and the Lyndon B. Johnson General Hospital serve as the major facilities for clinical activities in adult infectious diseases for house officers and students. The Division maintains active consultative and inpatient services in the hospial. Residents and fellows on the consultative service receive comprehensive laboratory and medical experience in all phases of clinical microbiology (bacteriology, mycology, virology, parasitology) as well as clinical infectious diseases. Regularly scheduled conferences include a weekly clinical conference, a city-wide infectious disease conference, and microbiology review sessions. Other clinical programs have been developed. The University Center for Bone and Joint Infection is a coalition of medical specialties for the treatment of complex and intractable infections of bone, joint and soft tissue formed by Hermann Hospital and the Medical School. The University Center for Travel Medicine at Hermann treats travelers diarrhea and prevents endemic diseases whether insect-borne or water-borne. Pre- and post-travel care, immunizations, medications for the business and vacation traveler using the latest Center for Disease Control recommendations health protection and education for the international traveler. Consultants on infectious diseases have a large transplant service to see patients with opportunistic infections at Hermann Hospital.

Pulmonary and Critical Care Medicine
The clinical activities of the Division encom- pass a broad range of acute and chronic disorders of the lung as well as medical critical care. Inpatient activities include supervision of the Medical Intensive Care Unit and the pulmonary consultative team both at Hermann Hospital and the Lyndon B. Johnson General Hospital. Residents assigned to the Medical Intensive Care Units work closely with the primary teams, the pulmonary fellow, and attending physician to care for all of these patients. Both of these services emphasize, in addition to routine diagnosis and therapy, the pathophysiologic basis of disease and the use of newer diagnostic techniques. There is also a consultative service at the M.D. Anderson Cancer Center. The clinical laboratories in the Division include a pulmonary function laboratory, an exercise performance laboratory, and a sleep laboratory. The emphasis of these laboratories is on the invasive and noninvasive assessment of abnormal pulmonary mechanics, disordered gas exchange, and pulmonary vascular disease.

Renal Diseases and Hypertension
The Division of Renal Diseases and Hypertension maintains programs in clinical Nephrology and Renal Transplantation. The inpatient nephrology service at Hermann Hospital provides care for patients with renal and electrolyte disorders, hypertension and other medical complications of end stage renal disease. In addition, the consultative service provides assistance with renal, fluid, and electrolyte problems at Hermann Hospital, the M.D. Anderson Cancer Center, and the Lyndon B. Johnson General Hospital. Both the inpatient and consultative services are integrated with a large acute hemodialysis unit performing 300 treatments a month, a separate chronic hemodialysis unit caring for approximately 150 patients and a home peritoneal dialysis program. Through continuing interaction with the Organ Transplantation Program at Hermann Hospital, house officers are exposed to current issues in renal transplantation.

Rheumatology and Clinical Immunogenetics
Patient care activities include active ambulatory care clinics at the Houston Medical Center Building and the Lyndon Baines Johnson General Hospital and consultative services for inpatients at Hermann Hospital and the LBJGH. The outpatient rheumatology clinics meet five half-days per week with approximately 300 patients (205 new) evaluated monthly. Acutely ill patients are admitted to the Hermann Hospital or LBJGH and are managed by the Internal Medicine house staff under the supervision of full-time faculty. In addition, a wide variety of rheumatologic and immunologic diseases are seen on the consultative service. The goals of the teaching program are to provide both practical experience in the diagnosis and treatment of rheumatic diseases and an understanding of the basic mechanisms underlying pathogenesis. Comprehensive emphasis is also given to the use and interpretation of laboratory tests relevant to rheumatic diseases, especially synovial fluid analysis, autoantibodies and HLA typing. A weekly clinical rheumatology conference focuses on case examples of clinical syndrome, problems, and treatments. Combined Rheumatology-Dermatology Conferences are held monthly to discuss cases and areas of shared interest. A bi-weekly combined Adult-Pediatric Rheumatology-Immunology Conference is held for all Texas Medical Center rheumatologits.

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The University of Texas Medical School at Houston
Department of Internal Medicine 6431 Fannin Street, Ste. 1.150
Houston, Texas 77030 (713) 500-6500 FAX (713) 500-6497

Internal Medicine General Medical School Health Science Center Contact Author Date of Last Edit 09/11/02