Yale connections around the world

When Tamara Lazic, now a second-year student at the School of Medicine, sought to combine a passion for languages with research for her thesis, she had no idea the project would take her halfway around the world to work in a clinic where a Yale physician collaborating with a former Yale fellow would perform a life-changing procedure on her mother.

A native of Belgrade, Serbia, Lazic traveled to Los Angeles in 1999 to live with her father, and in 2004 came to New Haven, after graduating from UCLA with a degree in physiological science. Like many students at the School of Medicine, she wanted to begin research for her thesis during the summer between her first and second years. But Lazic, who speaks Serbo-Croatian, English, Spanish and some Russian, also wanted to learn another language. She set her sights on Italy, which had the added bonus of being located just across the Adriatic Sea from her mother, a legal advisor in the Ministry of Internal Economic Relations of Serbia and Montenegro.

While researching overseas projects, Lazic came across the work of Robert I. White Jr., M.D., professor of diagnostic radiology and director of the Yale Vascular Malformation Center. An interventional radiologist, White travels widely to treat patients and educate physicians about hereditary hemorrhagic telangiectasia (HHT), a vascular disorder. Patients with HHT, also called Osler-Weber-Rendu syndrome, lack the capillaries that normally form between arteries and veins. This lack creates fragile sites that can rupture and bleed due to the flow of high-pressure arterial blood directly into veins. About 95 percent of people with HHT have recurrent nosebleeds, but lesions and malformations can occur in many parts of the body. Defects in smaller blood vessels, such as those inside the nose or on the skin, are known as telangiectases, while those in the larger blood vessels in the liver, lungs, brain and gastrointestinal tract are called arteriovenous malformations (AVMs). HHT affects approximately one person in 5,000, involves multiple organs and often goes undiagnosed. White has been on a mission to understand and treat HHT since 1990, when he helped found the Hereditary Hemorrhagic Telangiectasia Foundation International (www.HHT.org). Since then he has been instrumental in establishing 20 HHT Centers of Excellence in the United States, Europe and Japan. “For every 100 patients with HHT, 40 have lung or brain malformations, and half of those will be disabled or die prematurely from something that can be fixed,” he said. Treatment usually involves embolization, a minimally invasive procedure in which the blood supply to the abnormal blood vessels is cut off.

White’s enthusiasm for the HHT cause is contagious, and Lazic quickly signed on to spend last summer at the HHT center at the University of Bari in southern Italy, where she did research on diffuse pulmonary AVMs, the most severe form of the disease, in which multiple AVMs form in one or both lungs. White has close ties to the Bari center, which he visits twice a year to help treat patients. The center was established thanks to HHT patient Nicola Signorile, whom White met at a conference in Denmark in 1999. Signorile, a retired accountant, had suffered severe nosebleeds for 30 years before being diagnosed with HHT in 1997, but had been unable to find a physician to treat him. White encouraged him to seek out a physician in Italy who would be interested in learning more about diagnosing and treating the disease. Signorile’s search led him to Carlo Sabbà, M.D., FW ’90, a professor of medicine at the University of Bari, who had completed a two-year hepatology fellowship at Yale in 1990. Signorile introduced Sabbà to White at a conference in Toronto in 2000 and Sabbà was hooked: with the help of university President Giovanni Girone, a college classmate of Signorile, the University of Bari opened the Interdepartmental HHT Center in 2001 with Sabbà as its director.

Four years after it opened, the Bari center now treats 300 families from all over Italy and southern Europe. “Our center came about as Yale’s offspring, but is now growing into a beautiful adolescent,” said Sabbà. White has helped train doctors there to repair AVMs and continues to assist in complex cases during his regular visits. In 2005 he convinced Signorile, who had suffered a cardiac arrest following a severe nosebleed in which he lost two liters of blood, to come to Yale for a septal dermoplasty, a procedure perfected by Yale HHT team member Douglas A. Ross, M.D., associate professor of surgery (otolaryngology). Last June Signorile underwent the procedure, which involves replacing the lining of the nose with a skin graft from the thigh. He couldn’t be happier with the results. “It was extraordinary,” he said. “I want everyone to know, because people are afraid of this operation, especially in Italy.”

Meanwhile, Tamara Lazic’s mother, Vesna Lazic, 51, had a different problem. She had been suffering from pelvic pain and bleeding so severe that it was sapping her energy and making her daily activities difficult. When Lazic showed White her mother’s medical records, he suspected, correctly, uterine fibroids. In his travels, White also teaches uterine-fibroid embolization, a procedure similar to the one used to treat AVMs, in which the fibroid’s blood supply is cut off, literally starving the tumor to death. Viewing Vesna Lazic’s case as both a teaching opportunity (the procedure is unavailable in Serbia and had not been done at Bari) and a chance to help both her and her daughter, he offered to perform the procedure in Bari. Sabbà and Girone immediately arranged to accept Vesna Lazic as a patient at no charge, but the next obstacle was getting her to Italy. It normally takes a month to obtain a visa to enter Italy from Serbia, but White had to leave the country in just a few days. Girone used his contacts at the Italian embassy in Belgrade to prevail upon authorities to speed the process.

Lazic and her mother see each other only once a year, and were overjoyed to be reunited and to resolve Vesna Lazic’s medical problems. Vesna Lazic arrived in Bari in August; White successfully performed the embolization and taught doctors there how to do the procedure. “It opened a lot of doors for them,” said Lazic, who is grateful for the help she and her mother received.

Looking back, Lazic is amazed at the turn of events that led to her mother’s uterine-fibroid embolization. As a Yale medical student, she traveled 3,000 miles for her thesis project, where she met a former Yale patient, worked with a Yale-trained specialist in a center whose existence was sparked by Yale research and saw “image-guided therapy” performed on her mother by a Yale physician. All these encounters were in a sense made possible by Sanfurd G. Bluestein, M.D. ’46, a retired radiologist who is sponsoring Lazic’s medical education through a scholarship fund he established in 1996. It’s quite a journey for a young woman who grew up in war-torn Serbia and who sees the opportunity to attend Yale as a dream come true. “If you told me six years ago that I would end up at Yale,” she said, “I wouldn’t have believed you.” YM