T M Ganey

Carolinas Medical Center University, Charlotte, North Carolina, United States

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Publications (62)102.82 Total impact

  • Article: Letters.
    Timothy Ganey, Hans Joerg Meisel
    Spine 12/2014; 39(25):E1552. · 2.16 Impact Factor
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    ABSTRACT: After any physeal injury, the primary concern is the possibility of some pattern of growth alteration, particularly transphyseal bridging that may cause lasting deformities and impact subsequent patient care. Small areas of physeal bridging, however, may be associated with continued growth, rather than impairment. Seven patients with small central physeal bridges of the distal femur were identified. Demographic data and imaging studies were reviewed. Radiography identified small, relatively centrally located transphyseal osseous bridging that was associated with a linear (longitudinal) region of osseous density extending from the physeal bridge proximally into the metaphysis. This linear striation disappeared at the metaphyseal/diaphyseal gradation, an area of progression proximally from metaphysis to diaphysis. Only 1 patient had a significant leg length inequality. Magnetic resonance imaging confirmed the intrametaphyseal linear sclerotic bone and its disappearance with diaphyseal remodeling. Small, central transphyseal osseous bridges may form after radiologically confirmed acute physeal injury. Normal physiological (hydrostatic) growth forces can be sufficient to overcome such limited central bridging and allow continued, essentially normal, longitudinal growth. Level IV (retrospective case series); anatomic study.
    Journal of pediatric orthopedics 06/2013; · 1.23 Impact Factor
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    ABSTRACT: Therapeutic treatment of intervertebral disc repair using cells. The goal of the study was to test the hypothesis that repair of a damaged disc is possible using autologous adipose tissue derived stem and regenerative cells (ADRCs). Degradation resulting from either acute or chronic repetitive disc injury leads to disc degeneration. However, if a damaged disc could be repaired in the early stages, before the onslaught of degradation, then the disc degeneration process may be slowed down. Twelve dogs underwent a partial nucleotomy at 3 lumbar levels (L3-L4, L4-L5, and L5-L6); adjacent levels served as nonoperated controls. The animals (or discs) were allowed to recover from the surgery for 6 weeks. At that time subcutaneous adipose tissue was harvested and ADRCs were isolated. The 3 experimental discs that had undergone a partial nucleotomy were randomized to receive: (1) ADRCs in hyaluronic acid carrier (Cells/HA); (2) HA only; or (3) No Intervention. Assessments of the 3 experimental discs plus the 2 adjacent untouched discs were made using MRI, radiography, histology, and biochemistry. The animals were killed at 6 months and at 12 months. Repair in this study was specifically demonstrated through histology and biochemical analysis. Disc levels receiving ADRCs more closely resembled the healthy controls as evidenced in matrix translucency, compartmentalization of the anulus, and in cell density within the nucleus pulposus. Matrix analysis for Type-II collagen and aggrecan demonstrated evidence of a statistically better regenerative stimulation to the disc provided by ADRCs when compared to either the HA only or no intervention treatments. Autologous adipose tissue derived stem and regenerative cells, as used in this disc injury model, were effective in promoting disc regeneration, as evidenced by disc matrix production and overall disc morphology.
    Spine 10/2009; 34(21):2297-304. · 2.16 Impact Factor
  • John Lovejoy, Timothy M Ganey, John A Ogden
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    ABSTRACT: Three skeletally immature patients with scapulothoracic dissociation were reviewed. A 5-year-old child's arm, caught in a conveyor belt, led to complete upper extremity amputation. Multiple fractures, muscular damage, and cutaneous and subcutaneous tissue disruption (degloving) were present throughout the avulsed extremity. Replantation was considered, but not carried out because of these extensive injuries. He was treated with a myoelectric prosthesis. Two older boys had scapulothoracic dissociation (one open, one closed) associated with clavicular diaphyseal fractures following blunt trauma. In each case, the clavicle was stabilized, muscular disruptions were reattached, and bleeding was controlled locally, although no specific major vascular repair was required. There was no return of neurologic function, leaving each patient with a flail upper extremity. One patient and his family eventually elected to have a shoulder disarticulation followed by fitting with a myoelectric prosthesis. The other patient still had a flail extremity at his last evaluation 17 months postinjury, but did not return for subsequent evaluation.
    Journal of pediatric orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America 05/2009; 18(3):131-4. · 0.66 Impact Factor
  • Michael O'neal, Timothy M Ganey, John A Ogden
    Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine 02/2009; 19(1):65-7. · 1.50 Impact Factor
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    ABSTRACT: Successful bone repair is judged in achieving restitution of space and mechanical integrity, and in regaining function. When the biology or anatomy are insufficient to attain a full repair, therapeutic use of graft material has been used to omit compliance features such as strain tolerance, reduced stiffness, and attenuated strength, and instead promote primary or membranous-type bone formation within the physical approximation of a graft material. The challenge of most conductive materials is that they emerge from a static platform and in placement force the living system to adapt to placement, dimension, different properties, and eventually are only successful in degradation and replacement, or in integration. The synergy and interdependency between adhesion, ECM, and proteolysis are important concepts that must be understood to engineer scaffolds capable of holding up to standards which are more than cell decoration. Moreover, the reactive specificity to loading, degradation, therapeutic delivery during absorption remains a key aim of both academic and industrial designs. Achieving conductivity comes with challenges of best fit integration, delivery, and in integrated modeling. The more liquid is the delivery, the more modular the components, and adaptive the matrix to meeting the intended application, the more likely that the conductivity will not be excluded by the morphology of the injury site. Considerations for osteoconductive materials for bone repair and replacement have developed conceptually and advanced parallel with a better understanding of not only bone biology but of materials science. First models of material replacements utilized a reductionist-constructionist logic; define the constituents of the material in terms of its morphology and chemical composition, and then engineer material with similar content and properties as a means of accommodating a replacement. Unfortunately for biologic systems, empiric formulation is insufficient to promote adequate integration in a timely fashion. Future matrices will need to translate their biological surfaces as more than a scaffold to be decorated with cells. Conductivity will be improved by formulations that enhance function, further extended from understanding what composition best suits cell attachment, and be adopted by conveniences of delivery that meet those criteria.
    SAS Journal 01/2009; 3(3):108-112.
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    ABSTRACT: Low back pain is an extremely common symptom, affecting nearly three-quarters of the population sometime in their life. Given that disc herniation is thought to be an extension of progressive disc degeneration that attends the normal aging process, seeking an effective therapy that staves off disc degeneration has been considered a logical attempt to reduce back pain. The most apparent cellular and biochemical changes attributable to degeneration include a decrease in cell density in the disc that is accompanied by a reduction in synthesis of cartilage-specific extracellular matrix components. With this in mind, one therapeutic strategy would be to replace, regenerate, or augment the intervertebral disc cell population, with a goal of correcting matrix insufficiencies and restoring normal segment biomechanics. Biological restoration through the use of autologous disc chondrocyte transplantation offers a potential to achieve functional integration of disc metabolism and mechanics. We designed an animal study using the dog as our model to investigate this hypothesis by transplantation of autologous disc-derived chondrocytes into degenerated intervertebral discs. As a result we demonstrated that disc cells remained viable after transplantation; transplanted disc cells produced an extracellular matrix that contained components similar to normal intervertebral disc tissue; a statistically significant correlation between transplanting cells and retention of disc height could displayed. Following these results the Euro Disc Randomized Trial was initiated to embrace a representative patient group with persistent symptoms that had not responded to conservative treatment where an indication for surgical treatment was given. In the interim analyses we evaluated that patients who received autologous disc cell transplantation had greater pain reduction at 2 years compared with patients who did not receive cells following their discectomy surgery and discs in patients that received cells demonstrated a significant difference as a group in the fluid content of their treated disc when compared to control. Autologous disc-derived cell transplantation is technically feasible and biologically relevant to repairing disc damage and retarding disc degeneration. Adipose tissue provides an alternative source of regenerative cells with little donor site morbidity. These regenerative cells are able to differentiate into a nucleus pulposus-like phenotype when exposed to environmental factors similar to disc, and offer the inherent advantage of availability without the need for transporting, culturing, and expanding the cells. In an effort to develop a clinical option for cell placement and assess the response of the cells to the post-surgical milieu, adipose-derived cells were collected, concentrated, and transplanted under fluoroscopic guidance directly into a surgically damaged disc using our dog model. This study provides evidence that cells harvested from adipose tissue might offer a reliable source of regenerative potential capable of bio-restitution.
    European Spine Journal 12/2008; 17 Suppl 4:492-503. · 2.47 Impact Factor
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    ABSTRACT: The use of biological technologies for the treatment of degenerative spinal diseases has undergone rapid clinical and scientific development. BMP strategies have gained wide support for an inherent potential to improve the ossification process. It has been extensively studied in combination with various techniques for spinal stabilisation from both anterior and posterior approach. We studied the fusion process after implantation of rhBMP-2 in 17 patients with degenerative lumbar spine diseases in combination with dorsal fixation with pedicle screws and poly-ether-ether-ketone (PEEK) interbody cages. We used 12 mg rhBMP-2 carried by collagen sponge, 6 mg in every cage. Patient follow up consisted of pre-operative radiographic and clinical evaluation. Similar post-operative evaluations were performed at 3 and 6 months. Clinical assessment demonstrated clear improvement in all patients despite evidence of vertebral endplate osteoclastic activity in the 3-month radiographs. The 6-month radiograph, however, confirmed evidence of fusion, and no untoward results or outcomes were noted. While previous studies have shown exclusively positive results in both fusion rates and process, our study demonstrated an intermediate morphology at 3 months during the ossification process using Induct Os in combination with peek-cages using a PLIF-technique. The transient resorption of bone surrounding the peek cage did not result in subsidence, pain or complication, and fusion was reached in all cases within a 6-month-controlled evaluation. Although there was no negative influence on clinical outcome, the potential for osteoclastic or metabolic resorption bears watching during the post-surgical follow up.
    European Spine Journal 11/2008; 17(12):1735-44. · 2.47 Impact Factor
  • Spine 01/2008; · 2.16 Impact Factor
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    ABSTRACT: Disc herniation treated by discectomy results in a significant loss of nucleus material and disc height. Biological restoration through the use of autologous disc chondrocyte transplantation offers a potential to achieve functional integration of disc metabolism and mechanics. Chondrocytes that have been removed from damaged cartilaginous tissues maintain a capacity to proliferate, produce and secrete matrix components and respond to physical stimuli such as dynamic loading. Nucleus regeneration using autologous cultured disc-derived chondrocytes (ADCT) has been demonstrated in a canine model and in clinical pilot studies. In 2002 a prospective, controlled, randomised, multi-center study, EuroDISC, comparing safety and efficacy of autologous disc chondrocyte transplant, chondrotransplant DISC, plus discectomy (ADCT), with discectomy alone was initiated. A dog model was used to investigate the hypothesis that autologous disc chondrocytes can be used to repair damaged intervertebral disc. Disc chondrocytes were harvested and expanded in culture under controlled and defined conditions, returned to the same animals from which they had been sampled (autologous transplantation) via percutaneous delivery. The animals were analyzed at specific times after transplantation by several methods to examine whether disc chondrocytes integrated with the surrounding tissue, produced the appropriate intervertebral disc extracellular matrix, and might provide a formative solution to disc repair. The clinical goals of the EuroDISC study, were to provide long-term pain relief, maintain disc height and prevent adjacent segment disease. Interim analysis was performed after 2 years; Oswestry (low back pain/disability), Quebec Back-Pain Disability Scale, as well as Prolo and VAS score were used for the evaluation. Disc height was assessed by MRI. In the context of degenerative changes in an injury model: () autologous disc chondrocytes were expended in culture and returned to the disc by a minimally invasive procedure after 12 weeks; () disc chondrocytes remained viable after transplantation as shown by bromodeoxyuridine incorporation and maintained a capacity for proliferation after transplantation as depicted by histology; () transplanted disc chondrocytes produced an extracellular matrix that displayed composition similar to normal intervertebral disc tissue. Positive evidence of Proteoglycan content was supported by accepted histochemical staining techniques such as Safranin O-Fast Green; () both Type II and Type I collagens were demonstrated in the regenerated intervertebral disc matrix by immunohistochemistry after chondrocyte transplantation; and () when the disc heights were analyzed for variance according to treatment a statistically significant-correlation between transplanting cells and retention of disc height was achieved. A clinically significant reduction of low back pain in the ADCT-treated group was shown by all three pain score systems. The median total Oswestry score was 2 in the ADCT-treated group compared with 6 in the control group. Decreases in the disability index and VAS score in ADCT-treated patients correlated strongly with the reduction of low back pain. Decreases in disc height over time were only found in the control group, and of potential significance, intervertebral discs in adjacent segments appeared to retain hydration when compared to those adjacent to levels that had undergone discectomy without cell intervention. Autologous chondrocyte transplantation is technically feasible and biologically relevant to repairing disc damage and retarding disc degeneration.
    Biomolecular Engineering 03/2007; 24(1):5-21. · 3.17 Impact Factor
  • Osteoarthritis and Cartilage 01/2007; 15. · 4.26 Impact Factor
  • Osteoarthritis and Cartilage 01/2007; 15. · 4.26 Impact Factor
  • Source
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    ABSTRACT: Disc herniation treated by discectomy results in a significant loss of nucleus material and disc height. Biological restoration through the use of autologous disc chondrocyte transplantation (ADCT) offers a potential to achieve functional integration of disc metabolism and mechanics. Nucleus regeneration using autologous cultured disc-derived chondrocytes has been demonstrated in a canine model and in clinical pilot studies. In 2002 a prospective, controlled, randomized, multicentre study comparing safety and efficacy of ADCT plus discectomy, with discectomy alone was initiated. The clinical goals were to provide long-term pain relief, maintain disc height, and prevent adjacent segment disease. Interim analysis was performed after 2 years; Oswestry (Low Back Pain/disability), Quebec Back Pain Disability Scale, as well as Prolo and VAS Score were used for the evaluation. Disc height was assessed by MRI. A clinically significant reduction of low back pain in the ADCT-treated group was shown by all three pain score systems. The median total Oswestry Score was 2 in the ADCT group compared with 6 in the control group. Decreases in the Disability index in ADCT-treated patients correlated with the reduction of low back pain. Decreases in disc height over time were only found in the control group, and of potential significance, intervertebral discs in adjacent segments appeared to retain hydration when compared to those adjacent to levels that had undergone discectomy without cell intervention.
    European Spine Journal 09/2006; 15 Suppl 3:S397-405. · 2.47 Impact Factor
  • The Spine Journal 01/2006; · 3.36 Impact Factor
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    ABSTRACT: Magnetic resonance imaging (MRI) in children with a presumptive diagnosis of Sever's apophysitis and with continuing pain after conservative treatment demonstrated bone bruising within the trabecular bone of the metaphyseal region adjacent to the calcaneal apophysis. Limited portions of the apophyseal secondary ossification center showed similar increased signal changes. MRI studies following treatment with immobilization showed subsidence or disappearance of the metaphyseal but not any apophyseal signal changes commensurate with improvement in symptoms. Accordingly, the disorder commonly referred to as Sever's ''apophysitis'' may be a metaphyseal trabecular stress fracture, similar to the toddler's calcaneal stress fracture that has minimal or no involvement of the apophyseal ossification center, and thus should not be referred to as an apophysitis. Rather, it appears to be an overuse injury causing microinjury within the developing metaphyseal "equivalent" trabecular bone that has not completely adapted to the changing biologic (biomechanical) requirements of the growing, athletically active child.
    Journal of Pediatric Orthopaedics 08/2004; 24(5):488-92. · 1.16 Impact Factor
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    ABSTRACT: Disc degeneration and osteoarthritis are diseases of the matrix. Chondrocytes that have been removed from damaged cartilaginous tissues maintain a capacity to proliferate, produce, and secrete matrix components, and respond to physical stimuli such as dynamic loading. A dog model was used to investigate the hypothesis that autologous disc chondrocytes can be used to repair damaged intervertebral disc. Given the capacity for the cells in vitro to produce matrix molecules that would be appropriate for disc chondrocytes, the focus of the experiment was to investigate whether the cells would continue to sustain metabolic function after transplantation. No evidence for long-term integration exists for cell transplantation in species other than rats and rabbits. Furthermore, no controlled studies of 1-year duration have been published. Disc chondrocytes were harvested and expanded in culture under controlled and defined conditions, returned to the same animals from which they had been sampled (autologous transplantation) via percutaneous delivery. The animals were analyzed at specific times after transplantation by several methods to examine whether disc chondrocytes integrated with the surrounding tissue, produced the appropriate intervertebral disc extracellular matrix, and might provide a formative solution to disc repair. In the context of degenerative changes in an injury model: (1) autologous disc chondrocytes were expanded in culture and returned to the disc by a minimally invasive procedure after 12 weeks; (2) disc chondrocytes remained viable after transplantation as shown by Bromodeoxyuridine incorporation and maintained a capacity for proliferation after transplantation as depicted by histology; (3) transplanted disc chondrocytes produced an extracellular matrix that displayed composition similar to normal intervertebral disc tissue. Positive evidence of proteoglycan content was supported by accepted histochemical staining techniques such as Safranin O-Fast Green; (4) both type II and type I collagens were demonstrated in the regenerated intervertebral disc matrix by immunohistochemistry after chondrocyte transplantation; and (5) when the disc heights were analyzed for variance according to treatment, a statistically significantcorrelation between transplanting cells and retention of disc height was achieved. Autologous chondrocyte transplantation is technically feasible and biologically relevant to repairing disc damage and retarding disc degeneration.
    Spine 01/2004; 28(23):2609-20. · 2.16 Impact Factor
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    ABSTRACT: The long-term skeletal changes and the lack of significant clinical complaints in a 77-year-old woman with nail patella syndrome are described. Fifty-five years previously she was one of the first reported patients. These early patients came from two families with involvement of multiple individuals with the variable constellation of deformities. We reviewed her skeletal natural history and her family history as it related to nail patella syndrome involvement and treatment, and correlated the original premolecular biology description and subsequent long-term follow-up with the current molecular and genetic concepts of the cause of the variable expression of nail patella syndrome.
    Journal of Pediatric Orthopaedics B 11/2002; 11(4):333-8. · 0.53 Impact Factor
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    Timothy M Ganey, Hans Joerg Meisel
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    ABSTRACT: Lower back pain and disc degeneration negatively affect quality of life and impose an enormous financial burden. An extensive body of scientific work has evolved that characterizes the disc, demonstrating spinal anatomy and morphology that contribute to risk and likely promote failure. Ultimately, matrix failure is responsible for mechanical failure, which in turn results in spinal compromise anatomically and subsequent pain. One intervening approach to breaking this sequence has been to repopulate the anatomy with autologous disc chondrocytes--cells capable of restoring the matrix and retaining the mechanical balance by which the disc functions. This strategy has been implemented both in patients and in animal models, and early results, although preliminary, support the premise as a positive approach.
    European Spine Journal 11/2002; 11 Suppl 2:S206-14. · 2.47 Impact Factor
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    ABSTRACT: Purpose of study: The study was designed to assess whether autologous disc chondrocyte transplantation will prevent disc degeneration after discectomy. Cultured autologous cells were transplanted into the nucleus pulposus of 18 dogs by a closed procedure. Although it has been shown that disc cells sustain a phenotype in culture, the fate of re-implanted cells is not fully understood.Methods used: Mature dogs were radiographed before surgery. Blunt dissection was used to reach the margin of the outer annulus, and 100 mg of nucleus and inner annulus material was sampled from two levels (L1–L2 and L3–L4). The L1–L2 disc of each dog served as a control, and the L3–L4 level was used as the site for transplantation. Although the L2–L3 site was approached, the annulus was not violated. Disc chondrocytes were propagated in culture and reimplanted 10 weeks later under fluoroscopic guidance. Cells from four dogs were treated with BrdU during cultivation to assess viability and location posttransplantation. Postoperative radiographs were taken monthly, and the animals were euthanized at 3 months, 6 months, 9 months and at 1 year. Intervertebral discs were assessed by histology, radiography and magnetic resonance imaging (MRI). Vertebral segments T-13 through S-1 were removed en bloc, radiographed and prepared for MRI. Images were collected at 1.5 T in both T1 and T2 weightings. Disc heights were calculated using a spine index that averaged the height of the disc relative to the two adjacent vertebrae.of findings: MRI exhibited changes in the surgical defect and central retention of characteristic disc morphology. Although experimental levels demonstrated less proton density than the unoperated control, the level receiving cell transplantation (L3–L4) demonstrated a difference in quantity and intensity of signal. The chief pathology evident from the MRI examination was a loss of intensity in the central portion of the L1–L2 intervertebral discs. Although differences in disc height were apparent between levels receiving the cell transplantation and those that had not, no statistical correlation could be demonstrated. Over the 1-year study, positive changes associated with the level receiving cells were a reduction in marrow fibrosis and restoration of end plate morphology. Cells that were reintroduced into the disc appeared to populate, make matrix and suppress inflammatory reaction. Introduction of cells seemed to have a positive effect on cell height, MRI signal and matrix appearance. MRI changes were positive over time, showing enhanced central disc signal and reduction in end plate effusion. Although disc height could not be correlated with cell transplantation statistically, a difference in tissue structure was evident at both the micro and macro level.Relationship between findings and existing knowledge: Autologous cells transplanted into a damaged intervertebral disc appear to slow degeneration. Evidence of matrix production, suppressed inflammation and cell viability was evident grossly (dissection), by MRI, radiography, by histology and by nuclear marker. From these early results, autologous disc chondrocyte cell transplantation appears to offer the promise of retarding degeneration, maintaining intervertebral height and stimulating matrix regeneration after discectomy.Overall significance of findings: While cell viability, matrix production and matrix integration suggest autologous cell transplantation may be a valuable clinical tool, refining technology will strengthen the value in application.Disclosures: No disclosures.Conflict of interest: Timothy Ganey, stockholder; Timothy Ganey, other support.
    The Spine Journal 09/2002; 2(5):50-50. · 3.36 Impact Factor
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    ABSTRACT: The best way to stabilize supracondylar femur fractures remains debatable. Previous studies have compared internal fixation to intramedullary fixation, but none have compared the stiffness characteristics and strength of the 95 degrees angled blade plate (ABP) with the 95 degrees condylar side plate and screw (DCS). 14 synthetic femora were cut in half and the proximal pole of the distal fragment was made secure. A 1 cm gap was made parallel to the femoral condylar weight-bearing surface to create an extraarticular supracondylar femur fracture (OTA 33-A3). 7 femora were stabilized with an ABP and 7 with a DCS. Using an MTS compression/torsion servohydraulic testing machine, each femur was tested in 7 modes of loading: (1) axial compression; (2) anterior compression; (3) posterior compression; (4) medial compression; (5) lateral compression; (6) torsion in external rotation; and (7) torsion in internal rotation. The stiffness of the construct in each mode, the "maximum load in axial compression", and the fatigue characteristics in axial compression were measured. The DCS showed a statistically significant greater stiffness in axial compression and average maximal load than the ABP. The fatigue tests revealed no evidence of permanent deformation or loosening of either construct.
    Acta Orthopaedica Scandinavica 02/2002; 73(1):72-6.

Publication Stats

956 Citations
102.82 Total Impact Points

Institutions

  • 2013
    • Carolinas Medical Center University
      Charlotte, North Carolina, United States
  • 2004–2009
    • Tenet HealthSystem Medical, Inc.
      Dallas, Texas, United States
  • 1994–2009
    • University of South Florida
      • Department of Family Medicine
      Tampa, FL, United States
    • The University of Tampa
      Tampa, Florida, United States
  • 1990–1998
    • Shriners Hospitals for Children
      Tampa, Florida, United States