Faculty Bibliography

House [Television Program] -- The premise: A 16-year-old is brought to the hospital after experiencing breathing difficulties while making out with his girlfriend. When a chest X-ray reveals fluid in the pleural space (lining of the lung), Dr. Gregory House and his team conclude that the fluid must be blood, so they shoot dye into the teen's veins (venogram) and then his arteries (arteriogram) searching for the source. They discover a blockage in the liver and perform an MRI scan that reveals what appears to be an inflammatory patch (granuloma). They suspect the patient has Wegener's Granulomatosis (a vasculitis or inflammation of the blood vessels) and treat him with chemotherapy, which appears to cause his bladder to bleed. House then recommends FT 28, an experimental immunological treatment

As soon as the Journal of the American Medical Association's study from Britain which showed an almost 50% increase in hip fractures in elderly patients taking stomach drugs Nexium, Prevacid and Prisolec was published, many patients were frightened to continue taking drugs which only a day before had helped them live pain-free, reflux-free lives. Over interpretation of a perfectly good study and fear leads to good drugs becoming instant bad guys. Many doctors are sure to continue using proton-pump inhibitors because people do not have good alternatives to these drugs

Grey's Anatomy [Television Program] -- The premise: Intern George O'Malley (T.R. Knight) is worried because his father, [Harold O'Malley], having recently undergone a heart operation (aortic valve replacement), is now having an operation for esophageal cancer. The doctors don't know if the cancer has spread. Harold is told that the tumor won't be removed if it is too extensive. Harold tells the surgeon, Dr. Richard Webber (James Pickens Jr.), that he wants the cancer removed no matter what. The operation reveals metastases to the stomach, lymph nodes and liver. Webber follows the patient's wishes and performs an extensive operation. Postoperatively, Harold does poorly, requiring an emergency reintubation (insertion of a breathing tube), before going into kidney failure and dying. George wrestles with the fact that his father might have lived longer without surgery

One of them, Jason Ventress (David Arquette), accidentally shoots himself in the foot with a large handgun while contemplating suicide. [Joanna Lupone] bandages the foot and he is released. Another alumnus, Harry Kennison is punched in the nose. Lupone touches his tender nose and pronounces it broken. He is then sent home without treatment. The medical questions: What is the medical purpose of listing a person as someone to contact 'in case of emergency'? Shouldn't an accidental gunshot wound lead to questions about a possible suicide attempt? Is cleaning out and bandaging the wound (the treatment Ventress received) sufficient, or would he be given X-rays and antibiotics? Can a broken nose be diagnosed so easily -- without X- rays or at least a careful examination?

As the pioneer drug in a class known as CETP (cholesterol ester transfer protein) inhibitors, torcetrapib had been shown previously by Pfizer to raise HDL, or good cholesterol, by more than 60%. Now Pfizer has taken a public relations hit because of its study discovery that the torcetrapib group had a higher death rate than the control group. But the criticism is hardly fair when you consider the pioneer spirit and resources of the company and how this spirit has so often led to great drugs

Fortunately, thanks in part to flu vaccines and other public health measures, the last three pandemics have been progressively milder from over 50 million dead worldwide in the worst flu pandemic in 1918,102 million dead in 1957, to 1 million fatalities in 1968 (see 'The World's 'Most Unwanted' List,' p. 14). You've probably heard your parents or teachers talk about the possibility of a bird flu pandemic. Or perhaps you even saw the frightening TV docudrama shown on a major network that followed the events of a fictitious bird flu outbreak among, humans, and the widespread panic that followed. However, our public discussions of a possible flu pandemic from the H5N1 bird flu have been informed largely by the ghost of the 1918 Spanish Flu, which was caused by a new flu virus, known as H1N1.

I acknowledged that one 85-year-old patient, Anne, who had been coming to see me for 20 years, had been placed on Zyprexa when she became demented and paranoid that ruffians who had harassed her as a child had somehow re-entered her life (they hadn't). A small dose of Zyprexa had helped Anne enormously, and she was now much calmer and no longer paranoid. I mentioned that most of the psychiatrists I knew used milder and better-tolerated mood-stabilizing drugs such as Depakote for bipolar disorder, that they didn't rely on the more powerful and side- effect-plagued Zyprexa as a mainstay of treatment. And neurologists had told me that antipsychotics such as Zyprexa are often over- prescribed for dementia and are not indicated if the patient is relatively calm. I don't deny I can play a role in the treatment of mental illness, but this is best accomplished in conjunction with a true expert. For instance, when I learned that Zyprexa can cause weight gain, I called Anne's psychiatrist and together we made the decision not to stop Anne's prescription because she had not gained weight on it. She already had diabetes, which has recently been associated with Zyprexa, but the pill had not worsened her condition

The premise: Nurse Carla Espinosa (Judy Reyes) goes into labor. When she reaches the hospital, her cervix is 3 centimeters dilated. She is told to push. Then the obstetrician discovers that the fetus has a prolapsed umbilical cord and orders an emergency cesarean section. The baby is born with the cord wrapped around her neck (a nuchal cord) and is whisked away to intensive care but is soon pronounced fine. An umbilical cord prolapse most often requires an emergency C- section. In the case of an 'overt umbilical cord prolapse,' the cord starts moving into the vaginal canal before the baby does. This happens in fewer than 1 in 300 births. An emergency C-section is required to keep the blood supply to the fetus from being cut off due to pressure from the baby's head or constriction of the cord's blood vessels due to a temperature drop

Food-borne illness is a serious problem in this country, but E.coli 0157 is a very small part of that problem. The National Center for Health Statistics estimates more than 9,000 Americans die yearly from food-borne illnesses, and more than 75 million people get sick. But the Centers for Disease Control estimates that just 73,000 of these illnesses are from the kind of bacteria (E. coli 0157:H7) that has been found at Taco Bell, with 60 deaths yearly. Most victims get diarrhea, but few develop the kind of kidney failure that has currently affected at least three people. Of course, this hardly lets Taco Bell off the hook. The chain's response to the outbreak is hardly reminiscent of that for the spinach outbreak of the same toxigenic E. coli in September. Then the government had easy access to evidence. Now it must work through the Taco Bell bureaucracy. The Food and Drug Administration and the CDC have been trying to track the cause of the outbreak to a certain vegetable, believed to be green onions

About 36,000 Americans die each year from the flu, and 200,000 are hospitalized. Though a relatively small number of the deaths -- 100 -- are children 5 or younger, 20,000 hospitalizations include children in this age group. Inoculating children won't end this annual misery, but if more kids receive the vaccine, the impact of the flu virus could be softened considerably. *Efficacy. In addition, the flu shot's effectiveness in children has been questioned. Indeed, recent studies have indicated that the shot might be less effective in children younger than 2 because of weaker immune reactions. Two shots appear to be necessary to achieve comparable results. Does this mean these children shouldn't receive the shot -- or shots? No, it means parents and the children's doctors need to be vigilant in ensuring that these infants build up the required immunity. As for older children, the flu vaccine has proved highly effective. A 2001 study in the Journal of Pediatric Infectious Diseases showed a 77%-91% effectiveness against influenza in inoculated children ages 1-15. *Myths. The National Foundation of Infectious Diseases found that nearly half of the people surveyed this year believed erroneously that the flu vaccine, which uses a dead virus, can cause influenza. Another myth: A shot must be administered by November for it to be effective during the flu season, which generally runs from October through May. Because it takes less than a month for most patients to develop antibodies, and because flu season tends to peak in most parts of the USA in January, December is still a reasonable time to get the shot