Faculty Bibliography

Participants like Dr. Ross Brechner of the Maryland State Health Department said defining a big outbreak was difficult. One hundred cases could be a big one, ''but 1,000 would be a monster,'' Dr. Brechner said. The items include rugs, sets of china, jewelry, hundreds of envelopes, even wads of hundred-dollar bills, said two health officials, Dr. James Pearson of the Virginia Division of Consolidated Laboratory Services in Richmond and Elizabeth Franko, director of the Georgia Department of Health Laboratory. In the investigation, the C.D.C. collected blood from patients and people exposed to spores, to validate whether blood tests could help in detecting anthrax infection. For such testing, blood has to be collected at intervals of at least two weeks

DECATUR, Ga. -- About a month after anthrax spores were released from a letter in the office of Sen. Tom Daschle, D-S.D., researchers were able to stir up spores that remained there and disperse them into the air by simulating normal activity in the office, federal scientists reported. The scientists wore protective gear and moved carefully to avoid disturbing the office environment, placing 17 plates around Daschle's office to sample the air. The plates contained a blood agar gel that would allow anthrax spores, if any, to grow. The plates were left from 45 minutes to an hour in the sixth-floor room where the letter was opened on Oct. 15, the scientists said

Mr. and Mrs. [James Quinn] and Dr. [Louis E. Samuels] all spoke of his recovery as miraculous. Mr. Quinn said a major factor was his physical therapist, Kristi Olson, whom he jokingly called a tyrant. Mr. Quinn said that Dr. Samuels had kept him informed about the course of the five other AbioCor recipients and that he prayed for them. Tom Christerson is the only other living recipient to be publicly identified, at Jewish Hospital in Louisville. Two other unidentified recipients are at the University of California at Los Angeles and the Texas Heart Institute in Houston. Two other recipients have died, Mr. Tools and an unidentified man who died at the Texas institute from complications unrelated to the artificial heart. About nine years ago, Mr. Quinn developed idiopathic cardiomyopathy, a heart muscle disease with unknown origin. He did not have the coronary artery disease that caused Mr. Tools's heart to fail. To the extent comparisons are possible, Mr. Quinn appeared more robust in his first public appearance, about a month earlier in the recovery stage than Mr. Tools's

Pointing out that there had been at least 150 operations on the wrong site or the wrong patient since 1996, the Joint Commission on Accreditation of Healthcare Organizations issued its second..

Until the intentional spread of anthrax in recent months, only 18 cases of inhalation anthrax had been reported since 1950, and 227 of the skin form from 1955 to the beginning of the intentional spread this fall. Additional anthrax cases may have gone undetected over the years, but the number would be small, infectious disease experts said in interviews. The boy's physician, Dr. William Borkowsky, a pediatric infectious disease specialist at New York University, said he made a point of studying anthrax when bioterrorism became a threat in recent years. Even so, Dr. Borkowsky said he would have diagnosed the infant's lesion as a spider bite if he had not known that anthrax was present in New York City. ''The syndrome this child had had never been described in anthrax'' but had been linked to spider bites, Dr. Borkowsky said. ''The skin lesions were compatible with anthrax, but the rest of the picture was incompatible because we reviewed all published cases of anthrax dating to the 1950's and never found the particular blood problem, microangiopathic hemolytic anemia, linked to anthrax in an adult or a child.''

Unless a startling finding emerges showing that Ottilie W. Lundgren, 94, of Oxford, Conn., and Kathy T. Nguyen, the 61-year-old hospital worker from the Bronx, somehow inhaled large amounts of spores with nary a trace left around their homes, the cases of these two women also puncture the notion that many spores are required to kill. Some government analysts took note of the postal threat, but the authorities said they never foresaw the widespread consequences of a real postal assault: the undermining of the operations and popularity of the postal system; the sealing of the offices of half of the Senate; and, most chillingly, the secondary spread of spores from letter to sorting machine to letter and -- in the end -- to the skin and lungs of unlikely and unintended victims. Dr. [Jeffrey P. Koplan], the director of the federal Centers for Disease Control and Prevention. (Associated Press); Ottilie W. Lundgren, 94, the widow from Oxford, Conn., who was killed by anthrax. (Reuters); Kathy T. Nguyen, the 61-year-old hospital worker from the Bronx who died of inhalation anthrax. (Associated Press)

Unless some startling new finding emerges showing that Ottilie Lundgren and Kathy Nguyen somehow inhaled large amounts of spores with nary a trace left around their homes, the cases of these two women puncture the notion that a large number of spores is required to kill. As they review medical journals, investigators and anthrax experts are realizing that past cases foreshadowed consequences that instead took them by complete surprise. The journals present case histories in which unlikely victims were killed by the kind of long- distance contamination seen now. This evidence supported the idea that spores could disperse to unintended targets should someone spread the bacteria through the mail, said Col. Arthur M. Friedlander, a U.S. army research scientist

Nevertheless, [Eric A. Rose] said the device was not a cure for heart failure, and that it involved a complication rate 2.35 times higher than that for drugs in the study. The complications included serious infections, bleeding and mechanical malfunctions such as motor failure, kinking of the tubes and worn bearings. However, Rose said that the rate of complications is expected to fall with modifications of the device. Assist pumps may eliminate the need for some transplants, and so may help alleviate the serious shortage of donor hearts for transplant. Permanent assist pumps would also eliminate the risks of the immune-suppressing drugs that transplant recipients need to prevent rejection of the donated heart. Rose said that if the Food and Drug Administration approved assist pumps for permanent use, he expected treatment of end-stage heart failure eventually to resemble that of end-stage kidney failure. 'It is premature to say that VADs are as good a treatment now as dialysis, but you could envision that over time' they will become so, he said

The other event took place on Nov. 11, when Robert Tools, the first recipient of a self-contained artificial heart -- a total heart, not just an assist pump -- had a major stroke that may have been caused by the device. Mr. Tools's heart had been removed and replaced with a pump called the AbioCor at Jewish Hospital in Louisville, Ky., on July 2. The assist device is intended to help those with failure of one of the heart's two pumping chambers, or ventricles. The devices are most commonly used to aid the left ventricle, which pumps oxygen-rich blood to the body, and less often to assist the right ventricle, which pumps blood to the lungs to pick up oxygen. Assist devices are too large for two to fit into a patient with failure of both ventricles. A number of assist devices are marketed for temporary use as a ''bridge to transplant'' to keep patients alive while they wait for donor hearts. People have lived as long as four years with an assist device before a donor heart became available. Occasionally, the devices have been removed after a few months because patients' hearts recovered enough to pump on their own

For 130 days, Robert Tools's recovery as the first of five recipients of a self-contained artificial heart was faster and less eventful than his doctors at Jewish Hospital..