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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..

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

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 stroke was caused by a blood clot that may have come from Tools' artificial heart, called the AbioCor and manufactured by Abiomed Inc. The bleeding, in turn, may have been a consequence of the stroke. It is not unusual for some bleeding to occur into a clot- damaged area of the brain a few days after a stroke

''Any vaccination strategy for containing a smallpox outbreak should utilize the ring vaccination concept,'' the guidelines said. ''This includes isolation of confirmed and suspected smallpox cases with tracing, vaccination and close surveillance of contacts in these cases as well as vaccination of the household contacts of the contacts.'' Such vaccination involves detecting infected people and then finding everyone they had contact with when they could have transmitted the smallpox virus. The program would focus on vaccinating contacts in outward rings to create a buffer of immune people. Although smallpox vaccine is considered safe, it can lead to serious adverse effects among those receiving it for the first time. The plan mentions that patients who develop serious reactions can be helped by injections of vaccinia immune globulin, which is derived from the blood of people who have recently received smallpox vaccinations. The globulin is in short supply, with enough to treat only about 600 people, but plans are being made to increase the supply, Dr. [Lisa Rotz] said

With the agreement of Mr. Tools's wife, Carol, and a retired anesthesiologist who had been appointed as an advocate for Mr. Tools, Dr. [Robert D. Dowling] instructed engineers to override safety commands in a computer to stop the AbioCor mechanical heart. Until then, the device had beat flawlessly more than 20 million times inside Mr. Tools. Before receiving the implant, Mr. Tools was nearly bedridden from end-stage heart failure. He had lost more than 50 pounds, mostly muscle, and had difficulty even raising his head. Heart attacks had left such extensive scarring that the two main pumping chambers of his heart were failing badly, and his lungs were full of fluid. A formula used to predict survival in heart failure patients showed that statistically, Mr. Tools had an 80 percent chance of dying within 30 days. On Nov. 11, Mr. Tools suffered a major stroke that paralyzed the right side of his body and impaired his speech. The stroke was due to a blood clot that may have come from the AbioCor heart. The AbioCor was removed in an autopsy yesterday, and a detailed examination may provide clues to the origin of the stroke

The Sept. 11 attacks dealt ''a major blow to the global AIDS agenda'' because fears of terrorism displaced AIDS in the political dialogue in countries affected by H.I.V. and made it harder to get contributions to a fund that the United Nations has created for AIDS, tuberculosis and malaria, Dr. [Peter Piot] said. Disparities in H.I.V. rates are striking. Sixteen African countries have rates exceeding 10 percent among adults. But 119 countries have rates of less than 1 percent. Although H.I.V. came to Asia in the 1990's, it has infected 7.1 million people. This year, for the first time, new infections in Asia exceeded one million. Prevalence rates exceed 1 percent in Cambodia, Myanmar and Thailand. ''Few countries are acting vigorously enough to protect sex workers and clients'' from H.I.V., Dr. Piot said. ''Yet, it is from the comparatively small pool of sex workers first infected by their clients that H.I.V. steadily enters the larger pool of still-uninfected clients who eventually transmit the virus.''

Dr. [Laman A. Gray Jr.] and his partner, Dr. Robert D. Dowling, said the man had a type of lung problem known as interstitial edema that they attributed to the malnutrition. Otherwise, they said, tests show that the man's lungs are exchanging oxygen and carbon dioxide well. The man's liver function is near normal, and a blood test for creatinine, a standard measure of kidney function, shows improvement to 2.2 today compared with about 3 before the implant, the doctors said. A normal creatinine is less than about 1, and the man's lowest creatinine in the last two years was 1.9 as his kidneys also failed. The AbioCor is much quieter than the Jarvik-7 and ventricular assist devices and makes a soft swishing sound as it beats, Dr. Gray said. The man's AbioCor is pumping about seven liters a minute, in the range of a normal heart's but four times the amount the patient's failing heart could pump before the implant. Now Dr. Gray said he expected that the man would probably stay on a ventilator for another two weeks or so. To improve the man's comfort and allow him to get up in that period, Dr. Gray said, surgeons might soon cut a hole in the man's windpipe (a tracheotomy) to avoid keeping a breathing tube in his throat

The second 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. Tools' heart had been removed and replaced with a pump called the AbioCor on July 2. Now, his prognosis is uncertain. 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 a patient alive long enough to wait for a donor heart. 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 well enough to pump on their own

The puzzle is how Mrs. [Otillie W. Lundgren], a woman in her 90's who lived alone, walked with a cane and had limited contact with the world outside her home could have come down with inhalation anthrax. Anthrax has been rare in Connecticut; since 1950, the state has reported just one case, and that was the skin form involving a male mill worker in Glenville in 1968. Mrs. Lundgren's strain of anthrax matches that of the other 18 confirmed cases, said Tom Skinner, a C.D.C. spokesman. It will be later this week before scientists learn whether spores were present in her home, which investigators tested Tuesday. The medical detectives are also looking for evidence of contamination in her mail. On Monday, as Mrs. Lundgren's condition deteriorated rapidly, her chest X-ray became abnormal, but it did not show the characteristic widening of the mediastinum, the space between the lungs that is typically expanded by swollen lymph nodes when they are infected with anthrax, Dr. [Kenneth Dobuler] said. The hospital notified the health department, which performed additional tests to identify the microbe as B. anthracis