Faculty Bibliography

The most celebrated example of such discordant findings involved Andrew Speaker, the Atlanta lawyer who caused an international health scare after traveling to Europe in May with what was believed to be extensively drug-resistant tuberculosis, known as XDR. This month, Speaker's doctors downgraded his type of tuberculosis to multidrug-resistant, or MDR, after repeating tests that initially gave a different result. The overwhelming majority of tuberculosis cases are caused by bacterial strains that yield to the standard, or first-line, anti- TB drugs. Newer, second-line drugs are used if a strain of tuberculosis is MDR or XDR, which are resistant to the first-line drugs. If tuberculosis strains are not tested for drug resistance as soon as they are found in a patient, the problem may be detected too late to permit a cure. Reliable tests to determine resistance to first-line drugs were developed when the drugs were first marketed about a half-century ago. Fewer resistance tests exist for the newer, second-line drugs needed to treat MDR and XDR tuberculosis, and many of them are difficult to perform

That was the case in Tugela Ferry, a rural town in KwaZulu-Natal province in South Africa, when an outbreak of extremely drug- resistant tuberculosis -- XDR-TB for short -- killed 52 of its 53 victims, all of whom were also infected with HIV. The outbreak was detected in 2005, but it did not receive international attention until it was reported at the international AIDS meeting in Toronto last August. Using statistics from recent years, [Karin Weyer] said her team estimated that 6,000 new cases of multi-drug-resistant tuberculosis occurred in South Africa each year and that the rate of treatment failure was about 10 per cent. Assuming that most failures were due to the extremely drug-resistant form, a conservative estimate is 600 cases of XDR-TB in her country each year, Weyer said. The outbreak is not limited to Africa. Dr. Paul Nunn, a tuberculosis expert at the World Health Organization, told the meeting here that one or more cases of XDR-TB had been found in at least 28 countries. Extrapolating from data about the multi-drug- resistant form of tuberculosis, Nunn estimated that two-thirds of the XDR-TB cases were from China, India and Russia

The combination - taking one inexpensive antibiotic pill each day and sleeping under an insecticide-treated mosquito net - reduced the incidence of malaria by 97 percent compared with a control group, Dr. Anne Gasasira, an AIDS researcher at Makerere University in Kampala, Uganda, said Wednesday at a medical conference in Los Angeles. She said the findings had already changed medical practice in Uganda. But scientists said they had not yet determined whether the treatment would be as effective in HIV-negative children with malaria

Still, the effort is ''a remarkable success'' considering that only 2 percent of infected patients needing antiretroviral therapy were receiving it three years ago, said Dr. Kevin De Cock, the H.I.V./AIDS director at the World Health Organization, a United Nations agency in Geneva. Many numbers were discouraging. In 2006, about six times as many people became infected with H.I.V. as started treatment, meaning prevention efforts are faltering or not in place, Dr. De Cock told reporters by telephone. The Bush administration's emergency plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria were paying for care of about 1.27 million of the two million total, the United Nations said

An even more serious form, known as XDR-TB for extremely drug-resistant tuberculosis, does not respond to any of the fluoroquinolone class and to at least one of three second-line drugs (amikacin, capreomycin and kanamycin) that are given by injection. There are about 450 laboratories in the world now that can detect drug-resistant tuberculosis, although many are not performing to capacity, Dr. Mario C. Raviglione, who directs the health agency's tuberculosis department in Geneva, said in a telephone interview. Under the plan, all laboratories would perform 1.8 million cultures for tuberculosis in 2007 and 2.2 million in 2008, up from the estimated 200,000 in 2006. The laboratories would perform 750,000 drug susceptibility tests in 2007 and 900,000 in 2008, up from 75,000 in 2005

''This technique has a big potential in the vascular surgical field,'' said Dr. Toshiharu Shinoka, who directs pediatric cardiovascular surgery at Yale and who plans to conduct studies with Cytograft on the new vessel. He called the technique an advance over one he used in operations on children in Japan, in which vessels were grown from cells on a scaffold that then degraded and was absorbed into the body. Doctors not connected with the company agreed on the importance of the new technique. ''A potential benefit may be for infants and children with congenital heart defects,'' said Dr. Deepak Srivastava, director of the Gladstone Institute of Cardiovascular Disease at the University of California, San Francisco. Unlike grafts from cadavers, he added, ''the Cytograft vessels should be able to grow as the child does.'' Dr. Sergio A. Garrido, a vascular surgeon in Buenos Aires, said he implanted the Cytograft vessels in the forearm or upper arm under general anesthesia, in a different area from the malfunctioning shunt. The procedure took 60 to 90 minutes. Through surgical gloves, the Cytograft vessel, 5 1/2 to 11 * inches long, felt a little more delicate than a regular vein, he said

'Calling in Dr. [Michael DeBakey] was very important, a signal that he was in very serious condition, and consulting with a world leader in surgery this way was almost unthinkable in the Soviet period,' said Marshall Goldman, a Russian expert and senior scholar at Harvard. 'It was a measure of Dr. DeBakey's stature in Russia.' As a patient, [Boris Yeltsin] 'was not as bossy with me as he was with some of his Russian doctors,' DeBakey said, adding: 'He didn't get along with some of the doctors there. But he took a liking to me, listened, and that made things much better.' My requests for interviews with Yeltsin were always denied, so I was never able to ask him about DeBakey. But in a foreword to the Russian edition of DeBakey's book The New Living Heart (Adams, 1997), written with Antonio Gotto Jr., Yeltsin described DeBakey as 'a magician of the heart' and 'a man with a gift for performing miracles.'

The two drugs, which could be approved for marketing this year, would add two new classes of drugs to the four that are available to battle HIV, the virus that causes AIDS. That would be especially important to patients whose treatment is failing because their strain of virus has become resistant to drugs already in use. 'This is really a remarkable development in the field,' Dr. John Mellors of the University of Pittsburgh said at a news conference Tuesday at the 14th Annual Conference on Retroviruses and Opportunistic Infections in Los Angeles. Pfizer's drug works by blocking a portal on human immune system cells that HIV uses to enter and infect the cell. It would be the first AIDS drug that works by blocking a protein that is part of the human body rather than something in the virus. About 85 percent of newly infected patients have a virus that uses CCR5, while only about half of patients who have a resistant virus use CCR5. There has been some concern that blocking CCR5 would encourage the development of viruses that use the alternative portal

The outbreak resembles one last year that was linked to a different manufacturer's lens solution and a different microbe. In both instances, the cornea, the eye's transparent outer covering, is at risk. But why two different microbes caused the outbreaks is not known. ''It is beyond comprehension,'' said Dr. Dan B. Jones, the chairman of ophthalmology at Baylor College of Medicine in Houston, who detected a case of acanthamoeba keratitis, which is behind the current outbreak, on Friday. Acanthamoeba infections have been reported in many countries. Dr. Jones's team is credited for first identifying a corneal infection from acanthamoeba in the United States, in a rancher who was injured in an accident in Texas in 1973. That case did not involve contact lenses: while the rancher was working in a field, a piece of wire and hay hit his eye

Epidemiologists from the Centers for Disease Control and Prevention have linked the acanthamoeba keratitis outbreak to AMO Complete Moisture Plus Multi-Purpose Solution. Advanced Medical Optics of Santa Ana, Calif., manufactures the solution, used to clean and store soft contact lenses