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So when residents of Surat, India, learned in recent weeks that pneumonic plague had struck there, hundreds of thousands fled the western port city. And some apparently spread it to other cities, including India's three biggest -- Bombay, Calcutta and New Delhi. How many areas and people are affected remains unclear

'The results are dramatic,' Zach W. Hall, director of the National Institute of Neurological Disorders and Stroke, part of the N.I.H., said at a news conference. 'The study has the potential of improving the health and quality of life for thousands of Americans.' All participants had a 60 percent or greater narrowing of a carotid artery as determined by Doppler ultrasound or special X-rays known as arteriograms. The technology used was of the mid-1980's vintage, Dr. [James F. Toole] said. Some neurologists not connected with the study have criticized it because results of the ultrasound tests were not reviewed independently by a central committee as were the data about those who suffered strokes. Such a review was not possible, Dr. Toole said. 'THE PROCEDURE: Surgery to Prevent Strokes' shows methods for a new study that backs removal of fatty deposits from carotid arteries before thaey can cause symptoms or peoduce strokes. (Source: 'Heart Talk: Understanding Cardiovascular Diseases,' Dr. M.V. Barrow (COR-ED Publishing Company) (pg. 30)

A controversial operation to remove fatty deposits from a major artery in the neck sharply reduced the risk of stroke in people with no outward symptoms, scientists who conducted a large federally sponsored study said here Friday. Application of the findings could prevent many thousands of crippling and disabling strokes among the 500,000 to 600,000 people who now suffer a stroke each year in the United States and could save thousands of lives among the 150,000 who die from strokes each year, said Dr. Michael D. Walker of the NIH. The two carotid arteries, one on each side of the neck, are the main suppliers of oxygen and blood to the brain from the heart. With age, fat tends to build up in what are known as plaques in the carotid arteries, particularly at a site where the artery divides at the angle of the jaw

While the rat-catchers go after a rodent population that some say outnumbers India's population of at least 850 million, doctors, pharmacists and epidemiologists have reported using computer-operated electronic mail systems to exchange information on the latest plague suspects, to order drugs, and to catch up on the latest developments in plague research elsewhere in the world. The outbreak in India has reawakened ancient panic, highlighted faults in the country's approach to public health and even raised questions about the program toward an open, market economy. For most of its history, plague has been endemic in India. The last major outbreak was in 1955 when about 7,000 people died. Ten years before, the plague had struck Bombay, killing 12,000. Black & White Photo; Map; Graphic, Diagram; JOHN MOORE; AP; SURAT SLUM: RESIDENTS GO ABOUT THEIR BUSINESS AS OPEN SEWER FLOWS THROUGH REUTER; FLEEING THE PLAGUE: PEOPLE LEAVING SURAT THIS WEEK RAISED FEARS THAT DISEASE WOULD SPREAD TO OTHER PARTS OF THE COUNTRY MAP OF INDIA PAUL PERREAULT; SOUTHAM NEWS GRAPHICS; PNEUMONIC PLAGUE: HOW THE PLAGUE SPREAD HOW IT IS TREATED

A controversial operation to remove fatty deposits from a major artery in the neck sharply reduced the risk of stroke in individuals with no outward symptoms, scientists who conducted a large federally sponsored study said Friday. Those who stand to benefit have no outward sign of disease but are at risk for stroke from severe narrowing of either of the two carotid arteries in the neck due to a buildup of fatty substances from atherosclerosis. Application of the findings could prevent many thousands of crippling and disabling strokes among the 500,000 to 600,000 people who now suffer a stroke each year in the United States and could save thousands of lives among the 150,000 who die from strokes each year, said Dr. Michael Walker of the NIH

Pneumonic plague, which affects the respiratory system, is generally regarded as a public health emergency of the first order. It and bubonic plague are caused by the same bacterium, but pneumonic plague is considered far more of a threat because the infection is airborne. Airborne plague causes pneumonia and is the deadliest, most communicable form of plague. None of the suspected plague cases from Surat is bubonic, which could suggest that the plague originated elsewhere in the bubonic form and spread in pneumonic form to Surat. The scene in Surat during recent days resembled a grade B movie, except that it was real. It would be a miracle if no evacuees were carrying the plague-causing bacterium, Yersinia pestis, as they fled Surat, a port city of 1.6 million people in western India not far from Bombay. The threat extends beyond the country

Pneumonic plague, which affects the respiratory system, is generally regarded as a public health emergency of the first order. It and bubonic plague are caused by the same bacterium, but pneumonic plague is considered far more of a threat because it is airborne. The scene in Surat over the past days resembled a grade B movie, except that it was real. It would be a miracle if no evacuees were carrying the plague-causing bacterium, Yersinia pestis, as they fled Surat, a port city of 1.6 million people in western India near Bombay. The threat extends beyond the country

Officials of the World Health Organization have been playing down the threat. In interviews over the weekend, Dr. Giorgio Torrigiani, an official of the organization, said there was no danger to travelers to and from India. He also said he doubted that plague would spread beyond the [Surat] area, and he expressed confidence that the Indian Government was taking all necessary steps to contain the epidemic. Dr. Torrigiani said he was 'confident that there would not be a danger of plague spreading' outside of India. The Indian Government has said laboratory tests confirmed that the disease afflicting Surat is pneumonic plague. The Centers for Disease Control and Prevention in Atlanta has sent to India reagents needed to diagnose Y. pestis in the laboratory, at the urgent request of doctors there. But Dr. Duane J. Gubler, a plague expert at the Federal agency's field station in Fort Collins, Colo., said he had not received word of results. Dr. Gubler said he assumed that India was dealing with pneumonic plague but, he said, 'we are keeping an open mind about the situation.' Since the mid-1970's, domestic cats have become an important newly recognized source of transmission of plague to humans in the United States, but rarely elsewhere. Cats have been identified as the source of at least 15 human plague cases in this country, including several that resulted from pneumonic feline plague. Cats become infected by catching infected rodents and then spread the bacteria to humans, often through airborne infection

It and bubonic plague are caused by the same bacterium, but pneumonic plague is considered far more of a threat because it is airborne and can be spread by the coughing of the plague victim. None of the suspected plague cases from Surat is bubonic, which could suggest the plague originated elsewhere in the bubonic form -- perhaps from an outbreak 400 kilometres south of Surat -- and spread in the pneumonic form to Surat. The scene in Surat over the past days resembled a grade B movie, except that it was real. It would be a miracle if no evacuees were carrying the plague-causing bacterium, Yersinia pestis , as they fled Surat, a port city of 1.6 million people in western India near Bombay. The threat extends beyond the country

Cards will be given to travelers from the infected areas to alert them to call a doctor if they develop a fever or become ill, said Dr. Duane Gubler, a federal Centers for Disease Control and Prevention expert on plague. He emphasized that plague can be successfully treated with antibiotics if detected early. Without treatment, the mortality rate from pneumonic plague is 90 percent; with antibiotics, the mortality rate falls to 5 percent