Faculty Bibliography

A new chest surgery technique, endoscopic surgery, promises to spare tens of thousands of patients the standard bone-splitting chest surgery, which can leave patients with pain for the rest of their lives

'Health care is going to be the No. 1 problem over the next five years, and doctors are doing their profession and the public a terrible disservice by not getting into politics,' Governor [Howard B. Dean] said in an interview. 'If doctors don't get in there trying to lead the movement toward cost containment, the public and doctors will lose from the mistakes.' Governor Dean stopped practicing medicine on taking his new job, referring patients to his physician-wife, Judith Steinberg, a partner, and other doctors. But he said he was still adjusting to the sudden change of becoming a full-time politician. 'Lieutenant Governor was the perfect life,' he said. 'It gave me time for patients, politics and my family.' In medicine, unlike politics, Governor Dean said, 'you suggest courses of action and you expect them to be carried out.' Also, he said, politics involves a lot of ambivalence, which is an area that 'doctors by nature do not like to get into.'

Dr. [Lawrence L. Craven] noted an unusual incidence of bleeding complications among children who chewed gum containing aspirin to relieve the pain from a tonsillectomy. Noting reports that aspirin affected blood's ability to clot, he inferred that aspirin would be safer than dicumarol, an anti-coagulant that doctors had begun prescribing for heart attack patients in the 1940s. Paradoxically, aspirin poses risks of bleeding that can cause strokes, and aspirin can also cause gastrointestinal symptoms. But studies have shown that the benefits generally outweigh the risks

In July, the CDC issued general guidelines that said health-care workers should voluntarily test themselves for the viruses that cause AIDS and hepatitis B, and that those infected should stop doing 'exposure-prone procedures' unless they got permission from a panel of experts and informed their patients. The cluster in [David Acer]'s practice is the only known transmission of the virus from health-care worker to patients among the more than 180,000 AIDS cases reported to the CDC. Health officials have not been able to determine how the virus was transmitted. A recent series of investigations of 43 other infected health-care workers - involving 21 dentists and dental workers, 19 doctors and three nurses - found none of their 3,500 patients to be infected with the AIDS virus, [Roy Schwarz] said

Scuttling an effort by the CDC to have professionals devise lists of high-risk procedures that AIDS-infected doctors and other health-care workers should avoid, dozens of medical groups have refused to cooperate with the government on the plan, saying the risk of transmitting the AIDS virus to patients is insignificant

The action throws into confusion the government's effort, which calls on professional groups to devise lists of high-risk procedures that AIDS-infected doctors and other health-care workers should avoid. In July, the CDC issued general guidelines that said health-care workers should voluntarily test themselves for the viruses that cause AIDS and hepatitis B, and that those infected should stop performing certain 'exposure-prone procedures' unless they got permission from a panel of experts and informed their patients. The disease centers left it up to the professional groups to define the procedures posing the highest risks. Most groups at the AMA meeting found the data strong enough to say that the risk of transmission from health-care worker to patient was so low that compiling lists of high-risk procedures was worthless, [M. Roy Schwarz] said

In July, the CDC issued general guidelines saying that health care workers should voluntarily test themselves for the viruses that cause AIDS and hepatitis B and that those infected should stop doing certain 'exposure-prone procedures' unless they got permission from a panel of experts and informed their patients. The cluster in Dr. [David J. Acer]'s practice is the only known transmissionof the virus from a health care worker to patients among the more than 180,000 AIDS cases reported to the CDC. Health officials have not been able to determine how the virus was transmitted. In recent weeks, health officials have stepped up the number of investigations of possible AIDS infections among patients of infected health care workers. Dr. Michael Osterholm, chief epidemiologist at the Minnesota State Health Department, has compiled a list of 30 such investigations, often called 'look-back studies,' said Dr. [M. Roy Schwarz]

A very small study at the University of North Carolina in Chapel Hill suggests that inhalation of sodium and chloride may be of some use in therapeutic treatment of cystic fibrosis

Such 'films are often dressed up, so what you see looks almost perfect, and there's never anything on a film that shows bleeding and other problems,' Dr. [David Sabiston] said in an interview. He added: 'Films do not tell you about pre-operative and post-operative care, and more important, you do not hear the conversation in the operating room.' 'There's an old saying that 'the friendliness between surgeons is directly proportional to the distance between them,' ' said Dr. [Dan J. Ullyot], the San Francisco heart surgeon. For example, the team will determine whether aspirin use is a factor. Aspirin is a standard therapy to prevent a heart attack because it makes it harder for blood to clot. But bleeding can be a serious complication in heart surgery. 'We know some hospitals won't operate on someone who has had an aspirin and they do extensive screening for bleeding problems,' Dr. O'[Connor] said. 'Yet other places do not think such tests are important at all.'