Faculty Bibliography

Officials of Johns Hopkins Hospital in Baltimore, where an epidemiologic investigation is under way of 1,800 patients of a surgeon who died of AIDS, recently accused the disease-control agency of having created 'a policy vacuum' and of delaying in issuing new, more explicit guidelines. Patients have sued the hospital and the doctor's estate for failing to disclose that the surgeon was infected with the AIDS virus. Assessing the Risk Clues Are Scarce In Policy Puzzle 'If we ask health care workers to take the risk of getting infected, what are we doing to take care of them if they do become infected?' asked Dr. Donald P. Francis, an AIDS expert at the California Health Department. 'We had better have a basket to catch these people.' The Balancing Act Tough Questions And High Stakes Ruth Finkelstein, director of Research for the AIDS Action Council in Washington, citing the equivocal evidence of transmission in the Florida dentist's case, said, 'We don't feel the public health evidence is persuasive.'

'We're not investigators,' Dr. [John O. Pastore] said. 'But it's my conviction after examining babies, seeing X-rays and questioning doctors in Baghdad that there is a justifiable complaint about the violations of human rights.' The team went to Iraq after it sought and received an invitation from the Iraqi Medical Association and was the first group of independent physicians to assess medical conditions in Iraq since the embargo was imposed in September, Dr. Pastore said. The embargo permits Iraq to acquire as much food, medicine and medical spare parts as it needs, so long as it meets United Nations conditions. The Iraqi health officials and doctors told the group that the embargo's main medical effects were on children. Many with infections cannot be adequately treated because of a lack of intravenous penicillin and injectable forms of other antibiotics. Such patients were also suffering from dehydration and malnutrition because of a lack of injectable forms of vitamins and other nutritional substances, Dr. Pastore said. He said his team had seen such patients in a Baghdad hospital

The common problems include the hazards in breaches of confidentiality, a doctor's desire to treat a prominent person to enhance his status and income, a hospital's use of publicity about its care of a such a person to help draw other patients and the chaos that can result in a hospital from admission of a prominent person. Last week George Washington University Medical Center, where many government officials and other prominent people are treated President Reagan was taken after he was shot in the chest in 1981, sponsored a three-day course for doctors on the special problems of medical care for the prominent. Participants included Col. Lawrence C. Mohr Jr., the White House physician. Mohr, who works with President Bush's primary doctor, Dr. Burton J. Lee, and others urged hospitals to amend disaster plans to deal with prominent patients and medical schools to give lectures on this overlooked area of health care. They said the treatment and hospital care of elected officials can affect public policy in important ways

Health officials plan to test patients of doctor Rudolph Almaraz, a Johns Hopkins Hospital surgeon who died of AIDS, to determine whether any of them became infected with the AIDS virus through his medical care, hospital officials said

Instead of cutting open the abdomen to reach the gallbladder, as is standard procedure, surgeons can simply cut several small holes in the abdomen through which they insert a camera and surgical instruments. The technique is being applied most rapidly to remove gallbladders that have been inflamed by gallstones. The gallbladder is a pear-shaped sac about 4 inches long that stores bile that is made in the liver. In New York City recently, surgeons at the St. Luke's division of St. Luke's-Roosevelt Hospital Center made four small slits in a woman's abdomen to insert a camera and then watched on a video screen as they manipulated the long instruments through the holes to cut out her gallbladder

The common problems include the hazards of breaches of confidentiality, a doctor's desire to treat a prominent person to enhance his status and income, a hospital's use of publicity about its care of a such a person to help draw other patients and the chaos that can result in a hospital from admission of a prominent person. Prominent people can include Presidents to mayors and famous actors to leaders in small communities. Some may be considered prominent at one hospital, but not another. All such patients have the capacity to disrupt a medical center's system so that they fail to receive the ordinary standard of care. The presence of a prominent person can also interfere with the care of other patients unless plans are made in advance. For example, prominent patients are often allowed more visitors for longer periods than hospital rules permit. But the hubbub of additional visitors can jeopardize their recovery. Also, some prominent people under the pressures of their careers can insist on a premature or temporary discharge from the hospital. For example, Bill Parcells, the coach of the New York Giants who is being treated for a kidney stone, was discharged against his doctor's orders so he could direct his team in a football game against the Minnesota Vikings on Sunday

For up to 1 million Americans, iron is a poison. They have hemochromatosis, a hereditary disease that overloads the body with iron, causing a variety of problems, including diabetes and liver cancer. The genetic defect, an inborn error of metabolism, causes people to absorb too much iron from the diet. Because the body has no way to eliminate iron except by bleeding, the iron builds up in many organs over the years. Doctors can detect excess amounts of iron through a combination of blood tests that measure iron, iron-binding capacity and transferrin, the protein that transports iron through the body. In some cases, magnetic resonance imaging scans and liver biopsies are also performed

Death rates from heart surgery dropped 14% in hospitals in New York State for the first half of 1990 compared with the same period in 1989, state health officials said

After years of dismissing chronic fatigue syndrome as yuppie hypochondria, doctors in growing numbers are coming to believe that it is a distinct condition reflecting an overcharged immune system. The fact that most sufferers can identify the onset of symptoms is causing many doctors to reconsider