Faculty Bibliography

By spring doctors in 10 American medical centers will begin to send shock waves through 600 patients in an experiment approved by the Food and Drug Administration. The aim is to determine the safety and usefulness of the therapy for gallstones and to determine which among the 20 million Americans with gallstones would benefit from lithotripter therapy instead of surgery or dissolution with solvents. With an ultrasound machine like those commonly used in studying the fetus, doctors find the gallstones and position the patient so that the shock waves are focused on the stones, sparing surrounding tissue. (Older machines used on kidney stones typically use X-rays to find stones.) Noise Like Rifle Shots Up to 1,500 shocks are given in the procedure, which can last about an hour. An electrocardiogram is used to regulate the timing, avoiding shocks at a point in the heartbeat when it could trigger an irregular rhythm. Doctors and patients usually wear ear plugs because the shocks sound like rifle shots. If successful, the stone is broken into fragments small enough to pass through the body. The first lithotripter was developed in West Germany, by Dornier Medical Systems of Munich, after researchers discovered that shock waves created by raindrops striking an aircraft in supersonic flight can disintegrate solid materials. Dornier's newest model is the only one the F.D.A. has approved for the gallstone study, although lithotripters intended for kidney stones have been used in emergencies on a few patients with blockage of the bile ducts

Dr. Anthony J. Pinching, the scientist from St. Mary's Hospital Medical School in London whose team reported the apparent link between Gc and AIDS, said in an interview that ''it is my move.'' His team is repeating the laboratory tests on the original samples to exclude the possibility of a technical mistake and is expanding the studies to include a larger number of people with AIDS or infected with the virus. Dr. Pinching said he would not have expected confirmation from some teams because they used different statistical methods and did not study ''entirely comparable groups.'' Nevertheless, Dr. Pinching said he was surprised that none had confirmed the findings because the statistical evidence for the link between Gc variations and susceptibility to AIDS in his team's original study was ''so strong.'' 'Statistical Fluke' ''If something happened that established a higher prevalence of infection in black or Hispanic intravenous users to start with, and if blacks or Hispanics continued to share needles with people of their same race, that would tend to perpetuate the differences,'' Dr. [Harold W. Jaffe] said. ''But no one can explain why the prevalence would have been different to start with.''

''If you chew licorice and swallow enough of it, you get these symptoms,'' Dr. [Donald Seldin] said. But the woman did not eat licorice. Nevertheless, Dr. Seldin was not fooled. He looked for clues in Dr. Lynch's report of his house call. The tip-off was Dr. Lynch's description of the woman: she was well groomed except for tobacco stains on her blouse. There was a full spitoon on the floor. ''Some chewing tobaccos contain a lot of natural licorice,'' he said. Anyone who swallowed a lot of tobacco juice could develop the woman's symptoms. Indeed, he was told, her brand contained 10 percent natural licorice. ''Chewing tobacco adds a little spark to this woman's life, and she is being punished for her meager joy.'' Dr. Seldin said. ''Tell her to switch brands, but if she wants to continue chewing the same brand, tell her to stop swallowing.''

Organ transplants started long before doctors fully understood the workings of the immunologic defence system. Because the body so often tries to reject implanted organs, the transplants forced immunologists to learn more about how the body attacks foreign tissues and how it can be coaxed not to. ALREADY SUCCESSFUL in varying degrees with transplanting kidneys, livers and lungs, surgeons are pushing into new frontiers, such as working with animals on transplants of islet cells from the pancreas to treat diabetes. And in humans, doctors are experimenting with implants of patient's own adrenal cells into the brain to fight Parkinson's disease. By contrast, only five patients received permanent artificial hearts - all of whom have died. Perhaps 85 patients have had artificial hearts implanted as temporary 'bridges' while awaiting human hearts

The Government's first release of data on hospital care last year ''generated a storm of interest and controversy'' and recognition within the Federal Health Care Financing Administration of the ''need to do it better'' the next time because the data were not meaningful to the consumer, said Dr. William L. Roper who heads the agency that finances Medicare for 31 million Americans. Although hospitals traditionally monitor quality, Dr. [Uwe Reinhardt] said, the health profession ''has never thought it necessary to share those data with buyers, with any patient.'' Now, he said ''the market power has shifted'' and that attitude is unacceptable. ''We don't think that the data are relevant, reliable or useful,'' said Dr. James S. Todd, deputy executive vice president of the American Medical Association. ''It gives the imprimatur of being something reliable, something that people ought to pay attention to.'' But ''patients go to doctors, not hospitals,'' he said

Since then, Dr. [Leonard L. Bailey] said, he has rejected the idea of asking for emergency approval because, under such circumstances, the experimental surgery would have been ''just too visible.'' However, the push to do cross-species transplant experiments from Dr. [Keith Reemtsma]'s team at Columbia and others in Munich, West Germany, and Capetown, South Africa, ''defuses much of the criticism'' of this type of radical research, Dr. Bailey said. Dr. Bailey foresees using baboon hearts as ''bridges'' to human heart transplants for many among the thousands of children born each year with fatal heart defects. About 10 percent of congenital heart disease is incurable. A baby born with such a defect, Dr. Bailey said, ''needs a change of heart at birth.'' ''What we have discovered,'' Dr. Bailey said, is that the recipient forms such antibodies, but not in amounts sufficient ''to preclude the second transplants in our series of experiments.'' Experts to Review Experiments

Some surgeons think they may have reached the limits of success of heart transplants. They say that small gains might be made if survival statistics from different medical centers were compiled, spurring competition to improve each hospital's record. Additional gains might come if training requirements were established and if there were stronger controls on choosing recipients who have the best chance of benefiting. Already successful in varying degrees with transplanting kidneys, livers and lungs, surgeons are pushing into new frontiers, such as working with animals on transplants of islet cells from the pancreas to treat diabetes. And in humans, doctors are experimenting with implants of patients' own adrenal cells into the brain to fight Parkinson's disease. By contrast, only five patients received permanent artificial hearts - all of whom have died. Perhaps 85 patients have had artificial hearts implanted as temporary 'bridges' while awaiting human hearts

``Surgeons in the 21st century will spend most of their time replacing parts rather than removing them, as they have for the last century,`` said Dr. Keith Reemtsma, chief surgeon at Columbia-Presbyterian Medical Center and a transplant pioneer, as he reflected on a milestone that took place 20 years ago. It was on Dec. 3, 1967, that Dr. Christiaan Barnard performed the first human heart transplant in Capetown, South Africa, on Louis Washkansky, a 55-year-old grocer. The technique he used had been developed in animal studies by Dr. Norman E. Shumway and Dr. Richard R. Lower at Stanford, and it remains the basic approach today. Shumway's Stanford team has now performed 473 heart transplants since 1968, more than any other center

At the Oklahoma Transplantation Institute in Oklahoma City today, the fourth annual Christiaan N. Barnard Symposium, a prestigious scientific assembly in recognition of the 20th anniversary of [Christiaan Barnard]'s historic first human-to-human transplant, will be conducted. Already successful in varying degrees with transplanting kidneys, livers and lungs, surgeons are pushing into new frontiers, such as working with animals on transplants of islet cells from the pancreas to treat diabetes. And in humans, doctors are experimenting with implants of patient's own adrenal cells into the brain to fight Parkinson's disease. [Louis Washkansky], the first transplant recipient, survived 18 days. Now, from 77 percent to 87 percent of transplant patients survive at least one year, said Dr. Michael Kaye at the University of Minnesota, and from 73 percent to 85 percent live five years

Deciding how to treat comatose patients with little chance of recovery poses wrenching and unresolved ethical and economic issues. Doctors have long recognized the coma as an advanced state of brain failure in which a person lies in a sleep-like state with eyes closed. The problem of long-term comas looms over doctors and families every day in every hospital. Although accurate statistics about the numbers of comatose Americans are lacking, experts believe the numbers are increasing, largely as a result of the introduction of intensive care units in hospitals and new treatments for once-fatal conditions. Some coma patients are victims of heart attacks and strokes who were saved only to suffer brain damage. Many victims of Alzheimer's disease eventually become comatose. And some coma patients are victims of drug overdoses or automobile accidents. Yet the coma still has its mysteries. One is why some autopsies have found such a striking disparity between the limited extent of structural brain damage and the total devastation of the mind. Another concerns those who suffer from prolonged comas and the persistent vegetative state