Faculty Bibliography

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

Transplant surgeons attribute their successes not to a single breakthrough, but to several advances in several fields. ''It's a medical revolution of which surgery is just a part,'' Dr. [Keith Reemtsma] said. One major advance was cyclosporine, a drug used experimentally in heart transplants in 1980 and licensed in 1983. It is now used in combination with other anti-rejection drugs such as azathioprine and steroids. ''If we were inclined to get the best result out of every donor heart,'' Dr. [Jack Copeland] explained, ''we would choose only the best-risk patients for transplantation and exclude the sickest and oldest patients, and we could probably approach 100 percent survival at one year.'' Most transplant surgeons believe they should try to save the sickest patient, with the least stable getting the first available heart, Dr. Copeland said, adding that ''whether that makes sense in a time of severe donor shortage'' is a point that ''needs more public debate.'' Milestones In Heart Transplants 1967: First human heart transplant, by [Christiaan Barnard] in Capetown, South Africa. 1968: Stanford does its first heart transplant in program that becomes world's largest. 1972: Development of the bioptome, a device to monitor severe rejection reactions so that potent drugs can be used more precisely. 1977: Airplanes first used to transport hearts from donors at distant sites. 1983: F.D.A. licenses cyclosporine, an anti-rejection drug that allows vast expansion in number of centers performing heart transplants. 1985: Mechanical heart first used as a ''bridge'' to human heart transplant, by Dr. Jack Copeland at University of Arizona. 1985: First successful infant heart transplant, by Dr. Leonard Bailey at Loma Linda University. 1987: [Emmanuel Vitria] dies at 67, a record 18 1/2 years after his heart transplant.

''It is hell for people to see a loved one in a sleep-wake cycle, moving their eyes, and expecting - falsely -that the individual understands and will recover,'' said Dr. Fred Plum of the New York Hospital-Cornell Medical Center, an expert on comas. The PET scans have shown that the persistent vegetative state is comparable to the deepest stages of anesthesia and that such patients do not feel pain, exerting only reflex responses when pinched or otherwise stimulated. ''What was learned is extremely important because it allows physicians to deal more humanely with families,'' Dr. Plum said. With a more scientific basis for diagnosis and prognosis, families' uncertainty can be reduced. Dr. Sheldon Borrel, a rehabilitation medicine specialist at San Francisco General Hospital, surveyed health care workers and determined that those who were farthest removed from the coma patients' bedsides found it easiest to approve withholding life support. ''The closer you are to being the one who has to remove the tube,'' he said, ''the more difficulty you have with the decision.

LEAD: Nancy Reagan's doctors said today that final laboratory tests of tissue removed during her breast cancer surgery on Saturday showed no spread of the malignancy. They said Mrs. Reagan was ''recovering remarkably well'' with an excellent prognosis for full recovery. Mrs. Reagan's reaction to the news was ''just total relief,'' said her spokeswoman, Elaine Crispen, who has been at the hospital with the First Lady. ''Just fine. I feel great,'' the spokeswoman quoted her as saying. The Reagans received the news about the final tests at midmorning, then spent time looking at flowers and the get-well cards. ''The dogma is, if it is in the ducts, it does not spread to the lymph glands,'' Dr. [Peter J. Dawson] said. ''If you get all of it, then the patient should be home, free and clear.''

WASHINGTON - Nancy Reagan's doctors said Sunday that final laboratory tests of tissue removed during her breast cancer surgery Saturday showed no spread of the malignancy. They said Mrs. Reagan was ``recovering remarkably well`` with an excellent prognosis for full recovery

Mrs. [Nancy Reagan] was awake after the surgery at Bethesda Naval Hospital, and her vital signs were ''strong and stable'' as she rested comfortably in the recovery room, Mr. [Marlin Fitzwater] said. President Reagan visited his wife there and told her: ''Honey, I know you don't feel like dancing. So let's hold hands.'' Prognosis Seems Favorable Dr. Samuel Hellman, physician in chief at the Memorial Sloan-Kettering Cancer Center in New York, said in an interview that ''the big message is'' that Mrs. Reagan's cancer ''is a very favorable lesion.'' The current edition of ''Textbook of Surgery'' published in 1986 and edited by Dr. David C. Sabiston of the Duke University School of Medicine states, ''Modified radical mastectomy has become the procedure of choice for most surgeons in the United States.'' An earlier edition of the text was edited by Mrs. Reagan's father