Faculty Bibliography

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

The Nobel committee citation said that from 1976 to 1978, after the publication of Dr. [Susumu Tonegawa]'s first paper on the experiments that won him his award, he ''completely dominated this area of research.'' Dr. Erling Norrby, a virologist at the Karolinska Institute who is a member of the Nobel committee, said Dr. Tonegawa's discovery ''was completely unexpected'' and solved a mystery that had baffled scientists ''for 100 years.'' Although he did not originate thetheory that genetic change was involved, Dr. Tonegawa proved it in what the Nobel committee said was ''a convincing and elegant manner.'' By using the newer tools of molecular biology to study cancerous cells, Dr. Tonegawa showed that different pieces of the genes forming the antibodies could be shuffled, recombined and even lost to give rise to the DNA that is found in mature B lymphocytes and thus to an enormously diverse array of antibodies

Dr. Susumu Tonegawa, a 48-year-old Japanese scientist working at the Massachusetts Institute of Technology, was awarded the Nobel Prize in medicine Monday for his discoveries of how the body can marshal its immunological defenses against millions of different disease agents that it has never encountered. Tonegawa is the first Japanese scientist to win the Nobel Prize in Physiology or Medicine and only the second winner in that category since 1961 who did not have to share the prize, which amounts to $340,000 this year. Tonegawa was cited by the Nobel committee at the Karolinska Institute in Stockholm for discovering how the body can constantly change its genes to fashion a seemingly unlimited number of antibodies, each specifically targeted at an invading microbe or foreign substance

Tests on stored specimens have yielded the causes of epidemics years after they occurred. They have clarified diagnoses, determined the symptoms and damage a virus could cause and allowed scientists to complete in a few months nutrition, endocrine, cancer and other studies that otherwise would have taken many years. Sometimes stored samples have helped fight diseases unknown to those who collected them. Such is the case with AIDS. Since the recent discovery of the AIDS virus, scientists have thawed thousands of stored blood samples for evidence of the newly detected microbe. So far tests on stored blood have shown that the AIDS virus infected humans in Africa in the 1950s, and the search is still on for AIDS virus infections elsewhere and in earlier years

Because such a small number of the participants in the San Francisco study have been infected with HIV for many years without developing AIDS, said Dr. Scott D. Holmberg, an epidemiologist at the Centers for Disease Control, ''if one or two develop AIDS next week, it would change the predictions'' in the models derived from it and ''substantially increase the percentage of people who get AIDS.'' Dr. Jonathan Mann, director of the AIDS program of the World Health Organization, said that although the data about progression to AIDS ''are not reassuring,'' it was ''unjustifiable'' in the absence of proof to equate a positive blood test for HIV with a death warrant. ''We all know the epidemic is serious enough,'' Dr. Mann said. ''Any effort to force an answer where we don't have the ability to answer is a flawed exercise. We must be clear about what we don't know, and cannot know, and why we cannot know it, and not be afraid to say we don't know.'' And in the case of AIDS, he said, we can ''still leave room for hope.''

Such distinctions can be detected by a laboratory test known as the Western blot that can detect the specific proteins of the antibodies formed when a virus or other foreign substance enters humans. For example, the AIDS vaccine to be tested this fall, manufactured by Microgenesys Inc. of West Haven, Conn., is made from a protein called gp 160, a fragment in the outer coat of the AIDS virus. Gp stands for glycoprotein (sugar-protein); the 160 is a shortened version of the molecular weight of 160,000. Ms. [Elaine Baldwin] said the ethics committee did not address the question of who should be the first subjects in the AIDS vaccine experiments. Despite the rich tradition of scientists' trying new vaccines on themselves first and although Dr. Daniel Zagury, a French immunologist, gave himself an experimental AIDS vaccine that he also tested on people in Zaire, the N.I.H. scientists conducting the AIDS vaccine experiments have decided against this. The insect cells produce the gp 160 protein, which is then separated from insect proteins by a technique known as chromatography. The gp 160 vaccine has been tested in monkeys, chimpanzees and other animals, and they developed antibodies. But the animal results have uncertain meaning for humans, because no one knows what component of the AIDS virus is the most potent stimulator of protective antibodies in humans or what portion of the human immune system is most important in defending against invasion of the AIDS virus