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THE DOCTOR'S WORLD; A REFORMER'S BATTLE [Newspaper Article]

Altman, Lawrence K
''A surgeon never really knows how poor a surgeon he is,'' Dr. [Ernest A. Codman] said. He assailed the lack of standards because he maintained that ''the object of having standards is to be sure to raise them.'' So Dr. Codman proposed what he called the ''end result card.'' He called for follow-up examinations exactly one year after surgery or discharge from the hospital and urged that all hospitals standardize the data and then publish it. Such analyses, he contended, would substantially reduce the time it took doctors to learn whether certain operations were or were not worth doing. Dr. Codman did not succeed in his objective of forcing the Harvard teaching hospitals to adopt his ''end result card.'' But he spurred some reforms and had his supporters. One was Dr. William J. Mayo, a founder of the clinic that bears his name in Rochester, Minn
PROQUEST:951090631
ISSN: 0362-4331
CID: 82148

THE DOCTOR'S WORLD; AUTOPSIES: TEACHING TOOL [Newspaper Article]

Altman, Lawrence K
Results of Mr. Kennedy's recent autopsy have led to the arrests of two men in connection with his death. Officials in Palm Beach County, Fla., have said Mr. Kennedy, who was known to have had a drug problem, died from the effects of three drugs: cocaine, Demerol (a pain killer) and Mellaril (a mood altering drug). In one such case, Dr. Arnold S. Relman, the editor of The New England Journal of Medicine, discussed the case of a 44-year-old electrician from Nantucket who developed an acute illness affecting his lungs and kidneys. Dr. Relman, an expert in kidney disorders, diagnosed a rare condition called Goodpasture's syndrome that can affect both the lungs and kidneys. The electrician probably died of legionnaire's disease, a diagnosis that Dr. Relman said ''never crossed my mind.''
PROQUEST:951402471
ISSN: 0362-4331
CID: 82149

RED CROSS EVALUATES TEST TO DETECT AIDS IN DONATED BLOOD [Newspaper Article]

Altman, Lawrence K
For people not affected by hemophilia, the risk of developing AIDS from blood transfusions is about one case per 100,000 transfusions, according to a recent report in the Annals of Internal Medicine by Dr. James W. Curran, the head of the AIDS task force at the Atlanta centers, and Dr. Lewellys F. Barker of the American Red Cross. The biologic materials used to measure the AIDS antibodies were derived from the virus called HTLV-3 that was isolated at the National Cancer Institute recently. Researchers say they presume it to be the same as the LAV virus discovered among AIDS patients at the Pasteur Institute in Paris last May. Dr. [Alfred J. Katz] said Red Cross officials were excited by the new development because it was a step forward and because the Government and public had put the blood banking community ''under considerable pressure to do something in the way of lab testing'' for AIDS
PROQUEST:951302101
ISSN: 0362-4331
CID: 82150

THE DOCTOR'S WORLD; THE MYSTERY OF BALANCHINE'S DEATH IS SOLVED [Newspaper Article]

Altman, Lawrence K
In a conference room on the 15th floor of Columbia's College of Physicians and Surgeons, the whole story of Mr. [George Balanchine]'s life's end and the post-mortem diagnosis emerged. In attendance were more than a dozen doctors. Slides were projected in front of them, as Dr. Philip E. Duffy, the medical center's director of neuropathology, went over each of the clues that were seen only after Mr. Balanchine's death. ''There was a lot of pressure on both of us,'' Dr. [Edith J. Langner] said. ''People from the ballet would call up and ask if he had seen doctor so and so.'' The conference ended when Edward Bigelow, a dancer and long- time friend of Mr. Balanchine's, said: ''Even if you had known this diagnosis before Mr. Balanchine died, you couldn't have done anything because there was no treatment. Correct?''
PROQUEST:951432341
ISSN: 0362-4331
CID: 82151

Declining autopsy rates and diagnosis of myocardial infarction [Letter]

Altman LK
PMID: 6708267
ISSN: 0098-7484
CID: 61570

NEW U.S. REPORT NAMES VIRUS THAT MAY CAUSE AIDS [Newspaper Article]

Altman, Lawrence K
Even as the French and American researchers' confidence has grown steadily in recent weeks, a degree of uncertainty still clings to the findings, and the tension of the exhaustive search was apparent in interviews and visits to the research facilities. There was a sense of quiet triumph in the halls of the Atlanta centers last week, but the euphoria that might have been expected was tempered by the knowledge that months of research are still required to firmly ascertain whether LAV and HTLV-3 are the same, and whether the virus is the cause of AIDS. Dr. Robert C. Gallo of the National Cancer Institute, who headed the team that is reporting its findings in four papers in the journal Science, said that if the two viruses ''turn out to be the same I will say so.'' It is customary for researchers to send specimens of new organisms to other laboratories interested in the problem. But in the words of Dr. Donald Francis, who heads the Centers for Disease Control team of virologists investigating AIDS: ''Not many people are calling the French every week asking for that virus. You have to be cautious about working with what you think is the cause of AIDS.'' Researchers are hoping that the LAV and HTLV-3 are the same. Dr. James Curran, who heads the Atlanta centers' AIDS investigating team, said that if tests show the viruses to be different in major ways, ''then something is wrong because one virus causes AIDS.''
PROQUEST:950914821
ISSN: 0362-4331
CID: 82152

FEDERAL OFFICIAL SAYS HE BELIEVES CAUSE OF AIDS HAS BEEN FOUND [Newspaper Article]

Altman, Lawrence K
''I believe we have the cause of AIDS, and it is an exciting discovery,'' Dr. Mason, who is a virologist, said in an interview here. ''The public needs to know that this is a breakthrough and that it is significant.'' - What exactly is AIDS? ''We call it AIDS but we haven't fully described the disease yet,'' Dr. [James O. Mason] said. A diagnostic test might help clarify the definition. Researchers have found that AIDS affects about as many women as men in Zaire and Haiti whereas in the United States AIDS primarily affects homosexual men. A diagnostic test, Dr. Mason said, ''would help us tremendously to answer the question of why there is such a difference in sex distribution.''
PROQUEST:950909081
ISSN: 0362-4331
CID: 82153

THE DOCTOR'S WORLD; TINY PARASITE BLAMED IN DEVASTATING DISEASE [Newspaper Article]

Altman, Lawrence K
Dr. Harley Moon, a veterinarian at the National Animal Disease Center in Ames, Iowa, and a specialist in intestinal diseases, said he doubted that cryptosporidiosis had become more common. ''Veterinarians have just missed it,'' he said, ''and I suspect physicians have been missing it in people for decades as well.'' ''Just because you find cryptosporidia in an animal with diarrhea doesn't mean the parasite is the cause,'' Dr. [Ronald Fayer] said. A major scientific mystery about cryptosporidiosis is how humans and animals come in contact with the parasite. ''Solving that problem is what makes it a challenging disease,'' Dr. Philip H. Klesius, who directs the Agriculture Department's regional parasite laboratory in Auburn, Ala., said. ''We thought maybe dams were shedding enough cryptosporidia at the end of term to contaminate the newborn either as it passes through the birth canal or shortly thereafter,'' Dr. Klesius said. ''We surveyed 19 dams for 6 weeks 3 times a week and we could never find the organism. Yet their calves got cryptosporidiosis.'' The survey was not the final word but it added to the mystery of how animals get the disease
PROQUEST:951023481
ISSN: 0362-4331
CID: 82154

BOOKS OF THE TIMES [Newspaper Article]

Altman, Lawrence K
Lax. 267 pages. Times Books. $14.95. LINDA GALBRAITH is 26 years old and six months pregnant when she develops acute leukemia that, unless treated, will surely be fatal soon. But drug therapy cannot begin until her pregnancy ends, and Linda badly wants the child, her first. Treatment may leave her sterile, and a Caesarean section may kill her from bleeding or infection. Linda gambles with her life. If she can't live, she wants to ''leave something of me behind,'' relates Eric Lax, a freelance writer in Los Angeles, in this warm and readable nonfictional account of 10 West, a clinical research unit at the University of California at Los Angeles. A few weeks later, doctors induce labor and she delivers a baby girl. Labor is grueling and takes eight days. Linda almost dies, not from the disease, but from bearing the child. Like many other people, Linda finds herself in a hospital for the first time because of a sudden, life-threatening situation, with little time to prepare for the complicated options. Realistic in her tragedy, she says: ''Fifty years ago, I wouldn't have made it through obstetrics. I would have died in childbirth. I wouldn't have known I had leukemia.'' In quoting a discussion between nurses, Mr. Lax writes: ''We talked about which leukemia we'd want if we had to have the disease. I chose basal cell; it's the least rapidly progressing, least malignant cancer.'' Basal cell is a skin cancer, not a leukemia. Mr. Lax writes lucidly here and imprecisely there. ''It is a curious disease in that it cannot be grown in the lab,'' he says of a microorganism that cannot be cultured in test tubes. Some disease-causing microorganisms can be grown in the laboratory. But no disease can be grown
PROQUEST:950840701
ISSN: 0362-4331
CID: 82155

THE DOCTOR'S WORLD; HIATUS HERNIAS OFTEN MISDIAGNOSED [Newspaper Article]

Altman, Lawrence K
A hiatus hernia is a condition that arises when a portion of the stomach protrudes, or herniates, through a hole called the hiatus. The hiatus is the opening in the diaphragm through which the esophagus passes as it attaches to the stomach. The diaphragm, which separates the abdomen and chest, is a breathing muscle. A hiatus hernia is not, strictly speaking, an illness but an anatomic condition. It is relatively common - some reports have suggested that as many as 20 percent of North American adults have hiatus hernias. And the physician must remember that it is not the hiatus hernia that produces the symptoms, but the complications from it. And there is no correlation between the presence or severity of symptoms and the size of the hernia. Most hiatus hernias do not cause symptoms. But many do, and the most common is heartburn. As common as it is, definitions differ widely. Doctors most often describe it as an uncomfortable burning sensation, usually located below the breast bone, that tends to move up into the neck, waxing and waning in intensity. It tends to come on about an hour after eating, is sometimes aggravated by drinking citrus juices and large meals. It often wakes the sufferer during the night. Heartburn seems to result from a complication of hiatus hernias, the reflux of gastric acid from the stomach into the esophagus
PROQUEST:950999071
ISSN: 0362-4331
CID: 82156