Faculty Bibliography

Now, by harnessing newer X-ray techniques with other devices, radiologists are working more directly with patients and saving many from surgery. And in a growing number of hospitals, surgeons are asking radiologists: What can you do to spare my patient an operation? Among the newer things that radiologists are doing are these: Threading tubes through arteries to inject drugs, gels and other substances to stop uncontrolled bleeding from the bowel

From radiology's infancy, these specialists have taken X-rays of patients after they swallowed barium to detect disorders of the gullet, stomach and bowel. Patients have also swallowed pills so that gallstones could be detected by X-ray. Radiologists also injected chemical substances to outline the kidneys and blood vessels. Nevertheless, in using these techniques, radiologists were limited to their powers of observation and deduction. Several technological advances have made the transition to interventional radiology possible. In the 1960's, electronic engineers found ways to intensify the X-ray image so it could be relayed to a television screen in a brightly lighted room. This led to the development of image intensifier X-ray machines that allowed longer exposures with less radiation risk to patients. Another development was the CAT scanner, which, using a technique called computerized axial tomography, takes cross-sectional X-rays, slicing the anatomy in a specific area. Still another was the application to medicine of ultrasound, which was developed for submarine detection in World War II. Ultrasound is now widely used in medicine, largely because it is safer than X-rays. Nevertheless, the techniques involve significant risks. The tubes used by radiologists may perforate the bowel, leading to potentially lethal infections from seepage of intestinal contents into the abdominal cavity. Severe bleeding can result if the liver or other organ is torn. Instead of being snared, a gallstone may become wedged more tightly in a bile duct, necessitating a major operation to relieve the resultant obstruction

Norwegian pharmacists have begun placing warning labels on many prescription drugs. In a few instances, there have been reports of jail sentences imposed on drivers whose judgment has been impaired by these drugs. The warning is aimed at drivers of vehicles and workers who operate machinery. It cites such potential hazards as fatigue, poor concentration, drowsiness, dizziness and even fainting. Users are also cautioned that the hazards may increase when alcohol and psychotropic drugs, which affect the functioning of the mind, are mixed. Among the categories listed by Norwegian officials are antidepressant drugs and those containing the minor tranquilizer Valium, or diazepam. A second category is sleeping pills, particularly the longer-acting ones that can still affect a driver's performance the morning after

The Italian doctor molded a plaster of paris cast that went from my right palm to mid-shoulder with my elbow at a right angle and told me to keep it on for 30 days. He tied a long piece of gauze into a crude sling to hold up the heavy cast and went through a list of instructions regarding possible complications. I teased him about one that he omitted. ''Don't worry - we haven't had one in 10 years,'' he said. In restaurants, I ordered fish and other soft foods. Waiters and friends would help by cutting the portions. I often eat European style with a fork in my left hand, and doing it then was not unduly difficult. I could maneuver my left arm to reach into a pocket to pull out Italian lire whenever I needed to pay bills. Clerks cashed my traveler's checks, but they wrote ''broken arm'' in Italian next to my shaky signature. Because my arms ached too much to write, I tape recorded notes. The airline clerk refused to grant the approved request for the extra seat and said that the only reason that information about my cast was in the computer was for ''security reasons.'' The stewardess on the plane refused to move my seatmate until I said in a firm and clear voice meant to be overhead by the other passengers, ''TWA now assumes all l iabilities for any injuries that occur to anyone sittingnext to me.''

The committee said that ''the right hemisphere is also the superior one when it comes to in terpreting auditory impressions and in comprehension of music'' and ''can better recognize melodies and better distin guish voices and intonations.'' From the work on each hemisphere, or the ''split-brain research,'' scientists have learned much about the isolated capacities of each. Dr. [Roger W. Sperry]'s research showed that the isolated left hemisphere is concerned with abstract thinking, symbolic relationships and logical analysis of details, particularly temporal relationships. ''It can speak, write and make mathematical calculations,'' the Nobel citation said. Differences Between Sexes In recent years, several trends have emerged to show that female infants are more sensitive to sounds, particularly their mother's voice, and that they orient more to tones and are more startled by loud noises, according to Dr. Richard M. Restak's ''The Brain: The Last Frontier.''

FOR nearly two full days, 21-year-old Michael Bates, who had eight fingers severed by an iron press in a factory accident, lived under general anesthesia in a ''surgical marathon.'' It lasted 46 1/2 hours while a team of 44 doctors, nurses and technicians at the Massachusetts General Hospital in Boston reattached his fingers. Mr. Bates's accident occurred in Bellows Falls, Vt., and although he had not eaten in the three and a half hours between the accident and the beginning of the operation, doctors were concerned that some food remained in his stomach. For that reason, said Dr. Michael C. Long, the starting anesthesiologist, he gave Mr. Bates what is called ''rapid induction'' anesthesia. The rapidity of the method is aimed at preventing the vomiting of stomach contents and their inhalation into the lungs, which could cause a potentially fatal pneumonia. Shortly after the operation one month ago, the little finger on Mr. Bates's right hand, which had been reattached, had to be partially amputated because it lost circulation. However, yesterday the doctors reported they expected Mr. Bates to have ''good results'' from the operation

As with all public-health policy issues, there have been some dissenters. Indivi dual doctors questioned the priority of fighting infections of low incidence rather than other health problems. Members of religious sects opposed the practi ce of immunization to protect against any disease. Other individual s refused to accept the small risks associated with preventive measur es, such as contracting the disease from the inoculation, and would n ot sign the required informed-consent forms. Significant Perils Remain In a sense, New York City's problem reflects the success of immunization advances. In past epidemics of childhood infections, parents rushed their children to the doctor's office and publichealth clinics to get immunizations. Now, with these preventive measures having drastically reduced the incidence of the diseases, there has been apathy among the public, health officials and government officials. The possiblity of infecting large groups remains. Immunizations provide the barrier that prevents the few cases of some infections from spreading to larger groups. It requires a large enough number of susceptible individuals for an outbreak to occur, a required number that varies depending on such factors as the virulence of the infecting organism. The dynamics of epidemics are still largely mysterious, and no one can predict accurately when the next would occur if too few people are immunized

The drug is aminoglutethimide. In 1960, Ciba-Geigy marketed it as Elipten, for use as a supplemental drug in the treatment of epilepsy. Then, in 1966, Elipten was withdrawn from the market because of side effects involving the adrenal glands. This pair of glands produce vital hormones and are located on top of the kidneys. (Their name, adrenal, is simply Latin for ''near the kidneys.'') [Harvey Cushing]'s syndrome is uncommon. One of its most distinctive features is a peculiar distribution of fat, which collects in the face and upper back as a ''buffalo hump'' and on the abdomen, while sparing the arms and legs. Cushing's syndrome is also characterized by retention of salt and water, high blood pressure, weakening of bone and connective tissue, and diabetes, among other things. Researchers found that this drug produced adrenal insufficiency by preventing the normal conversion of cholesterol to pregnenolone, which is the first of several steps in the body's synthesis of important hormones, including sex hormones. The drug also blocks other reactions in the adrenal glands. By 1973, se ven years after Elipten was withdrawn from the market, Food and Drug Administration officials wrote Ciba-Geigy to suggest that it submi t a New Drug Application for the use of Elipten in treating Cush ing's syndrome. Last April, after further research and approval by t he Federal drug agency, Ciba-Geigy marketed Elipten as Cytadren. By then, Ciba-Geigy's patent had expired

For almost a century, the [William S. Halsted] radical mastectomy reigned as the standard treatment of breast cancer. Rarely in surgical history has an operation lasted as long as Halsted's. Now its dominance has been challenged by the advances in cancer biology as well as by other forms of surgical, radiation and drug therapies. Its role in treating breast cancer has been highly controversial for some time. Recently I looked up Dr. Halsted's papers again in an attempt to answer the questions that I first asked myself in medical school. There, we heard about a controversy set off in Edinburgh by Dr. Robert McWhirter who suggested that simple mastectomy combined with postoperative radiation was equally effective as Dr. Halsted's radical mastectomy. During specialty training, we also heard the benefits of less radical breast operations argued by Dr. George Crile Jr. and Dr. Oliver Cope. Most important, the breast cancers that Dr. Halsted considered small measured about three inches by three inches and are huge by today's standards. As a result of mammography, patient education and self-examination - techniques developed in the last two decades - breast cancers now ca n be detected when they are only a few millimeters in size. The startling fact is th at many of the first patients to undergo Halsted radical mastectom ies would not be considered candidates for the operation today because the cancer was too advanced

They extended the findings of other researchers to show that alcohol exerts a physical effect that in some unknown way temporarily makes the brain membrane more fluid. They also found that when rats were made alcoholic, the rats protected themselves by adapting and making their brain cell membranes stiffer. Then when alcohol was added to the stiffer membranes in the laboratory, their physical state tended to become more fluid - but not as fluid as the membranes of nonalcoholic rats. The membranes of brain cells of alcoholics, even when they go a few days without taking alcohol, might stay at plus two, a state in which the cells perform less effectively. Because the cell is now unnaturally stiff, the body seems to crave alcohol to return to the semifluid normal state. That state could also be dangerous, producing a dependency on alcohol to keep the membrane in its normal semifluid state. Without the alcohol, the hallucinations of DT's might result, a sign of chaotic communication between the brain cells, according to this theory. The researchers also found that much less alcohol - about one-third as much - dissolves into the brain cell membranes of chronic alcoholic rats than those of normal rats. That evidence, according to the theory, explains why chronic alcoholics could have very high, even seemingly lethal, amounts of alcohol in their blood yet still drive and carry out other functions. The reason, according to the theory, is that only about a third as much of the alcohol in the blood of chronic alcoholics dissolves into the brain-cell membranes in comparison with nonalcoholics