Faculty Bibliography

Shiners are so common that they tend to be regarded as one of life's tribulations, hardly serious beyond the embarrassment of the injury. I examined her to make sure there was no emergency condition, and in the process, I went through a mental checklist of routine medical questions. Commonly this checklist yields little or nothing beyond reassurance that a minor mishap is no more than that; sometimes it reveals a truly dangerous situation. It has to be done, especially with black eyes, which occasionally can be associated with brain damage. Meanwhile, I ran my fingers over her skull without detecting any obvious skull fracture, although I knew that fatal brain damage could occur without any fracture. I also checked to make sure there was no thin, watery fluid dripping from her nostrils. Such a leak might have been spinal fluid oozing from a fracture of the base of the skull. We returned home to apply ice packs to her forehead. Among other things, I examined her eyes again, according to my mental checklist. Had her pupils become wider or narrower than when first examined a few minutes earlier? If they had widened, it might have indicated serious damage to her brain. I flashed a beam of light into her eyes to determine if her pupils reacted normally. If they had been unable to constrict, and then widen when the light was turned off, it would have been evidence of life-threatening brain damage

Although demineralized bone is dead, it has the capacity to signal living cells called fibroblasts that pervade the body's tissues to make bone, even when the implant is not in contact with existing bone. Fibroblasts normally make scar tissue. But demineralized bone stimulates fibroblasts to change their basic nature and to turn into cells called chondroblasts that make cartilage and then new bone. Cartilage is a normal step in the bone formation process. First, bone in powder form is much more versatile than cadaver bone because the powder can be shaped into any form, wasting none. Cadaver bone itself has been less effective than fresh bone, the researchers said, and the new process holds the promise of being much more effective than fresh bone. And, unlike fresh bone, it can be stored until needed. Patients receiving transplants from other parts of their own bodies may suffer complications not only from the longer time needed for the conventional operations but also from the removal of the bone itself. Transplanted bone tends to grow in a pattern that is not uniform; the demineralized bone becomes a part of the surrounding bone, eliminating that problem

The artificial skin is still experimental, is made in small amounts in a laboratory and is available only at the Boston hospital, Dr. [John F. Burke] said in an interview. ''We can make only a very small proportion of what we need,'' Dr. Burke said. ''We have to treat one patient at a time, because we can't make it quick enough for others.'' Accordingly, it has been used only for patients with large burns

''We can make only a very small proportion of what we need,'' he said. ''We have to treat one patient at a time because we can't make it quick enough for others.'' Once the new cells are in place as an outer layer, they ''really heal like a sunburn, in less than a week,'' Dr. [John F. Burke] said. ''What we do is make a scaffolding on which'' the cells grow. The deeper, or dermal, layer is intended to be permanent. It is composed of biological materials from cowhide and shark cartilage. Regaining Normal Sensations The anatomic construction of the materials proved to be as important as their chemical nature, Dr. Burke said. ''How it's dispersed in space is really very important.'' The pores had to be about 50 microns apart, ''almost exactly what it is in the normal'' skin, he said

Although Dr. [Benjamin L. Aaron] described himself as someone who ''doesn't get anxious about things,'' he acknowledged that he was ''on edge at times.'' One such time, he said, was when, in the operating room, he was unable to locate the bullet in Mr. [Reagan]'s left lung. ''He didn't like being beaten on and he hated some of that, but he got it anyway,'' Dr. Aaron said. Dr. [Joseph M. Giordano] said that although ''we kept telling each other that he's just another patient, in fact that was not really true.'' For example, the surgeons adjusted the timing of their hospital rounds to avoid interfering with Presidential business and to give him adequate rest. Mr. Reagan's humor, Dr. Giordano said, ''made him more natural and easier to approach as a patient.'' The doctors also used it as a barometer to judge his recuperation. Dr. Aaron said that ''we could tell when he wasn't feeling well because he wouldn't talk much. When he felt good, he talked and joked incessantly.''

Dr. Dennis S. O'Leary, who has been the principal medical spokesman about President [Nancy Reagan]'s emergency surgery and recuperation since he was shot on Monday, said today that ''nothing of significance'' had been concealed from the public although his reports had been ''as upbeat as possible without damaging my credibility.'' At times, Dr. O'Leary said, he was ''working with a little bit less than complete information.'' Mr. Reagan continued his convalescence today after sleeping through most of the night at George Washington University Hospital here. His temperature had been elevated to ''moderate levels'' last night but was normal this morning, the White House said. White House and hospital officials declined to specify the temperature in degrees. Treatment of Lung Problems ''This is a switch,'' Mr. [Vernon E. Jordan Jr.] said, referring to the visit that Mr. Reagan made to Mr. Jordan when he was recuperating in a hospital. The President replied, ''It sure hurts getting shot.'' The White House said today that Timothy J. McCarthy, the Secret Service agent wounded Monday, was making ''excellent progress.'' Thomas K. Delahanty, the District of Columbia police officer who was shot, was reported to be in good condition, walking and showering

''That's great news, just great, especially about Jim,'' Mr. [Nancy Reagan] said, according to a White House bulletin. The President apparently was in a jovial mood, because the statement reported that Mr. Reagan also said: ''We'll have to get four bedpans and have a reunion.'' Mr. Reagan rose to shake hands with Mr. [Timothy J. McCarthy] when he and his wife, Carolyn, paid a brief visit to the President's hospital room about midday. Mr. Reagan had a fever of 102 degrees yesterday morning. By afternoon, it had dropped to near the normal 98.6. Later, however, it went up again, to 101 degrees. Other than describing his fever today as ''mild,'' hospital officials and the White House refused to disclose the specific degree of temperature. Possible Cause of Fever At a news conference yesterday, Dr. Benjamin L. Aaron, one of Mr. Reagan's surgeons, said that an infection ''could not be ruled out'' and that the fever probably was due to the collection of blood and a condition called atelectasis in which air sacs in the lung collapse

Dr. Daniel Ruge, Mr. [Nancy Reagan]'s personal physician, said in an evening medical bulletin that Mr. Reagan's condition ''is satisfactory'' and he ''remains alert and generally comfortable.'' The surgeon said that the virtual absence of fever was ''a little unusual for a patient who had suffered a major lung injury.'' Asked if it was dangerous for the President's temperature to rise to 102 degrees, Dr. [Benjamin L. Aaron] replied, '' I don't really know. It is indicative that part of the lung is indeed not functioning as well as it might, which has been the case most of the week.'' Dr. Aaron said that an ''infection could not be ruled out'' and that there ''always was a chance for infection to develop.'' If cultures of Mr. Reagan's sputum or other fluids show evidence of bacterial infection, antibiotic therapy would be resumed, Dr. Aaron said

Interviewed later in his office, Dr. O'[Leary] said that the facts as reported in the Times article were accurate. He said his concern was that the article might be misinterpreted by laymen as suggesting that the President was in shock and near death, even though the Times article said that Mr. [Reagan] was ''never in shock.'' Dr. O'Leary also confirmed reports that Mr. Reagan had fallen to one knee and that he had to be supported by aides when he arrived at the emergency room. Dr. O'Leary attributed the President's symptoms - chest pain, shortness of breath, and the collapse - to a combination of a vasovagal reaction and orthostatic hypotension. Dr. [Frank C. Spencer] also said, ''Why would you give that amount of blood if he was not in a life-threatening situation and the patient's life was no in serious danger?''

Dr. [Daniel Ruge] also said that Mr. [Reagan] ''is experiencing some pain and fatigue in response to his injury.'' He said that the pain was ''normal for one experiencing an injury and surgery of this type.'' Watched Award Ceremonies Plans were being made to halt the President's pain medications, according to a White House source who saw the President today. The source also said that Mr. Reagan had ''a nasal catheter'' in his nostrils and an intravenous tube in his arm. Those devices are commonly used in the post-operative care of patients. In Mr. Reagan's case, the doctors could not remove it as early as they had hoped. Dr. [Richard A. Davis] said it was his understanding that prior to his arrival ''either the endotracheal tube was removed for a brief period or the respirator was shut off for a brief period while Mr. Reagan was given a trial period of breathing on his own.''