Faculty Bibliography

Babesiosis is caused by a parasite that is commonly found in many animals. The parasite most commonly linked to the human illness in this country is called Babesia microti, which is transmitted to humans through the bites of ticks, primarily a common deer tick in northern states, Ixodes dammini. During their developing stages, the ticks pick up the parasite from infected mice and possibly other rodents. There is an unusual feature of babesiosis. Rocky Mountain spotted fever and other tick-borne diseases are spread by adult ticks, whereas babesiosis is spread by the nymph, or middle form, which is tiny and more difficult for an individual to detect on the body. When the technicians examined a sample of the lawyer's blood, they noticed the parasite within the man's red cells and thought the lawyer had malaria. But on closer examination, they suspected that the parasites were those that caused babesiosis. A parasitologist then confirmed the diagnosis.

''Physicians need to be alerted to such patients,'' Dr. [Carl Eisdorfer] said, because most family physicians, internists and other doctors involved in primary care generally do not check older patients for dementia unless they pick up a clue during the examination or are requested to do so by the patient or a relative. Once a doctor has diagnosed dementia in an older patient, the next task is to determine if the underlying cause is reversible. Tranquilizers, barbiturates and many other sleep medications, moodaltering drugs, such as Thorazine, and diuretic-type drugs used to treat heart disease, among other compounds, have been found to be common causes of reversible dementia. If the use of a medication is found to be the problem, the patient's doctor can then adjust the dosage. Diagnosing dementia in its earlier stages can be extremely difficult, although experts are increasingly relying on newer, sophisticated psychological tests. One such test measures patients' speed and accuracy in sorting cards imprinted with letters of the alphabet.

Dr. [John Reynolds] said that he could not determine if the hearing loss had become worse in recent years because the last audiogram, or hearing test, was done in 1973. At that time, the audiogram showed ''no significant change since'' one done in 1971, Dr. Reynolds said. He also said that he ''assumed'' that the hearing loss was a ''normal consequence of aging.'' After 10 minutes of exercise testing in April 1979, Dr. Richard Taw of Santa Monica said, Mr. [Ronald Reagan]'s heart rate reached 155 beats a minute, or 100 percent of the maximum predicted value for a man his age. Dr. Taw said that Mr. Reagan's test had shown ''absolutely no evidence of coronary artery disease'' and that ''his performance was surprising to me.'' Mr. Reagan's most serious past medical problem apparently was a prostate operation in 1967. Dr. Burton Smith, Mr. Reagan's urologist, said that the operation, a common one called a TUR, or transurethral prostatectomy, was done to correct an anatomical abnormality of a portion of Mr. Reagan's urinary bladder called the ''neck'' and to remove about 30 ''seedlike prostatic stones.'' The operation was done because Mr. Reagan had suffered a series of urinary tract infections that have not recurred in the last six years, Dr. Smith said. He also said that Mr. Reagan has not had any stones affecting his kidneys or bladder.

One such example may have been Anton van Leeuwenhoek, the inventor of the microscope. The ''animalcules'' that van Leeuwenhoek described in 1681 in his own stool when he looked through his primitive microscope were probably Giardia lamblia. Van Leeuwenhoek apparently had no symptoms. Much more recently, doctors have learned that giardiasis is like so many other diseases. People like van Leeuwenhoek can be ''carriers;'' that is, they can harbor the parasite without experiencing any symptoms. The reason is a scientific mystery. Doctors diagnose the condition by looking through a microscope at a stool specimen and identifying a pear-shaped parasite whose two nuclei give the organism the appearance of a face with two ''eyes.'' The organism has four pairs of flagella with which it thrashes around the small intestine to sap the body of vital nutrients. Because of the variability in the number of organisms excreted, experts recommend that three different stool samples be collected over the period of a week.

Examination by electron microscopy of the elastic fibers of individuals with Pseudoxanthoma Elasticum (PXE) revealed that the principal alterations were in the elastin moiety of the elastic fibers. The elastin had a granular appearance, an increased affinity for cationic stains, and it often demonstrated sites of increased density presumed to represent foci of calcification. In contrast to the elastin, the microfibrillar component of the elastic fibers was unchanged, both in morphologic appearance and in distribution. There was no clear correlation between the extent of the morphologic alteration in the elastic fiber and the level of clinical severity. Morphologically altered fibers were often found together with unaltered fibers. Changes similar to those seen in patients with PXE were also found in biopsies obtained from clinically unaffected consanguinous relatives. The pattern of inheritance in several of the families examined was compatible with autosomal recessive, whereas in at least one family a more complex mode of transmission seems likely. The electron microscopic data therefore provide further support for the genetic heterogeneity of PXE

Elastic fibers have been shown to contain two proteins, insoluble elastin and the elastic fiber microfibril, a glycoprotein. The microfibril has been suggested to play a morphogenetic role in determining the presumptive shape and direction of the forming elastic fiber. The principal alteration seen in individuals with the disease Pseudoxanthoma Elasticum is in insoluble elastin which loses its amorphous appearance and affinity for anionic stains, and takes on a finely granular appearance and shows increased affinity for cationic stains. Normal elastic fiber microfibrils are sometimes associated with this material; although, in general, these structures are not present in the elastic fibers that are markedly altered in this disease