Faculty Bibliography

On Saturday, a team of five doctors performed a minimally invasive procedure to implant flexible stent-grafts in the popliteal arteries behind each knee. Mr. [Dick Cheney] was given local anesthesia during the procedures, which together lasted six hours. Mr. [Stephen E. Schmidt] said that, before they started, the vice president's doctors had expected to perform the procedure only on the artery in Mr. Cheney's right knee. But during the procedure, he said, the doctors decided to repair both knees. Although the stent-graft procedure avoids the use of general anesthesia, ''there still is stress associated with the procedure under local anesthesia, and there are potential complications,'' said Dr. K. Craig Kent, chief of vascular surgery at Weill Cornell and Columbia University medical schools

Mr. [Cheney], 64, who has had four heart attacks, will remain overnight in the hospital after the procedure. Steve Schmidt, his spokesman, described the surgery as an elective procedure so it would ''not become a problem over time.'' The aneurysm is in the popliteal artery behind Mr. Cheney's right knee, his spokesman said. During a routine examination in July, the vice president's doctors ''identified small, dilated segments of the arteries behind both knees,'' according to a statement

Ruge was standing near Reagan when John W. Hinckley Jr. shot him in the chest outside the Washington Hilton and followed in another car as the Secret Service sped the president to George Washington University Hospital. Ruge later said in interviews with this reporter that he had erred in neglecting to invoke the 25th Amendment to transfer presidential powers to vice-president George Bush temporarily, because of Reagan's need for emergency chest surgery, requiring general anesthesia. Ruge said that he wanted to be publicly invisible as the White House physician and declined to talk with medical reporters at the time. But Ruge later said that he had also erred in refusing interviews

Dr. Ruge was lauded for insisting that Mr. Reagan be treated by the hospital's trauma team, instead of taking charge himself or summoning high-powered surgeons from other medical centers, as has occurred in many cases involving other dignitaries. Dr. Ruge instructed staff members at George Washington to make the same medical and surgical decisions for the president that they would make for any patient in the same condition. Dr. Ruge said he had studied the Constitution during the 10 weeks that Mr. Reagan had been in office and carried a copy of the 25th Amendment in his bag. Section 3 of the amendment should have been invoked to transfer executive powers to Mr. [George Bush] for at least a day or two, Dr. Ruge said, ''because Mr. Reagan could not communicate with the people a president is supposed to communicate with.'' As a neurosurgeon, Dr. Ruge was well qualified to observe Mr. Reagan closely. After Mr. Reagan disclosed in 1994 that he had Alzheimer's disease, Dr. Ruge said he had never detected any signs of Alzheimer's in talking with him almost daily from 1981 to 1985

An international health organization has reported that it has suspended more than $150 million in grants to Uganda because of serious mismanagement. Officials of the agency, the Global Fund to Fight AIDS, Tuberculosis and Malaria, said Wednesday that they had taken the action to warn Uganda and other countries that they needed to manage the fund's grants properly. The fund had awarded Uganda $201 million in five grants and had already paid out $45.4 million of that. Two grants were made to help fight AIDS and two for malaria. The fifth grant was for tuberculosis control. Some started in 2003, and some this year. Payment will resume 'as soon as Uganda comes up with a proper plan to rectify the issues of mismanagement,' said Jon Liden, a spokesman for the fund. It has given Uganda until Oct. 24 to improve management of the grants

Dr. Chan, 58, who is both affable and media-savvy, first drew public attention when, as director of the Hong Kong department of health, she boldly directed the territory's response to two major disease outbreaks that threatened the world's health and economy. In 1997, she ordered 1.4 million chickens and ducks slaughtered to control the first cases of the A(H5N1) strain of avian influenza. In 2003, she led the investigation of SARS, a new virus that emerged in China. Indeed, Dr. Chan faced such complaints after the first cases of A(H5N1) avian influenza appeared in Hong Kong in 1997. No vaccine was effective against the strain. But the virus was susceptible to a drug, amantadine, and Dr. Chan authorized the equivalent of US$1.3- million to buy a large supply of it in case a large outbreak occurred. Black & White Photo: Peter Parks, AFP, Getty Images / A woman cleans at a Hong Kong poultry market in an effort to combat the spread of a deadly strain of avian flu.; Black & White Photo: Carol T. Powers / the New York Times / Dr. [Margaret Chan] was instrumental in containing the virus when it struck in 2003. Chan is now the World Health Organization's chief of pandemic influenza

Officials have been racing to develop a vaccine because they worry that if that strain mutated and combined with a human influenza virus to create a new virus, it could spread rapidly. Tens of millions of birds have died from infection with the virus and from culling to prevent the spread of the virus. About 100 people have been infected, and about 50 have died from this strain of the avian influenza virus, called A(H5N1). So far there has been no sustained human-to-human transmission, but that is what health officials fear, because it could cause a pandemic. The director of the National Institute of Allergy and Infectious Diseases in the United States, Dr. Anthony Fauci, said that while the vaccine that has undergone preliminary tests could be used on an emergency basis if a pandemic developed, it would still be several months before that vaccine was tested further and, if licensed, offered to the public. In Taiwan, Dr. Kuo Hsu-sung, director general of the Center for Disease Control, said that the authorities in Taiwan were so concerned about the long-term risks of an influenza pandemic, as well as the annual harm from more routine outbreaks of human influenza, that the island planned to build its own human influenza vaccine factory. But building a factory and putting it into production will take four years, Kuo warned. For now, Taiwan has a supply of Tamiflu, the only medicine known to work against bird flu, adequate to treat 1 percent of its population

Influenza viruses are grown in chicken eggs, and the vaccine industry has difficulty obtaining enough of them to produce the standard influenza shots each year. That is among the reasons that the industry can currently produce only an estimated 450 million doses of standard influenza vaccine for the human strains, Dr. [Anthony S. Fauci] said. Dr. Kou Hsu-sung, the director general of Taiwan's Center for Disease Control, said the island was so concerned about the long-term risks of routine influenza outbreaks and an influenza pandemic that it plans to build its own human influenza vaccine factory. In years past, standard influenza vaccine has had to be discarded because too few people wanted it. In the case of the human avian influenza vaccine, said Dr. [William Schaffner], the Vanderbilt expert, ''how many people will show up and present their arms?''

The bacteria are commonly found where pigs are raised. Animals without symptoms carry the bacteria in their tonsils and noses. Sichuan Province has one of the largest pig populations in China, and news organizations have reported a concurrent outbreak among pigs in that area. There is no evidence that the illness has been transmitted from one person to another in the outbreak, the health agency said. There was no immediate evidence that China, which came under fire for covering up the outbreak of SARS, or sudden acute respiratory syndrome, in 2002 and 2003, was hiding information about the Streptococcus suis outbreak. Health officials say more laboratory tests are needed to determine why the Sichuan outbreak is so large and the death rate so high. Among the questions infectious disease specialists have raised is whether Streptococcus suis has mutated to become more virulent. Scientists say China should search for other factors that might explain the high death rate. Another unusual feature of the outbreak is that many patients have developed bleeding under the skin, and some have developed toxic shock syndrome