Faculty Bibliography

Working under primitive conditions in a small rural hospital in Brazil, a surgeon has developed a bold new operation for heart failure that supporters say promises to allow tens of thousands of people to resume daily activities, stop many medications and avoid transplants. The operation defies conventional medical wisdom because it removes living tissue from the heart. The size of an enlarged heart is reduced by cutting out a large slice of living muscle from the main pumping chamber, which is then stitched together while the patient's heart is beating

On Jun 3, 1996 the FDA approved a new test, which measures the amount of the AIDS virus in the blood, to help determine how fast an individual's infection with HIV is progressing to full-fledged AIDS. Roche Diagnostic Systems Inc received approval to market and distribute the test, called the Amplicor H.I.V.-1 to laboratories in the US

Group B strep infections are the most common serious infection in newborns. About 7,600 newborns, or 1 in 500, develop group B strep infections each year. Infection is usually acquired during pregnancy when the bacteria climb from the vagina to the womb or during passage through the birth canal. Treatment is directed at the mother following testing about one month before she gives birth because group B strep infections in newborns ''are easier to prevent than trying to save the baby after it occurs,'' said Dr. Anne Schuchat, a CDC epidemiologist. Dr. Schuchat said federal officials were urging pregnant women to ask doctors about possible treatment because ''this is one bad thing that can happen to your baby that you can actually do something about up front.''

New York Yankees pitcher David Cone is suffering from complications of a rare type of aneurysm in an artery in his right armpit that developed from the motion he used to deliver countless pitches during his career, according to a doctor familiar with the case. It is not clear whether Cone will be able to return to the Yankees, but two other pitchers on minor league teams who developed similar aneurysms had the problem corrected surgically and one of them has resumed playing professional baseball

Our experience with medical students in a large inner city hospital left us concerned that students' fears affect their ability to learn about and care for HIV-positive people. Therefore, we decided to create an environment in which the students could feel safe exploring their own attitudes and feelings about HIV. To accomplish the goal, we developed a curriculum in the ambulatory care of HIV-positive people. We recruited and trained patients from an HIV support group at our hospital to work with students in one-on-one sessions to teach interviewing, physical exam, and patient counseling skills. As part of a 4-week ambulatory clerkship for third year students we developed a minicourse which included four sessions with didactic and experiential components. The first week consisted of an orientation and group discussion in which patients told the students about what its like to live with HIV. During each of the following three sessions, students met with a preceptor to learn about HIV in an ambulatory care setting. The didactic session was followed by one-on-one student/patient encounters in which students practised skills discussed that week and patients gave them feedback. At the close of the day, the entire group reconvened to discuss what had happened. As a result of this integrated approach, students are experiencing the relational aspects of providing medical care, often for the first and only time. In the process they are learning to take good social histories and are learning how patients with HIV relate to and sometimes reorganize their family and social support systems. Students have the opportunity to get to know, in depth, a relatively healthy person who is living with a chronic, stigmatizing illness. Both patients and students are talking to each other on a level of intimacy that is rare in the training environment. Patients express a new appreciation of their own role and power in the relationship and a new insight into the struggles of the provider. Faculty experience a renewed commitment to the importance of creating an environment where the students can discover for themselves the joy of the connection between doctor and patient. Students have an opportunity to relate to patients not as pathology, but as people with lives before and beyond the medical system. This model is practical and may be useful in teaching about other chronic diseases in the ambulatory setting

Molecular fingerprinting techniques are rapidly becoming indispensable tools for hospital epidemiology. On the other hand, the relative complexity and unfamiliarity of these techniques to most hospital diagnostic laboratories limit their usefulness. In an attempt to provide a solution for this dilemma, we tested the feasibility and efficacy of a cooperative venture in which molecular typing of isolates recovered from patients in six hospitals was performed at two microbiology research laboratories with expertise in these techniques. In a small preliminary study, 30 methicillin-resistant Staphylococcus aureus (MRSA) and 30 vancomycin-resistant Enterococcus faecium (VREF) isolates were collected over a 3-week period from six hospitals in the metropolitan New York area and transported to the Laboratory of Microbiology at The Rockefeller University during the summer months of 1994. Nineteen of the 27 confirmed MRSA isolates were closely related strains carrying the same mecA and the same Tn554 polymorphs in a pulsed-field gel electrophoresis (PFGE) background represented by closely related subtypes of a single pattern, indicating the wide distribution of this MRSA clone among the participating hospitals. Typing of the same 27 MRSA isolates was also performed at the Tuberculosis Center of the Public Health Research Institute and identical results were obtained. The 29 confirmed VREF isolates were highly heterogeneous and belonged to as many as 23 distinct clonal types as defined by PFGE patterns and probing with vanA. Characterization of the 60 isolates by these methods was completed in one month of full-time effort by a single experienced laboratory assistant guided by a doctoral-level expert in molecular fingerprinting techniques. The collection of samples for both MRSA and VREF was not intended to address epidemiological questions but to determine the feasibility of a multicenter study. On the basis of our preliminary findings we are encouraged that a larger cooperative effort is possible and with the correct sampling method we believe that epidemiological and surveillance studies could be accomplished that would provide a tracking system to assist hospitals, clinics, and chronic care facilities in controlling the spread of multidrug-resistant pathogens

We have detected new clues to the composition and function of 'Transfer Factor' using the direct Leucocyte Migration Inhibition (LMI) test as an in vitro assay of Dialysates of Leucocyte Extracts (DLE). This approach has revealed two opposing antigen-specific activities to be present in the same > 3500 < 12,000 DA dialysis fraction - one activity is possessed of Inducer/Helper function (Inducer Factor). The opposing activity is possessed of Suppressor function (Suppressor Factor). When non-immune leucocyte populations are cultured with Inducer Factor they acquire the capacity to respond to specific antigen and inhibition of migration occurs. This conversion to reactivity is antigen-specific and dose-dependent. When immune leucocyte populations are cultured with Suppressor Factor their response to specific antigen is blocked and Inhibition of Migration is prevented

The case of a 35-year-old woman who reported to Siegel with abnormal and sometimes missing periods is recounted. The diagnosis was premature menopause