Faculty Bibliography

In the medical evaluation of older men with erectile dysfunction, obtain a detailed history to determine whether the dysfunction is organic or psychogenic. Determine if there are underlying pathologic processes--most notably vascular diseases--or other factors responsible for the dysfunction, such as medications or nerve or arterial damage from surgery. Lifestyle changes in mid-life (regular exercise, a low-fat diet, and smoking cessation) increase a man's chances of remaining potent as he grows older. Treatments for impotence include injection therapy, vacuum devices, and implants. Each therapy has advantages and disadvantages, and the informed patient plays an important role in choosing the therapy that is right for him

Methicillin-resistant Staphylococcus aureus (MRSA) has been detected in nursing homes and long-term care facilities. Studies disagree about the risk of infection with MRSA in colonized patients. MRSA colonization and infection were tracked for one year in all admissions to a 60-bed ward at the Philadelphia VA Nursing Home Care Unit (NHCU) from the time of its opening in June, 1990. Patients and staff were blinded to culture results, and the NHCU followed universal precautions for all patients. Of the first 72 patients, 7 were found to be colonized with MRSA; only one of them was known to have had MRSA prior to NHCU transfer. Three patients died (2 had negative cultures prior to death), and 1 was discharged home. Three patients spontaneously cleared MRSA colonization and lived to the end of the study. Three patients appeared to be colonized by MRSA after admission; subsequent cultures were negative. No patients were infected by MRSA in the NHCU. At the close of the study, one year after the nursing home opened, no patient in the nursing home had a culture positive for MRSA. In conclusion, colonization with MRSA at the time of admission to the nursing home is not uncommon, but patients can spontaneously clear it. Besides, nursing homes that pre-screen only those patients with classic risk factors may be admitting many MRSA-colonized patients. Nonetheless, universal precautions appear to be effective in limiting transmission of MRSA in the nursing home; in this study, MRSA acquisition was sporadic and brief.

Pneumonic plague, which affects the respiratory system, is generally regarded as a public health emergency of the first order. It and bubonic plague are caused by the same bacterium, but pneumonic plague is considered far more of a threat because the infection is airborne. Airborne plague causes pneumonia and is the deadliest, most communicable form of plague. None of the suspected plague cases from Surat is bubonic, which could suggest that the plague originated elsewhere in the bubonic form and spread in pneumonic form to Surat. The scene in Surat during recent days resembled a grade B movie, except that it was real. It would be a miracle if no evacuees were carrying the plague-causing bacterium, Yersinia pestis, as they fled Surat, a port city of 1.6 million people in western India not far from Bombay. The threat extends beyond the country

Pneumonic plague, which affects the respiratory system, is generally regarded as a public health emergency of the first order. It and bubonic plague are caused by the same bacterium, but pneumonic plague is considered far more of a threat because it is airborne. The scene in Surat over the past days resembled a grade B movie, except that it was real. It would be a miracle if no evacuees were carrying the plague-causing bacterium, Yersinia pestis, as they fled Surat, a port city of 1.6 million people in western India near Bombay. The threat extends beyond the country

Officials of the World Health Organization have been playing down the threat. In interviews over the weekend, Dr. Giorgio Torrigiani, an official of the organization, said there was no danger to travelers to and from India. He also said he doubted that plague would spread beyond the [Surat] area, and he expressed confidence that the Indian Government was taking all necessary steps to contain the epidemic. Dr. Torrigiani said he was 'confident that there would not be a danger of plague spreading' outside of India. The Indian Government has said laboratory tests confirmed that the disease afflicting Surat is pneumonic plague. The Centers for Disease Control and Prevention in Atlanta has sent to India reagents needed to diagnose Y. pestis in the laboratory, at the urgent request of doctors there. But Dr. Duane J. Gubler, a plague expert at the Federal agency's field station in Fort Collins, Colo., said he had not received word of results. Dr. Gubler said he assumed that India was dealing with pneumonic plague but, he said, 'we are keeping an open mind about the situation.' Since the mid-1970's, domestic cats have become an important newly recognized source of transmission of plague to humans in the United States, but rarely elsewhere. Cats have been identified as the source of at least 15 human plague cases in this country, including several that resulted from pneumonic feline plague. Cats become infected by catching infected rodents and then spread the bacteria to humans, often through airborne infection

It and bubonic plague are caused by the same bacterium, but pneumonic plague is considered far more of a threat because it is airborne and can be spread by the coughing of the plague victim. None of the suspected plague cases from Surat is bubonic, which could suggest the plague originated elsewhere in the bubonic form -- perhaps from an outbreak 400 kilometres south of Surat -- and spread in the pneumonic form to Surat. The scene in Surat over the past days resembled a grade B movie, except that it was real. It would be a miracle if no evacuees were carrying the plague-causing bacterium, Yersinia pestis , as they fled Surat, a port city of 1.6 million people in western India near Bombay. The threat extends beyond the country

Cards will be given to travelers from the infected areas to alert them to call a doctor if they develop a fever or become ill, said Dr. Duane Gubler, a federal Centers for Disease Control and Prevention expert on plague. He emphasized that plague can be successfully treated with antibiotics if detected early. Without treatment, the mortality rate from pneumonic plague is 90 percent; with antibiotics, the mortality rate falls to 5 percent

Researchers from the University of Washington and Fred Hutchinson Cancer Research Center in Seattle, using a tumor registry, were able to identify clinic participants who developed ovarian cancers before 1992. Nine of the 11 had taken clomiphene, sold under the brand names Clomid and Serophene, and 5 of the 9 had taken the drug during 12 or more monthly cycles

In an effort to guard against the spread of the pneumonic plague outside of India, federal health officials in the US said on Sep 24, 1994 that they plan to increase surveillance at airports in the US to identify any cases among passengers coming from infected areas of India

The history, nature and treatment for pneumonic plague, an epidemic of which is spreading through Surat India, are examined