Faculty Bibliography

NCIS [Television Program] -- The premise: In an abandoned warehouse in Georgetown, a man is proposing to his bride-to-be when he discovers the dead body of a sailor covered with maggots. The Naval Criminal Investigative Service is called and uses the maggots to determine that he has been dead for almost five days. NCIS medical examiner Dr. Donald 'Ducky' Mallard (David McCallum) finds no signs of trauma or injury but discovers a blood alcohol level five times normal, a worn-out (cirrhotic) liver and multiple organ failure. Other recreational drugs, including Ecstasy, are found in the man's bloodstream. At first, the team believes that the sailor must have died of a combination of drugs and alcohol. But forensics expert Abby Sciuto (Pauley Perrette) uses a mass spectrometer to identify high levels of a mystery compound that turns out to be a poison derived from the oleander plant

The inch-long sore was pale, a whitish gray against the red background. Unfortunately, it told his future. The oral pathologist had performed a biopsy, which had shown the sore to be melanoma, and a CT scan revealed that it was already invading the bones of [ARTHUR]'s face. A few weeks after Arthur's death, a woman in her late 50s came to see me with firm rubbery lymph nodes on the front and back of her neck. I immediately thought that lymphoma was the most likely possibility, but at the same time I noticed that her hair was very thick and dark for her age. I probably wouldn't have noticed her hair at all pre-Arthur, since hair is not the usual stalking horse for an internist. But I was now alert to things out of the ordinary. This more innocent possibility -- hair dye allergy -- quickly eclipsed lymphoma as my lead theory. I ordered a CT scan of the neck rather than going straight to a biopsy, as I would have done if I had had no other explanation than cancer. We were relieved that the CT scan showed 'reactive nodes' rather than suspicious-for-cancer nodes. Eventually, after the patient washed the dye out of her hair, the swellings in her neck began to shrink

Vaccines are better preventatives than invasive procedures. Millions of women infected with the offending virus can develop pre- cancers requiring removal. These women must be carefully screened as they live in fear of one abnormal Pap test to the next. Given a choice, most women would prefer a vaccine to this unpleasant routine, and the $360 cost of the vaccine is far less than the thousands spent on a biopsy or colposcopy procedure. The problem with combating the human papilloma virus in the United States isn't only cervical cancer or precancerous cells. The problem also is an epidemic of sexually transmitted genital warts. The CDC says HPV causes more than 6 million new cases of genital warts in this country every year. Gardasil is not only effective; it's quite safe. It is a non- infectious, mercury-free vaccine genetically engineered using viral particles and simple yeast. Studies in 11,000 girls have shown it to be without significant short-term side effects. Dr. William Schaffner, vice president of the National Foundation of Infectious Disease and chairman of the Department of Preventative Medicine at Vanderbilt University, says: 'I strongly believe this great cancer- prevention benefit should be extended to all girls and young women for whom the vaccine is indicated.'

BACKGROUND:Coronary artery calcification (CAC) is associated with an increased risk of cardiovascular disease; little is known, however, about thoracic aortic calcification (AC). Our goal was to characterize risk factors for CAC and AC and to estimate the genetic contribution to their variation. METHODS AND RESULTS/RESULTS:The presence and quantity of CAC and AC were measured with electron beam computed tomography and fasting blood tests and cardiovascular risk factors were obtained in 614 asymptomatic Amish subjects. CAC prevalence was higher in men than women (55% versus 41%; P<0.0001), although there was no sex difference in AC prevalence (51% and 56% in men and women, respectively; P=0.95). Age was more strongly associated with AC presence (odds ratio [OR], 2.7 for 5 years) than CAC presence (OR, 1.9 for 5 years) (homogeneity P=0.001). Subjects with AC had a 3.3-fold higher odds of having CAC. Heritabilities of CAC and AC presence were 0.27+/-0.17 (P=0.04) and 0.55+/-0.18 (P=0.0008), respectively, whereas the heritabilities of quantity of CAC and AC were 0.30+/-0.10 (P=0.001) and 0.40+/-0.10 (P<0.0001), respectively. The genetic correlation between CAC and AC quantity was 0.34+/-0.19, whereas the environmental correlation between these 2 traits was 0.38+/-0.09. CONCLUSIONS:CAC and AC have similar risk factors, except male gender is associated only with CAC and age is more strongly associated with AC. The patterns of correlations suggest that CAC and AC share some common sets of genes and environmental factors, although it is likely that separate genes and environmental factors also influence calcification at each site.

House [Television Program] -- The premise: A 16-year-old is brought to the hospital after experiencing breathing difficulties while making out with his girlfriend. When a chest X-ray reveals fluid in the pleural space (lining of the lung), Dr. Gregory House and his team conclude that the fluid must be blood, so they shoot dye into the teen's veins (venogram) and then his arteries (arteriogram) searching for the source. They discover a blockage in the liver and perform an MRI scan that reveals what appears to be an inflammatory patch (granuloma). They suspect the patient has Wegener's Granulomatosis (a vasculitis or inflammation of the blood vessels) and treat him with chemotherapy, which appears to cause his bladder to bleed. House then recommends FT 28, an experimental immunological treatment

When the United States went to war in 1941 following Pearl Harbor, the health of the troops became a primary concern. Determined to prevent the medical casualties of World War I, where the number of American soldiers killed by influenza (44,000) almost matched the number lost in battle (50,000), military officials made vaccination mandatory. "Yes, the shots hurt and even caused illness sometimes, but the soldier survived," [Arthur Allen] writes. "Returning from the war he wanted his children to have the same protection." World War II made vaccination fashionable. Polio turned it into a national crusade. No disease drew as much attention in postwar America, or created as much fear. Primarily striking children, polio killed some of its victims and paralyzed others, leaving behind vivid reminders for all to see: wheelchairs, leg braces, iron lungs, deformed limbs. The quest for a means of prevention led to the largest public health experiment in American history, involving nearly two million school- age volunteers. When Jonas Salk's killed-virus polio vaccine was declared "safe, effective and potent" in 1955, the nation celebrated as if a war had ended - and, indeed, one had. At a White House ceremony, President Dwight D. Eisenhower choked back tears as he told the young researcher: "I have no words to thank you. I am very, very happy." The polio vaccines of Salk and Albert Sabin marked a special moment in medical history. As late as the 1950s, parents had been encouraged to expose their children to diseases like measles, mumps and chicken pox in order to get them over with before adulthood, when the dangers increased. Now, there were vaccines for all these illnesses, and more were on the way. Some researchers spoke openly of a future without infectious disease. "Will such a world exist?" a scientist asked. "We believe so." In our current age of AIDS, Ebola and avian flu, one marvels at the arrogance of these words

The trials in Africa and India involved a chemical, cellulose sulfate or Ushercell, and were the second failure of a potential microbicide in a full-scale trial in recent years. In one of the latest trials, a standard check by an independent scientific committee found an increased risk of HIV infection among women who used cellulose sulfate compared with those who used a placebo gel. An ideal microbicide would work in three ways. First, it would kill HIV in the vagina and cervix. Second, the microbicide would prevent any virus that escaped from attaching to a woman's cells, which is the way HIV starts to infect. Third, for any virus that did enter cells, the microbicide would block an enzyme that HIV needs to replicate

Although the volume/outcome relation for percutaneous transluminal coronary angioplasty (PTCA) is well established, it is unclear how the relation has changed over time. To examine trends in hospital and operator volume and outcomes for PTCA, we conducted a retrospective cohort study of discharge records of patients who underwent PTCA at nonfederal hospitals in Florida and New York from 1996 to 2001. Hospital/operator pairs were divided into 4 classes using American College of Cardiology/American Heart Association volume classifications. Outcome measurements were operator and hospital procedure volume and a combined end point of inpatient mortality and emergency coronary artery bypass graft surgery. Of 452,404 patients, the number of patients who underwent PTCA from 1996 to 2001 increased from 58,180 to 92,277, with a mean annual increase of 9.1%. The risk-adjusted end point of mortality and emergency coronary artery bypass grafting decreased over time, occurring in 2.8% of admissions in 1996 and in 1.6% of admissions in 2001. Class 1 hospital/operator pairs, which were operators performing >or=75 procedures at hospitals performing >400 procedures, had the lowest occurrence of the end point overall and in each year. The risk-adjusted end point difference between classes narrowed over time. In conclusion, outcomes were best for patients receiving care from class 1 hospital/operator pairs, and an increasing proportion of patients received care from class 1 pairs. There were outcome differences within subpopulations of operators in classes 2 and 4, which suggest possibilities for alternative volume classification guidelines.