Faculty Bibliography

Officials at Duke University Hospital admitted today that they made several mistakes when doctors inserted the wrong organs on Feb. 7. Ms. Santillan has Type O blood. The transplanted organs were Type A. The chief surgeon did not ask when he received the heart and lungs from an organ bank if they matched the patient. As word of Ms. Santillan's plight spread, so did the hunt for organs. Duke University Hospital officials pushed all the connections they had, not because of their mistake, they said, but because Ms. Santillan's condition was so dire. And worsening. At Duke University Hospital on Wednesday, Federico Santillan led relatives in prayer for his niece [Jesica Santillan]. (Susana Vera/The News & Observer); Ms. Santillan's cousin Beatriz Vazquez, home in Guadalajara, Mexico, lighted a candle for her yesterday, while Dr. [Duane Davis], right, and Dr. [William Fulkerson] held a news conference at Duke University Hospital. (Photographs by Associated Press)(pg. A23)

As word of [Jesica Santillan]'s plight spread, so did the hunt for organs. Duke Hospital officials pushed all the connections they had, not because of their mistake, they said, but because Santillan's condition was so dire. And worsening

The same could be said of many of the AIDS scientists at the 10th Conference on Retroviruses and Opportunistic Infections, where Dr. [Sebastian Lucas] presented a series of stunning, if grim, autopsy photographs. Even though these molecular biologists, statisticians and other scientists are a vital part of the AIDS research team, they do not take care of patients, so they seldom witness the damage that H.I.V. can inflict on various organs and tissues. By the same token, doctors practicing today see autopsy results much less often than did their counterparts a few decades ago because far fewer autopsies are now being done. By contrast, Dr. Lucas has gained an extraordinary perspective on AIDS from having performed 1,000 autopsies on H.I.V. patients in England and Africa. He has found many ways to apply the classic credo of pathology: to learn from the dead to heal the living. Photographs are effective educational tools in medicine as they are in other fields. So Dr. Lucas went on to show slides of other H.I.V.-related conditions like toxoplasmosis, tuberculosis, pneumocystis pneumonia and H.I.V. nephropathy, a kidney disease that is common in blacks

'The Piano Tuner' by Daniel Mason is reviewed.

Swedish scientists reported a study supporting the link between the harmless virus, known as GBV-C, and HIV. But the Swedish and American authors disagreed at a meeting in Boston on Thursday about whether GBV-C could cause the apparent benefit or whether it was simply an indicator of something else as yet undetected that might account for the findings. By adding GBV-C to HIV in human blood cells in the laboratory, an American team led by Dr. Jack Stapleton of the University of Iowa found that GBV-C blocked the docking sites on the surface of the CD- 4 blood cell that HIV needs to enter to cause infection. It also found that adding GBV-C led to the production of natural substances called chemokines that are known to inhibit HIV

Swedish scientists reported a study supporting the link between the harmless virus, known as GBV-C, and H.I.V. But the Swedish and American authors disagreed about whether GBV-C could cause the apparent benefit or whether it was simply an indicator of something else -- as yet undetected -- that might account for the variability of H.I.V. infection. By adding GBV-C to H.I.V. in human blood cells in the laboratory, a team led by Dr. Jack T. Stapleton of the University of Iowa found that GBV-C blocked the docking sites on the CD-4 blood cell that H.I.V. needs to enter to cause infection. If further studies show that GBV-C significantly slows the progression of H.I.V., the researchers said a goal might be to identify a protein that could be used to mimic the GBV-C infection to aid H.I.V. patients

In the study, the rate of transmitting H.I.V. was 8.2 per thousand sexual acts in the first five months after a person became infected, and 1.5 per thousand sexual acts in the next year or two, Dr. [Maria J. Wawer] said. The risk then rose sharply, to 4.5 per thousand sexual acts, in the 15 months before death from AIDS. The findings are consistent with what was already understood to be a kind of AIDS cycle: a rise, a dip and then another rise in the amount of H.I.V. in the blood as the infection progresses. Other new data reported at the meeting added to earlier findings suggesting that H.I.V. infections might be on the rise. In part, the concerns reflect outbreaks of syphilis and other sexually transmitted diseases that can correlate with a risk of acquiring H.I.V. Such outbreaks have been reported in a number of cities. That as many as 20 percent of H.I.V.-infected people a year in this country spend time in a correctional facility underscores an urgent need for researchers to find ways to reduce the risk of H.I.V. transmission by departing inmates, Dr. [David A. Wohl] said

OBJECTIVES: To explore whether differences in disease prevalence, disease severity, or emergency department (ED) admission thresholds explain why black persons, Medicaid, and uninsured patients have higher hospitalization rates for ambulatory care sensitive (ACS) conditions. MATERIALS AND METHODS: The National Hospital Ambulatory Care Survey was used to analyze the ED utilization, disease severity (assessed by triage category), hospitalization rates, and follow-up plans for adults with five chronic ACS conditions (asthma, chronic obstructive lung disease, congestive heart failure, diabetes mellitus, and hypertension). The National Health Interview Survey was used to estimate the prevalence of these conditions in similarly aged US adults. RESULTS: Black persons, Medicaid, and uninsured patients make up a disproportionate share of ED visits for these chronic ACS conditions. Cumulative prevalence of these conditions was higher in black persons (33%) compared with white persons (27%) and Hispanic persons (22%), but did not differ among the payment groups. All race or payment groups were assigned to similar triage categories and similar percentages of their ED visits resulted in hospitalization. Black persons and Hispanic persons (odds ratios for both = 0.7), were less likely than white persons, whereas Medicaid and uninsured patients (odds ratios for both = 0.8), were less likely than private patients to have follow-up with the physician who referred them to the ED. CONCLUSIONS: The disproportionate ED utilization for chronic ACS conditions by black persons and Medicaid patients does not appear to be explained by either differences in disease prevalence or disease severity. Follow-up arrangements for black persons, Medicaid, and uninsured patients suggest that they are less likely to have ongoing primary care. Barriers to primary care appear to contribute to the higher ED and hospital utilization rates seen in these groups

Accurate information and an informed perspective could bring the public's fear of smallpox more in line with its real risk. Exaggerating the side effects of a largely safe vaccine is not the best way to treat the fear of the virus