Faculty Bibliography

Dr. Marcelle Layton, an assistant commissioner in the health department's communicable disease bureau, confirmed the gist of the account by Dr. [Richard P. Fried], a specialist in infectious diseases. The C.D.C. was not notified, Dr. Layton said, because the initial culture tests performed on Ms. [Erin O'Connor] and on the letter showed no evidence of anthrax. Dr. Fried said he re-examined Ms. O'Connor on Oct. 3 and on Oct. 8, when the lesion had developed into a black crust, which is characteristic of cutaneous anthrax. But Dr. Fried and the health department were perplexed because anthrax did not grow on the culture taken from the skin lesion. Ms. O'Connor then went to Dr. Marc Grossman, a dermatologist at Columbia-Presbyterian Center, who had never seen a case of anthrax. But on Oct. 4, when the first case of anthrax was reported in Florida, Dr. Grossman had readied and given a lecture on cutaneous anthrax to young doctors at the school

Anthrax spores were identified in cultures of Mr. [Ernesto Blanco]'s nose, and he was initially categorized as an exposure, not a case, of anthrax. Though he was hospitalized with a fever and cough, his symptoms were not typical of inhalation anthrax, and laboratory tests of his sputum and chest fluid showed no signs of anthrax bacteria. American doctors have had little experience with inhalation anthrax because just 18 cases were reported in the United States last century. In this form of the disease, the bacteria in the body produce a toxin that destroys tissue. Doctors have believed that inhalation anthrax is fatal because by the time the symptoms of infection appear, the toxin is already doing its deadly work, and antibiotics are ineffective against it. It may be that the antibiotics Mr. Blanco received as a precaution saved his life. The intern, Jordan Arizmandi, 23, worked as a reporter for The National Enquirer but was not known to have ever been in the mailroom, where health officials believe workers were exposed to the bacteria. A communications major at Florida Atlantic University in Boca Raton, Mr. [Hank Arizmandi]'s internship ended on July 17, several weeks before the terrorist attacks and well before the anthrax exposure first became known

On Oct. 4, when Tommy Thompson, the secretary of health and human services (the CDC's parent agency), disclosed the first anthrax case, he said it appeared to be an isolated case in Florida, possibly linked to natural exposure to anthrax in the environment. Last week, when the most pressing health problem was the degree to which the country was vulnerable to anthrax, the CDC's Morbidity and Mortality Weekly Report, the bulletin that doctors and health workers look to for information about communicable diseases, devoted only two paragraphs to the anthrax situation, providing only sketchy details of the first two cases and a description of anthrax symptoms. Communication from the CDC is particularly important because anthrax in humans is rare in this country, with just 236 cases of all types reported between 1955 and 1999. Most doctors have never seen a case, and they look to the CDC for guidance

Last week, when the most pressing health problem was the degree to which the country was vulnerable to anthrax, the C.D.C.'s Morbidity and Mortality Weekly Report, the bulletin that doctors and health workers look to for information about communicable diseases, devoted only two paragraphs to the anthrax situation, providing only sketchy details of the first two cases and a description of anthrax symptoms. Communication from the C.D.C. is particularly important because anthrax in humans is rare in this country, with just 236 cases of all types reported between 1955 and 1999. Most doctors have never seen a case, and look to the C.D.C. for guidance. When Florida health officials called the C.D.C. to report that Robert Stevens, 63, had apparently developed inhalation anthrax, the centers deployed 15 epidemiologists and other scientists. In confirming the case and seeking its source, the Epidemic Intelligence Service has relied on traditional Sherlock Holmes-style sleuthing and the skills of colleagues in the laboratory, who use the latest genetic and other laboratory tests, Dr. [Jeffrey P. Koplan] said

En las etapas iniciales de la investigacion, los epidemiologos no pudieron asumir nada, y el mismo paciente era incapaz de comunicarse; se encontraba en coma cuando llego al hospital en Atlantis, Florida, y murio sin recobrar el conocimiento. Asi que los trabajadores de la salud tuvieron que entrevistar a su esposa y familiares para reconstruir lo que habia hecho en las dos semanas anteriores. Donde se detuvieron, comieron y durmieron los [Stevens] en el transcurso del viaje? Estuvo expuesto a contacto con un animal enfermo? Pelo de cabra? Stevens trabajaba como editor fotografico para The Sun, un tabloide vendido en supermercados y publicado por America Media Inc. en Boca Raton, Florida. Los epidemiologos fueron alli y a su hogar en la cercana Lantana, donde preguntaron que hacia Stevens en su tiempo libre. Cuidaba un jardin? Pasaba mucho tiempo al aire libre? Si ese era el caso, donde? Con quien? Tambien recogieron muestras de polvo, tierra y respiraderos, buscando una posible fuente de materiales contaminados con antrax. Mientras estos investigadores se centraban en posibles causas naturales, otros examinaban la posibilidad mas siniestra: que Stevens fuera victima de un ataque organizado. Visitaron todos los hospitales de la zona para hablar con los trabajadores de control de infecciones, asi como con otros doctores, para revisar historiales medicos, microbiologicos y de rayos X de los pacientes atendidos por meningitis, fallos respiratorios graves, septicemia, fiebres inexplicadas y enfermedades como tularemia que pueden producir sintomas similares a los del antrax. Es posible que alguna pudiera haber sido antrax y fuera identificada por error como alguna otra cosa? El antrax por inhalacion produce inflamacion de los nodulos linfaticos en el mediastino, una zona que se encuentra entre la parte de atras de los pulmones y la espina dorsal. La inflamacion puede verse con rayos X. Lo paso por alto un radiologo? En todo su trabajo, los epidemiologos 'no encontraron nada sospechoso', declaro el doctor James M. Hughes, importante experto del CDC quien superviso la investigacion desde Atlanta, Georgia. Los epidemiologos hablaron con Blanco para saber todo lo que hizo las anteriores dos o tres semanas. Era un fanatico de la jardineria como Stevens? Compartian los dos una parcela para dedicarla a jardin? Habian comprado fertilizante o harina de huesos del mismo distribuidor? Que hacian juntos fuera del trabajo, si es que hacian algo juntos, Blanco y Stevens? Puesto que Blanco y Stevens eran companeros de trabajo, los epidemiologos preguntaron por recientes obras de construccion o renovacion en las oficinas de American Media. Podia alguien mas haber sacado tierra que contuviera esporas de una vaca que muriera de antrax hace muchos anos? Hicieron pruebas al polvo en grietas, bajo los escritorios y en los tubos y filtros del sistema de ventilacion. Se encontraron esporas de antrax en el teclado de Stevens. Tambien se detectaron esporas en muestras de las superficies de trabajo en la sala de empaque de American Media, informo el CDC

Hugh-Jones, the anthrax expert at Louisiana State, said terrorists could not simply open a jar of anthrax spores on a subway or sprinkle some spores around and infect thousands of people. A person must inhale about 8,000 to 10,000 spores to be infected, Hugh-Jones said. And, he said, 'getting an efficient aerosol is a lot of work -- you can't just pump it up in an aerosol can.'

Worldwide, most people who contract anthrax get the cutaneous form, in which spores enter the skin, usually through a cut or a scratch. Most of the time, these cases occur in people who handle animal hides or wool that contained anthrax spores. In the United States, 224 human cases of cutaneous anthrax were reported from 1944 to 1994. People who eat undercooked meat from animals that were infected with anthrax can contract gastrointestinal anthrax, in which spores germinate into bacteria in the intestines, causing nausea, vomiting, fever and abdominal pain. Untreated, about 25 to 60 percent of people with ingestional anthrax die. Worldwide, relatively few anthrax cases have been gastrointestinal. The disease starts when a person inhales spores into the lung. Once there, the spores travel to lymph nodes in the mediastinum, in the middle of the chest, a journey that can take just a few hours. There, in the lymph nodes, in a process the Sverdlovsk outbreak shows can take anywhere from days to weeks, the spores in the lymph nodes turn into anthrax bacteria, which begin producing deadly toxins that attack body tissues. Because the timing of this germination process can vary, it is hard to know until about 60 days have passed if a person who inhales the spores has the disease

With health officials still awaiting test results of Mr. [Bob Stevens]'s co-workers and other American Media employees, fears continued to spread. Many people rushed to drugstores for antibiotics used to treat anthrax exposure. Others reported dust from office construction projects to health authorities. Some worried that a stuffy nose or upset stomach might indicate anthrax exposure. Even as the authorities urge calm, South Florida residents have grown tense since Friday, when Mr. Stevens, 63, a layout editor for The Sun supermarket tabloid, died of anthrax. Days later, spores were detected in the nasal cavity of Ernesto Blanco, a 73-year-old mail supervisor at The Sun, which is owned by American Media Inc., publisher of The National Enquirer, The Globe and The Star supermarket tabloids. American Media executives said today that the possibility of anthrax contamination had caused some to speculate whether terrorists had chosen the company for attack because it is called American Media, like American Airlines or United Airlines. They also worried that customers would be reluctant to buy copies of their papers for fear that they might be laced with anthrax

Dr. [Leland H. Hartwell], cited for discovering a specific class of genes that control the cell cycle, knew he was being considered for the award. But the Nobel committee could not call him directly because he had an unlisted telephone number, Dr. Hartwell said. Word came when his wife, Teresa Naujack, awakened him about 3 a.m. after she received a call from a public relations worker at the Hutchinson cancer center who was up waiting to learn who had won. The Nobel committee cited Dr. Hartwell for discovering more than 100 genes that coordinate the four-stage process by which one cell grows, duplicates its chromosomes, verifies this duplication and then divides, leaving two daughter cells to begin the cycle again. Each step in the complex sequence must be perfectly timed to ensure that the next phase proceeds to produce exact, healthy replicas of the parent cell. Dr. Hartwell was cited by the Nobel committee for discovering a gene that he called ''start'' because it begins the cell cycle, and for developing a theory he called the checkpoint concept. The checkpoint concept holds that the cycle stops to repair any damage to the cell's DNA before the cell progresses to the next phase of the cycle, preventing flaws from being passed on to daughter cells

KW - Television programs [Television Program] -- ''West Wing'' President Josiah Bartlet has multiple sclerosis, a chronic neurological ailment that the first lady, a physician, has treated secretly during Mr. Bartlet's first term. Multiple sclerosis is usually not fatal, though it is often disabling. But it has not hampered Mr. Bartlet's work. Mr. [Aaron Sorkin] asked his research staff to find an affliction that did not put Mr. Bartlet in a wheelchair, could go undetected for years at a time, and that could be in remission and undetectable in checkups because there was no laboratory test for it. The search turned up multiple sclerosis, an ailment that Mr. Sorkin said he knew little about. Putting the spotlight on multiple sclerosis also tapped television's great potential to educate, even though Mr. Sorkin said that was not his intent. ''As storytellers primarily, our only obligation is to captivate for however long we have asked for your attention,'' Mr. Sorkin said. He also said: ''We try not to lie on the show, and I know that is a strange thing to say in the context of fiction.'' President Bartlet's physician-wife, Abigail, who is not the White House physician, has secretly injected him with Betaseron. But the plot hints that even she may not know everything about his medical history. For example, during Mr. Bartlet's many trips, other doctors could have prescribed medications without her knowledge. In one scene, the White House counsel suggests the possibility that her husband could have had a secret affair, acquired a sexually transmitted infection and been treated for it, all without her knowledge