Faculty Bibliography

Surgeons in Louisville, Ky., performed the first hand transplant in the United States on Sunday, replacing the left hand of a New Jersey man with one taken from an unidentified donor who had died a few hours |earlier. Mr. Scott's hand transplant is the third ever performed and the second within five months. Clint Hallam, 48, of Australia is progressing well after receiving a hand and forearm transplant in Lyon, France, last September. Mr. Hallam is able to grasp a glass in his hand and drink from it, two of his doctors said in recent interviews

Mr. Scott's hand transplant is the third ever performed and the second within five months. Clint Hallam, 48, of Australia is progressing surprisingly well after receiving a hand and forearm transplant in Lyons, France, last September. Mr. Hallam is able to grasp a glass in his hand and drink from it, two of his doctors said in recent interviews. Mr. Scott's hand was reattached about two inches above the wrist by a team headed by Dr. Warren C. Breidenbach, a hand surgeon with Kleinert, Kutz and Associates Hand Care Center and assistant clinical professor of surgery at the University of Louisville. Dr. Breidenbach rushed back from a meeting on immunology in Colorado when a donor hand suddenly became available. Last night, Mr. Scott, who trains and supervises a team of 200 paramedics for Virtua Health, a hospital company based in Marlton, N.J., was reported sleepy but in stable condition after awakening from general anesthesia. Mr. Scott is taking a combination of immunosuppressant drugs in standard use in heart, liver and kidney transplants to preserve the hand transplant. His body has shown no signs of rejecting the hand

The births made the octuplets an immediate sensation in the news and renewed the debate about fertility drugs and their enormous medical and human costs, but here in the neonatal intensive care unit on the fourth floor of Texas Children's Hospital, the glare of world attention fades away next to the blip of the infant monitors. Now, although two babies remain under a pound and a half, all are gaining weight, ounce by ounce. The babies have a 95 percent chance of surviving to their expected discharge in late March, said Dr. Leonard Weisman, the head of the neonatal unit. As he led a visiting doctor through the unit, Weisman said he was 'cautiously optimistic' that the babies, all listed in critical condition, would turn out normal. Initially, all the babies breathed with the aid of mechanical ventilators. Now the surviving octuplets breathe on their own. A pump blows air through the tubing to help keep their chest walls from collapsing. The babies also receive caffeine to prevent apnea and stimulate their breathing

The boy has black hair. He is barely a foot long. He is curled up on a pillow and strapped in a cloth bumper dotted with hearts, to keep his arms and legs in the same flexed position they were in in the womb. As he sleeps beneath a radiant warmer in the dark and quiet room, machines track his skin temperature, heart rate, blood pressure, oxygen level and other vital measurements. Two Beanie Babies lie nearby. One toy serves an extra function: the Beanie's weight holds the air tubes in place. Above, a cardboard sign identifies him as Baby F, or Ikem. At 1 pound, 7 ounces, he is the smallest of the seven surviving octuplets born here last month. The strongest and largest, at 2 pounds 10 ounces, is his only brother, Jioke. He rests in a similar warmer in the same room. The first of the eight babies, Ebuka, a girl, was born on Dec. 8, almost four months earlier than the mother's due date of April 1. The mother, Nkem Chukwu, had been treated at the MacGregor Fertility Clinic in Houston and, because of religious beliefs, had rejected the idea of destroying any of the fetuses to give the others a greater chance of survival. The seven others were born on Dec. 20, making them the world's first set of octuplets to be born alive. The largest weighed less than 2 pounds. The smallest, a girl named Odera, weighed 10.3 ounces and died on Dec. 26

This year, the 50th anniversary of Ruth's death, his sports legacy has been extolled again as baseball heroes of newer generations breezed past the home-run record the Babe [Ruth] held for 34 years, until 1961. But unknown to many, Ruth also left a legacy in the annals of medical history. In fact, he was among the first patients anywhere to receive experimental chemotherapy, and some researchers say he was the first ever to receive a combination treatment of chemotherapy and radiation for his type of cancer. For Ruth, the chemotherapy worked dramatically -- but only temporarily. Nevertheless, knowledge gained from his case helped shape the therapy that is now standard for his disease. But the images of a hoarse Ruth, perpetuated in audio and videotapes on the Internet and in sports broadcasts, in addition to his well-known smoking and drinking proclivities, have contributed to the myth that Ruth had throat cancer, which is generally taken to mean cancer of the larynx, or voice box

In 1938, as a New York University/Bellevue Hospital intern, I recorded notes on the 384 cases I saw during my 1-month ambulance duty. Although I intended to use them to follow up the clinical course of patients I admitted to Bellevue, the long hours and pressure of work made this ambitious goal unachievable. Sixty years later, after retirement from academic medicine and medical practice at New York University School of Medicine, I found the long-lost notes among my papers. They are of historic interest since they provide insight into aspects of primary and emergency medicine of the era when the therapeutic efficacy of the sulfanilamide class of agents was under investigation, a unique view of the life of an intern just before interns were replaced on ambulances by technicians, and a glimpse of the surprising character of several neighborhoods of pre-World War II Manhattan. The notes also provide the basis for a current analysis of case incidence and treatment by disease category. A description of the confluence of social, economic, and political forces that led to the establishment of the Bellevue Hospital Ambulance Service, the first such urban service in the world, is included

The efficacy and toxicity of foscarnet cream for the treatment of mucocutaneous herpes simplex virus lesions or lesions that were clinically unresponsive to systemic acyclovir treatment (median, 30.5 days) in AIDS patients were studied in a phase I/II, open-label, nonrandomized multicenter trial. In the study, 20 patients with advanced stages of AIDS were treated with foscarnet 1% cream five times a day for a mean duration of 34.5 days. Response of index lesions (n = 20) was judged to be completely healed (8 lesions), excellent (4 lesions), or good (1 lesion) in 65% of lesions. The median time to first negative herpes simplex virus culture of index lesion was 8 days. Among 15 patients with pain at baseline, 11 had complete resolution of pain and 2 had at least a 50% reduction. Clinical adverse events included skin ulceration (4 patients), application site reactions (3 patients), fever (3 patients), and headache (3 patients). Five (25%) patients developed new lesions due to herpes simplex virus at sites other than those being treated topically while enrolled in the study. Topical foscarnet 1% cream appears to be a safe and effective treatment for acyclovir-unresponsive mucocutaneous herpes simplex virus infection in AIDS patients

CONTEXT: Typing of Mycobacterium tuberculosis could provide a more sensitive means of identifying outbreaks than use of conventional surveillance techniques alone. Variants of the New York City W strain of M tuberculosis were identified in New Jersey. OBJECTIVE: To describe the spread of the W family of M tuberculosis strains in New Jersey identified by molecular typing and surveillance data. DESIGN: Population-based cross-sectional study. SETTING AND SUBJECTS: All incident culture-positive tuberculosis cases reported in New Jersey from January 1996 to September 1998, for which the W family was defined by insertion sequence (IS) IS6110 DNA fingerprinting, polymorphic GC-rich repetitive sequence (PGRS) typing, spacer oligotyping (spoligotyping), and variable number tandem repeat (VNTR) analysis. MAIN OUTCOME MEASURE: Identification and characterization of W family clones supplemented by surveillance data. RESULTS: Isolates from 1207 cases were analyzed, of which 68 isolates (6%) belonged to the W family based on IS6110 and spoligotype hybridization patterns. The IS6110 hybridization patterns or fingerprints revealed that43 patients (designated group A) shared a unique banding motif not present in other W family isolates. Strains collected from the remaining 25 patients (designated group B), while related to W, displayed a variety of IS6110 patterns and did not share this motif. The PGRS and VNTR typing confirmed the division of the W family into groups A and B and again showed group A strains to be closely related and group B strains to be more diverse. The demographic characteristics of individuals from groups A and B were specific and defined. Group A patients were more likely than group B patients to be US born (91 % vs 24%, P<.001), black (76% vs 16%, P<.001), human immunodeficiency virus positive (40% vs 0%, P = .007), and residents of urban northeast New Jersey counties (P<.001). Patients with group B strains were primarily non-US born, of Asian descent, and more dispersed throughout New Jersey. No outbreak had been detected using conventional surveillance alone. CONCLUSIONS: The implementation of multiple molecular techniques in conjunction with surveillance data enabled us to identify a previously undetected outbreak in a defined geographical setting. The outbreak isolates comprise members of a distinct branch of the W family phylogenetic lineage. The use of molecular strain typing provides a proactive approach that may be used to initiate, and not just augment, traditional surveillance outbreak investigations

In the freshwater coelenterate, hydra, asexual reproduction via budding occurs at the base of the gastric region about two-thirds of the distance from the head to the foot. Developmental gradients of head and foot activation and inhibition originating from these organizing centers have long been assumed to control budding in hydra. Much has been learned over the years about these developmental gradients and axial pattern formation, and in particular, the inhibitory influence of the head on budding is well documented. However, understanding of the role of the foot and potential interactions between the foot, bud, and head patterning systems is lacking. The purpose of this study was to investigate the role of the foot in the initiation of new axis formation during budding by manipulating the foot and monitoring effects on the onset of first bud evagination and the time necessary to reach the 50% budding point. Several experimental situations were examined: the lower peduncle and foot (PF) were injured or removed, a second PF was laterally grafted onto animals either basally (below the budding zone) or apically (above the budding zone), or both the head and PF were removed simultaneously. When the PF was injured or removed, the onset of first bud evagination was delayed and/or the time until the 50% budding point was reached was longer. The effects were more pronounced when the manipulation was performed closer to the anticipated onset of budding. When PF tissue was doubled, precocious bud evagination was induced, regardless of graft location. Removal of the PF at the same time as decapitation reduced the inductive effect of decapitation on bud evagination. These results are discussed in light of potential signals from the foot or interactions between the foot and head patterning systems that might influence bud axis initiation