Faculty Bibliography

The growing strength of managed care has diminished the financial and clinical autonomy of many orthopaedic surgeons. In part to offset these negative trends, new relationships are being developed to define doctors' methods of contracting with health-maintenance organizations. These include physician practice management companies (PPMs), independent practice associations, management service organizations, and physician-sponsored organizations. Each entity offers distinct advantages and disadvantages. While the PPM is the most popular new vehicle to offset adverse market trends, it carries with it some of the greatest potential pitfalls. In every case, before negotiating to join one of these new entities, it is important for a physician to have a solid understanding of the competing claims made by each entity, as well as insight into the fiscal health of the particular company in question. For some doctors, these arrangements offer a solution to current woes. For others, PPMs interpose another meddlesome intermediary in a market already bloated by layers of bureaucracy.

It is the first time that a drug has led to growth of new coronary blood vessels by mimicking the way collateral vessels naturally develop in some people with blocked arteries. The drug, a protein known as a growth factor, is called F.G.F.-1 (for fibroblast growth factor). The doctors made it with genetic engineering techniques in their laboratory in Fulda, Germany. F.G.F.-1 was injected into heart muscle near the grafts that surgeons made to create new channels around blocked coronary arteries during standard bypass operations at the Fulda Medical Center. For now, the drug could not replace bypass surgery, the German doctors said. Dr. Thomas-Joseph Stegmann, the head of the team, said the chief objective was to prove the concept that F.G.F.-1 could safely produce new blood vessels in the heart. Although other growth factors are now used safely in medical practice, some experts had warned of dangers with F.G.F.-1. One, Dr. Wolfgang Schaper of the Max Planck Institute in Bad Nauheim, Germany, wrote in 1993 that he doubted that the growth factor would have more than moderate benefit and said ''its pronounced toxicity would preclude its use in human patients.''

Women with scleroderma had fetal cells present in their blood decades after pregnancy more often and in larger numbers than mothers who did not have the condition. The disease is scleroderma, an autoimmune disorder in which the body mysteriously attacks its own healthy tissues. For equally mysterious reasons, scleroderma strikes women four times as often as men. The study neither proves that fetal cells cause scleroderma nor provides a full explanation of how such cells might cause the disease. But identification of such a link has astonished many experts in scleroderma and related diseases who said the finding, if confirmed, would have important implications for autoimmune disorders

Long after a woman has given birth, cells from her fetus may still circulate in her bloodstream, and a new study being reported Thursday has linked those cells to development of a disease in the mother years after pregnancy. The disease is scleroderma, a so-called autoimmune disorder in which the body mysteriously attacks its own healthy tissues. For equally mysterious reasons, scleroderma strikes women four times as often as men. The study neither proves that fetal cells cause scleroderma nor provides a full explanation of how such cells might cause the disease. But identification of such a link has astonished many experts in scleroderma and related diseases who said that the finding, if confirmed, would have important implications for autoimmune disorders

Long after a woman has given birth, cells from her fetus may still circulate in her blood stream, and a new study being reported today has linked those cells to development of a disease in the mother years after pregnancy. The disease is scleroderma, a so-called autoimmune disorder in which the body mysteriously attacks its own healthy tissues. For equally mysterious reasons, scleroderma strikes women four times as often as men. The study neither proves that fetal cells cause scleroderma nor provides a full explanation of how such cells might cause the disease. But identification of such a link has astonished many experts in scleroderma and related diseases who said that the finding, if confirmed, would have important implications for autoimmune disorders

But now that NASA is giving Glenn one last chance to show his 'right stuff' in space, he is enlisting the medical profession to his side: One rationale cited by the agency for Glenn's participation in the flight is the opportunity to carry out medical research on what will be the oldest-ever human body to orbit the Earth. Sen. Glenn, D-Ohio, will be 77 when he is launched on a 10-day space shuttle flight scheduled for October. He has volunteered for two experiments to assess muscle loss and sleep disturbances during the shuttle flight. In metabolism experiments for the shuttle flight, Glenn will swallow capsules containing one type of amino acid and receive intravenous injections of another. Then low-level X-ray studies will help detect any changes in lean body mass. Because amino acids are the building blocks of protein, the aim will be to relate any changes in hormonal levels with loss of protein and muscle atrophy in Glenn and, eventually, eight other crew members. For a sleep experiment, Glenn will swallow melatonin or placebo pills before retiring on four nights. He will also swallow a capsule containing a small thermometer to record core body temperature because that is a good indicator of biological rhythms. Devices attached to Glenn's scalp, chest and wrist during monitoring periods will record brain wave activity, breathing patterns and movements during sleep

Hillary Rodham Clinton's recent accusation that a 'vast right-wing conspiracy' exists to destroy her husband and his political agenda was bound to strike a nerve. There has been a lot of loose and malicious talk about the President, the right has spread much of it, and our culture feasts on conspiracy theories. But Mrs. Clinton's allegation is not exactly new. She asserts that an extremist minority, unable to defeat the President at the polls, is trying to thwart the will of the majority through a systematic campaign of slander. In the 1830's, Andrew Jackson attributed the same motives to his most strident critics. Later Abraham Lincoln, Theodore Roosevelt and Woodrow Wilson did the same. President Franklin D. Roosevelt, who was attacked more bitterly, perhaps, than any other modern chief executive, played the conspiratorial card shrewdly during his 1936 re-election campaign. He did so in reply to the American Liberty League, an organization of ultraconservative millionaires that spent a small fortune on advertising and promotions to portray him as 'the foul breath of Communist Russia.'

Efforts to make it easier to take combinations of drugs to combat the AIDS virus have met with mixed results, scientists said here today. A crucial problem in combination therapy is that H.I.V., the AIDS virus, often becomes resistant to one or more of the drugs. Often it is because the person cannot tolerate the drug regimen. But the reasons are not always clear in other cases. In the French study, participants took triple drug therapy (AZT, 3TC and indinavir) for three months. Then one-third of the group stayed on triple therapy. Each of the remaining thirds took different combinations of two of the three drugs (one AZT and 3TC; the other AZT and indinavir). The study stopped ahead of schedule when it became clear that two drugs were less effective in suppressing H.I.V

Paunches, buffalo humps in the neck, puffy cheeks and other unusual accumulations of fat are changing the body shapes of a surprising number of people taking the newer combination therapies to combat the AIDS virus, doctors said here today. The complication seems to have occurred most often among people taking drugs that belong to the new class known as protease inhibitors. But it has also occurred among people taking other drugs to combat H.I.V., the virus that causes AIDS. The lower percentages came from observations of patients by doctors. These studies came from Emory University in Atlanta, Cornell University Medical College in New York, San Francisco General Hospital, Ottawa General Hospital in Canada, the National Institutes of Health and the United States Food and Drug Administration