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This year 20,000 people will suffer brain death from trauma. Only 15% of these people will be organ donors. When the rest are buried or cremated, they will take with them approximately 34,000 kidneys, and as many as 17,000 hearts, livers, pancreata, and pairs of lungs. Thus as many as 100,000 transplantable organs will be lost."These statistics are only a rough estimate, but they're the best we can do without undertaking a very expensive study," says Jeffrey Prottas, PhD, chair of the organ procurement section of the Task Force on Organ Transplantation. They were derived from a literature survey commissioned by the task force, which was formed under the National Transplantation Act of 1984 to evaluate issues generated by the practice of replacing the organs of one person with those of another. And while these figures may be inexact, the task force thinks they are a reasonable illustration

"This his is one of the worst things that has ever happened to me in the operating room and I sincerely hope I never have to experience another thing like it."The quotation is from a letter written to a colleague by the chair of anesthesiology at a major university medical center. He is discussing the death of a patient during a routine fracture reduction.The patient, Richard Davidson, appeared to be as good an operative risk as one could find. He was 35 years old, tall, muscular, and robustly healthy. He had slipped on an icy street and had sustained a compound fracture of the ankle, the repair of which necessitated an open reduction.The operation was successful, but as the tourniquet was removed from Davidson's leg, he had a few premature ventricular contractions. Attempts at suppressing arrhythmia were only temporarily successful, and 60 minutes after the tourniquet's release,

It is a Sunday morning late in August. A few casually but neatly dressed young men and women exchange greetings and anecdotes as they survey the brunch buffet: plump blueberries in a handcrafted ceramic bowl, coffee cakes stuffed with nuts and fruit, a chafing dish of spiced sausage, and pitchers of coffee and apple cider. They fill their plates and join the other guests in the sun-dappled living room.Throughout the summer, this group—mostly medical students—has enjoyed many such Sunday gettogethers at this home in Evanston, Ill. The brunches, which have become something of a tradition, are actually planning sessions for another tradition, "The Realities of Medicine," a week-long program designed to acquaint second-year medical students at the University of Illinois College of Medicine at Chicago with issues pertinent to the art and practice of medicine before they embark on their clinical rotations.The program is the brainchild of the

Nancy S. Wexler, PhD, is a clinical psychologist, a member of the department of neurology at Columbia University in New York City, president of the Hereditary Disease Foundation, and one of the principal investigators of the team that found the marker for Huntington's disease. Her curriculum vitae is impressive, but her future is uncertain. She stands a 50% chance of developing the disease she has studied.Like others at risk for Huntington's disease or adult polycystic kidney disease—another late-onset genetic disorder—she has been consigned to decades of uncertainty. There are no enzyme assays or easily identified chromosomal abnormalities that foretell these diseases. Those with a family history must go through their 20s, 30s, and possibly 40s looking for the symptoms of the disorder—and hoping that they won't find them.But this won't be the case much longer, if reports given at the 38th Annual Meeting of the American Society for

"The A he goal is to alleviate human disease—and to do it with a power that has heretofore been reserved for the gods."This statement describing gene therapy is from the introduction to an award-winning series of articles published in March in the Chicago Tribune. The introductory installment also depicts researchers "gearing up to undertake something that would have seemed like science fiction less than five years ago. They hope to break into a patient's cells and replace a malfunctioning gene."The article reflects two popular—if not prevelent— conceptions about gene therapy: that its effect on the population will be tantamount to that of splitting the atom; and that its realization is just around the corner.These notions need to be revised, according to panelists at the recent Symposium on Gene Therapy sponsored by the Scientists' Institute for Public Information and Stanford University. The panelists, pioneers of gene therapy, explained

"MEDICINE GETS ITS FINGERS in every nook and cranny of human existence," says Gideon Bosker, MD, explaining why the field holds such fascination for the writer and reader alike.Bosker speaks from experience. He spends 30 hours a week intensely involved with the basic stuff of humanity as attending physician in the Department of Emergency Medicine at Good Samaritan Hospital and Medical Center in Portland, Ore. He spends another 30 hours as a writer—reflecting on the myriad aspects of human existence.Within the last decade the latter 30hour increments have involved writing or editing textbooks and journal articles in geriatric medicine and emergency medicine and designing continuing education seminars for specialists in those fields. They now also involve preparing the first issue of Ambulatory Medicine Letter—a newsletter for primary care physicians scheduled to debut in December.But his colleagues in medicine are only one sector of Bosker's audience. Since

THE UNLIKELY combination of biotechnology and ancient cultural tradition has produced a highly effective program to eliminate Tay-Sachs disease.The program was born of despair after an ultra-Orthodox Jewish rabbi in New York realized that his once-healthy infant daughter had Tay-Sachs disease. She would be the fourth of his children to die of the genetic disorder. Like the others, she would suffer progressive neurological deterioration. She would become severely mentally retarded, lose her vision and motor control, have cerebral seizures, and, probably before her sixth birthday, die.To make matters worse, the rabbi knew that his family might not have seen the last of Tay-Sachs. Both he and his wife carried a recessive allele for the disease, so chances were one in four that any additional offspring would be affected. Moreover, ultra-Orthodox law proscribed abortion; contraception is permitted only under certain conditions.He knew his fate was not unique. The

"I am thoroughly exhausted from the excitement." The speaker: H. John Evans, MB, chair, Medical Research Council Clinical and Population Cytogenetics Unit, Western General Hospital, Edinburgh, Scotland. The occasion: a summary of a recent two-day symposium in Chicago entitled "Chromosomes and Cancer: From Molecules to Man."The symposium, organized by the University of Chicago, was the fifth annual seminar on cancer research sponsored by Bristol-Myers Company, New York. And this year, perhaps more than ever before, the excitement extended well beyond the speaker's podium. Those in the audience seemed to sense that they were witness to, or perhaps participants in, a new era of cancer research.Janet D. Rowley, MD, professor of hematology and oncology at the University of Chicago, put this new era into historical perspective, terming it the third technological chapter in research linking cancer with chromosomal abnormalities. This refers not only to chromosome abnormalities that are found

Holding a light pen, an aeronautical engineer begins to draw over a diagram illuminated on a video screen at McDonnell Douglas Corporation in St Louis. Slowly, a revised picture begins to take shape.But what emerges is not a part for high-performance aircraft. Instead the engineer is using the equipment to simulate craniofacial surgery. By rearranging sections of bone on a computerized three-dimensional (3-D) image of a skull, he is giving a normal appearance to the cranium of a child with a severe congenital anomaly.The engineer at the video console is Jim Warren, a unit director at McDonnell Douglas. His unlikely involvement in reconstructive surgery is the outgrowth of a collaboration with Michael Vannier, MD, assistant professor of radiology, and Jeffrey L. Marsh, MD, professor of plastic and reconstructive surgery, Washington University School of Medicine, St Louis. Together, under the auspices of the university's Edward Mallinckrodt Institute of Radiology,

In what one of the principal investigators refers to as "one of life's gentle ironies," two teams of researchers recently simultaneously announced the identification of a protein product of an oncogene (Science 1983; 221:275-276; Nature 1983;304:35-39).The oncogene, sis, is associated with the simian sarcoma virus; its product appears to be plateletderived growth factor (PDGF). The linking of the two represents the first association of a previously identified oncogene with a protein known to have a normal physiological function—in this case, the stimulation of fibroblastic and neuroglial cell proliferation.The discovery has intriguing implications on several levels. It provides long-sought evidence that an oncogene codes for a cellular growth factor. Because PDGF stimulates growth in normal cells, its overproduction could be a factor in the genesis of tumor cells. This possibility is reinforced by the fact that sarcomas and gliomas, human tumors in which there is evidence of heavy sis

LAST YEAR, Sydney J. Peerless, MD, was among the first to learn the results of an eight-year international surgical study. "My jaw dropped. I couldn't believe what I found," he said. "What the data were telling me was that with 95% confidence we can rule out a 5% benefit from extracranial/intracranial [EC/IC] bypass surgery."Peerless, who is professor of neurosurgery at Canada's University of Western Ontario, London, was principal neurosurgical investigator in the 71-center study. His incredulity was mirrored 500-fold when the study was presented at the International Congress of Neurosurgery in Toronto a month later. And, when he reprised the study's findings at a special symposium at the American Association of Neurological Surgeons in Denver this spring, it was apparent that many of his colleagues still refused to believe what they were hearing.Yet the message was straightforward. The neurosurgeons were told that the intricate microsurgical procedure—the anastamosis of

"THE BIG SPONGE" is what initiates call ARAC—the Atmospheric Release Advisory Capability—and it is vital to the clean-up after a nuclear accident. But this sobriquet doesn't refer to a propensity for mopping up radiation. It alludes to ARAC's ability to soak up data on weather conditions, regional geography, and the release of radionuclides into the atmosphere at thousands of sites around the globe.ARAC is a contingent of about 30 physicists, meteorologists, electronic engineers, computer scientists, and technicians who work at the Department of Energy's (DOE) Lawrence Livermore National Laboratory across the bay from San Francisco. It was initiated in 1974 and beefed up considerably after the accident in a nuclear power plant at Three Mile Island (Pa) in 1979.The ARAC staff employs computer models to estimate the extent of surface contamination as well as radiation doses to population centers after hypothetical or real nuclear accidents.ARAC works fast.

Calcium entry blockers, a class of drugs of which two—verapamil and nifedipine—have been approved by the Food and Drug Administration for the treatment of angina, have begun to show promise in certain other disorders involving smooth muscle as well.One such disorder is essential hypertension. Trials with both FDA-approved drugs have been in progress in Europe and Japan since the early 1970s and have yielded almost uniformly encouraging results. Among physicians in the United States who have administered the drugs to patients with hypertension on an individual basis, the feeling is one of cautious optimism.Other disorders are those that involve spasms in smooth muscle, such as asthma, achalasia, myometrial contractions, and migraine. Here, however, most investigators agree that it is much too early to issue a verdict. David Tinkleman, MD, assistant clinical professor of pediatrics at the Medical College of Georgia School of Medicine in Augusta, is conducting a

Two teams of investigators have provided the first evidence that the translocation of a single piece of DNA from one chromosome to another involves and perhaps "turns on" an oncogene in human cells. This evidence was presented at a recent Bristol-Myers symposium, "Chromosomes and Cancer: From Molecules to Man," at the University of Chicago.The laboratories of Carlo M. Croce, PhD, associate director of the Wistar Institute in Philadelphia, and Philip Leder, MD, chair, Department of Genetics, Harvard Medical School, Boston, pursued different avenues of research to arrive at the same conclusion: The translocation between the terminal ends of chromosomes 8 and 14 in Burkitt's lymphoma cells involves an exchange of two genes (among others)— one that codes for a region of the antibody molecule and one that is an oncogene called the myc gene (the human homologue of the avian myelocytomatosis virus). The translocation, which occurs in 90% of

The 1982 Albert Lasker Memorial Awards for Medical Research were presented to seven investigators at a recent luncheon in New York City. Five of the scientists shared the $15,000 award for basic research, and two the equal award for clinical research.The basic research awards were presented to J. Michael Bishop, MD; Harold E. Varmus, MD; Hidesaburo Hanafusa, PhD; Raymond L. Erikson, PhD; and Robert C. Gallo, MD, for their "revolutionary discoveries" of the human genes known as oncogenes "which have provided a long-sought link between viruses and the development of cancer." The recipients of the clinical research award, Roscoe O. Brady, MD, and Elizabeth F. Neufeld, PhD, were cited for their "original and creative contributions to the understanding of two groups of inherited [enzymedeficiency] diseases—lipid storage diseases and mucopolysaccharide storage disorders."The Oncogene InvestigatorsBishop, 46, and Varmus, 43, both professors of microbiology, University of California School of Medicine,

WHERE THERE'S SMOKE there's... likely to be an increased risk for some disease. Recently stroke was added to the list of diseases and medical events linked to cigarette smoking.The link, forged by the Framingham Heart Study, was reported at the 12th International Joint Conference on Stroke and Cerebral Circulation in Tampa, Fla. The investigators said that now that the cohort is old enough to have had a substantial number of strokes, they have found that the smokers in the group have a significantly higher risk of stroke than do the nonsmokers.But the forecast was not universally bad for smokers. Philip A. Wolf, MD, who presented the results at the conference, noted that the risk of stroke was dose related and reversible. The risk of stroke in light smokers (who smoked ten or fewer cigarettes per day) was not significantly higher than that in nonsmokers. However, the stroke risk of heavy smokers (those who smoked

Two seemingly common forms of medication—a cough syrup and a plain blue tablet—represent two of the most recent innovations in oral controlled-rate drug delivery systems.The cough syrup, Delsym, in which dextromethorphan is the active ingredient, is the first representative of the Pennkinetic system to reach the market. In this system, developed by Pennwalt Corporation, Rochester, NY, a drug in an ionic state is bound to a polymer matrix. Some of the drug/polymer complex is subsequently coated with ethyl cellulose. Then a mix of coated and uncoated particles, which average about 100 μm in length, is suspended in a syrup.A patient taking a single one-teaspoon dose of the syrup swallows approximately 1 million drug/polymer particles. The drug remains unavailable until it reaches the gastrointestinal system, but once there, ions present in digestive fluids diffuse through the ethyl cellulose coat (if it is present) and bind with the polymer, displacing

The A. he patient died, but—the old story—the therapy was a success. Indeed, an Associated Press story heralded the treatment as a major medical break-through. The story, which hit newsstands across the nation on February 15, began hyperbolically, "For the first time, doctors have cured a deadly assault on the body's immune system, saving the life of a week-old baby with an experimental treatment called monoclonal antibodies."The article was referring to the treatment of Bryan Ahlers, who during surgery to repair a heart defect three days after his birth at Children's Hospital, Buffalo, NY, was given a routine blood transfusion. When rash, fever, diarrhea, and ascites developed, immunologist Byung H. Park, MD, recognized the classic symptoms of graft v host disease (GVHD). This seemed an unlikely response until physicians discovered that Bryan had no thymus. With no mature T lymphocytes of his own, the lymphocytes in the transfused blood

500 YEARS AGO, a host of navigators were competing for Columbus' commission. Today, a good portion of the scientific community is vying for the same kind of opportunity—a government-funded exploration that should produce the ultimate map. In the 15th century, the map was to be of the world. In the 20th, it's to be of the human genome.There's no doubt that such a map, which would identify the chromosomal location of each of the 100 000 human genes, would be a boon to all of the biologic sciences, particularly to medicine (JAMA 1987;258:1131-1132). The question now is how the map should be put together and who should put it together. The answer depends on who is talking.In recent months, there has been ample opportunity to hear from just about anyone with a stake in the quest, from representatives of the National Institutes of Health (NIH) and the Department

"HOW MANY of you have performed this procedure?" the speaker asked the packed auditorium. Some 300 hands went up.He pursued the questioning: "How many of you still do it?" Six hands were raised.The poll was informal, conducted as a coda to a series of presentations on chemonucleolysis therapy for herniated lumbar disks at the recent meeting of the American Association of Neurological Surgeons (AANS) in Denver. But it says a lot about how neurosurgeons' opinions of the technique have changed in the few years since the chymopapain enzyme injection received FDA approval (JAMA [MEDICAL NEWS] 1983;249:1115-1123).As neurological surgeons' experience with the procedure has grown, so has their discontent. Early rumblings were detected at the annual meeting of the Congress of Neurological Surgeons (CNS) late in 1983. At that meeting, surgeons who were performing the procedure reported failure rates of 5% to 33% (JAMA [MEDICAL NEWS] 1984; 251:13-15,

AS THE National Heart, Lung and Blood Institute (NHLBI) prepares to raise the nation's cholesterol consciousness, several clinical investigators are contending that lowering serum cholesterol is not a public health matter. They would like to see cholesterollowering programs tailored to the individual rather than presented as an edict to the population at large.None of the naysayers is challenging the notion that hyperlipidemia should be treated. Nor does any of them doubt that excessive dietary cholesterol is often associated with coronary disease. What they are taking issue with is the NHLBI's recommendation that all Americans above the age of 2 years reduce their intake of dietary fats to 30% of calories and of saturated fats to 10% of calories (JAMA 1985;253:2080-2086). They contend that cholesterol education programs should not be designed around this dietary dictum.Although dietary fat has been a putative culprit in coronary artery disease since the 1950s,

DRUG RESISTANCE keeps cancer chemotherapy from working the way it should. Because chemotherapy employs drugs that kill tumor cells preferentially, it should eradicate the malignancy before irreversible damage is done to the host. But it fails to do so when, at concentrations that are tolerable to normal host tissue, cytotoxic agents are no longer able to dispatch tumor cells.Recently 24 investigators, who have spent many years trying to determine how and why tumor cells can adapt and thrive in the presence of toxic agents, spent two days discussing their findings. The occasion was the Ninth Annual Bristol-Myers Symposium on Cancer Research in Washington, DC, the home of the organizing institution, the Vincent T. Lombardi Cancer Research Center, Georgetown University School of Medicine and Hospital.Several themes surfaced: That the first evidence of drug resistance is often a change in tumor-cell chromosomes; that a single mechanism is often responsible for

WHEN GENE THERAPY becomes clinical reality, one of its first uses may be in treating cancer patients with drug-resistant tumors.John S. Lazo, PhD, associate professor of pharmacology, Yale University School of Medicine, New Haven, Conn, told the Bristol Myers Symposium on Cancer Research that he can foresee using gene therapy to restore sensitivity to chemotherapy in resistant cells; to produce toxic chemicals in resistant tumor cells; and to make normal host cells resistant to chemotherapy so that higher doses of cytotoxic compounds can be used.The trick, of course, is to isolate the genes that can produce proteins to do these things; to get those genes into the proper cells; and to see that the genes are expressed appropriately in vivo.Researchers at several institutions have been investigating gene therapy for genetic disease, and have found that it is indeed possible to transplant a gene into a stem cell

Ophthalmologists may inadvertently injure patients' retinas during eye surgery, warns Joseph L. Calkins, MD, assistant professor of ophthalmology at Johns Hopkins University School of Medicine, Baltimore.During a symposium on light toxicity at the recent joint meeting of the American Academy of Ophthalmology and the International Congress of Ophthalmology in San Francisco, Calkins said that the disturbing incidence of cystoid macular edema in patients who have undergone cataract surgery may possibly be the result of prolonged exposure to the light source in a surgical microscope.In an interview with JAMA MEDICAL NEWS, Calkins cited studies indicating that 40% to 50% of routine cataract extractions are followed by cystoid macular edema detectable by fluorescein angiography shortly after surgery (Invest Ophthalmol 1975;14:68-72, Ann Ophthalmol 1971;3:1234-1240). "This condition often masks as normal postsurgical blurred vision," he explained. The tipoff comes when the blurring persists longer than it should.He continued, "In most cases,

Hospital—or hypnosis?That is a choice some terminally ill patients are making, and hypnosis can be the far better alternative, says Wallace L. LaBaw, MD, of Denver, who has treated dozens of such patients over the past decade. He tells of the woman, for example, who "drove her little daughter to the shopping center, picked up some groceries at the Safeway, and then went home and died, alert and feeling like a useful wife and mother to the very end."LaBaw continues, "Many patients, when placed in a hospital, feel abandoned. Physicians are too often inclined to mark time in quiet desperation or to indulge in desperate heroics with these patients. I've done it myself. Certainly, some patients have to be in the hospital at some time, but many do not—we keep them there because we don't want them to think we're not doing anything as doctors."LaBaw, a former

LESS IS MORE is the early word from the latest and largest aspirin trial. The preliminary results of the United Kingdom Transient Ischemic Attack/Aspirin Trial (UK TIA)—the first large study to evaluate low-dose against high-dose aspirin—indicate that 300 mg of aspirin daily is just as effective as 1200 mg in preventing myocardial infarction and stroke in patients with cerebrovascular disease. And as expected, the lower dose has fewer side effects.Charles Warlow, MD, one of the study's principal investigators, presented the preliminary findings at the 12th International Joint Conference on Stroke and Cerebral Circulation in Tampa, Fla. His findings may have seemed like old news but they provided the first firm clinical evidence for a truism of basic research: low-dose aspirin is more effective than high-dose in preventing thrombogenesis. Warlow noted that clinical substantiation had been a long time in coming due to the difficulties inherent in recruiting a study

"CANCER PATIENT SURVIVAL: what progress has been made?" is a question that has been widely debated within the medical community for the last few years. It is also the title of a document released last month by the US General Accounting Office (GAO).The GAO is the organization that exposed the Pentagon's imprudent spending habits a few years ago. It therefore seemed a good arbiter for the dispute between the National Cancer Institute (NCI), which has claimed major advances toward eradicating cancer, and its critics, who charge that progress has been negligible. Many observers expected the report to deliver the definitive answer its title promised.It didn't. Instead, the GAO said merely that it accepts the NCI's survival statistics, but doesn't agree with the institute's interpretation of them. It stated that "advances in the detection and treatment of cancer from 1950 to 1982 have extended patient survival in all but

THE WORD "BREAKTHROUGH" is rearing its head again. This year, it has popped up in descriptions of a radical treatment for Parkinson's disease: the transplantation of tissue from the adrenal medulla to the right caudate nucleus of the brain (Associated Press, 4/16/87).Its evocation is inspired by early reports indicating that the first patients to undergo the procedure on this continent have demonstrated a marked improvement in neurological function. Nonetheless, the surgeons who have performed the procedure caution that neither the mechanism of action nor the long-term effects of the grafts have been identified. Moreover, two graft recipients have died unexpectedly within two months of surgery.The publication by surgeons at the Universidad Nacional Autonoma de Mexico, Mexico City, of favorable results in two patients (N Engl J Med 1987;316:831-834) appears to have stimulated activity among surgeons in the United States. On April 9 and 21, similar operations were performed

Screening an at-risk population for early-stage lung cancer—a practice that has been declared ineffective by the American Cancer Society (ACS) because studies have not shown that it lowers mortality rates—nonetheless received emphatic support at the recent annual meeting of the Radiological Society of North America in Chicago.In defense of radiological screening, John R. Muhm, MD, director of diagnostic radiology at the Mayo Clinic, Rochester, Minn, cited results of the ongoing Mayo Lung Project, and Robert T. Heelan, MD, assistant attending radiologist, Memorial Sloan-Kettering Cancer Center, New York City, presented data from the National Lung Program (NLP). These programs, as well as a third conducted at Johns Hopkins University in Baltimore, are sponsored by the National Cancer Institute (NCI), Bethesda, Md.Both Muhm and Heelan emphasized that the value of radiography in detecting early-stage disease is limited to certain forms of the disease—adenocarcinoma, squamous cell carcinoma, and large-cell carcinoma—that are

Some victims of knee and shoulder injuries— including sidelined athletes—and patients with degenerative joint diseases are moving their limbs freely and without pain, thanks to a carbon-composite implant for ligaments and tendons. The implant, developed by a team of engineers and orthopedic surgeons at the University of Medicine and Dentistry of New Jersey in Newark, provides a biodegradable scaffold upon which torn tissues can regrow.The New Jersey investigators, led by Harold A. Alexander, PhD, director of the orthopedic research laboratories, and Andrew Weiss, MD, director of orthopedic surgery, had been frustrated in their search for a good permanent prosthesis for tendons and ligaments. As Alexander said in an interview with JAMA MEDICAL NEWS, "We couldn't come up with a material that was biocompatible, yet strong and resilient enough to withstand the demands made on these structures. So we concentrated on developing a replacement that was not dependent upon long-term

THE HUMAN GENOME Initiative has received another vote of confidence. The National Research Council, an arm of the National Academy of Sciences that is empowered by Congress to advise the federal government, is recommending a $3-billion effort to map and sequence the human genome.The committee advises appropriating $200 million each year for the project over the next 15 years. It emphasizes that funding should be generated de novo, not diverted from existing biologic and medical research efforts.As envisioned, the project would be executed in two stages: genome mapping and DNA sequencing. The first would involve preparing both physical maps, in which previously identified DNA segments are aligned in proper order on the appropriate chromosome, and genetic maps, which demonstrate the frequency with which two traits are likely to be inherited together (JAMA 1987;258:1131-1132).The recommendation paralleled provisions of two Senate bills—the science initiative bill introduced last summer by

CONTROVERSY AND CONFUSION surround a new regulation that expands the availability of investigational new drugs (INDs) beyond clinical trials.The rule, known informally as the "Treatment IND," describes procedures for making promising INDs available to patients with serious or immediately life-threatening disease for whom other forms of treatment have been inadequate (JAMA 1987;257:1858). In essence an extension of the "Compassionate IND," it is not a new concept or practice, but a codification and extension of existing procedures. Yet many believe that the consequences of its enactment will be far ranging: that it will threaten controlled clinical trials; make untried drugs available; and create a two-tiered system of care for the critically ill.Since the regulation went into effect last June, the Food and Drug Administration (FDA) has made three drugs available under its provisions—cytomegalovirus (CMV) immune globulin to prevent CMV infection in patients with kidney transplants; ifosfamide and mesma for

TREATING musculoskeletal diseases in the aged is one thing. Rehabilitating elderly patients is another. According to participants at a recent national multidisciplinary conference, the latter is often a greater challenge than the former.At the fifth annual seminar titled "Them Ol' Bones," sponsored by St Luke's Medical Center in Phoenix, specialists in orthopedics, rheumatic diseases, physiatrics, and rehabilitation nursing offered a number of suggestions designed not so much to add years to the patients' lives as to add life to their years.Participants generally agreed that the overall goal of rehabilitation defined by Stanley Wainapel, MD, is to restore the patient to the maximum level of his or her physical, mental, social, and vocational abilities. The hard part is determining these abilities in the individual patient, says Wainapel, who is assistant director of physical medicine and rehabilitation, St Luke's Hospital, New York City.He cites statistics from studies showing that

"COMB SEARCHES" may be on the way to replacing strip searches in criminals' nightmares, thanks to a new technique known as DNA fingerprinting.The technique, which produces a visual representation of a person's genome, enables the identification of perpetrators from as little as a single hair root, providing they have left some biologic evidence—hair, skin cells, blood, or semen—at the scene of the crime.DNA fingerprinting was developed by British geneticist Alec Jeffreys, PhD, in 1985. Jeffreys, professor of genetics at the University of Leicester, built upon a discovery, five years earlier, of certain hypervariable regions called minisatellites in unexpressed areas of DNA.The hypervariability was evidenced in the number of repetitions of certain sequences of base pairs. For example, in a given minisatellite, a certain 32-base pair segment may appear 28 times in one person's DNA, 22 times in another's, and 19 times in a third person's.It was

THE FIRST DNA PROBES for oncogenes are awaiting Food and Drug Administration approval for use in cancer diagnosis. They may become to the 1990s what cytogenetics was to the 1980s and histology to the previous decades: the best means of providing a specific diagnosis of several forms of cancer.Although all three techniques provide a physiological indication of cellular changes related to carcinogenesis, each demonstrates something different. Histology detects gross cellular abnormalities; cytogenetics reveals alterations in banded chromosomes; molecular analysis uncovers changes in specific regions of DNA.Molecular analysis relies on the use of DNA probes, synthetic copies of specific genes that are radioactively labeled. When these probes are added to denatured DNA samples in a procedure called Southern blotting, they will hybridize with the gene whenever it is present. Thus, they can be used to indicate a gene's chromosomal location as well as the number of times it appears

IN ABOUT two weeks, New York City begins strict enforcement of what has been called "the most sweeping nonsmoking law in the United States." It is just one of a growing number of indications that those Americans who continue to smoke in the months and years ahead will find fewer public places to do so.That eventually may include more of those who can't even go home to smoke—the inmates of the nation's jails and prisons. In Utah, for example, the Davis County Jail now is smoke free.The National Commission on Correctional Care, Chicago, says the Davis County sheriff made the decision after studying the experience of the smoke-free jail in Orchard Cove, Wash, noting the legislature's prohibiting of smoking in any general public place, realizing his jail is poorly ventilated, and arranging counseling and medical service for inmates addicted to tobacco. The commission says complaints "have been minimal."

AEROSOL DELIVERY of pentamidine may be the key to effective prophylaxis and therapy for Pneumocystis carinii pneumonia (PCP) in patients with acquired immunodeficiency syndrome (AIDS).According to early studies, not only does the aerosolized form of the drug appear to eradicate and prevent PCP, it does so without many of the serious side effects associated with parenterally administered pentamidine. The results have prompted two companies, LyphoMed, Inc, Melrose Park, Ill, and Fisons Corporation, Bedford, Mass, to compete for the exclusive rights to market it under the Food and Drug Administration's (FDA) Orphan Drug Act. Both companies are sponsoring extensive clinical trials.LyphoMed, which is backing trials at San Francisco General Hospital, already has exclusive US marketing rights for intravenous and intramuscular pentamidine for the treatment of PCP until 1991. However, that exclusivity applies only to parenteral delivery and an indication for treatment. LyphoMed would also like to have a monopoly