Miami Herald - Thursday, October 17, 1985
Steve Sternberg, Herald Medical Writer

The doctor, Dixon Yeste, operated on 400 patients between 1978 and his death in 1983. As of August, none of those patients had developed AIDS, a new study shows.

"This study of 400 persons found no evidence that transmission of AIDS to patients occurred and nothing to suggest that the surgeon shouldn't have been practicing," said Dr. Jeffrey Sacks, of the federal Centers for Disease Control in Atlanta.

Sacks reported his study in a letter to this week's New England Journal of Medicine. He did not identify Yeste as the doctor. However, medical sources in Miami say his study focused on Yeste's patients.

In 1981, Sacks' study reports, the surgeon began to experience the classic symptoms of acquired immune deficiency syndrome. He became weak, he lost weight, his glands became swollen.

At first, said Dr. Ian Nisonson, former chief of urology at Baptist Hospital in South Dade, one of several hospitals where Yeste practiced, the disease went undiagnosed. Yeste was able to continue to practice medicine and surgery.

"In the last year or six months of his life," Nisonson said, "he did take a leave of absence because he was not feeling well. Nobody had answers for him. They thought he might be suffering from mononucleosis or hepatitis."

Yeste performed surgery until a few weeks before his death of pneumonia on July 12, 1983, in an intensive care ward at Baptist, doctors say. In the last days before his death, he became so weak he withdrew from a scheduled operation and asked for another surgeon to take over.

"That's when I was contacted," said Nisonson, a Baptist surgeon. "He said he could not proceed.

"I don't think anyone knew he had AIDS a year before he died. Whether they knew it three months before, I don't know," the surgeon said. "I honest to God don't know."

Researcher Sacks said he compared patients' names with Florida's confidential registry of AIDS patients. He obtained the names from the files of several hospitals.

None of the names appeared on the AIDS list.

For 347 of the 400 patients, more than three years had elapsed since surgery, the study said. At least two years had passed for the remaining 53, Sacks said. Doctors say the incubation period for AIDS may be five years or more.

"It is not the perfect study," Sacks said. "We did not look for HTLV-III in patients, we simply looked at reported AIDS cases." He said no effort was made to contact patients and test their blood for HTLV-III, the virus that causes AIDS.

State law, Sacks said, permits epidemic control specialists to examine hospital records. "We do not need informed consent from the patient to look at a record," he said.

And though Florida doctors must report AIDS cases by law, they are not required to report the swollen glands, fever and weight loss that precede AIDS, called AIDS-related complex.

If those patients exist, Sacks said, the study did not detect them.

Researchers examined more than 500 records, some from patients who had not had surgery. They studied 400 records of surgical patients to see whether Yeste could have inadvertently bled into a wound and infected anyone.

"We reviewed every operative note and found no unusual occurances," Sacks said in an interview.

At the time of Yeste's death at age 42, his presence in the operating room raised questions about whether he might have infected one of his patients. At that time, researchers had not written guidelines for health workers with AIDS.

Since the disease can be transmitted through blood or body fluids, Sacks said, a surgeon could "theoretically" give AIDS to a patient if he nicked himself with a scalpel.

Now, the Centers for Disease Control recommends that hospital workers with AIDS wear gloves when they have wet lesions on their hands, or when they are touching a patient's mucus membranes or broken skin.

Always watch for outdated information. This article first appeared in 1985. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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