HICN608 Medical News Part 1/4 
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 HICN608 Medical News Part 1/4

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Volume  6, Number  8                                            April  4, 1993

              !                                                !
              !              Health Info-Com Network           !
              !                    Newsletter                  !
                         Editor: David Dodell, D.M.D.
    10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA
                          Telephone +1 (602) 860-1121
                              FAX +1 (602) 451-1165

Compilation Copyright 1993 by David Dodell,  D.M.D.  All  rights  Reserved.  
License  is  hereby  granted  to republish on electronic media for which no
fees are charged,  so long as the text of this copyright notice and license
are attached intact to any and all republished portion or portions.  

The Health Info-Com Network Newsletter is  distributed  biweekly.  Articles
on  a medical nature are welcomed.  If you have an article,  please contact
the editor for information on how to submit it.  If you are  interested  in
joining the automated distribution system, please contact the editor.  

E-Mail Address:

                              FidoNet = 1:114/15

                         anonymous ftp = vm1.nodak.edu

                       FAX Delivery = Contact Editor


                       T A B L E   O F   C O N T E N T S

1.  Comments & News from the Editor
     What a Week! .........................................................  1

2.  Medical News
     CancerNet Update for April 1993 ......................................  3
     Huntington Disease Gene is Found .....................................  6
     Taxol Availability ...................................................  9
     Taxol Approval Caps Years of Effort .................................. 11

3.  Centers for Disease Control and Prevention - MMWR
     [02 April 1993] Methemoglobinemia in an Infant -- Wisconsin, 1992 .... 15
     Classification of American Indian Race on Birth Certificates ......... 19
     Sliding-Associated Injuries in College/Professional Baseball ......... 24
     Cigarette Smoking Among {*filter*}s ....................................... 26
     Publication of CDC Surveillance Summaries ............................ 29

4.  Food & Drug Administration News
     New Combination Vaccine for Small Children ........................... 31
     Home Cholesterol Test Available ...................................... 33
     IV Drug Cladribine for Treatment Hairy Cell Leukemia ................. 35

5.  Articles
     Bone, Muscle, Motion ................................................. 36

6.  Announcements of Studies/Research
     NIAID Begins First Test of Novel HIV Peptide Vaccine ................. 44

7.  AIDS News Summaries
     AIDS Daily Summary for March 29 to April 2, 1993 ..................... 46

Health InfoCom Network News                                          Page    i
Volume  6, Number  8                                            April  4, 1993

                        Comments & News from the Editor

                                 What a week!

First, there was all the bouncing mail from u.washington.edu.  Second, when
the first crisis was over, more bounces came through.  It appears that the
problem with u.washington.edu has been fixed.  I have received a note of
apology from the Assistant Director of their computer center.  

Due to a totally unrelated problem, the post office machine at asu.edu (the
newsletter originates from asuvm.inre.asu.edu) had its own fouled up mailer
this past week.  It seems that some of the messages got stuck there, so that
is why some of you received additional bounces towards the end of the week.

It appears that it might have finally quieted down, we can just keep our
fingers crossed.

First, I would like to thank everyone who has sent in a donation for the
Mednews OCR/Scanner Fund.  The total is now at $748.  We are more than half
way to our goal.

For our new subscribers, I am trying to raise enough money to buy a good
flatbed scanner to scan in new articles and news releases for the newsletter.  
Cost for a new scanner is approximately $1000.  To prevent boring our old

I have sent everyone individually thank you notes, but some email has bounced.  
If you see your name below, but did not receive a thank you note, please drop
me a line.  

If you would like to send in a contribution, mail a check to:

                                 David Dodell
                      10250 North 92nd Street, Suite 210
                      Scottsdale, Arizona 85258-4599  USA

Thank you to the following individuals whose contributions I just received:

James Pennebaker
Jerome Lang
Robert Walker

Health InfoCom Network News                                            Page  1
Volume  6, Number  8                                            April  4, 1993

Again, thank you for all the contributions sent so far.

David Dodell
Editor, HICNet Medical Newsletter

Health InfoCom Network News                                            Page  2
Volume  6, Number  8                                            April  4, 1993

                                 Medical News

            |       NATIONAL           INSTITUTE           |
            |               C A N C E R                    |
            |  INTERNATIONAL           INFORMATION         |
            |               C E N T E R                    |


CancerNet has been updated for April. The following statements
were modified.  

Changes to the Cancer Information Statements

{*filter*} acute lymphocytic leukemia                           cn-101024
{*filter*} Hodgkin's disease                                    cn-100003
{*filter*} non-Hodgkin's lymphoma                               cn-100066
{*filter*} soft tissue sarcoma                                  cn-100921
{*filter*}cancer                                                cn-100022
Bladder cancer                                             cn-101206
{*filter*} cancer                                              cn-100013
Chronic lymphocytic leukemia                               cn-101003
Chronic myelogenous leukemia                               cn-101031
Cervical cancer                                            cn-100103
Colon cancer                                               cn-100008
Cutaneous T-cell lymphoma                                  cn-100098
Endometrial cancer                                         cn-100089
Ewing's sarcoma                                            cn-100021
Gastric cancer                                             cn-100025
Intraocular melanoma                                       cn-101279
Islet cell carcinoma                                       cn-100790
Lip and {*filter*}cavity cancer                                 cn-102840
Malignant thymoma                                          cn-101248
Melanoma                                                   cn-101302
Neuroblastoma                                              cn-100530
Nonsmall cell lung cancer                                  cn-100039
Osteosarcoma                                               cn-100049
Ovarian epithelial cancer                                  cn-100950
Pancreatic cancer                                          cn-100046

Health InfoCom Network News                                            Page  3
Volume  6, Number  8                                            April  4, 1993

Parathyroid cancer                                         cn-100541
Pituitary tumor                                            cn-101273
Plasma cell neoplasm                                       cn-100281
Prostate cancer                                            cn-101229
Renal cell cancer                                          cn-101070
Small cell lung cancer                                     cn-100040
Testicular cancer                                          cn-101121
Vulvar cancer                                              cn-101038
Wilms' tumor                                               cn-100719

Patient statements:

{*filter*} non-Hodgkin's lymphoma                               cn-200066
Childhood non-Hodgkin's lymphoma                           cn-200915
Malignant thymoma                                          cn-201248
Neuroblastoma                                              cn-200530
Parathyroid cancer                                         cn-200541
Testicular cancer                                          cn-201121
Vulvar cancer                                              cn-201038

Changes to Supportive Care and Screening Guidelines

Constipation, impaction, and bowel obstruction             cn-303510
Hypercalcemia                                              cn-304462
Lymphedema                                                 cn-300442
{*filter*}complications secondary to cancer therapy             cn-302904
Skin integrity changes secondary to cutaneous metastases   cn-304277
Superior vena cava syndrome                                cn-304708

Screening for {*filter*} cancer                                cn-304723
Screening for skin cancer                                  cn-304724

Request the Monthly PDQ Statement Changes (cn-305001) for a description
of the changes in the statements listed above.

News items:

Health InfoCom Network News                                            Page  4
Volume  6, Number  8                                            April  4, 1993

PDQ Distributors                                           cn-400003
Cancerlit Distributors                                     cn-400006
PDQ Voluntary Protocol Submission General Information      cn-400010
Group C protocol information                               cn-400014
NCI High Priority Clinical Trials                          cn-400007
NCI-designated Cancer Centers                              cn-400008

To request the CancerNet Instructions and Contents List, send a mail message,
leaving the subject line of the message blank, and in the body of the message,  
enter HELP.  Address the mail message to:

To request the modified statements, follow the above directions, and in the
body of the mail message, enter the statement code. When requesting more than
one statement, enter each code on a separate line.

CancerNet statements are now available in Spanish. To request the Instructions
and Contents List in Spanish, enter SPANISH in the body of the mail message.
If you would like to request the statements in Spanish, substitute the prefix
"cs-" in front of the number (e.g., cs-100022 to receive the statement on {*filter*}
cancer in Spanish). All of the physician and patient statements are available
in Spanish. Supportive care statements and Cancer screening guidelines are not
currently available in Spanish. News items that are available in Spanish have
a # next to the statement title. Although both the English and Spanish are
updated at the same time each month, the Spanish statements do not reflect the
changes made in the English statements until the following month( to allow
time for translation). If you are interested in requesting CancerNet
statements or news articles in Spanish, it is suggested that you request an
updated Contents List.

If you are redistributing the PDQ information you retrieve from CancerNet to
others at your location, the ICIC would be interested in hearing how you reuse
the information, how useful you find it, etc. Additionally, we may be able to
suggest ways to enhance your use of the information or we may have other
information that would be useful to you. Please send responses to:

Cheryl Burg
NCI International Cancer Information Center

Health InfoCom Network News                                            Page  5
Volume  6, Number  8                                            April  4, 1993

                       Huntington Disease Gene is Found
                    Huntington's Disease Society of America
                         Press Release March 23, 1993

                            Research Breakthrough:
                      Huntington's Disease Gene is Found

          An international team of scientists, led by Dr. James Gusella of
     Massachusetts General Hospital, Boston, Massachusetts, has identified the
     gene which causes Huntington's Disease, a hereditary neurological
     disorder which is always fatal and for which there is no treatment or
          After nearly 10 years of intensive, collaborative effort, the
     scientists have discovered a variation in the coding for a gene on
     chromosome 4 occurring in people affected by Huntington's Disease
     (HD).  The scientists have done exhaustive research with hundreds of
     {*filter*} samples to establish that this variation is actually responsible
     for the illness.  How this variation in the genetic coding causes HD has
     not been established and will require a great deal more research.  
          Although it is expected that the procedure for predictive testing
     for HD will be simplitied, there is still no cure or treatment for the
     disease.  Studies will now focus on the tissues, organs, or cell types in
     which the gene is normally expressed, the gene's normal role, and how its
     expression is altered in HD.
          The collaborative research team includes Francis Collins of the
     University of Michigan; John Wa{*filter*}h of the University of California at
     Irvine; Hans Lehrach and Anne-Marie Frischauf at the Imperial Cancer
     Research Center in London, England; David Housman, Massachusetts
     Institute of Technology; Peter Harper, University of Cardiff, Wales; and
     James Gusella.  
          Major financial support for this research has been provided by the
     National institute of Neurological Disorders and Stroke, the Huntington's
     Disease Society of America, and the Hereditary Disease Foundation.  
          The Huntington's Disease Society of America (HDSA) is a national
     organization with 31 chapters throughout the United States, dedicated to
     ensuring care and support for people affected by HD and their families,
     and to finding a cure through research.  
          At leagt 25,000 Americans are known to be affected by HD, and an
     additional 125,000 are at risk of inheriting it from an affected parent.  
     First symptoms of HD are usually detected in mid-life, and the disease
     runs a devastating, degenerative course.  
          For further information on HD, HDSA, or the recent research
     developments, call HDSA's national office at (800) 345-RDSA or (212) 242-

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Volume  6, Number  8                                            April  4, 1993

                         Huntington Disease Gene Found
                            By Dr. Richard H. Myers

     After nearly ten years of effort, an international team of scientists
     headed by Dr. James P. Gusella in Boston has successfully identified the
     gene which causes Huntington's Disease.  

                                What Was Found?

     A variation in the genetic code for a gone on chromosome 4 was found
     among persons affected with Huntington's disease.  Normally, the genetic
     code of this gene has three DNA bases, CAG, which are repeated several
     times.  Among persons with Huntington's disease, the number of repeats of
     this sequence approximately doubles.  

     Hundreds of Huntington's disease and normal {*filter*} samples were studied to
     establish that this variation is specific to Huntington's disease gene
     carriers and actually is responsible for the illness.  How this variation
     in sequence causes Huntington's disease has not been established.  Much
     more research will be needed to determine the exact mechanisms which
     cause brain cells to die in Huntington's disease.

                          What Does This Mean for Me?

     In the immediate future, there will be no changes.  The methods for the
     treatment or diagnosis of Huntington's disease will remain the same for
     some time.  

     However, with further investigation, new possibilities will arise for
     persons at risk for Huntington's disease.  Until now, many {*filter*}
     specimens were necessary for a genetic test.  Once the procedure has been
     validated, it is expected that a test will be possible with only a {*filter*}
     sample from the person wishing to be tested.  In addition, testing will
     become less complex and less expensive.  

     Nevertheless, genetic testing in Huntington's disease remains a personal
     decision which should be considered very carefully.  Although the test is
     expected to become technically less complex, the personal implications
     will remain substantial and it is necessary that testing continue to be
     carried out through a program of appropriate counseling.  

                   Is there a Cure for Huntington's Disease?

     There is neither a cure nor a treatment for Huntington's disease.  The

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Volume  6, Number  8                                            April  4, 1993

     search for a treatment in Huntington's disease will be difficult because
     the mechanism by which this gene causes the disease has not been
     determined.  The preliminary studies of the Huntington's gene indicate
     that it is a gene which has not been previously studied.  It does not
     appear at present to be a member of any family of recognized genes and
     may represent a new class of genes.  Studies are now in progress to

     1.   In what tissues, organs or cell types is this gene
          normally expressed?

     2.   At what stage of development is this gene normally

     3.   What is the normal role of this gene?

     4.   How is the expression of this gene altered in people with
          Huntington's disease?

     It is hoped that methods to minimize and perhaps to halt the harmful
     effects of the gone will be found.  This will undoubtedly require an
     intense scientific effort and will take considerable time.  

     The scientific community has worked very hard in finding the gone and the
     process was long and tedious and required great patience and
     perseverance.  Hundreds of {*filter*} samples and brain specimens were
     utilized in the research and the cooperation of the families with
     affected members has been phenomenal.  We can all take pride in the
     cooperative effort that led to this discovery.  Nevertheless, the job is
     not over until an effective treatment is found.  We need to continue to
     work for funding and to continue the collaboration between families and
     the scientific community.

Health InfoCom Network News                                            Page  8
Volume  6, Number  8                                            April  4, 1993

            Letter to Investigators on Availability of Taxol (2/93)

The following is the text of a letter sent on January 14, 1993 by the National
Cancer Institute's Drug Management and Authorization Section of the Cancer
Therapy Evaluation Program to all investigators using Taxol injection (NSC
125973) through the NCI's Division of Cancer Treatment.

Taxol has been approved by the U.S. cooking.net">food and Drug Administration (FDA) for the
treatment of metastatic carcinoma of the ovary. Therefore, the National Cancer
Institute (NCI) will discontinue the distribution of Taxol through the Group
C, Treatment Referral Center (TRC) Protocol for refractory ovarian cancer, and
Special Exception mechanism for any NEW patients on January 15, 1993. Supplies
of Taxol Injection are available commercially through pharmaceutical
wholesalers.  Physicians wishing additional information on Taxol may contact
Bristol-Myers Squibb at 1-800-829-6587.

The National Cancer Institute, with the assistance and cooperation of the
manufacturer, Bristol-Myers Squibb, will continue to make Taxol available free
of charge to physicians for individual patients who started treatment under a
Group C, TRC or Special Exception Protocol.  Additional drug for these
patients may be requested by completing a Clinical Drug Request form (NIH-986)
or by using the NCI's Electronic Ordering System.  The protocol number and the
patient's first name and first initial of the last name must be indicated on
the request.  Taxol for patients on the TRC protocols should be ordered as in
the past by protocol number.

Accrual of patients to the TRC protocol (TRC-9202), "Taxol in Patients with
Previously Treated Refractory {*filter*} Cancer" will continue through February
19, 1993.  Information from this patient population is expected to provide
useful clinical information regarding the use of Taxol in the treatment of
{*filter*} cancer.  After accrual is discontinued, these patients will continue to
receive Taxol at no cost as long as they continue to be treated on the

Taxol, which is sent to you from DCT, NCI under the Group C, TRC and/or
Special Exception protocols, is still considered investigational since
treatment was initiated before FDA approval of the agent.  Therefore, for
patients whose treatment was initiated under a Group C, TRC or Special
Exception protocol, we request that you take the following action so that we
may comply with FDA reporting regulations.

     1.  Adverse drug reactions must continue to be reported to
     the Cancer Therapy Evaluation Program at 301-230-2330.

     2.  The "Report of Independent Investigator" is still

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Volume  6, Number  8                                            April  4, 1993

     required  at the conclusion of therapy for Special Exception

     3.  Continue to comply with the data reporting requirements
     described in the Group C or TRC protocols.

Investigators with patients enrolled in NCI sponsored clinical trials other
than Group C, TRC or Special Exception protocols will continue to receive
clinical drug supplies from the NCI through standard ordering procedures.

Questions concerning Taxol should be directed to the Drug Management and
Authorization Section at 301-496-5725.

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Volume  6, Number  8                                            April  4, 1993

                      Taxol Approval Caps Years of Effort

The following is the text of a press release from the National Cancer
Institute, dated December 29, 1992.

Taxol (paclitaxel), a drug whose development was spearheaded by the National
Cancer Institute (NCI), has been approved by the U.S. cooking.net">food and Drug
Administration (FDA) for treating ovarian cancer that has failed other
therapy.  The new drug will be marketed by Bristol-Myers Squibb Company.

Ovarian cancer is diagnosed in about 21,000 women in the United States each
year and claims 13,000 lives.  Although most patients initially respond to
chemotherapy, the cancer often recurs in a form that is resistant to most

"Taxol is a very important drug, and I am proud of NCI's role in bringing it
to the public," said NCI Director Samuel Broder, M.D. "The cooking.net">food and Drug
Administration and NCI's network of investigators have been exemplary in
collaborating to expedite development of this drug," he added.  "Taxol is not
a cure, but it clearly can help many women with advanced ovarian cancer who
have few other options."

Broder also praised the Department of Agriculture's Forest Service, the
Department of the Interior's Bureau of Land Management, and Bristol-Myers
Squibb for their cooperation with NCI in developing an adequate supply of
taxol, which originally was scarce.  These collaborations were made possible
by the Federal Technology Transfer Act of 1986, he noted.


Interest in taxol dates from the late 1960s, when a crude extract of bark from
the Pacific yew tree, Taxus brevifolia, which was being tested in a large-
scale NCI plant screening program, showed activity against cancer cells
growing in culture.  In 1971, chemists at Research Triangle Institute in North
Carolina, working under an NCI contract, isolated the active component from
the extract and named it "taxol."

As additional quantities of the drug gradually became available, NCI was able
to evaluate it in animal tumor systems.  Taxol proved active against a number
of these tumors, and the institute selected it in 1977 as a candidate for
clinical trials.

However, the sole source of taxol was Pacific yew bark, in which the
concentration of taxol is low.  Obtaining bark and extracting taxol is costly

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Volume  6, Number  8                                            April  4, 1993

and time-consuming.  These supply problems seriously impeded access to the

                              Mechanism of Action

In 1979, scientists at the Albert Einstein College of Medicine, whose work was
partially funded by NCI, reported that taxol had a novel effect on animal
cells.  They found the drug acted to stabilize fiber-like structures called
microtubules that play a key role in the life cycle of cells.  In the presence
of taxol, cells become clogged with bundles of microtubules and cease to grow
and divide.

This discovery, which suggested that taxol's way of attacking tumors was
unique, increased scientists' interest in studying the drug, and NCI
intensified its development efforts.  Phase I trials were begun in 1983 under
the auspices of the institute's Division of Cancer Treatment.  In 1985, Phase
II trials were undertaken, although their scope was limited because of the
restricted drug supply.  [In Phase I clinical trials of a cancer drug, the
drug is given to a small number of patients,     principally with the aims of
learning the best way to administer it and determining how much can be given
safely.  Phase II trials are aimed at determining which tumor types the drug
may be active against.  Phase III trials are large-scale trials designed to
establish whether or not the new agent is more effective than other therapies
against a specific type of cancer.]

In 1989, clinical investigators at The Johns Hopkins Oncology Center reported
that taxol produced partial or complete responses in 30 percent of previously
treated patients with advanced ovarian cancer.  This surprisingly good result
created a stir among cancer researchers and greatly increased demand for the
scarce drug.


In order to increase supplies of taxol and bring it to market as quickly as
possible, NCI announced in August 1989 that it was holding an open competition
for a commercial partner to assist in taxol development.  Bristol-Myers Squibb
was selected in December 1989 as a result of this competition.  In 1990, as
more taxol became available, Phase III clinical trials began.

In January 1991, NCI and Bristol-Myers Squibb signed a Cooperative Research
and Development Agreement.  The agreement stipulated that Bristol-Myers Squibb
would procure Pacific yew bark, supply formulated taxol to NCI, seek
alternative, renewable sources of the drug, and follow the necessary
procedures to obtain approval of taxol by the cooking.net">food and Drug Administration.  

Health InfoCom Network News                                            Page 12
Volume  6, Number  8                                            April  4, 1993

In return, NCI agreed to give the company exclusive access to its clinical and
pre-clinical data on taxol.

In 1991, NCI also initiated a series of agreements that enabled the Department
of Agriculture's Forest Service and the Department of the Interior's Bureau of
Land Management to cooperate with Bristol-Myers Squibb in procuring large
quantities of Pacific yew bark.

                               Increased Supply

Taxol supplies increased as a consequence of these agreements, enabling NCI to
make the drug available through a special program (Treatment Referral Center)
to certain patients with advanced ovarian cancer who were not eligible for
other clinical trials. Subsequently, as a result of additional information
suggesting that the drug was useful in {*filter*} cancer, the Treatment Referral
Center expanded its services to include patients with advanced {*filter*} cancer.

Bristol-Myers Squibb registered Taxol as a proprietary name in May 1992.  Two
months later, the company filed a New Drug Application for Taxol with the FDA,
and in December, the FDA approved the drug for treatment of patients with
ovarian cancer which had failed previous chemotherapy.

Like most other cancer {*filter*}, taxol has certain side effects and can cause
unpleasant and sometimes dangerous toxicity.  However, its risks are
outweighed by its potential benefits for certain patients with advanced
ovarian cancer.

                                Current Trials

Clinical data, some of which are preliminary, suggest that, in addition to its
proven usefulness in treating refractory (treatment-resistant) ovarian cancer,
taxol may prove helpful in treating {*filter*}, lung, and head and neck cancers.  
The drug does not appear useful for patients with melanoma, or with colon,
prostate, renal, or cervical cancers.

Trials to determine whether taxol is effective in other cancer types are
--------- end of part 1 ------------


Fri, 22 Sep 1995 03:51:23 GMT
 [ 1 post ] 

 Relevant Pages 

1. HICN608 Medical News Part 2/4

2. HICN608 Medical News Part 3/4

3. HICN608 Medical News Part 4/4

4. HICN609 Medical News Part 1/4

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