From: david@stat.com (David Dodell)
Subject: HICN610 Medical News Part 3/4
Reply-To: david@stat.com (David Dodell)
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------------- cut here -----------------
University of Arizona
Tucson, Arizona



                               Suggested Reading

Tan SL, Royston P, Campbell S, Jacobs HS, Betts J, Mason B, Edwards RG (1992).  
Cumulative conception and Livebirth rates after in-vitro fertilization. Lancet 
339:1390-1394. 

For further information, call:
                        Physicians' Resource Line
                             1-800-328-5868
                               in Tucson:
                                694-5868


























HICNet Medical Newsletter                                              Page 28
Volume  6, Number 10                                           April 20, 1993



::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
                                   Articles
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

                    LOW LEVELS OF AIRBORNE PARTICLES LINKED
                           TO SERIOUS ASTHMA ATTACKS
                           American Lung Association 

     A new study published by the American Lung Association has shown that 
surprisingly low concentrations of airborne particles can send people with 
asthma rushing to emergency rooms for treatment.  
     The Seattle-based study showed that roughly one in eight emergency visits 
for asthma in that city was linked to exposure to particulate air pollution.  
The actual exposure levels recorded in the study were far below those deemed 
unsafe under federal air quality laws.  
     "People with asthma have inflamed airways, and airborne particles tend to 
exacerbate that inflammation," said Joel Schwartz, Ph.D., of the Environmental 
Protection Agency, who was the lead author of the study.  "When people are on 
the threshold of having, a serious asthma attack, particles can push them over 
the edge." 
     The Seattle Study correlated 13 months of asthma emergency room visits 
with daily levels of PM,,,. or particulate matter with an aerodynamic diameter 
of 10 microns or less.  These finer particles are considered hazardous because 
they are small enough penetrate into the lung.  Cities are considered out of 
compliance with clean air laws if the 24-hour average concentration of PM10 
exceeds 150 micrograms per cubic millimeter of air.  
     In Seattle however, a link between fine particles and asthma was found at 
levels as low as 30 micrograms.  The authors concluded that for every 30 
microgram increase in the four-day average of PM10, the odds of someone with 
asthma needing emergency treatment increased by 12 percent.  
     The findings were published in the April American Review of Respiratory 
Disease, an official journal of the American Thoracic Society, the Lung 
Association's medical section.  
     The study is the latest in a series of recent reports to suggest that 
particulate matter is a greatly under appreciated health threat.  A 1992 study 
by Dr. Schwartz and Douglas Dockery, Ph.D., of Harvard found that particles 
may be causing roughly 60,000 premature deaths each year in the United States.  
Other studies have linked particulate matter to increased respiratory symptoms 
and bronchitis in children.  
     "Government officials and the media are still very focused on ozone," 
says Dr. Schwartz.  "But more and more research is showing that particles are 
bad actors as well."      One problem in setting, standards for particulate 
air pollution is that PMIO is difficult to study.  Unlike other regulated 
pollutants such as ozone and carbon monoxide, particulate matter is a complex 
and varying mixture of substances, including carbon, hydrocarbons, dust, and 

HICNet Medical Newsletter                                              Page 29
Volume  6, Number 10                                           April 20, 1993

acid aerosols.  
     "Researchers can't Put people in exposure chambers to study the effects 
of particulate air pollution," says Dr. Schwartz.  "We have no way of 
duplicating the typical urban mix of particles.  " Consequently, most of what 
is known about particulates has been learned through population-based research 
like the Seattle study.  
     Given that the EPA's current priority is to review the ozone and sulfur 
dioxide standards, the agency is unlikely to reexamine the PM10 standard any 
time soon.  Until changes are made, there appears to be little people with 
asthma can do to protect themselves from airborne particles.
     "In some areas, you can get reports on air quality, but the reports only 
cover the pollutant that is closest to violating its standard, and that's 
rarely particulate matter," says Dr.  Schwartz.  "However, PM10 doesn't have 
to be near its violation range to be unhealthy."































HICNet Medical Newsletter                                              Page 30
Volume  6, Number 10                                           April 20, 1993

               NIH Consensus Development Conference on Melanoma

The National Institutes of Health Consensus Development Conference on 
Diagnosis and Treatment of Early Melanoma brought together experts in 
dermatology, pathology, epidemiology, public education, surveillance 
techniques, and potential new technologies as well as other health care 
professionals and the public to address (1) the clinical and histological 
characteristics of early melanoma; (2) the appropriate diagnosis, management, 
and followup of patients with early melanoma; (3) the role of dysplastic nevi 
and their significance; and (4) the role of education and screening in 
preventing melanoma morbidity and mortality.  Following 2 days of 
presentations by experts and discussion by the audience, a consensus panel 
weighed the scientific evidence and prepared their consensus statement. 
 
Among their findings, the panel recommended that (1) melanoma in situ is a 
distinct entity effectively treated surgically with 0.5 centimeter margins; 
(2) thin invasive melanoma, less than 1 millimeter thick, has the potential 
for long-term survival in more than 90 percent of patients after surgical 
excision with a 1 centimeter margin; (3) elective lymph node dissections and 
extensive staging evaluations are not recommended in early melanoma; (4) 
patients with early melanoma are at low risk for relapse but may be at high 
risk for development of subsequent melanomas and should be followed closely; 
(5) some family members of patients with melanoma are at increased risk for 
melanoma and should be enrolled in surveillance programs; and (6) education 
and screening programs have the potential to decrease morbidity and mortality 
from melanoma. 
 
A copy of the full text of the consensus panel's statement is available by 
calling the NIH Office of Medical Applications of Research at (301) 496-1143 
or by writing to:  Office of Medical Applications of Research, National 
Institutes of Health, Federal Building, Room 618, Bethesda, MD 20892.














HICNet Medical Newsletter                                              Page 31
Volume  6, Number 10                                           April 20, 1993

                         NCI-Designated Cancer Centers

The Cancer Centers Program is comprised of 55 NCI-designated Cancer Centers 
actively engaged in multidisciplinary research efforts to reduce cancer 
incidence, morbidity, and mortality.  Within the program, there are four types 
of cancer centers:  basic science cancer centers (14), which engage primarily 
in basic cancer research; clinical cancer centers (12), which focus on 
clinical research; "comprehensive" cancer centers (28), which emphasize a 
multidisciplinary approach to cancer research, patient care, and community 
outreach; and consortium cancer centers (1), which specialize in cancer 
prevention and control research. 
 
Although some cancer centers existed in the late 1960s and the 1970s, it was 
the National Cancer Act of 1971 that authorized the establishment of 15 new 
cancer centers, as well as continuing support for existing ones.  The passage 
of the act also dramatically transformed the centers' structure and broadened 
the scope of their mission to include all aspects of basic, clinical, and 
cancer control research.  Over the next two decades, the centers' program grew 
progressively. 
 
In 1990, there were 19 comprehensive cancer centers in the nation. Today, 
there are 28 of these institutions, all of which meet specific NCI criteria 
for comprehensive status. 
 
To attain recognition from the NCI as a comprehensive cancer center, an 
institution must pass rigorous peer review.  Under guidelines newly 
established in 1990, the eight criteria for "comprehensiveness" include the 
requirement that a center have a strong core of basic laboratory research in 
several scientific fields, such as biology and molecular genetics, a strong 
program of clinical research, and an ability to transfer research findings 
into clinical practice. 
 
Moreover, five of the criteria for comprehensive status go significantly 
beyond that required for attaining a Cancer Center Support Grant (also 
referred to as a P30 or core grant), the mechanism of choice for supporting 
the infrastructure of a cancer center's operations.  These criteria encompass 
strong participation in NCI-designated high-priority clinical trials, 
significant levels of cancer prevention and control research, and important 
outreach and educational activities--all of which are funded by a variety of 
sources. 
 
The other types of cancer centers also have special characteristics and 
capabilities for organizing new programs of research that can exploit 
important new findings or address timely research questions. 
 

HICNet Medical Newsletter                                              Page 32
Volume  6, Number 10                                           April 20, 1993

Of the 55 NCI-designated Cancer Centers, 14 are of the basic science type.  
These centers engage almost entirely in basic research, although some centers 
engage in collaborative research with outside clinical research investigators 
and in cooperative projects with industry to generate medical applications 
from new discoveries in the laboratory. 
 
Clinical cancer centers, in contrast, focus on both basic research and 
clinical research within the same institutional framework, and frequently 
incorporate nearby affiliated clinical research institutions into their 
overall research programs.  There are 12 such centers today. 
 
Finally, consortium cancer centers, of which there is one, are uniquely 
structured and concentrate on clinical research and cancer prevention and 
control research.  These centers interface with state and local public health 
departments for the purpose of achieving the transfer of effective prevention 
and control techniques from their research findings to those institutions 
responsible for implementing population-wide public health programs.  
Consortium centers also are heavily engaged in collaborations with 
institutions that conduct clinical trial research and coordinate community 
hospitals within a network of cooperating institutions in clinical trials. 
 
Together, the 55 NCI-Designated Cancer Centers continue to work toward 
creating new and innovative approaches to cancer research, and through 
interdisciplinary efforts, to effectively move this research from the 
laboratory into clinical trials and into clinical practice. 
 
Comprehensive Cancer Centers (Internet addresses are given where available) 
 
University of Alabama at Birmingham Comprehensive Cancer Center
Basic Health Sciences Building, Room 108
1918 University Boulevard
Birmingham, Alabama 35294
(205) 934-6612
 
University of Arizona Cancer Center
1501 North Campbell Avenue
Tucson, Arizona 85724
(602) 626-6372
Internet:  syd@azcc.arizona.edu
 
Jonsson Comprehensive Cancer Center
University of California at Los Angeles
200 Medical Plaza
Los Angeles, California 90027
(213) 206-0278

HICNet Medical Newsletter                                              Page 33
Volume  6, Number 10                                           April 20, 1993

Internet:  rick@jccc.medsch.ucla.edu
 
Kenneth T. Norris Jr. Comprehensive Cancer Center
University of Southern California
1441 Eastlake Avenue
Los Angeles, California  90033-0804
(213) 226-2370
 
Yale University Comprehensive Cancer Center
333 Cedar Street
New Haven, Connecticut 06510
(203) 785-6338
 
Lombardi Cancer Research Center
Georgetown University Medical Center
3800 Reservoir Road, N.W.
Washington, D.C. 20007
(202) 687-2192
 
Sylvester Comprehensive Cancer Center
University of Miami Medical School
1475 Northwest 12th Avenue
Miami, Florida 33136
(305) 548-4800
Internet:  hlam@mednet.med.miami.edu
 
Johns Hopkins Oncology Center
600 North Wolfe Street
Baltimore, Maryland 21205
(410) 955-8638
 
Dana-Farber Cancer Institute
44 Binney Street
Boston, Massachusetts 02115
(617) 732-3214
Internet:  Kristie_Stevenson@macmailgw.dfci.harvard.edu
 
Meyer L. Prentis Comprehensive Cancer Center of Metropolitan
Detroit
110 East Warren Avenue
Detroit, Michigan 48201
(313) 745-4329
Internet:  cummings%oncvx1.dnet@rocdec.roc.wayne.edu
 
University of Michigan Cancer Center

HICNet Medical Newsletter                                              Page 34
Volume  6, Number 10                                           April 20, 1993

101 Simpson Drive
Ann Arbor, Michigan 48109-0752
(313) 936-9583
BITNET:  kallie.bila.michels@um.cc.umich.edu
 
Mayo Comprehensive Cancer Center
200 First Street Southwest
Rochester, Minnesota 55905
(507) 284-3413
 
Norris Cotton Cancer Center
Dartmouth-Hitchcock Medical Center
One Medical Center Drive
Lebanon, New Hampshire 03756
(603) 646-5505
BITNET:  edward.bresnick@dartmouth.edu
 
Roswell Park Cancer Institute
Elm and Carlton Streets
Buffalo, New York 14263
(716) 845-4400
 
Columbia University Comprehensive Cancer Center
College of Physicians and Surgeons
630 West 168th Street
New York, New York 10032
(212) 305-6905
Internet:  janie@cuccfa.ccc.columbia.edu
 
Memorial Sloan-Kettering Cancer Center
1275 York Avenue
New York, New York 10021
(800) 525-2225
 
Kaplan Cancer Center
New York University Medical Center
462 First Avenue
New York, New York 10016-9103
(212) 263-6485
 
UNC Lineberger Comprehensive Cancer Center
University of North Carolina School of Medicine
Chapel Hill, North Carolina 27599
(919) 966-4431
 

HICNet Medical Newsletter                                              Page 35
Volume  6, Number 10                                           April 20, 1993

Duke Comprehensive Cancer Center
P.O. Box 3814
Durham, North Carolina 27710
(919) 286-5515
 
Cancer Center of Wake Forest University at the Bowman Gray School
of Medicine
300 South Hawthorne Road
Winston-Salem, North Carolina 27103
(919) 748-4354
Internet:  ccwfumail@phs.bgsm.wfu.edu
 
Ohio State University Comprehensive Cancer Center
300 West 10th Avenue
Columbus, Ohio 43210
(614) 293-5485
Internet:  dyoung@magnus.acs.ohio-state.edu
 
Fox Chase Cancer Center
7701 Burholme Avenue
Philadelphia, Pennsylvania 19111
(215) 728-2570
Internet:  s_davis@fccc.edu
 
University of Pennsylvania Cancer Center
3400 Spruce Street
Philadelphia, Pennsylvania 19104
(215) 662-6364
 
Pittsburgh Cancer Institute
200 Meyran Avenue
Pittsburgh, Pennsylvania 15213-2592
(800) 537-4063
 
The University of Texas M.D. Anderson Cancer Center
1515 Holcombe Boulevard
Houston, Texas 77030
(713) 792-3245
 
Vermont Cancer Center
University of Vermont
1 South Prospect Street
Burlington, Vermont 05401
(802) 656-4580
 

HICNet Medical Newsletter                                              Page 36
Volume  6, Number 10                                           April 20, 1993

Fred Hutchinson Cancer Research Center
1124 Columbia Street
Seattle, Washington 98104
(206) 667-4675
Internet:  sedmonds@cclink.fhcrc.org
 
University of Wisconsin Comprehensive Cancer Center
600 Highland Avenue
Madison, Wisconsin 53792
(608) 263-8600
BITNET:  carbone@uwccc.biostat.wisc.edu
 
 
 
Clinical Cancer Centers
 
 
University of California at San Diego Cancer Center
225 Dickinson Street
San Diego, California 92103
(619) 543-6178
Internet:  dedavis@ucsd.edu
 
City of Hope National Medical Center
Beckman Research Institute
1500 East Duarte Road
Duarte, California 91010
(818) 359-8111 ext. 2292
 
University of Colorado Cancer Center
4200 East 9th Avenue, Box B188
Denver, Colorado 80262
(303) 270-7235
 
University of Chicago Cancer Research Center
5841 South Maryland Avenue, Box 444
Chicago, Illinois 60637
(312) 702-6180
Internet:  judith@delphi.bsd.uchicago.edu
 
Albert Einstein College of Medicine
1300 Morris Park Avenue
Bronx, New York 10461
(212) 920-4826
 

HICNet Medical Newsletter                                              Page 37
Volume  6, Number 10                                           April 20, 1993

University of Rochester Cancer Center
601 Elmwood Avenue, Box 704
Rochester, New York 14642
(716) 275-4911
Internet:  rickb@wotan.medicine.rochester.edu
 
Ireland Cancer Center Case Western Reserve University
University Hospitals of Cleveland
2074 Abington Road
Cleveland, Ohio 44106
(216) 844-5432
 
Roger Williams Cancer Center
Brown University
825 Chalkstone Avenue
Providence, Rhode Island 02908
(401) 456-2071
 
St. Jude Children's Research Hospital
332 North Lauderdale Street
Memphis, Tennessee 38101-0318
(901) 522-0306
Internet:  meyer@mbcf.stjude.org
 
Institute for Cancer Research and Care
4450 Medical Drive
San Antonio, Texas 78229
(512) 616-5580
 
Utah Regional Cancer Center
University of Utah Health Sciences Center
50 North Medical Drive, Room 2C110
Salt Lake City, Utah 84132
(801) 581-4048
BITNET:  hogan@cc.utah.edu
 
Massey Cancer Center
Medical College of Virginia
Virginia Commonwealth University
1200 East Broad Street
Richmond, Virginia 23298
(804) 786-9641
 
 
Consortia

HICNet Medical Newsletter                                              Page 38
Volume  6, Number 10                                           April 20, 1993

 
Drew-Meharry-Morehouse Consortium Cancer Center
1005 D.B. Todd Boulevard
Nashville, Tennessee 37208
(615) 327-6927








































HICNet Medical Newsletter                                              Page 39
Volume  6, Number 10                                           April 20, 1993



::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
                             General Announcments
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

                 THE UCI MEDICAL EDUCATION SOFTWARE REPOSITORY 

This is to announce the establishment of an FTP site at the University of 
California, for the collection of shareware, public-domain software and other 
information relating to Medical Education.  

Specifically, we are interested in establishing this site as a clearinghouse 
for personally developed software that has been developed for local medical 
education programs.  We welcome all contributions that may be shared with 
other users.  

To connect to the UCI Medical Education Software Repository, ftp to: 

                     FTP.UCI.EDU

The Repository currently offers both MSDOS and Macintosh software, and we hope 
to support other operating systems (UNIX, MUMPS, AMIGA?).  

Uploads are welcome.  We actively solicit information and software which you 
have personaly developed or have found useful in your local medical education 
efforts, either as an instructor or student.  

Once you have connected to the site via FTP, cd (change directory) to either 
the med-ed/mac/incoming or the med-ed/msdos/incoming directories, change the 
mode to binary and "send" or "put" your files.  Note that you won't be able to 
see the files with the "ls" or "dir" commands.  Please compress your files as 
appropriate to the operating system (ZIP for MSDOS; Compactor or something 
similar for Macintosh) to save disk space.  

After uploading, please send email to Steve Clancy (slclancy@uci.edu) (for 
MSDOS) or Albert Saisho (saisho@uci.edu) (for MAC) describing the file(s) you 
have uploaded and any other information we might need to describe it.

Note that we can only accept software or information that has been designated 
as shareware, public-domain or that may otherwise be distributed freely.  
Please do not upload commercial software!  Doing so may jeopardize the 
existence of this FTP site.  

If you wish to upload software for other operating systems, please contact 
either Steve Clancy, M.L.S. or Albert Saisho, M.D. at the addresses above.

HICNet Medical Newsletter                                              Page 40
Volume  6, Number 10                                           April 20, 1993



::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
                              AIDS News Summaries
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

                              AIDS Daily Summary

The Centers for Disease Control and Prevention (CDC) National AIDS  
Clearinghouse makes available the following information as a public  service 
only. Providing this information does not constitute endorsement  by the CDC, 
the CDC Clearinghouse, or any other organization. Reproduction  of this text 
is encouraged; however, copies may not be sold.  Copyright 1993, Information, 
Inc., Bethesda, MD 

      ==================================================================    
                                April 12, 1993 
      ==================================================================    

"NIH Set to Test Multiple AIDS Vaccines" Reuters (04/08/93)  (Frank, 
Jacqueline) 

     Washington--The Clinton administration will permit the National  
Institutes of Health to test multiple AIDS vaccines instead of  only allowing 
the Army to test a single vaccine, administration  sources said Thursday.  The 
decision ends the controversy between Army AIDS researchers who had hoped to 
test a vaccine made by  MicroGeneSys Inc. and the National Institutes of 
Health, which  contended that multiple vaccines should be tested.  Health and  
Human Services Secretary Donna Shalala said a final announcement  on the 
therapeutic vaccine trials was expected to be made last  Friday.  Companies 
including Genentech Inc., Chiron Corp., and  Immuno AG have already told NIH 
that they are prepared to  participate in the vaccine tests.  The testing is 
intended to  demonstrate whether AIDS vaccines are effective in thwarting the  
replication of HIV in patients already infected.  Shalala refuted last week's 
reports that the Clinton administration had decided  the Army's test of the 
MicroGeneSys VaxSyn should proceed without tests of others at the same time.  
"The report was inaccurate,  and I expect there to be some announcement in the 
next 24 hours  about that particular AIDS research project," said Shalala.   
Administration sources subsequently confirmed that NIH director  Dr. Bernadine 
Healy and Food and Drug Administration Commissioner David Kessler had 
convinced the White House that multiple  vaccines should be tested 
simultaneously.  But MicroGeneSys  president Frank Volvovitz said a test of 
multiple vaccines could  triple the cost of the trial and delay it by two 
years.

==================================================================    


HICNet Medical Newsletter                                              Page 41
Volume  6, Number 10                                           April 20, 1993

"The Limits of AZT's Impact on HIV" U.S. News & World Report (04/12/93) Vol. 
114, No. 14, P. 18 

     AZT has become the most widely used drug to fight AIDS since it  was 
approved by the Food and Drug Administration in 1987.   Burroughs Wellcome, 
the manufacturer of AZT, made $338 million  last year alone from sales of the 
drug.  However, a team of  European researchers recently reported that 
although HIV-positive patients taking AZT demonstrated a slightly lower risk 
of  developing AIDS within the first year of treatment, that benefit  
disappeared two years later.  The Lancet published preliminary  findings of 
the three-year study, which could give more reason  for critics to argue the 
drug's cost, side effects, and general  efficacy.  Even though U.S. 
researchers concede the study was  more comprehensive than American trials, 
many argue the European  researchers' suggestion that HIV-positive patients 
experience  little improvement in their illness before the development of  
AIDS symptoms.  In addition, researchers have long been familiar  with the 
--------- end of part 3 ------------

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