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HICNet Medical News Digest      Mon, 18 Dec 1995        Volume 08 : Issue 44

Today's Topics:

  CancerNet Update for Nov 1995
  Common Bacterium Found in Clogged Carotids
  Genes for Sudden Death

             +------------------------------------------------+
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                        Editor: David Dodell, D.M.D.
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Compilation Copyright 1995 by David Dodell,  D.M.D.  All  rights  Reserved.
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                             Associate Editors:

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       Tom Whalen, M.D., Robert Wood Johnson Medical School at Camden

        Douglas B. Hanson, Ph.D., Forsyth Dental Center, Boston, MA

             Lawrence Lee Miller, B.S. Biological Sciences, UCI

            Dr K C Lun, National University Hospital, Singapore

             W. Scott Erdley, MS, RN, SUNY@UB School of Nursing

      Jack E. Cross, B.S Health Care Admin, 882 Medical Trng Grp, USAF

  Albert Shar, Ph.D. CIO, Associate Prof, Univ of Penn School of Medicine

 Stephen Cristol, M.D. MPH, Dept of Ophthalmology, Emory Univ, Atlanta, GA

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----------------------------------------------------------------------

Date: Thu, 14 Dec 95 06:30:45 MST
From: david@stat.com (David Dodell)
To: hicnews
Subject: CancerNet Update for Nov 1995
Message-ID: <y2P4FD4w165w@stat.com>

            +----------------------------------------------+
            |       NATIONAL           INSTITUTE           |
            |               C A N C E R                    |
            |  INTERNATIONAL           INFORMATION         |
            |               C E N T E R                    |
            +----------------------------------------------+
                    |  CancerNet@icicc.nci.nih.gov  |
                    +-------------------------------+




CancerNet was updated on November 1, 1995.

PDQ Statements
--------------

The following PDQ summaries were added or updated in CancerNet with the
November update (see the file Monthly PDQ Changes -- cn-405001 for detailed
information on the changes in each statement).

New cancer screening and prevention statement:

Prevention of breast cancer (cn-304730)

Changed treatment statements for physicians:

Adrenocortical carcinoma (cn-101198)
Adult acute lymphocytic leukemia (cn-101024)
Adult Hodgkin's disease (cn-100003)
Adult non-Hodgkin's lymphoma (cn-100066)
Adult primary liver cancer (cn-101195)
Breast cancer (cn-100013)
Breast cancer and pregnancy (cn-105380)
Carcinoma of unknown primary (cn-103331)
Cervical cancer (cn-100103)
Chronic lymphocytic leukemia (cn-101003)
Colon Cancer (cn-100008)
Endometrial cancer (cn-101176)
Gastrointestinal carcinoid tumor (cn-101064)
Hairy cell leukemia (cn-101651)
Intraocular melanoma (cn-101279)
Laryngeal cancer (cn-101519)
Lip and oral cavity cancer (cn-102840)
Nonsmall cell lung cancer (cn-100039)
Oropharyngeal cancer (cn-101521)
Ovarian epithelial cancer (cn-100950)
Pancreatic cancer (cn-100046)
Plasma cell neoplasm (cn-100281)
Prostate cancer (cn-101229)
Rectal cancer (cn-100076)
Small cell lung cancer (cn-100040)
Testicular cancer (cn-101121)
Thyroid Cancer (cn-101252)
Vaginal Cancer (cn-101055)

Changed treatment statements for patients:

Breast cancer (cn-200013)
Cervical cancer (cn-200103)
Ovarian epithelial cancer (cn-200950)
Vaginal cancer (cn-201055)
Vulvar cancer (cn-201038)

Changed supportive care statement:

Cancer and suicide (cn-305546)

Changed cancer screening and prevention statements:


Cancer screening for patients (cn-305499)
Cancer screening overview (cn-303092)
Screening for breast cancer (cn-304723)
Screening for testicular cancer (cn-304729)

Changed drug information statements:
None.

Changed CancerNet News
----------------------

The following news bulletin was added:

NCI Director Stresses Importance of Mammography (cn-400122)

The following news bulletins were changed:

Breast Cancer BMT Protocols Encourage Accrual (cn-400019)
Breast Reconstruction Trials using Saline-Filled Implants (cn-400077)
CANCERLIT Distributors (cn-400006)
NCI High Priority Clinical Trials (cn-400007)
NCI Surgical Oncology Branch Trials (cn-400081)
NIH Sponsored Toll Free and Non-Toll Free Information Lines (cn-400034)
Overview of NCI Databases - PDQ and CANCERLIT (cn-400005)
PDQ Voluntary Protocol Submission Guidelines (cn-400010)
PDQ Voluntary Submission Checklist for Institutions (cn-400011)
PDQ Voluntary Submission Checklist for Pharmaceutical Companies (cn-400012)
Prevalence of 185delAG Alteration in BRCA1 (cn-400121)
Role Found for VHL Tumor Suppressor Gene (cn-400116)

The following news bulletin was deleted:

NCI Treatment Referral Center Clinical Trial for Breast Cancer (cn-400008)

Publications
------------
The following information about publications was added:
None.

The following publication information was changed:

Journal of the National Cancer Insitute Monographs (cn-400066)
NCI Materials for Community Outreach Programs and Health Professionals
  (cn-400017)
NCI Publications for Cancer Patients and the Public (cn-400002)

The following publication information was deleted:
None.

NCI Fact Sheets
---------------
The following fact sheets were added:

Cryosurgery in Cancer Treatment: Questions and Answers (cn-600734)
Information Associates Program: Questions and Answers (cn-600027)

The following fact sheets were changed:
Breast Cancer and the BRCA1 Gene: Questions and Answers (cn-600350)
Cancer Information Service: Questions and Answers (cn-600025)
PDQ Search Service: Questions and Answers (cn-600026)

The following fact sheets were deleted:
None.

CANCERLIT Citations and Abstracts:
----------------------------------
No new CANCERLIT citations and abstract topics were added.

The CANCERLIT citations and abstracts for November will be available
after November 8, 1995.

Instructions:

Access to CancerNet via the World Wide Web is now available
on NCI's International Cancer Information Center Web server.

URL   http://wwwicic.nci.nih.gov/CancerNet.html

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

          cancernet@icicc.nci.nih.gov

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 also 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 anal cancer in Spanish .
All of the physician and patient statements are 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, or are interested in redistributing
the information from CancerNet, request the news article, Redistribution
of Cancernet (cn-400030) , to find out about conditions that apply when
redistributing the information.  This article also has information on
other sites providing access to CancerNet information.

Please send comments or questions to:

Cheryl Burg
NCI International Cancer Information Center
Internet: cheryl@icicc.nci.nih.gov


From ICICB.NCI.NIH.GOV!cheryl  Thu Nov 30 14:49:13 1995 remote from stat
Received: by stat.com (1.65/waf)
        via UUCP; Thu, 30 Nov 95 15:20:07 MST
        for david
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Date: Thu, 30 Nov 1995 15:41:06 -0500
From: Cheryl Burg <cheryl@ICICB.NCI.NIH.GOV>
To: david@stat.com
Subject: CancerNet Update for December
Message-Id: <95Nov30.161352est.23118@icic.icic.nci.nih.gov>



            +----------------------------------------------+
            |       NATIONAL           INSTITUTE           |
            |               C A N C E R                    |
            |  INTERNATIONAL           INFORMATION         |
            |               C E N T E R                    |
            +----------------------------------------------+
                    |  CancerNet@icicc.nci.nih.gov  |
                    +-------------------------------+




Changes to CancerNet, December 1995



CancerNet was updated on November 30, 1995, for December.


An NCI Clinical Announcement on Adjuvant Therapy of Breast Cancer with
Tamoxifen is available in document cn-400122.


PDQ Statements
--------------

The following PDQ summaries were added or updated in CancerNet with the
December update (see the file Monthly PDQ Changes -- cn-405001 for detailed
information on the changes in each statement).


Changed treatment statements for physicians:
Adult acute lymphocytic leukemia (cn-101024)
Adult Hodgkin's disease (cn-100003)
Adult non-Hodgkin's lymphoma (cn-100066)
Adult soft tissue sarcoma (cn-100921)
Bladder cancer (cn-101206)
Breast cancer (cn-100013)
Cervical cancer (cn-100103)
Childhood non-Hodgkin's lymphoma (cn-100915)
Childhood rhabdomyosarcoma (cn-100759)
Chronic myelogenous leukemia (cn-101031)
Colon cancer (cn-100008)
Ewing's sarcoma (cn-100021)
Lip and oral cavity cancer (cn-102840)
Mesothelioma (cn-101071)
Neuroblastoma (cn-100530)
Nonsmall cell lung cancer (cn-100039)
Ovarian epithelial cancer (cn-100950)
Pancreatic cancer (exocrine) (cn-100046)
Parathyroid cancer (cn-100541)
Pheochromocytoma (cn-102494)
Plasma cell neoplasm (cn-100281)
Prostate cancer (cn-101229)
Rectal cancer (cn-100076)
Small cell lung cancer (cn-100040)
Testicular cancer (cn-101121)
Thyroid cancer (cn-101252)
Vaginal cancer (cn-101055)

Changed treatment statements for patients:
Adult acute myeloid leukemia (cn-201029)
Adult Hodgkin's disease (cn-200003)
Breast cancer (cn-200013)
Cutaneous T-cell lymphoma (cn-200098)
Mesothelioma (cn-201071)
Parathyroid cancer (cn-200541)
Plasma cell neoplasm (cn-200281)
Vaginal cancer (cn-201055)

Changed supportive care statements:
None.

Changed cancer screening and prevention statements:
Breast Cancer Screening for Patients (cn-305499)
Screening for prostate cancer (cn-304727)

Changed drug information statements:
None.

Changed CancerNet News
----------------------

The following news bulletins were added:
Collaborative Study Supports Genetic Link to Male Sexual Orientation
  (cn-400032)
Known Risk Factors for Breast Cancer in the U.S. (cn-400033)
AIDS Escalates in Younger Americans (cn-400018)
Audit Report for NSABP Protocol B06 (cn-400043)
Reanalysis of NSABP Protocol B06 (cn-400044)
Audit and Reanalysis of NSABP Data Support Lumpectomy and Radiation
for Early-Stage Breast Cancer - Press release (cn-400124)
** Clinical Announcement:  Adjuvant Therapy of Breast Cancer -- Tamoxifen
Update ** (cn-400122)
NCI Issues Clinical Announcement About Long-Term Use of Tamoxifen in Breast
Cancer Treatment (Press release) (cn-400123)


The following news bulletins were changed:
NCI CancerNet Service (cn-400004)
Reanalysis of NSABP Protocol B06 (cn-400027)
Reanalysis of NSABP Protocols B13 and B14 (cn-400028)
Redistribution of CancerNet and CancerNet Availability (cn-400030)

The following news bulletins were deleted:
Survival Following Breast Sparing Surgery vs. Mastectomy (cn-400020)
AHCPR Clinical Practice Guidelines on Management of Cancer Pain (cn-400015)
NCI Director Stresses Importance of Mammography (cn-400122), (this article is
  now listed as an NCI fact sheet; see item cn-600522)

Publications
------------
The following information about publications was added:
None.

The following publication information was changed:
None.

The following publication information was deleted:
None.

NCI Fact Sheets
---------------
The following fact sheet was added:
NCI Director Stresses Importance of Mammography (cn-600522)

The following fact sheets were changed:
Questions and Answers about the Cancer Information Service (cn-600025)
Questions and Answers about Tamoxifen (cn-600716)
Questions and Answers about Adjuvant Therapy for Breast Cancer (cn-600720)

The following fact sheets were deleted:
Breast Cancer Screening (cn-600513)
Questions and Answers About Prostate Cancer (cn-600054)
NCI Sponsored Clinical Trials of Antineoplastons (cn-600091)

CANCERLIT Citations and Abstracts:
----------------------------------
No new CANCERLIT citations and abstract topics were added.

The CANCERLIT citations and abstracts for December will be available
after December 7, 1995.



Instructions:

Access to CancerNet via the World Wide Web is now available
on NCI's International Cancer Information Center Web server.

URL   http://wwwicic.nci.nih.gov/CancerNet.html

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

          cancernet@icicc.nci.nih.gov

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 also 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 anal cancer in Spanish .
All of the physician and patient statements are 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, or are interested in redistributing
the information from CancerNet, request the news article, Redistribution
of Cancernet (cn-400030) , to find out about conditions that apply when
redistributing the information.  This article also has information on
other sites providing access to CancerNet information.

Please send comments or questions to:

Cheryl Burg
NCI International Cancer Information Center
Internet: cheryl@icicc.nci.nih.gov




---
Internet: david@stat.com                 FAX: +1 (602) 451-6135
WWW: http://www.stat.com/~david

------------------------------

Date: Fri, 15 Dec 1995 14:22:33 -0700
From: David Dodell <david@dental.stat.com>
To: hicnews
Subject: Common Bacterium Found in Clogged Carotids
Message-id: <19951215142238.05ef7edd.in@dental.stat.com>

American Heart Association Journal Report:

Common bacterium found in clogged carotids;
Is it a 'passenger' or possible factor in disease?

        DALLAS, Dec. 15 -- The bacterium that's a common cause of pneumonia,
bronchitis and sinus infections is frequently found in atherosclerotic
plaques removed from clogged arteries in the neck, a new study in today's
American Heart Asociation journal Circulation shows.    University of
Washington researchers studied 56 samples of tissue taken from patients
during endarterectomy, the surgical removal of fatty deposits from the
carotid, the major artery on each side of the neck that supplies blood to
the head.  Thirty-two of the 56 tissue samples tested positive for the
presence of Chlamydia pneumoniae, a bacterial species first isolated from
respiratory infections a decade ago, report J. Thomas Grayston, M.D., and
his colleagues at the University of Washington, Seattle, and the Dameron
Hospital in Stockton, Calif., where the surgery was performed.

Because chlamydial infections respond readily to antibiotics, the
researchers propose conducting a trial with an effective antibiotic to see
if the bacteria could be eradicated and if that would have a favorable
effect on carotid blockages.  Patients to be included in such a carefully
controlled trial would be those ineligible for surgery or who don't yet need
surgery.

Evidence of viral infections have been found in atherosclerotic plaques,
points out
Robert W. Wissler, Ph.D., M.D., in an editorial accompanying the Grayston
team's study.  The new results "raise questions very similar to those
commonly heard when reports are published about the presence of viral
antigens in atherosclerotic lesions," writes Wissler, a University of
Chicago professor.  "The biomedical scientific community then frequently
asks, are these (viruses and bacteria) merely passengers that lodge in
diseased tissue, or do they really have something to do with the cause or
progression of the disease?"

These questions require further investigation, he says, especially since
they concern atherosclerosis, "the most prevalent debilitating and lethal
disease in the United States."  In atherosclerosis, plaques gradually grow
in walls of arteries, narrowing them and reducing blood flow.  Plaques can
become unstable and rupture, resulting in stroke or heart attack.

In previous studies, Grayston and his University of Washington colleagues have
demonstrated that evidence of Chlamydia pneumoniae infections is frequently
found in plaques from coronary arteries but not in normal, healthy coronaries.

Contact:  J. Thomas Grayston, M.D., University of Washington, Seattle: (206)
543-9236;  reporters may call (214) 706-1173 for a copy of his journal report.
---
Internet : david@dental.stat.com
WWW   : http://www.stat.com/~david
Telephone: +1-602-860-1121
FAX      : +1-602-451-1165


------------------------------

Date: Fri, 15 Dec 1995 14:28:11 -0700
From: David Dodell <david@dental.stat.com>
To: hicnews
Subject: Genes for Sudden Death
Message-id: <19951215142818.05f4a992.in@dental.stat.com>

American Heart Association Journal report:

Genes for sudden death: experts say new findings
can have 'huge' implications for affected families

DALLAS, Dec. 15 -- Families plagued with fainting spells and sudden cardiac
deaths,
even in children, may have some help soon.

An international team of researchers studying the heart-rhythm abnormality
called long QT syndrome has shown for the first time that it's possible to
prescribe therapy to control the lethal cardiac disease based on the
different genetic defects involved.

A study published in Friday's (Dec. 15) American Heart Association journal
circulation "raises the possibility that the triggers for life-threatening
arrhythmias differ among long QT syndrome patients according to the specific
gene mutation involved," the authors say.

"This study provides the first demonstration of differential responses by
LQTS patients to interventions targeted according to their specific genetic
defect," the scientists write.

Victims of long QT syndrome often make headlines because their deaths are so
tragic and unexpected.  Deaths may occur in the swimming pool, on the
playing field or at school, and sometimes follow sudden fright or other
emotional stress.  "We have known that most LQTS patients should avoid
strenuous physical activity," says Peter J. Schwartz, M.D., lead author of
the new study and professor of cardiology at the University of Pavia in
Italy.  "But there are some who do very well with physical activity."

LQTS threatens whole families, physically and psychologically, because until
now it has been difficult to decide on the most effective treatment for each
individual patient.  "The implications (of the new findings) for therapy
could be huge if our data are confirmed," Schwartz says.

"One major implication of this study is that two very different forms (of
LQTS)  .  .  .  can be segregated by a simple clinical test," points out
Michael R. Rosen, M.D., of Columbia University's College of Physicians and
Surgeons in New York City, in an editorial that accompanies the Circulation
report.

The clinical test involves giving patients an old drug called mexiletine, a
sodium channel blocker, and measuring its effects on the "QT interval" in
the electrocardiogram, a graphic record of electrical impulses produced by
the heart.  The QT interval provides a sensitive index of heart disease
because it is electrical evidence of what's going on in the muscle cells of
the heart's main pumping chambers, the ventricles, explains Schwartz.

When the ventricles contract, a large "QRS" wave appears on the
electrocardiogram
(ECG).  As the ventricles "repolarize" to get ready for another heartbeat,
the T wave appears on the graph.  The entire cycle between the origin of the
Q and the end of the T waves -- the QT interval -- is normally about 400 to
440 milliseconds at a heart rate of 60 beats per minute.  But in typical
LQTS patients the interval exceeds 500 and sometimes even 600 milliseconds.
(See accompanying illustration showing normal and long QT intervals.)

Schwartz says long QT syndrome is the most common cause of sudden cardiac
death in the segment of the population under 20 years old.  Experts think
between one in 5,000 and one in 10,000 persons may carry a faulty gene for
long QT.

The scientist recommends that parents of a child who faints during physical
activity or emotional stress ask the child's physician to check the QT
interval.  That's because research has shown that physical and emotional
stress are primary triggers for sudden death among many LQTS patients.

"But other LQTS patients die in their sleep," Schwartz says, "and we
couldn't figure out why."  Drugs called beta blockers are "extremely
effective" in protecting many LQTS patients -- but they fail to protect
about 20 percent of the patients.

 "We have provided a first link between the genetic findings and clinical
responses that may influence therapy," Schwartz explains.  "I think we have
made a reakthrough because it may become possible to select a specific
therapy that matches a specific genetic defect," Schwartz explains.  "Now we
think we know why some (LQTS) patients are protected by beta blockers and
others are not."

What they found is that the patients with defects on chromosome 3 are less
likely to
benefit from beta-blocking therapy.  In fact, the slow heart rates induced
by beta blockers may even be dangerous for some chromosome 3 patients who
may often need a pacemaker to increase their heart rate, the researcher says.

In patients with defects on chromosome 7, engaging in strenuous physical
activity or any type of stress raises their heart rate, but their QT
interval remains very long.  Thus they have a high risk of life-threatening
arrhythmia and sudden cardiac death.  By contrast, Schwartz notes,
chromosome 3 patients "very effectively" shorten their QT interval when
heart rate increases.

"This may explain why many of them perform even vigorous physical exercise
without problems," he says.     "We are just scraping the surface of this new
world," says Schwartz, "because now we recognize long QT syndrome is several
genetic diseases with a common expression -- a long QT interval."

The new study was performed in 15 LQTS patients, six males and nine females
whose average age was 20 years.  Eight patients belong to three families
with LQTS genetically linked to chromosome 3 and seven patients belong to
two families with the disease linked to chromosome 7, the scientists report.

The specific genetic mutations were identified by a Salt Lake City, Utah,
research team headed by Mark T. Keating, M.D., of the University of Utah, a
co-author of the new study who is credited with several important genetic
discoveries in this field.

Because it included only 15 patients, the new study should not be regarded
as definitive, Schwartz believes.  "It's just a first step and it needs
confirmation.  I would not extrapolate from our small study to the entire
population of long QT patients," he says.

"The merit of our study is in having for the first time attempted to use the
genetic
information indicating that two specific ion channels, sodium and potassium,
were involved, to assess the possibility of different responses to
therapies," Schwartz says.  "This methodological approach opens new
perspectives for patients affected by the long QT syndrome."

Schwartz and his co-workers are expanding their study to include many more
families with LQTS.  Identifying the remaining genes -- "there should be at
least three more," he says -- is also necessary because there are some
families with LQTS not linked to either chromosomes 3 or 7 or to chromosomes
11 and 4, also involved in long QT.

Arthur J. Moss, M.D., of the University of Rochester (N.Y.), Schwartz and their
associates, in a study published Nov. 15 in Circulation, showed that genes
on chromosomes 3, 7 and 11 can cause different T waves on the ECG of
patients with long QT syndrome.         In 1979, Schwartz, Moss and Richard S.
Crampton, M.D., of the University of Virginia established an international
registry, which now includes more than 550 LQTS families. Schwartz and
Keating's co-authors of the new study include: Silvia G. Priori, M.D.;
Emanela H. Locati, M.D.; Carlo Napolitano, M.D.; and Francesco Cantu, M.D .,
of the University of Milan; Jeffrey A. Towbin, M.D., of Baylor College of
Medicine, Houston; Hicham Hammoude, M.D., of the Sainte-Ode Hospital Center
in Belgium; Arthur M. Brown, M.D., of Case Western Reserve University,
Cleveland; and Ling-Sing K. Chen, Ph.D., and Thomas J. Colatsky, Ph.D.,
of Wyeth-Ayerst Research, Princeton, N.J.
---
Internet : david@dental.stat.com
WWW   : http://www.stat.com/~david
Telephone: +1-602-860-1121
FAX      : +1-602-451-1165


------------------------------

End of HICNet Medical News Digest V08 Issue #44
***********************************************


---
Internet: david@stat.com                 FAX: +1 (602) 451-6135
WWW: http://www.stat.com/~david