From <@uga.cc.uga.edu:owner-mednews@ASUACAD.BITNET> Wed Mar 22 06:32:25 1995 with BSMTP id 6050; Wed, 22 Mar 95 06:04:50 EST UGA.CC.UGA.EDU (LMail V1.2a/1.8a) with BSMTP id 1646; Wed, 22 Mar 1995 01:59:56 -0500 HICNet Medical News Digest Tue, 21 Mar 1995 Volume 08 : Issue 08 Today's Topics: [MMWR] Occupational Lead Surveillance -- Taiwan, July-December 1993 [MMWR] Update: Dracunculiasis Eradication -- Ghana and Nigeria, 1994 Moderate physical activity confers CVD benefits on men and women FDA Approval of AIDS Virus Test on Oral Fluid Samples FDA Saline-Filled Breast Implant Update National Cancer Institute's CancerNet Update March 1995 FDA Approves New Diabetes Drug Armed Forces Institute of Pathology CE Course Schedule Latin-American Congress on Organ/Tissue Transplantation +------------------------------------------------+ ! ! ! Health Info-Com Network ! ! Medical 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 Internet: mednews@stat.com Bitnet: ATW1H@ASUACAD Mosaic WWW *Asia/Pacific: http://biomed.nus.sg/MEDNEWS/welcome.html *Americas: http://cancer.med.upenn.edu:3000/ *Europe: http://www.dmu.ac.uk/0/departments/pharmacy/archive/www/MEDNEWS/welcome. html Compilation Copyright 1994 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. Associate Editors: E. Loren Buhle, Jr. Ph.D. Dept. of Radiation Oncology, Univ of Pennsylvania 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 Subscription Requests = mednews@stat.com anonymous ftp = vm1.nodak.edu; directory HICNEWS FAX Delivery = Contact Editor for information ---------------------------------------------------------------------- To: hicnews 1993 Occupational Lead Surveillance -- Taiwan, July-December 1993 Lead poisoning has been recognized as an occupational disease for centuries and has been linked with both severe and subtle health damage (1- 3). In July 1993, the government of Taiwan initiated a compulsory system* for surveillance of elevated blood lead levels (BLLs) among workers in that country (4). All lead-exposed workers in lead-using factories** are identified and included in the lead surveillance system. This report summarizes findings from this program for July-December 1993. A total of 18 categories of production processes (e.g., battery recycling or manufacturing, lead smelting, plastic stabilizer additive processing, and lead-based paint production) or occupation/job categories constitute the high-lead exposure group. Lead-exposed workers in these settings are required to have their BLLs monitored annually by one of 22 specified, certified hospital laboratories. Based on job titles and an occupation register published by the Labor Council of Taiwan, a minimum of 4500 workers in Taiwan were directly exposed to lead-contaminated work environments (at exposure levels ranging from 0.002 mg per cubic meter to 3.051 mg per cubic meter***), and 10-fold more workers were indirectly exposed (e.g., secretaries who work at the same factories but in jobs that do not entail direct lead exposure). Employers are required by law to report at least annually to local health bureaus and labor inspection offices the BLLs and results of health examinations (specifically designed for lead-exposed workers and performed at one of the specified hospitals). Labor Council factory inspectors are responsible for enforcing this law. To ensure employer and worker participation, employers are subject to fines equivalent to $1200-$2400 U.S. for delayed reporting (i.e., beyond 3 months) or failure to report. To encourage continued reporting by local health officials, the Ministry of Health publishes a quarterly report that contains county-specific BLL results and complete rates of follow-up. During July-December 1993, BLLs were tested in 2905 lead-exposed workers. The mean BLL in males (n=1941) was 15.0 ug/dL (standard deviation [sd]= plus or minus 15.1 ug/dL) and in females (n=964), 12.5 ug/dL (sd= plus or minus 12.2 ug/dL). Mean BLLs were significantly (p less than 0.05, Z test) higher than BLLs for the total population aged greater than or equal to 15 years in Taiwan (9.6 ug/dL for males; 7.4 ug/dL for females) (5). In addition, BLLs in 287 (9.9%) workers exceeded the applicable regulatory level (40 ug/dL for males; 30 ug/dL for females). Most monitored workers were employed in soldering/cable stripping (452) and in battery recycling/manufacturing (364) (Table 1). Mean BLLs were highest among battery workers (34.6 ug/dL) and plastic manufacturers (27.5 ug/dL), and BLLs were elevated for approximately 25% of workers in plastic-manufacturing factories and 50% in battery-producing factories. Mean BLLs and proportions of workers with elevated BLLs were lowest in the following exposure categories: electric plating and painting, railroad workers, traffic police, and soldering/cable stripping. The surveillance system in Taiwan also provides for an intervention team (including epidemiologists, industrial hygienists, and physicians) to evaluate the workplaces of workers with elevated BLLs. This response includes monitoring ambient lead exposure levels, evaluating the company's health and safety procedures, providing technical assistance to reduce lead exposure, and improving high-risk work practices and worker behaviors (including prevention of inadvertent transport of lead from the workplace to the worker's home). Through February 1995, the intervention teams had investigated the workplaces of 201 (70%) of the 287 workers with elevated BLLs. Priorities for follow-up are based on the BLLs of the workers involved. Reported by: TN Wu, PhD, CY Shen, PhD, GY Yang, MD, SH Liou, MD, KN Ko, MPH, SL Chao, MPH, CC Hsu, MPH, JS Lai, PhD, PY Chang, MD, Disease Surveillance and Quarantine Svc, Ministry of Health, Taiwan, Republic of China. Div of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC. Editorial Note: The establishment of the compulsory occupational lead surveillance system described in this report is an important step in industrial hygiene and occupational disease prevention in Taiwan, and similar systems may be used in other countries and settings. In particular, the surveillance system in Taiwan indicates the usefulness of exposure information to target monitoring activities and using that information to target intervention efforts. This system should facilitate improvements in the industrial hygiene of the work environment, assist in evaluating the effects of intervention, and reduce both primary and secondary (e.g., take-home) exposures to lead. Since the mid-1980s, occupational lead surveillance programs have been developed in both Taiwan and the United States. In both countries, these systems are laboratory-based and legally mandated; however, each system also has distinguishing features (Table 2). In particular, in Taiwan, companies subject to surveillance are predetermined based on predicted potential for exposure and are required to report to the government. In comparison, in the United States, companies are required to self- identify the existence of lead exposures and then to comply with the requirements of the Occupational Safety and Health Administration (OSHA) General Industry (6) and/or Construction Standards (7), which include provisions for environmental and medical monitoring. In Taiwan, 70% of the workers in workplaces where elevated BLLs were detected received follow-up interventions. In the United States, follow-up interventions vary according to state resources and BLLs. Seven of the 14 CDC-funded state-based surveillance programs have formal or informal agreements with OSHA for referral and follow-up of cases. However, the apparent exclusion of the nonman-ufacturing sector (e.g., construction) is an important potential limitation in Taiwan and may preclude identification of new hazards or sources of lead poisoning, as well as reflect an underestimate of the magnitude of the problem outside of the manufacturing sector. Finally, the reported compliance with monitoring was relatively high in Taiwan (2950 [66%] workers monitored of an estimated 4500 exposed); in comparison, based on an assessment in California in 1986, the requirements of the OSHA standard for air and blood lead monitoring have been adhered to by only a small proportion of facilities**** (8). Despite this apparently low compliance with biologic monitoring provisions of the standard, state- based surveillance programs have succeeded in identifying industries and occupations where lead hazards remain (9). Although the systems in Taiwan and the United States differ, the beneficial public health effects of surveillance in each country are substantial--large numbers of workers with exposure and/or elevated BLLs have been identified (10), monitored, and trained to prevent future lead poisoning. The surveillance system in Taiwan reflects efforts to establish improved occupational health surveillance in conjunction with rapid growth in industrial capacity. The legal mandate in Taiwan enables the incorporation of surveillance requirements as integral parts of standard business operations, rather than only as reactive responses to a public health problem, and emphasizes that occupational health concerns are an important part of industrialization. References 1. La Dou J. Occupational medicine. Englewood Cliffs, New Jersey: Prentice Hall, 1990:297. 2. Rempel D. The lead-exposed worker. JAMA 1989;262:532. 3. Hamilton A. Exploring the dangerous trades. Boston: Little Brown, 1943. 4. Wu TN, Shen CY, Yang GY, et al. Establishment of an occupational diseases surveillance system to monitor blood lead levels in Taiwan. Prev Med 1995 (in press). 5. Liou SH, Wu TN, Chiang HC. A nation-wide survey of blood lead level in Taiwan. Taipei, Taiwan: Taiwan Department of Health, 1992. 6. Office of the Federal Register. Code of federal regulations: occupational safety and health standards. Subpart Z: Toxic and hazardous substances--lead. Washington, DC: Office of the Federal Register, National Archives and Records Administration, 1985. (29 CFR ***1910.1025). 7. Occupational Safety and Health Administration, US Department of Labor. Lead exposure in construction: interim final rule. Federal Register 1993;58:26590-649. (29 CFR ***1926). 8. Rudolph L, Sharp D, Samuels S, Perkins C, Rosenberg J. Environmental and biological monitoring for lead exposure in California workplaces. Am J Public Health 1990;80:921-5. 9. Rabin R, Brooks D, Davis L. Elevated blood lead levels among construction workers in the Massachusetts Occupational Lead Registry. Am J Public Health 1994;84:1483-5. 10. CDC. Adult blood lead epidemiology and surveillance--United States, fourth quarter, 1993. MMWR 1994;43:246-7. * Based on the Labor Safety and Health Law (enacted in 1974 by the Labor Council of Taiwan). ** Defined according to the worker's occupation/job category and the company's production process, which is registered on the license of every factory in Taiwan. *** Data from a Labor Council survey of working environments of lead-related workers; in the United States, the maximum allowable exposure to lead in air is 50 ug per cubic meter (0.050 mg per cubic meter). **** In 1986, an estimated 2.6% of facilities using lead had ever done any environmental monitoring, and 1.4% of facilities (employing 2.6% of potentially lead-exposed workers) had routine biologic monitoring programs. ------------------------------------------------------------------------- - NOTE: In this report, ug/dL represents micrograms per deciliter. --LBW ------------------------------------------------------------------------- - ------------------------------ To: hicnews 1994 Update: Dracunculiasis Eradication -- Ghana and Nigeria, 1994 The plan for the global eradication of dracunculiasis (i.e., Guinea worm disease) was developed in October 1980 (1). Since 1987-1988, Global 2000, Inc., the United Nations Children's Fund (UNICEF), and the U.S. Agency for International Development have assisted the Guinea Worm Eradication Programs in Ghana and Nigeria, countries in west Africa. In 1989, Ghana and Nigeria ranked first and second in the number of reported cases of dracunculiasis with 179,556 and 640,008 cases, respectively (2). This report summarizes data for the two countries during 1994 and describes efforts toward eradication of dracunculiasis. Ghana In 1994, Ghana (1991 population: 16 million) reported to the World Health Organization (WHO) 8432 cases of dracunculiasis in 1347 villages with known endemic disease, representing substantial declines in the numbers of cases (53%) and villages with known endemic disease (42%) from 1993. Since initiation of active surveillance in 1989, the numbers of cases and villages with known endemic disease have been reduced by 95% (Figure 1) and 79%, respectively. In 1994, an average of 74% of villages with known endemic disease submitted surveillance reports on time each month; the rate of timely reporting increased from 30%-45% during January-March (when ethnic disturbances occurred in parts of the northern region, which has high rates of dracunculiasis) to 98% during October- December. During 1994, the northern region reported 69% of all cases in the country. Five of the 10 regions reported no indigenous cases for greater than or equal to 3 consecutive months. Overall, 65% of the reported cases were fully contained (i.e., the case was detected within 24 hours of worm emergence, the worm extracted surgically and/or the lesions bandaged, and the affected person prevented from entering sources of drinking water to prevent transmission); the percentage of contained cases increased steadily during the year, from 30% in January to 93% in December. Nigeria In 1994, Nigeria (1992 population: 90 million) reported to WHO 35,749 cases of dracunculiasis in 2571 villages with known endemic disease, representing substantial declines in the numbers of cases (53%) and villages with known endemic disease (29%) from 1993 (3). From July 1988 through December 1994, the annual numbers of cases and villages with known endemic disease declined 95% (Figure 2) and 56%, respectively. In 1994, an average of 75% of villages with known endemic disease submitted surveillance reports on time. Five of the 30 states and the Federal Capital Territory reported 66% of the total number of cases; seven states reported no cases. By December 31, approximately 72% of the remaining villages with known endemic disease had begun case-containment measures designed to prevent further transmission. Reported by: S Bugri, MD, Ghana Guinea Worm Eradication Program, Ministry of Health, Ghana. AA Adeyemi, MD, Nigeria Guinea Worm Eradication Program, Federal Ministry of Health and Social Svcs, Nigeria. Global 2000, Inc, The Carter Center, Atlanta. World Health Organization Collaborating Center for Research, Training, and Eradication of Dracunculiasis, Div of Parasitic Diseases, National Center for Infectious Diseases, CDC. Editorial Note: This report documents continued progress in Ghana's and Nigeria's efforts to eradicate dracunculiasis. However, the civil disturbances in Nigeria and ethnic fighting in Ghana during 1994 may slow this progress. For example, during January 1995 in Ghana, 1971 cases of dracunculiasis were reported, a 136% increase over the 834 cases reported in January 1994. However, concerted efforts to rapidly reinstitute eradication efforts in Ghana as the ethnic strife subsided resulted in rapid detection and full containment of 97% of the cases. Improvements in surveillance and case containment in Ghana and Nigeria indicate that the two countries may reach the goal of eradicating dracunculiasis by the end of 1995. References 1. Hopkins DR, Foege WH. Guinea worm disease [Letter]. Science 1981;212:495. 2. World Health Organization. Dracunculiasis: global surveillance summary, 1993. Wkly Epidemiol Rec 1994;17:121-8. 3. CDC. Update: dracunculiasis eradication--Ghana and Nigeria, 1993. MMWR 1994;43:293-5. ------------------------------ To: hicnews women 0100000@orichalc.acsu.buffalo.edu> National Center American Heart Moderate physical activity confers CVD benefits on men and women SAN ANTONIO, March 10 -- Even moderate physical activity offers women and men protection against heart attack and stroke, according to a trio of studies reported today at the American Heart Association's 35th Annual Conference on Cardiovascular Disease Epidemiology and Prevention. Two of the three studies show activity's link to reduced cardiovascular risk in women. To date most studies on the benefits of physical activity have focused on men. Boston researchers reported a reduced risk of heart attack and stroke in physically active women. The findings emerged from the Nurses' Health Study, a collection of data on 73,029 female nurses, who were 40 to 65 úÿ úÿ(Continued from last message) years old when they were originally surveyed in 1986 regarding physical activity and other lifestyle practices. The nurses were divided into five equal groups (quintiles) according to estimated level of physical activity. The researchers expressed physical activity in terms of energy expenditure, which takes into account duration and intensity. In the four years after the survey, 168 heart attacks and 139 strokes occurred among the nurses. Nurses in the highest activity group (the fifth quintile) had a 44 percent lower risk of heart attack and a 42 percent lower risk of stroke compared to nurses in the lowest group (first quintile). The impact of physical activity was not substantially affected by cardiovascular risk factors, such as high blood pressure, smoking and diabetes. For heart attack, the risk decreased progressively with increasing physical activity, says JoAnn E. Manson, M.D., Dr.P.H., co-director of women's health at Brigham and Women's Hospital and Harvard Medical School. For example, women in the second quintile had an 11 percent lower risk compared to the least active women. The risk of ischemic (markedly decreased blood flow) stroke was especially reduced and was 56 percent lower among women in the highest quintile of physical activity compared to the lowest. The risk of a hemorrhagic (bleeding) stroke was only modestly and insignificantly lower among exercisers. "The greatest reduction in risk of heart attack and stroke was in those women who exercised most frequently," says Manson. "It's difficult to tease out individual activities, because we have combined intensity and duration, but it appears that even more moderate forms of exercise, such as walking, were associated with lower risk." "The benefits compare favorably with other risk-reducing behaviors," she adds, "and they are consistent with findings in men. The bottom line of this report is that physical activity seems to confer similar cardiovascular benefits in women and men." Seattle investigators estimated that physical activity may reduce the risk of heart attack by 50-60 percent in postmenopausal women. Even modest levels of activity appeared to offer substantial benefits. The study involved 268 women (cases) who had had a myocardial infarction, or heart attack, and 925 women who had not had heart attacks (controls). The average age of all the women was about 67. All the women completed a survey that included a number of questions related to leisure-time physical activity. Using the type of activity, frequency and duration, the investigators estimated the energy expenditure of each woman. The women were then divided into four equal groups (quartiles) based on physical activity levels. The risk of heart attack was estimated for each activity group by comparing the number of cases and controls in the group. Women in the three quartiles with the highest levels of physical activity had a 48 to 60 percent lower risk of heart attack, compared to women in the lowest quartile. The reductions persisted after controlling for the effects of such other heart disease risk factors and contributing factors as age, cigarette smoking, high blood pressure, diabetes, family history of heart disease, blood cholesterol, aspirin use and estrogen therapy. Overall, the scientists say, the risk of heart attack among post-menopausal women decreases by 50 percent with modest leisure-time energy expenditures, equivalent to 30 to 45 minutes of walking for exercise three times a week. "Numerous studies have looked at the influence of physical activity on coronary risk, but most did not include women," says Rozenn N. Lemaitre, Ph.D., M.P.H., a research scientist in the Cardiovascular Health Research Unit at the University of Washington, Seattle. "Many studies also have not been adjusted for other risk factors. So, while our findings may not be entirely new,they definitely contribute new knowledge about physical activity and women's health." Rhode Island investigators found that even "light activity on less than a daily basis" not only lowers the risk of coronary death and but also lowers mortality from all causes. These findings emerged from the long- term follow-up of the Israeli Ischemic Heart Disease Study, involving 8,463 Israeli men who were followed for 21 years. The men were all government employees who were at least 40 years old and had no evidence of coronary disease when they were surveyed in 1963 and 1965. Men who reported any leisure-time physical activity in the baseline surveys had a 21 percent lower risk of coronary mortality and a 16 percent lower all-cause mortality. Light activity on a daily basis was associated with 27 percent and 19 percent reductions in coronary and all-cause mortality, respectively. Men who reported moderate or heavy physical leisure-time activity had a 29 percent lower risk of coronary mortality while all-cause mortality was reduced by 16 percent. The mortality reductions emerged after the investigators took into account other factors that can contribute to the development of heart disease such as age, systolic blood pressure (the first reading in a blood pressure measurement), cigarette smoking, total and HDL cholesterol levels, body mass index (a measure of obesity) and psychosocial factors. "The take-home message from this study was the finding that most of the benefit occurred with light activity, not even on a daily basis," says Charles B. Eaton, M.D., assistant professor of family medicine at Brown University and director of the heart disease prevention center at Memorial Hospital of Rhode Island in Pawtucket. "The second important message is that the benefits of physical activity appear to be independent of weight or HDL-cholesterol [the "good" cholesterol]." The association between physical activity and all-cause mortality is a third noteworthy aspect of the study. "Most studies have focused on the effect of physical activity on coronary mortality," he says. "To my knowledge, this is one of the few prospective studies to suggest an effect on mortality from any cause." Manson's co-investigators were: Meir J. Stampfer, M.D., Dr.P.H.; Walter C. Willett, M.D., Dr.P.H.; Graham A. Colditz, M.D., Dr.P.H.; Frank E. Speizer, M.D.; and Charles C. Hennekens, M.D., Dr.P.H. Lemaitre's colleagues were: Susan R. Heckbert, M.D., Ph.D.; Bruce M. Psaty, M.D., Ph.D.; and David S. Siscovick, M.D., M.P.H. Eaton's associates were: Jack H. Medalie, M.D.; Susan A. Flocke, M.S.; Steve Zyzanski, Ph.D.; Shlomit Yari; and Uri Goldbourt, Ph.D. ------------------------------ To: hicnews Statement on FDA Approval of AIDS Virus Test System Based on Oral Fluid Samples December 23, 1994 The Food and Drug Administration today announced that it has approved the first U.S. HIV test system using oral fluid samples. Until now, all approved HIV tests have used blood samples. In approving this new HIV test system, FDA approved both a product for collecting specimens of oral fluid and a specific test used to analyze the specimens for the presence of antibodies to HIV, the virus that causes AIDS. The test system is intended for use in subjects 13 years of age or older. Use of the specimen collection product is subject to several restrictions. This new HIV test system is not as accurate as the approved HIV- antibody tests used on blood. Studies show that for every 100 people infected with HIV, the oral-fluid-based test will miss one or two. For every 100 people who are not infected, test results will be incorrectly positive for approximately two people. The test system includes a specially treated cotton pad on a stick and a preservative solution in a plastic container. A trained collector instructs the subject to place the pad between the lower gum and cheek to obtain a sample of oral fluid. The pad is then stored in the preservative until the sample is processed and analyzed by a qualified laboratory using an ELISA test specifically licensed for testing oral fluid samples. FDA approved this HIV test system with the following restrictions: o The test system is available for purchase and distribution only through physicians. o The test system may be administered only by individuals properly trained in its use. o The test system must not be provided to subjects for home use. o Testing of the oral fluid samples for HIV antibodies may be carried out only with the Oral Fluid Vironostika HIV-1 Microelisa System. o The test system may be used for diagnosis only and must not be used to screen blood donors. o Before the oral fluid specimen is collected, subjects must be given a "Subject Information" sheet. The information sheet provides information about the reduced accuracy of testing oral fluid compared with testing blood and about the alternative of testing blood. Because there is currently no confirmatory test for use with oral fluid samples, the sheet informs subjects that if their oral fluid samples are found to be positive for HIV antibodies they should have blood samples drawn and tested with a licensed blood-based test to verify their HIV status. It also gives subjects information on how to reduce the risks of HIV infection. The oral fluid sample collection kit for HIV testing is manufactured by Epitope Corporation of Beaverton, Ore., and is marketed under the name "OraSure HIV-1 Oral Specimen Collection Device." The Oral Fluid Vironostika HIV-1 Microelisa System approved to test specimens is manufactured by Organon Teknika Corporation of Durham, N.C. ------------------------------ To: hicnews SALINE-FILLED BREAST IMPLANT UPDATE FDA is receiving inquiries about its decision to require manufacturers of saline-filled breast implants to proceed in conducting studies to demonstrate the safety and effectiveness of these devices. The companies will be required to enroll patients promptly in clinical trials, report the data in stages and disseminate revised patient information. The saline implants may remain on the market while these studies are conducted. The following may be used to respond to inquiries. Saline-filled breast implants are silicone envelopes filled with salt water. These devices were on the market prior to the Medical Device Amendments of l976, which gave FDA regulatory authority over these products. Like many other pre-amendment devices, saline-filled implants have been allowed, under the law, to remain on the market until FDA systematically requires manufacturers to demonstrate their safety and effectiveness. Saline implants currently are the only product generally available to women who seek breast implants. Although they have silicone rubber envelopes like silicone gel-filled implants, FDA believes that saline implants present a lower degree of risk than gel-filled implants because leakage or rupture would release only salt water into the body. Since 1992, gel-filled implants for breast reconstruction have been available only for women who could not use saline-filled implants, and who agreed to participate in clinical studies. The two manufacturers of the saline-filled implants -- McGhan Medical Inc. and Mentor Corp, both of Santa Barbara, Calif. -- have agreed to conduct studies and submit data, as follows: TYPE OF STUDY STUDY COMPLETED Preclinical testing (short-term) 1995 10-year retrospective epidemiological study 1996 -- rupture/failure rate 1-year large, simple clinical trial 1997 -- short-term complications -- peri-operative infections, deflation and capsular contracture 3-year prospective clinical study 1998 -- augmentation and reconstruction patients -- full clinical profile -- quality of life FDA is also requiring the companies to submit a complete battery of preclinical data. The first set of these data will be submitted in the first quarter of l995. The agency will review the new studies as they become available, and will make public any significant new health information derived from these studies. Manufacturers will use the information to update labeling as appropriate. The agency plans to issue a final rule calling for the submission of premarket approval applications in 1998. By that time the manufacturers will have submitted all preclinical data, as well as the results of both the epidemiology study on rupture rates and the large simple trial on complication rates. The remaining three-year clinical data and quality of life assessment will be required as part of the marketing application. FDA has called on the American Society of Plastic and Reconstructive Surgeons to assist the manufacturers in recruiting the clinical investigators and patients needed to conduct these studies in a timely manner. The manufacturers have also agreed to disseminate, through surgeons, updated patient information to prospective patients. FDA is in the process of updating the patient information sheet, with the assistance of health professional groups, consumer groups and the manufacturers. Women considering implants should carefully read these patient information sheets, as well as the informed consent form, and discuss the risks with their doctors before undergoing implant surgery. Known risks include rupture, capsular contracture and infection. Saline implants are also known to interfere with mammography. Special radiographic techniques need to be used on women with implants in order to minimize interference. ------------------------------ To: hicnews +----------------------------------------------+ | NATIONAL INSTITUTE | | C A N C E R | | INTERNATIONAL INFORMATION | | C E N T E R | +----------------------------------------------+ | CancerNet@icicb.nci.nih.gov | +-------------------------------+ Changes to CancerNet, March 1995 CancerNet was updated on March 1, 1995. PDQ Statements -------------- The following PDQ statements were added or updated in CancerNet with the March update (see the file Monthly PDQ Changes -- cn-405001 for detailed information on the changes in each statement). New Statements: None Changed Statements: Changed treatment statements for physicians: Adult Acute Lymphocytic Leukemia (cn-101024) Adult Hodgkin's Disease (cn-100003) Anal Cancer (cn-100022) Bladder Cancer (cn-101206) Breast Cancer (cn-100013) Carcinoma of Unknown Primary (cn-103331) Childhood Acute Lymphocytic Leukemia (cn-100026) Childhood Hodgkin's Disease (cn-103043) Chronic Lymphocytic Leukemia (cn-101003) Colon Cancer (cn-100008) Cutaneous T-cell Lymphoma (cn-100098) Hypopharyngeal Cancer (cn-101500) Laryngeal Cancer (cn-101519) Lip and Oral Cavity Cancer (cn-102840) Liver metastases (cn-103856) Lung metastases (cn-103855) Malignant pericardial effusion (cn-103860) Malignant pleural effusion (cn-103861) Neuroblastoma (cn-100530) Oropharyngeal Cancer (cn-101521) Osteosarcoma (cn-100049) Pancreatic Cancer (exocrine) (cn-100046) Pituitary Tumors (cn-101273) Primary Central Nervous System Lymphoma (cn-104272) Prostate Cancer (cn-101229) Rectal Cancer (cn-100076) Skin Cancer (Non-Melanoma) (cn-101228) Testicular Cancer (cn-101121) Thyroid Cancer (cn-101252) Wilms' Tumor (cn-100719) Changed treatment statements for patients: Anal Cancer (cn-200022) Bladder Cancer (cn-201206) Chronic Lymphocytic Leukemia (cn-201003) Neuroblastoma (cn-200530) Osteosarcoma (cn-200049) Pancreatic Cancer (exocrine) (cn-200046) Pituitary Tumors (cn-201273) Thyroid Cancer (cn-201252) Wilms' Tumor (cn-200719) Changed supportive care statements: Fatigue (cn-304461) Changed cancer screening and prevention statements: Screening for Cervical Cancer (cn-304728) Cancer Prevention Overview (cn-304750) Prevention of Colorectal Cancer (cn-304731) Changed drug information statements: None. Changed other PDQ information: None. Changed CancerNet News and NCI Publication Information: ------------------------------------------------------- The following news bulletin was added: Breast Reconstruction Trials using Saline-Filled Implants (cn-400077) The following news bulletins were changed: Institutional Protocol Submission Checklist (cn-400011) How to Access NCI Information Resources -- U.S. Residents (cn-400035) How to Access NCI Information Resources -- International (cn-400036) NIH Consensus Development Conference on Ovarian Cancer (cn-400041) [This bulletin was changed in a Special Update on February 10, 1995.] FDA's Mammography Quality Standards Act Takes Effect (cn-400075) The following news bulletin was deleted: Selected NSABP Trials Reopened (cn-400060) úÿ úÿ(Continued from last message) No NCI publications were changed: NCI Fact Sheets --------------- The following fact sheets were added: Increased Cancer Incidence Due Mainly to Screening and Smoking (cn- 600343) Results of Community Effort to Enhance Cigarette Smokers Quit Rates Reported (cn-600344) Q&A on COMMIT (cn-600345) The following fact sheets were changed: Cancer Research Funding (cn-600011) The National Cancer Institute Cancer Centers Program (cn-600012) Community Clinical Oncology Program (cn-600013) Synovial Sarcoma (cn-600061) Mycosis Fungoides and Sezary Syndrome (cn-600063) Breast Cancer Deaths Decline Nearly 5 Percent (cn-600613) CANCERLIT Citations and Abstracts: ---------------------------------- No new CANCERLIT citation and abstract topics were added. The CANCERLIT citations and abstracts for March will be available on March 8, 1995. Instructions: 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@icicb.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. 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Please send comments or questions to: Cheryl Burg NCI International Cancer Information Center Internet: cheryl@icicb.nci.nih.gov ------------------------------ To: hicnews FDA APPROVES NEW DIABETES DRUG We have been receiving inquiries about the approval of metformin, a new drug for treatment of adult onset non-insulin dependent, or type II, diabetes, a serious disorder of blood sugar control. Type II diabetes afflicts 12 million Americans and can cause damage to the eyes, kidneys, heart and peripheral circulation. The following may be useful in answering questions. Patients with type II diabetes are generally advised to lose weight and maintain a strict diet. If these measures fail to control blood sugar levels, they are generally prescribed oral drugs and, if these fail, insulin injections. Metformin is an oral medication for controlling elevated blood sugar levels in type II diabetes. It differs from other currently approved antidiabetic drugs chemically and in how it works. It can be used together with currently available oral antidiabetic drugs. In March 1994, an FDA advisory committee voted unanimously to recommend that FDA approve metformin for people with diabetes who cannot achieve adequate blood sugar control with diet alone. At this meeting the president of the American Diabetes Association urged approval of metformin as a safe and effective drug that controls blood glucose by mechanisms different from currently available drugs. In people with diabetes, the pancreas does not produce enough insulin to control blood sugar, which then rises to harmful levels. Metformin and other oral anti-diabetic drugs lower these elevated blood sugar levels. Currently approved and marketed anti-diabetic drugs work by stimulating the pancreas to secrete more insulin. Metformin increases the body's response to its own insulin. Unlike the other drugs, metformin rarely causes hypoglycemia and generally does not cause weight gain. It may cause temporary anorexia (loss of appetite), abdominal discomfort or nausea. One concern with oral antidiabetic drugs -- including metformin -- is the potential risk of cardiovascular death. A warning to this effect is contained in the labeling for these drugs. Studies are under way to gain more information about this and other complications. Safety concerns about a related drug -- phenformin -- resulted in its being removed from the market in 1977. Phenformin was found to promote the development of lactic acidosis, a life-threatening buildup of lactic acid in the blood that was fatal in about one patient in one thousand treated for a year. Numerous studies with metformin and marketing experience in other countries have shown that, although it can cause lactic acidosis, the risk is much less than that of phenformin. Patients given metformin should be made aware of lactic acidosis symptoms -- malaise, rapid breathing, shortness of breath and severe weakness -- and be advised to contact their doctors immediately if they experience any of these. Lactic acidosis can be diagnosed with laboratory tests and requires that metformin therapy be stopped immediately and proper supportive care initiated. During worldwide marketing, patients on metformin have developed lactic acidosis at about one tenth the rate of those on phenformin. Metformin has been approved in about 80 countries and has never been withdrawn for safety reasons. The manufacturer, Lipha Pharmaceuticals Co. of New York, N.Y., submitted an application for marketing to FDA in September l993. A patient package insert will be included with metformin. Lipha will conduct an educational campaign to inform health professionals and patients about the drug's risks and benefits and appropriate precautions. The company will also conduct a postmarketing study in 10,000 patients to increase knowledge about potential safety problems. Metformin will be sold under the trade name Glucophage. The product will be distributed in the United States by Bristol- Myers Squibb of Princeton, N.J. ------------------------------ To: hicnews ARMED FORCES INSTITUTE OF PATHOLOGY POSTGRADUATE SHORT COURSES ON CONTINUING EDUCATION 13-17 Feb Controversies & Recent Contemporary Hotel Advances in Surgical Lake Buena Vista, FL Pathology 17-19 Feb Respiratory Tract & Marriott Rivercenter Mediastinum San Antonio, TX 19-22 Feb Pediatric Pathology Grosvenor Resort Lake Buena Vista, FL 25-26 Feb Neuroradiology Review Hyatt Regency Bethesda, MD 6-9 Mar Pediatric Radiology AFIP Washington, DC 6-31 Mar Otolaryngology: Head & Neck AFIP Washington, DC 13-17 Mar Forensic Dentistry Holiday Inn Crowne Plaza Rockville, MD 1-2 Apr Abdominal & Gastrointestinal AFIP Imaging Washington, DC 2-7 Apr Orthopedic Pathology Wyndham Hotel Annapolis, MD 3-14 Apr Update & Review of AFIP Anatomic Pathology Washington, DC 22-23 Apr Uroradiology AFIP Washington, DC 24-28 Apr Advanced Forensic Pathology FBI Academy Quantico, VA 2-5 May 17th Annual Hematopathology Bethesda Marriott Bethesda, MD 20-21 May Musculoskeletal Imaging AFIP Washington, DC May 31- Controversias y Adelantos Caribe Hilton & Casino 3 Jun Nuevos en Patholgia San Juan, PR Quirurgica 5- 9 Jun Diagnostic Exfoliative & Fine Marriott Hotel Needle Aspiration Cytology Washington, DC 6- 9 Jun Descriptive Veterinary AFIP Pathology Washington, DC 10 Jun Endoscopic Biopsy of the AFIP Gastrointestinal Tract Washington, DC 21-23 Jun Histopathology AFIP Washington, DC Jun 27- Forensic Anthropology University of Bradford 1 Jul Bradford, England 2- 5 Jul Controversies & Recent Snowmass Lodge & Club Advances in Surgical Pathology Snowmass, CO 17-21 Jul Musculoskeletal Radiology AFIP Washington, DC 22-28 Jul Uroradiology AFIP Washington, DC 7-10 Aug Pathology of Laboratory USUHS Animals Bethesda, MD 14-18 Aug 5th Annual Radiologic Westin Bayshore Pathologic Correlation Vancouver, BC, CANADA 18-20 Aug Analytical & Molecular AFIP Techniques in Environmental Washington, DC Toxicology & Pathology 20-30 Aug Healing Arts: Voyage of Greece/Turkey Discovery Sea Cruise Aug 26 - Ophthalmic Pathology for Georgetown University 1 Sept Ophthalmologists Conference Center Washington, DC 11-12 Sept Gastrointestinal Surgical Washington Marriott Pathology Washington, DC 13-17 Sept Hepatic '95 Washington Marriott Washington, DC 16-17 Sept Pulmonary & Mediastinal AFIP Radiology Washington, DC 18-22 Sept Neuroradiology AFIP Washington, DC Sept 30 - Pulmonary & Mediastinal Marriott Riverwalk 1 Oct Radiology San Antonio, TX 23-26 Oct Difficult Diagnosis in Omni Hotel Surgical Pathology Charleston, SC 18-19 Nov Interpretation of Prostatic AFIP Biopsy Washington, DC 1- 3 Dec Respiratory Tract Disney Contemporary & Mediastinum Hotel Resort Lake Buena Vista, FL 4- 8 Dec Oral Pathology Grosvenor Resort Lake Buena Vista, FL Schedules are published monthly. Press announcements will be published as information becomes available. For additional information, clarification, or registration materials you may write or call: AFIP/ARP, Educ. Div.(INT), Washington, DC 20306-6000; Telephone 301/427-5231; Fax 301/427-5001; or INTERNET: CAME@email.afip.osd.mil ------------------------------ To: hicnews 8th LATIN-AMERICAN CONGRESS ON ORGAN AND TISSUE TRANSPLANTATION 1st IBERO-AMERICAN SYMPOSIUM ON ORGAN PROCUREMENT 1st LATIN- AMERICAN SEMINAR ON BRAIN DEATH 1st IBERO-AMERICAN SEMINAR ON THE TEACHING OF HEALTH BIOETHICS 3rd INTERNATIONAL WORKSHOP ON CARE TO PATIENTS WITH CHRONIC RENAL FAILURE IN DEVELOPING COUNTRIES Havana, Cuba April 24-28, 1995 Dear colleague: The Latin-American Society of Transplantation and the Council of Scientific Societies of the Ministry of Public Health of Cuba are honored in inviting you to participate in the 8th Latin-American Congress on Organ and Tissue Transplantation, the 1st Ibero-American Symposium on Organ Procurement, the 1st Latin-American Seminar on Brain Death, the 1st Ibero-American Seminar on the Teaching of Health Bioethics and the 3rd International Workshop on Care to Patients with Chronic Renal Failure in Developing Countries, which will be held on April 24- 28, 1995, at the International Conference Center Havana, Cuba. The central subject of the Congress will be problems related to: ORGAN AND TISSUE TRANSPLANTATION, ORGAN PROCUREMENT, BRAIN DEATH AND CHRONIC RENAL FAILURE IN DEVELOPING COUNTRIES. The main purpose of simultaneously holding these conferences, is to gather specialist in organ transplantation of the Ibero-Latin-American region to discuss relevant topics related to our work and allow them to share their experiences and exchange points of view on a broad scope of topics related to the subject. To this end we are developing a scientific and cultural program that we hope will please the participants. Additionally, you will have the opportunity of enjoying the friendship, warn climate and traditional Cuban hospitality. Looking forward to meeting you personally in Havana Dr. Ra.l Herrera ValdThetas Chairman of the Organizing Committee SPONSOR - Latin-American Transplantation Society CO-SPONSORS - Latin-American Society of Nephrology - Pan-American Society of Dialysis and Transplantation - Pan-American Health Organization-World Health Organization - National Organization of Transplantation of Spain - Ministry of Public Health of Cuba - Council of Scientific Societies of the Ministry of Public Health of Cuba LATIN-AMERICAN TRANSPLANTATION SOCIETY President : Hugo Valencia Guzman (Peru) vice-president : Raul Herrera Valdes (Cuba) Secretary : Armando Vidalon Fernandez (Peru) Alternate Secretary : Adolfo Delgado Rodriguez (Cuba) Treasurer : Walter Chaname Delgado (Peru) Alternate Treasure : Jorge P. Alfonzo Guerra (Cuba) HONORARY CHAIRMEN Dr. Julio Teja Perez Minister of Public Health of Cuba Dr. Noel Gonzalez Jimenez Chairman National Commission of Organ Transplantation Dr. Rodrigo Alvarez Cambras Director, Frank Pais Hospital Dr. Raul Gomez Cabrera Director, Hermanos Ameijeiras Hospital úÿ úÿ(Continued from last message) Dr. Miguel A. Marquez PAHO/WHO Representative in Cuba ORGANIZING COMMITTEE Chairman : Dr.Raul Herrera Valdes Secretary : Dr. Adolfo Delgado Rodriguez Treasurer : Dr. Jorge P. Alfonzo Guerra MEMBERS : Renal Transplant : Dr. Charles Magrans Buch Dr. Reynaldo Manalich Comas Heart Transplant : Dr. Noel Gonzalez Jimenez Dr. Felix Duarte Castaneda Liver Transplant : Dr. Lazaro Quevedo Guanche Dr. Leonel Gonzalez Rapado Bone Marrow Transplant : Dr. Jose M. Ballester Santovenia Dr. Jose Carnot Uria Neural Transplant : Dr. Raul Macias Gonzalez Dr. Carlos Suarez Monteagudo Cornea Transplant : Dr. Jaime Alemany Martorell Dr. Marcelino Rios Torres Bone Transplant : Dr. Rodrigo Alvarez Cambra Dr. Eddy Sanchez Noda Pediatric Transplant : Dr. Santiago Valdes Martin Dra. Lourdes Lopez Agramonte Immunology : Dr. Sergio Arce Bustabad Dr. Catalino Ustariz Garcia Organ Procurement : Dr. Rene Ruiz Armas Dr. Arnaldo Vall Martin Brain Death : Dr. Calixto Machado Curbelo Dr. Orlando Garcia Garcia Medical Ethics : Dr. Jose Jordan Rodriguez Dr. Jorge Gonzalez Perez Nursing : Lic. Maria Teresa Trincado Agudo Lic. Raquel Perez Campo PCO, International Conference Center : Lic. Alicia Garcia Gonzalez TOPICS - Ethical, social, legal and economic aspects - Brain death - Procurement and preservation of organs and tissues - Immuno-biology - Management of the recipient with chronic organ failure - Clinical and surgical aspects - Immunosuppression, cyclosporines, mono- and poly-clonal antibodies, new agents - Long-term prognosis - Transplantation in pediatric patients - Xenotransplantation - Record and statistics - Nursing services in organ transplantation PROGRAM The Scientific Program will include pre-Congress courses, lectures, symposia and free communication in the modalities of oral, posters and video presentations. PRE-CONGRESS COURSES They will held on the 24th and will delivered by highly qualified professors on the respective subjects. Participants will receive a certificate. LECTURES Lectures about the latest developments on the above mentioned topics will be offered by specialists of renowned international prestige SYMPOSIA Updated knowledge and the experiences achieved in the field of transplantation in different countries will be presented FREE-PAPER PRESENTATION They will be presented in the modalities of oral presentations, posters and videos Oral presentations may be accompanied by graphic support such as slides and overhead projections. Posters shall be presented in a format of 0.95 m wide and up to 2 m high. They shall include introduction, materials, methods, results, debates and conclusions. Video requirement: Only Betamax and VHS (NTSC 3.58 standard) videocassettes will be accepted. ABSTRACT PRESENTATION Format - two-hundred and fifty words maximum - Title in capital letters at the top the page - Author(s) - Name, address, and country to which your institution belongs - P.O. box. fax, telex and telephone number - Name of speaker if other than main author Confirmation of accepted papers by the Organizing Committee will be sent no later than January 31st, 1995. WORKING LANGUAGES English and Spanish; simultaneous interpretation will be provided for the main activities of the Congress AUDIOVISUAL Audiovisual aids must meet the following requirements : Slides 35mm Video-cassettes Betamax or VHS (NTCS 3.58) Films 16-, 35- mm and super 8 TECHNOLOGICAL EXHIBITION The 7th International Fair of Medical Techniques "Health for All" will take place parallel to the Congress at Pabexpo, the International Conference Center's Exhibition Hall. More than 300 companies from 25 countries will display a wide variety of cutting edge technology and pharmacology SOCIAL PROGRAM All participants and guest registered in the Congress will participate in official activities. Speakers and accompanying persons will be able to choose from a specially designed program of optional tours organized before, during and after the Congress. REGISTRATION FEES Physicians: US $200.00 Residents and other professionals: US $150.00 Nurses: US $ 125.00 Accompanying persons US $ 75.00 Participants who register through the International Conference Center's representative travel agencies listed in this brochure will take advantage of the following services: -TECHNICAL AND SCIENTIFIC ACTIVITIES Information and consulting on the program Confirmation of guest status Reception and acceptance of contributed papers -TOURISTIC ACTIVITIES Granting of visas, ticket reservation, hotel bookings, optional tours,etc. PRE REGISTRATION Please send us the enclosed registration form as soon as possible. The Organizing Committee will kindly appreciate any information you could give to your colleagues about this Congress. IMPORTANT DATES December 31st, 1994 Deadline for the reception of papers abstracts January 31st, 1995 Confirmation of acceptance of papers by the Organizing Committee April 24th, 1995 Pre-Congress courses/Opening of the Congress April 25 to 28, 1995 8th Latin-American Congress on Organ and Tissue Transplantation 2do IBERO-AMERICAN COURSE ON NEPHROLOGY This course will take place immediatly before the Congress, from April 20 to 22, 1995 and will be held in the city of Santiago de Cuba. Course Coordinator : Dr. Carlos Valle Santana TOPICS - Molecular biology of renal damage - Chronic renal failure - Up-date of dialytic methods - Post-transplantation acute renal failure - Hypertension in renal transplantation Registration fee: US $150.00 For more information, please contact: 8th Latin-American Congress on Organ Transplantation Palacio de las Convenciones Calle 146 e/ 11 y 13, Playa Apartado Postal 16046 , La Habana, Cuba Tels : (537) 22-5511 to 19 ext. 1514 (537) 81-2413 / (537) 81-3968 Telex: 511609 palco cu Fax (537) 33-1657 or 22-8382 NOTICE We would be specially grateful if you communicate with Committee via FAX _________________________________________________________________ _____ 8th LATIN-AMERICAN CONGRESS ON ORGAN TRANSPLANTATION April 24-28, 1995, Havana, Cuba REGISTRATION FORM Please fill in block letters: Name:____________________________________________________________ _____ Surname:_________________________________________________________ _____ Address:_________________________________________________________ _____ Postal Code:____________________________________________________________ _____ City:______________________________ Country:_______________________________ Fax No.____________________________ Telex No.______________________________ Telephone________________________________________________________ _____ Speciality_______________________________________________________ _____ Institution:_____________________________________________________ _____ ___ I kindly request further information ___ I will participate alone ___ I will be accompained __ persons(s) I will attend the 2nd Ibero-American Course on Nephrology Yes__ No__ I will attend pre-congress courses Yes__ No__ I will present paper Yes__ No__ Title:___________________________________________________________ _____ _________________________________________________________________ _____ Modality __Oral presentation __Posters ___Video _________________________________________________________________ _____ OTHER COOPERATING AGENCIES BAHAMAS: Havanatur Bahamas - Tel. 322-2606 - Telex (809) 322-2606 - Fax 1191-809-3265785 BARBADOS: Bim International Travel Inc. - Tels. (809) 4310127 / 4310123 - Fax (809) 431-0123 BENELUX: Havanatur Benelux - Tel. 32-2502.0700 - Telex 23614 - Fax 32-2502.34.75 CANADA: Cubanacan-Canada - Tel. 4166010343 - Telex. (21) 6524017 - Fax 416 6010346,Toronto CHILE: Cosmo Service - Tel. 633224 / 6399320 - Telex 241309 cosmo cl - Fax 6392331 FRANCE: Havanatur Paris - Tel. (1) 4742.58.58 - Telex 215 891F - Fax (1) 4265.1801 GERMANY: IT Reisen. Internationale Touristik GmbH - Telex 8881 425 - Fax 0221 / 253220 Tropicana Touristik - Tels. 030-8537041 / 7042 - Telex 186760 tropi d - Fax 030 / 583.40.70 HAITI: Citadelle S.A. - Tel. 225900 - Telex 20141 - Fax 22-1792 IRLANDA: Cubatravel - Tel. (01) 713422 - Telex 31594.g.e.t - Fax (01) 798006 JAMAICA: Caribic Vacations - Tels. (809) 952-5013 / 4469 - Telex 2001/5374 caribic - Fax (809) 952-0981/8288 JAPON: Co-your Tours Co. Ltda - Tel. 03-3574-1594 - Telex 36372 coyou - Fax 03-3574-0018 Kyoei Havanatur Ltd. - Tel (03) 3581-7451 - Telex J 27349 kyoeitok - Fax 03-3581-4725 NICARAGUA: Soltours - Tel. 663913 / 663914 - Fax 661591 PANAMA: Atlantis Tours - Tel. 64-4466 / 64-4471 - Fax (507) 64.8370 PARAGUAY: Intertours - Tel. 211747 / 624-212229 - Telex 22142 Py - ITR Fax (595-21) 211870 Asuncion SWEDEN: Columbus Resor ab - Tel. + 46 8 33 88 80 - Telex 10186 colum s - Fax +46 8 34 09 50, Estocolmo ------------------------------ End of HICNet Medical News Digest V08 Issue #08 *********************************************** --- Editor, HICNet Medical Newsletter Internet: david@stat.com FAX: +1 (602) 451-1165 Bitnet : ATW1H@ASUACAD