Sample of "Medical Meandering"

with Medical & Transplant News.

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AOL Resources -

Sundays 10:00 PM ET, Kidney/Pancreas Transplant,
Keyword: People Connection, Private Room, (Keyword to: aol://2719:2-2-kidney%20pancreas%20tx)Kidney Pancreas Tx (Keyword to: aol://2719:2-2-kidney%20pancreas%20tx)
Monday 9:00 PM ET, Liver Disease & Transplant
Keyword: Better Health, Mutual Support Room, Mutual Support Room (Keyword to: aol://2719:3-691-Mutual%20Support%20Room)
Tuesday 9:00 PM ET, Lung Transplant
Keyword: People Connection, Private Room, Carols lung tx room (Keyword to: aol://2719:2-2-Carols%20lung%20tx%20room)
Thursday, 7:00 PM ET, Heart Transplant
Keyword: Better Health, Health Conf. Room Health Conf (Keyword to: aol://2719:3-193-Health%20Conference)
Friday, 9:00 PM ET All Organs/Tissues Transplant
Keyword: Better Health, IMH Conf Room, Hyperlink: IMH Chat (Keyword to: aol://2719:3-49-IMH%20Chat)
Saturday 12:00 Midnight ET, Organ Transplant Support
Keyword: Better Health, IMH Conf Room, Hyperlink: IMH Chat (Keyword to: aol://2719:3-49-IMH%20Chat)
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NEW CHATS --- ACCESSIBLE TO ALL ON THE WEB
Better Health and Medical Network (Keyword to: http://www.betterhealth.com/BH2/frontframe/0,1329,,00.html) http://www.betterhealth.com is offering a dedicated transplant chat room, as well as other medical chat rooms, which will eventually be open 24hrs, 7days.
For Netscape 4.0 or Internet Explorer 3.0 download the i-chat plug-in at:
ichat Download (Keyword to: http://www.ichat.com/download/index.html) http://www.ichat.com/download/index.html
If you experiene problems loading the plugin properly, please visit:
ichat Technical Support - Clients (Keyword to: http://www.ichat.com/help/index.html) http://www.ichat.com/help/index.html
America Online Users: i-chat does not support AOL's browser. If you do not have Netscape or Internet Explorer (NOT AOL's version of IE) and do not want to download either of the browsers, you may access the chatroom via AOL, then select HTML script, although you may experience problems.
D/L Netscape: www.netscape.com (Keyword to: http://www.netscape.com/) http://www.netscape.com
D/L IE: www.internetexplorer.com (Keyword to: http://www.internetexplorer.com/) http://www.internetexplorer.com/
Tuesdays, 9:00 PM ET, Arthritis Chat
Wednesday 9:00 PM ET, Heart Transplant Support
Wednesdays, 10:00 PM ET, Transplant Support Chat
Thursdays 8:00 PM ET, Heart Smart
Many others coming soon
IF YOU'RE INTESTED IN HOSTING A CHAT PLEASE REPLY FOR INFO :).
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The International Transplant 1996 Directory, Published by "Transplant News" (Not SacMall-Transplant News) is available at no charge, ($6.00 S&H) from Transplant Awareness Inc. I highly recommend for anyone interested in transplants. It includes:
*Complete listiing, by state, of every organ, tissue, eye and bone marrow transplant
program, and patient support groups.
*All Federal government agencies and contqact person involved in directing
transplant programs.
*Pharmaceutical/biotechnology companies.
*Insuance and managed care companies with "centers of excellence" networks
including a list of centers by organ.
*National office of all the major transplant organizations.
*International organ, tissue, eye and bone marrow programs.
*Website internet and World Wide Web address.
Sent $6.00 for Shipping and Handling to Transplant Awareness Inc,
P. O. Box 7634 Arlington, Va. 22207. Phone 703-534-8587,
Fax 703-534-7759, Email tai01@aol.com
Thanks to Transplant News and Transplant Awareness Inc. for this generous donation. Please contact either org. for the 1997 edition.
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Reader Requested Info...A Randomized Controlled Trial of Epoprostenol Therapy for Severe Congestive Heart Failure: The Flolan International Randomized Survival Trial (FIRST) Summary: This trial evaluated the effects of epoprostenol on patients with severe left ventricular failure. Patients with class IIIB/IV congestive heart failure and decreased left ventricular ejection fraction were eligible
for enrollment if angiography documented severely compromised hemody namics while the patient was receiving a regimen of digoxin, diuretics, and an angiotensin-converting enzyme inhibitor. We randomly assigned 471 patients to epoprostenol infusion or standard care. The primary end point was survival; secondary end points were clinical events, congestive heart failure symptoms, distance walked in 6 minutes, and quality-of-life measures. The median dose of epoprostenol was 4.0 ng/kg/min, resulting in a significant increase in cardiac index (1.81 to 2.61 L/min/m2), a decrease in pulmonary capillary wedge pressure (24.5 to 20.0 mm Hg), and a decrease in systemic vascular resistance (20.76 to 12.33 units). The trial was terminated early because of a strong trend toward decreased survival in the patients treated with epoprostenol. Chronic intravenous epoprostenol therapy is not associated with improvement in distance walked, quality of life, or morbid events and is associated with an increased risk of death.
[Am Heart J 134(1): 44-55, 1997. © 1997 Mosby-Year Book, Inc.]
In summary, despite both conceptual and preliminary clinical evidence of benefit, chronic epoprostenol infusion in severe left ventricular failure resulted in increased mortality rates and no evidence of improved quality of life. Efforts to improve the plight of severely symptomatic patients caused by left ventricular failure should focus on other avenues. This trial points out the critical importance of controlled trials that are
adequately sized and have objective measurements to assess the clinical impact of therapeutic interventions. The poor outcome of both the control group and the experimental group in this trial despite treatment with standard regimens for heart failure emphasizes the need to continue efforts in this field. The Flolan International Randomized Survival ... (Keyword to: http://www.medscape.com/mosby/AmHeartJ/1997/v134.n01/ahj1341.califf/ahj1341.califf.html) http://www.medscape.com/mosby/ AmHeartJ/ 1997/v134. n01/ahj1341.califf/ahj1341.califf.html
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A Preliminary Study of Ribavirin Plus Interferon in the Treatment for Chronic Hepatitis C Robert J. Bailey, MD, University of Alberta Edmonton, Alberta and Daphne L. Meyer, RN GI Research Capital Health Region Edmonton, Alberta
Learning Objectives:
* To review preliminary data from a Canadian trial of interferon plus ribavirin therapy for
chronic hepatitis C * Interferon and ribavirin have a role to play in patients not responding and/or relapsing after previous treatment with interferon
* It remains to be seen how effective the role is in patients not responding to past
interferon
* Ribavirin is a safe medication in combination with interferon
Abstract:
Interferon alpha (IFN) monotherapy has resuslted in sustained response rates for approximately 20% of patients with hepatitis C. Ribavirin, a guanosine analogue, when used alone in patients with hepatitis C alters transaminase values but fails to influence the course of the disease. Preliminary studies with the two drugs, IFN and ribavirin, in combination appear promising. The present study was designed to assess the combination of the two drugs in patients who had not responded to IFN or who
had relapsed when a trial of IFN had been completed.
41 patients with aminotransferases at least 1.5 times above normal and a positive test for hepatitis C RNA by polymerase chain reaction are undergoing treatment. Of these 41, ten relapsed after an initial course of IFN and 31 patients were nonre-sponders to IFN. Both groups are being treated with a combination of IFN 3 million units three times per week and ribavirin 1000 mg per day for wt. 75 kg. The treatment period is 12 months for the relapse group, six months for the non-responders.
At three months, ten of ten patients in the relapse group have a normal ALT (mean 19.25). Hepatitis C RNA levels are Of the 12 patients who responded at three months, 11 have received treatment for six months. Nine remain with a biochemical response (normal ALT's). Hepatitis C RNA levels remain to be reported in this group.
The combination of IFN and ribavirin has few side effects, most attributed to IFN. Ribavirin led to a drop (mean 26 g/L) in hemoglobin and a rise (mean 9 mmol/L) in total bilirubin in five patients. These preliminary results indicate that IFN and ribavirin appear to be encouraging as a combination to treat patients with hepatitis C.
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Drug May Offer New Way to Beat Colds NEW YORK (Reuters) -- It's not a cure, but researchers say a new drug can cut the misery of the common cold by blocking uptake of the virus itself. The drug "reduces the illness associated with (laboratory-introduced) rhinovirus colds in humans," reports Dr. Ronald Turner, an expert on the common cold at the University of South Carolina in Charleston. He presented his
findings Tuesday during a meeting of the American Society for Microbiology (ASM) in Toronto. Rhinoviruses are viruses that infect the nose, causing about 40% of colds in adults. They bind to human cells via a receptor called 'intracellular adhesion molecule-1,' or ICAM-1. When this binding is complete, infection can occur. Turner led a team of genetic engineers to create a molecule called BIRR 4, which closely mimics the structure of ICAM-1. When BIRR 4 is introduced into the nose via a nasal spray, it acts as a 'decoy' -- luring rhinoviruses away from ICAM-1 receptors. An ASM statement explains that fewer rhinoviruses are then left to bind with 'real' receptors -- "preventing attachment of the virus to nasal cells." At present, drugs used to combat colds merely limit the body's immune response to the virus. Previously developed antiviral drugs have proven ineffective, with the added drawback of unwanted side
effects. Two major drug companies -- Bayer and Boehringer Ingelheim -- are currently developing these types of drugs. The cost to the consumer of such a medication, if and when one became commercially available, is unknown.
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An important quotation about Alpha1 Antitrypsin Deficiency In the relatively short span of 30 years since its discovery, the growing understanding of alpha1-AT [alpha1-antitrypsin] deficiency and its therapy has revolutionized pulmonary medicine. Research linking smoking to the development of emphysema in non-alpha1-AT-deficient individuals has added a scientific basis to the recommendations against
smoking for all individuals with early emphysema....While understanding of the pathophysiology and the development of a therapy for alpha1-AT-associated emphysema document a dramatic success story, a number of unresolved questions remain. Still not understood are those additional factors, other than genotype and environmental exposure, that determine the broad clinical variability observed in individuals with alpha1-AT deficiency. How the medical community will meet the
challenge of disseminating genetic advances made in the laboratory to the practicing clinician and society is also highlighted by the slow spread of information about alpha1-AT deficiency. One recent study showed that patients with alpha1-AT deficiency were not diagnosed until a mean age of 41, after 5.7 years of dyspnea and/or othe respiratory symptoms. Additionally, 42% of the patients saw an average of three physicians before their condition was correctly diagnosed. -Wulfsberg EA, Hoffman DE, Cohen MM, Alpha1-Anyitrypsin deficiency: impact of genetic discovery
on medicine and society. JAMA. 1994; 271:217-22.
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Porcine neural cell product for transplantation into people with advanced Parkinson's disease was well tolerated in patients treated with the therapy in a phase I study. The study results, presented Sunday at a medical symposium in San Diego, also showed evidence of clinical improvement in patients who were treated with NeuroCell-PD.
In the study's 10 evaluable patients who were measured at a time when their L-dopa medication was wearing off, preliminary data indicated an average improvement of 13.2 points at six months after surgery on a standardized scale that measures a patient's ability to perform a variety of movements. This result was statistically significant, compared to an evaluation that was taken prior to surgery (p<0.05).
Although there have not been any absolute epidemiologic studies on Parkinson's disease, medical experts believe that approximately 500,000 Americans have Parkinson's disease, and another 50,000 cases are diagnosed each year. The resulting medical expenses, early retirement, and nursing home care cost $5.6 billion a year. http://www.genzyme.com
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St. John's Wort Study Launched Bethesda, MD--The National Institutes of Health (NIH) is launching the first U.S. clinical trial of St. John's wort, an herb widely used in Europe to treat depression. The three-year study, sponsored by NIH's Office of Alternative Medicine (OAM), the National Institute of Mental Health (NIMH) and
the Office of Dietary Supplements (ODS), will include 336 patients with major depression who will be randomly assigned to one of three treatment arms for an eight-week trial. One-third of the patients will receive a uniform dose of St. John's wort, another third will be given placebo, and the final third will take a selective serotonin reuptake inhibitor (SSRI), a type of antidepressant commonly prescribed for
depression. "This study will give us definitive answers about whether St. John's wort works for clinical depression," said NIMH Director Steven E. Hyman, M.D. "The study will be the first rigorous clinical trial of the herb that will be large enough and long enough to fully assess whether it produces a therapeutic effect."
"The compilation of research done thus far, although encouraging, still leaves some unanswered questions about exactly how the herb works," said Wayne B. Jonas, M.D., director of OAM, which is funding the study. "The interest and collaboration among these three NIH components in this clinical trial will provide the scientific expertise and clinical guidance to rigorously investigate this herb's benefit or risk in the treatment of depression." In Germany, where physicians routinely prescribe herbs for a variety of medical illnesses, millions of doses of St. John's wort, known also by its botanical name, Hypericum perforatum, are used daily. However, no studies of long-term use have been conducted and published studies have used several different doses. This study will use a standardized preparation containing a 900 mg daily dose of the herb. In addition, study participants who respond positively will be followed for another 18 weeks. The goal of the followup is to determine if patients given St. John's wort have fewer relapses than patients given placebo.
An overview of 23 clinical studies in Europe, published August 3, 1996, in the British Medical Journal, found that the herb may be useful in cases of mild to moderate depression. The NIH study will examine patients with the moderate form of the disorder. NIH officials said the clinical trial will be coordinated by Jonathan
Davidson, M.D., at Duke University Medical Center, which has received a three-year contract to conduct the $4.3 million study. Patient enrollment is expected to start next spring. For information, call NIMH (301) 443-4536 or visit the NIMH Website at http://www.nimh.nih.gov. Or: OAM Clearinghouse 1-888-644-6226 or visit the OAM website at http://altmed.od.nih.gov. Watch for the new ODS website in late Fall at
http://dietary-supplements.info.nih.gov. For info call ODS: 301-435-2920.
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Treatment for Incontinence MINNEAPOLIS, Sept. 29 /PRNewswire/Medtronic, Inc. (NYSE: MDT) today announced clearance by the U.S. Food and Drug Administration to market Interstim(R) Continence Control Therapy, the first implantable treatment ever to use electrical stimulation of the sacral nerves to manage urinary urge incontinence. It is estimated by the Agency for Health Care Policy and Research that approximately 13 million Americans suffer from urinary incontinence, costing the nation's health care system an estimated $11.2 billion annually. Of incontinence
sufferers, approximately five million people suffer from urge incontinence -- strong, sudden urges to urinate followed by the involuntary losses of urine. This form of incontinence is particularly distressing for people because of the unpredictability of the frequency and severity of these leaking episodes. While it affects both men and women, more than 85% of sufferers in this country are women between the ages of 30 and 59. Similar to the way a pacemaker delivers electrical stimulation to the heart, the Interstim Continence Control Therapy uses electrical pulses to help control ladder function -- avoiding or at least reducing accidental urination or leakage. It currently is being used by physicians and patients in Europe, Canada, Australia, Africa and the Middle East. Patients interested in the Interstim Continence Control Therapy
should consult their physician or a urologist to discuss risks and benefits and to assess whether this therapy is appropriate for them. Patients and physicians can
call 800-664-5111, extension 3000.
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Significant Purchasing Power on Rx Medications AKRON, Ohio, Sept. 29 /PRNewswire/ -- As a result of soaring enrollment in femScript(R) and aVida Rx(TM) over 200,000 men and women nationwide -- people without insurance coverage for medications or those whose plans do not cover the cost of certain drugs are collectively saving millions of dollars on brand name prescriptions for a wide variety of medical conditions. Since health plans may limit or do not offer coverage for certain prescriptions -- including Medicare -- the opportunity to save on brand name drugs
has wide appeal. Consumers enroll via the Internet, www.femscript.com,or a toll-free call to 800-511-1314 for an annual membership fee of $9.95. Presentation of a membership card along with a prescription for one of the eligible brand products entitles an individual to the program savings at more than 25,000 participating pharmacies. femScript(R) and aVida Rx(TM) formulary products are equal or similar to drugs that an individual may now be taking, and Mindala says most physicians are willing to accommodate patients with a revised prescription when medically appropriate to save their patients money. For more information contact Jim Mindala of FFI Health Services, Inc. at 800-290-2007 ext. 16 or Laura Carabello of CPR Communications, Inc., 201-641-1911.
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Reader Requested Info...Diabetes and Depression By Laura Helmuth, DIABETES.COM One of the most common and potentially dangerous side effects of diabetes is rarely included in the standard list of possible complications. This condition, depression, is common in the non-diabetic population as well, but coupled with diabetes, it can interfere with disease management and lead to a web of physical, mental, and emotional complications. Fortunately, depression is treatable.
If you learn to recognize its danger signs, and know how to seek treatment, depression can be controlled. One unexpected benefit may be that, once depression has lifted, your diabetes should become much easier to manage.
For centuries, physicians have noticed that chronic disease and depression are frequent companions. As early as 1684, Dr. Thomas Willis wrote of the "Sadness, or long sorrow" that accompanies many chronic illnesses. If it had been 1984, he might have written that depression seems to exacer bate diabetes, and possibly even trigger it. Although it is not true of all diabetes cases, many people report that the onset of their type II diabetes occurred during a time of severe stress or depression.
Even if stress or depression did not precipitate your diabetes, one thing is clear: Diabetes can be very depressing. In the general population, the lifetime risk of depression is 10 to 25 percent for women and 5 to 12 percent for men. However, the prevalence of depression in the diabetic community is much higher--25 to 33 percent. Anyone with a chronic medical condition suffers an increased risk of depression, but the relationship between diabetes and depression is particularly strong because the
disease has so many possible complications, and makes relentless demands on people who have it. Laura Helmuth is a Berkeley, California, psychologist and writer.
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Got Allergies? Try Washing Your Cat October 3, 1997 NEW YORK (Reuters) - If you love your cat - but your allergies are driving you crazy - there may be a ray of hope. A new study suggests that frequently washing your feline could reduce shedding of allergy-irritating proteins. But getting the little kitty into the bathtub every two to four weeks without some serious bites and scratches can be another matter entirely, notes senior investigator Dr. Judith Woodfolk, a research associate at the
University of Virginia Asthma and Allergic Diseases Center in Charlottesville. And the technique may or may not be successful at reducing sniffling and sneezing, depending on how much allergen your cat produces.
"The major findings of the paper are that even though the (allergen) levels are reduced, they are not maintained at low levels for long periods of time so you would have to repeatedly wash the cat - which may not that feasible for the patient," she said. "It works to a degree, but its unfortunately not a very satisfactory method."
Of the 6 million people in the U.S. that are allergic to cats, one out of three live with at least one cat in the house, according to the report in a recent issue of the Journal of Allergy and Clinical Immunology. Contrary to common belief, cat hair is not the cause of an allergic reaction. Rather proteins secreted by the sebaceous glands in the skin accumulate on cats' hair and can become airborne, lingering long after the cat is gone - and causing an allergic reaction. Success may also depend on the amount of allergen made by the cat. In the study, the cats had roughly 67 milligrams of the most allergenic protein, but varied from 3 to 142 milligrams. Total immersion reduced cat allergens by anywhere from 19% to 92%. While removing carpets and sofas that retain cat allergens and filtering the air are largely ineffective at making a dent in allergen load on their own, more study is needed to determine if adding a third step - regular cat washings - could help reduce symptoms, the
authors concluded. SOURCE: Journal of Allergy and Clinical Immunology (1997;100:307-312)
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Thanks to novijo@chesco.com ...
This 85 year old couple, having been married almost 60 years, had died in a car crash. They had been in good health the last ten years mainly due to her interest in health food, and exercise.
When they reached the pearly gates, St. Peter took them to their mansion which was decked out with a beautiful kitchen and master bath suite and Jacuzzi. As they "oohed and aahed" the old man asked Peter how much all this was going to cost. "It's free," Peter replied, "this is Heaven."
Next they went out back to survey the championship golf course that the home backed up to. They would have golfing privileges everyday and each week the course changed to a new one representing the great golf courses on earth. The old man asked, "what are the green fees?".Peter's reply, "This is heaven, you play for free."
Next they went to the club house and saw the lavish buffet lunch with the cuisines of the world laid out. "How much to eat?" asked the old man. "Don't you understand yet? This is heaven, it is free!" Peter replied with some exasperation. "Well, where are the low fat and low cholesterol tables?" the old man asked timidly.
Peter lectured, "That's the best part...you can eat as much as you like of whatever you like and you never get fat and you never get sick. This is Heaven."
With that the old man went into a fit of anger, throwing down his hat and stomping on it, and shrieking wildly. Peter and his wife both tried to calm him down, asking him what was wrong. The old man looked at his wife and said, "This is all your fault. If it weren't for your blasted bran muffins, I could have been here ten years ago!
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Chat hosts are welcome to list their scheduled chats.
All readers are invited to submit items of interest.
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