"In fact, if you look at prostates in men over the age of 70 or 80, about half the men have prostate cancer in the gland," says Philip Kantoff, HMS assistant professor of medicine and director of genito-urinary oncology at Dana Farber Cancer Institute.
Many prostate tumors grow slowly and do little harm, but others follow a rapid and deadlier course. Until recently, there has been little way of knowing which tumors are destined to develop into lethal cancers.
Kantoff, along with Edward Giovannucci, assistant professor in the Department of Nutrition in the Faculty of Public Health, and Myles Brown, assistant professor of medicine, have made a finding that could eventually lead to a new method for determining which men are likely to develop virulent prostate tumors.
The finding focuses on a small stretch of "stuttering" or repeating DNA on the X chromosome. The DNA repeat consists of the same three bases, CAG, but the number of stutters varies: Men have anywhere from 10 to 35 CAG repeats.
Kantoff and his colleagues found that men with fewer CAG repeats on their X chromosome are more likely to develop prostate cancer and, especially, aggressive prostate cancer. Kantoff announced the findings two weeks ago at the annual meeting of the American Society for Clinical Oncology.
More than 317,000 men will be diagnosed with prostate cancer this year. The finding could lead to a new method of identifying which future patients have a high risk of developing aggressive prostate cancer, saving those who have a lower risk from needless procedures such as radical prostate surgery.
The discovery of a link between androgens and prostate cancer could also lead to new treatments, such as hormone blockers. "I don't want to take this too far but it really supports intervention strategies here," says Kantoff.
Kantoff first began to suspect a link between the X- chromosome CAG repeats and prostate cancer a year and a half ago, while attending a professional meeting. Data presented at the meeting showed that African-American men-who reportedly have higher rates of prostate cancer-have, on average, fewer CAG repeats in their androgen-receptor gene than Caucasians or Asians.
Kantoff had known from in vitro work done by researchers in other labs that the length of the CAG repeat could affect how the androgen receptor works. Normally, androgens circulating in the blood get into the prostate cell and bind to the androgen receptor; the bound pair-androgen hormone and androgen receptor-then enters the nucleus and activates the DNA, which in turn tells the cells to grow and divide. The researchers had shown that shortening the CAG repeat sequence-that is, removing CAGs from the androgen gene in vitro-resulted in an androgen receptor that increased activation of DNA.
Suspecting that shorter CAG repeats in men could be making androgen receptors in their prostate cells more active, Kantoff, along with Brown, hatched the idea for an experiment. The idea was to see if men with shorter CAG repeats on their X chromosomes had a greater likelihood of developing prostate cancer.
The researchers enlisted the collaboration of Giovannucci and other colleagues at HSPH. "They had been sitting on these DNAs from blood banked in 1982," Kantoff says. The blood had been banked as part of the Physician's Health Study, an ongoing study of 22,000 men, which was originally undertaken for the purpose of determining the effect of beta-carotene and aspirin.
Every two years, participants report on their health, saying- among other things-whether or not they have developed prostate cancer. Men reporting prostate cancer are asked to send pathological reports indicating the severity of the tumors-grade and stage-and whether the cancer has spread to other organs.
Kantoff and his colleagues were given the blood of 591 men with prostate cancer and 591 men of approximately the same age without cancer. The researchers did not know which samples belonged to men with prostate cancer.
However, the researchers also found that men with 19 repeats were 250% more likely to develop aggressive-high- stage, high-grade metastatic-cancer than those with 25 repeats. Men with 19 repeats were at no greater risk for developing low-stage low-grade cancers than men with 25 repeats. "What was unbelievable about it in my mind then was that it was related strictly to the aggressive forms of prostate cancer," Kantoff says.
How might the shorter CAG repeat be causing aggressive prostate cancer in these men? Kantoff suggests the CAG repeat plays a more subtle role than cancer genes, such as the breast cancer gene BRCA1. "BRCA1 initiates formation of tumors," Kantoff says. In contrast, the CAG repeat, through its effect on the androgen receptor, may nudge the development of tumors that have already formed.
"So this is a promotional factor. It has something to do with stimulating the cancer to grow and in so doing, potentially causing further mutations which give rise to more aggressive forms," he says.
Yet the short CAG repeat is not the only culprit. "This is not the answer. This is not the sole reason that people develop aggressive prostate cancer. It probably accounts for a goodly amount of it in a population sense," says Kantoff.
It's still not clear how the new findings will affect patients. "Somebody walks in the door with prostate cancer-how do we use this information to make a clinical decision? I don't know. Nobody knows yet," says Kantoff.
Yet the findings lead to intriguing speculation. A young man who does not have cancer but has the short repeat might be cautioned that he could face problems down the road. Or a man with cancer who has a long CAG repeat might be reassured that the virulent form is unlikely to develop. If a man is in a high risk group, a doctor might be able to intervene with androgen blocking drugs. Such interventions are likely to be years away, however, and the development of the CAG marker as a new screening device also faces several hurdles.
"It may turn out we have information already with PSAs [Prostate Specific Antigens] and biopsies," Kantoff says. He and his colleagues are currently conducting studies to see how effective existing methods of diagnosing prostate cancers are in predicting the development of prostate cancer. Such studies could reveal what may be added by the new CAG marker.
Meanwhile, the findings could potentially open many exciting avenues of inquiry. Androgen receptors are found in all cells and, through their interaction with male hormones, affect many behaviors. "There's a lot of implications here," Kantoff says.
-Misia Landau
Joseph Murray
Joseph Murray, HMS professor emeritus of surgery and the
recipient of the 1990 Nobel Prize in Medicine, is this
year's Class Day speaker. He is also chief emeritus of
plastic surgery at Children's Hospital and the Brigham and
Women's Hospital.
Murray, a graduate of the 1943B HMS class, performed the world's first human kidney transplant in 1954. The surgery, which took place at the former Peter Bent Brigham Hospital, involved two men who were identical twins. In 1959, Murray performed the first successful kidney allograft between brothers and, in 1962, was the first to successfully graft from the kidney of a cadaver.
Murray went on to help develop the first immunosuppressive drug, which made it possible for people to receive organ transplants from unrelated donors. It was for these accomplishments that he received the Nobel Prize in Medicine. Following his transplantation work, Murray devoted his career to correcting congenital facial deformities in children.
On May 24, Murray was honored at the unveiling of an exhibit at Brigham and Women's Hospital on the history of transplantation. The event marked the 40th anniversary of the surgery of one of Murray's patients, who is currently the world's longest-living transplant recipient.
Nedim Jaganjac, from Bosnia, and Ozren Tosic, from Serbia,
are both graduating students in the School of Public
Health's MPH program. They are this year's recipients of the
Albert Schweitzer Award, given annually to a graduate whose
past work and recent activities show a "reverence for life,"
exemplifying Albert Schweitzer's quest to "make my life my
argument." The Schweitzer Award is jointly sponsored by HSPH
and the Albert Schweitzer Fellowship. In the following
interview, the two men discuss with Focus their experience
in the war-ravaged region and their goals for improving
public health.
Focus: You were both doctors working in the former Yugoslavia before coming here. What kind of medical work were you doing?
NJ: I was a physician in emergency medicine the first five months of the war when it was the toughest in Sarajevo-when we had to reorganize emergency medical services from one type to another that was convenient to the war zone. We established more than a hundred small medical facilities. Then we had to deal with many other issues that were not usually our task-like funerals, like graveyards. Also, I was driving ambulances. I was injured twice. Once I got shot in the stomach, and the other time I hurt my knee. Eight of our colleagues were killed and many more injured while helping patients. That was April '92 to July '92. After that I was national officer for UNICEF in Bosnia dealing with health, nutrition and immunization for the whole country.
OT: In 1992 when war broke out, I had two jobs. One was working in neurology in University Clinic Hospital in Belgrade-I was on the other side of the frontline. There was no war in Serbia and I didn't feel the direct consequences of war, but there were certainly shortages of hospital materials-medicines, supplies. I was also running a private general medical clinic that I started in 1989. In 1993, I founded another company to help international humanitarian organizations to establish themselves in Serbian Montenegro and the part of Bosnia that was approachable.
Focus: You were both doing very valuable work. Why did you decide to leave and come to the Harvard School of Public Health?
OT: As the war started to unravel, and we kept receiving in the neurological department consequences of the war-people with half of their heads missing and still alive; people paralyzed-really difficult and serious neurological injuries, and also when I saw it was impossible to treat them because of the lack of material, I started to think about public health. All these shortfalls of the medical system started to surface as a result of economic shortages. Citizens, professionals from Yugoslavia, the public in general and some leaders perceived privatization and market economy as a panacea, a cure for everything. Being aware that it is not true but not being able to articulate it as well as I would wish to, I thought it would be best to go to the center of academic excellence that teaches those subjects.
NJ: We both somehow got oriented to public health issues because we wanted to help patients on a larger scale. You can do it up to a certain level if you don't have training. You can act upon your instincts and good faith and do something. But then you reach the stage when you have to really make some important decisions and when you want to push your work-without the tools it's quite impossible.
Focus: What are some of the lessons you've learned over the last year?
NJ: Yugoslavia is not the only part of the world in crisis. There are patterns-it's the same in the Middle East, in Somalia, in Rwanda. In these complex humanitarian emergencies, aid has strategic importance and is usually not in the hands of the people who know how to deal with it. The impact of the aid is sometimes even harmful. We need to redirect or reorganize the way that aid organizations are working and to utilize better the resources they're providing. And that's exactly what I want to work on.
OT: One of the lessons is we have to deal with what we have locally. I came here to change things. Now I see that yes, things should be changed, but you cannot change people. People are there-with their culture, with specific views, attitudes, with specific social, economic systems. What I've learned is how to make peace with what is there.
Focus: What are your plans?
OT: I'm going to Australia in August to work with the indigenous populations. I'm going to maintain my links with Serbia and Montenegro and the public health professionals there. My general medical clinic is still working as we speak now. So I definitely have bridges that I don't want to break.
NJ: I still want to maintain my contact with Bosnia. I'm going this week and will stay for a month. And then I'm moving to the Middle East where they have the same problems. I'll probably be working with UNICEF there. You see, understanding this pattern-what's going on in the global sense-I think can help Bosnia much more than being there, actually living in Sarajevo and trying to get something done from there. So helping one patient, then helping many under the siege on public health care, and now helping globally-that's the goal I'm trying to achieve.
Focus: Will you go back to the former Yugoslavia?
OT: It's not possible not to go back.
NJ: We have to.
-Misia Landau
The report, an effort to quantify teaching expectations and distribute them equitably, calls for basic science department faculty who receive some of their salary from HMS to teach in at least one core medical course each year. Full professors who receive most or all of their salary from HMS can be asked to teach medical students at least 200 hours per academic year. Those who do not receive compensation from HMS (generally hospital-based individuals) are expected to teach medical students up to 50 hours per year, if asked to do so.
Faculty in the clinical departments, including instructors, are expected to teach medical students at least 50 hours per academic year-full professors in these departments, at least 100 hours-if asked to do so. Basic scientists with faculty appointments in the hospital-based clinical departments are expected to contribute at least 50 hours of their time per academic year, again, if asked.
In all cases, the department head is responsible for deciding the relative contributions of different faculty, but the needs of medical students, as determined by the Council of Masters, must be met.
Other contributions, including teaching of predoctoral PhD students in the basic science departments and of residents and fellows in the clinical departments, may be used by department heads to temporarily offset obligations to medical student education. To compensate for faculty members who teach above the minimal level, it was recommended that clinical institutions establish a Medical Student Teaching Fund, contributed to by HMS and faculty compensation groups.
The Council approved a proposal for a Master of Medical Science degree in Clinical Investigation. The goal of the established two-year Clinical Investigator Training Program-a cooperative effort between the Beth Israel Hospital, the Harvard-MIT HST Division and Pfizer, Inc.-has been to train physicians from a variety of clinical disciplines in the techniques and processes utilized in patient-oriented research. The program's codirectors, Alan Moses and Robert Rubin, reported that a specific curriculum has been developed during the last five years that allows trainees to develop direct experience in the performance of clinical investigations, and, through didactic course work, provides them with a strong foundation in computational and statistical sciences, study design, biomedical ethics, principles of clinical pharmacology, in vitro and in vivo measurement techniques, and many aspects of the drug development process.
Gerald Fischbach and Nancy Oriol-cochairs of the Sub- committee on Public Service-and other Council members presented for consideration the Student Proposal on Community Service at HMS. The subcommittee endorsed several proposals from the student committee including the development of a one-hour orientation program for incoming students describing public service opportunities at HMS, and a resource book to be maintained by the Office of Enrichment.
The Council approved the seeking of funding for two student projects. The first will be an annual community service day similar in scope to Soma Weiss Day. At the suggestion of Dean Daniel Tosteson, it was agreed to call it Dean Robert Ebert Day. The second is a stipend program to defray costs, such as travel expenses, for student community service work. Dean Tosteson reported that some monies have been donated and identified to partially cover the first year costs for both programs. In addition, the Council agreed to refer to the Masters the student proposal for academic credit for scholarly endeavors in public service.
Finally, Council members expressed strong interest in developing a proposal regarding the role and importance of public service-and faculty participation in this service-within the academic mission of the school.
Eugene Braunwald (l) and Charles Hennekens celebrated the
establishment of the Braunwald chair at a recent ceremony at
HMS.
In recognition of his achievements in medical and clinical
research, Eugene Braunwald, longtime head of the Department
of Medicine at Brigham and Women's Hospital, was honored
with the dedication of the Eugene Braunwald Chair at HMS,
previously named after the 19th century epidemiologist John
Snow. Charles Hennekens, currently the John Snow Professor
of Medicine, will be the first incumbent of the Braunwald
Chair.
A special award was given to Mitchell Rabkin, professor of medicine and president of Beth Israel Hospital. Rabkin received an honorary S. Robert Stone Award for Teaching for thirty years of exemplary service to Harvard Medical School.
The following quotes have been selected from student and faculty nominations.
Orah Platt (above) and David Golan (below), recipients of the teaching awards from 2nd- and 1st-year students, respectively, receive their awards from Dean Tosteson.
"Dr. Cahalane encourages students' personal and professional development beyond the boundaries of clinical rotations. He recognizes students' strengths and provides constructive feedback of our weaknesses. Perhaps most importantly, Dr. Cahalane encourages students to assume the responsibility for their development as a life-long process. I will always attribute the beginning of my professional growth to my exposure to Dr. Cahalane."
I was anxious to pass out. Surgery, my first rotation, begins on July 1, and I was glad to have the opportunity to feel the gruesomeness of the situation before I entered the more pressured atmosphere of the wards. I wanted to be desensitized.
So I was somewhat disappointed when our surgery preceptor arranged for us to watch a nonsurgical drainage of a pelvic abscess and a fiberoptic endoscopy. Though the abscess drained approximately 500 ml of yellow-brown pus, it did not have quite the drama of an open incision.
After this initial disappointment, our preceptor took us to watch the reconstruction of a breast after a complete mastectomy. In the procedure, the rectus abdominis muscle is removed from the abdomen to be used as tissue for the new breast. When we entered the operating room, the woman's face was hidden behind a steel blue curtain. Her abdominal muscle had already been removed, and the deep, rectangular crater left behind was packed with gauze. The layers of fat, fascia and muscle were visible at the margins. Three surgeons were carefully dissecting off the top layer of skin from the tissue that used to be her right breast. The highly vascular subcutaneous tissue now exposed was sweating delicate rivulets of blood.
Upon hearing that we were medical students, the surgeon offered a brief explanation. "This is really an excellent procedure. You can see how healthy the tissue is," he said. He scraped his scalpel against the denuded chest wall and demonstrated the ample vascular supply by milking a few more drops of blood. "But as you can see, this is quite involved surgery. It's not for everyone."
The gore of medicine has always frightened me. I cringe at the thought of reducing dislocated joints, stitching bloody wounds, and dressing gangrenous toes. The NBC-TV show ER parades the blood and guts on prime time in trauma after trauma. After watching every Thursday, my parents and nonmedical friends tell me, "I could never do what you are doing!"
I, too, thought that this was the horror of medicine. Yet becoming desensitized to the physical realities of surgery does not seem quite the challenge I had anticipated. Over time, the horrifying becomes commonplace, the gruesome mundane. As another surgeon told us, "The surgery itself gets pretty boring after a while. It's the human interest in the patients that makes this job interesting."
But it also makes the job more difficult. In my first two years of medical experience, I have found that dealing with the emotional pain is an even greater challenge. The suffering elicits a visceral response in me, and it does not go away.
Every Monday morning, we find a list of patients posted according to diagnosis on a specified door. These patients have agreed to let us practice histories and physicals on them. I was choosing between two patients, and I noticed that the small bowel obstruction was in the room with a patient whom I had interviewed the previous week. So, instead, I took the pancreatic cancer in the next room. Still savoring the last moments of my weekend, I entered the room expecting to find an elderly, sickly man. But Mrs. W was a young, blond, 50-year-old woman. In January, she had been diagnosed with nonresectable pancreatic cancer, which carries a particularly dismal prognosis.
In taking her history, I learned that Mrs. W had two children. She worked in a shop in Connecticut. She had never drunk or smoked. She had no personal or family history of cancer. Except for a large incision spanning her abdomen from her navel to her sternum, she was perfectly normal on physical examination.
She was hoping to go home on Wednesday. I asked her if she had made any plans for when she returned home. She looked at me, and she cried. After a pause, she replied, "I'm just going home to wait and see how long I have."
Another patient I met through my hospice work was dying of cardiac failure, and his lungs were filled with fluid. He sat bolt upright in his bed so the liquid would pool at the bottom of his lungs, leaving his apices clear for breathing. In the last hours of his life, his nurse said he was breathing so rapidly, trying to get the oxygen into his fluid-filled lungs, that he could no longer speak. And as he sat dying, tears were running down his cheeks. He was not yet ready to leave life.
After one of my Patient-Doctor sessions, I was walking through a dimly lit linoleum hallway in the deep recesses of the hospital, and I nearly bumped into a gurney sitting there. As I looked back, I noticed an older man lying in the temporary bed, patiently waiting his turn for a procedure. I found myself wondering what I was doing in the hospital. How could I have chosen this? I expected the gruesomeness of medicine. But I didn't anticipate the pain.
Yet I know I will survive the pain, and I know it will be hard. But even in my short experience, I have seen the beauty that exists in the relationships I form with my patients. The dehumanization of disease forges a powerful connection between patient and caregiver. And I feel honored to share the lives of my patients so intimately and deeply.
Editor's Note: Ellen Rothman is finishing her second year at HMS. Her column, "On Becoming a Doctor," appears in every other issue of Focus.
Her May 29 talk, "Issues of Importance for the Art of Medicine," addressed the future of health care from the perspective of the minority practitioner. Novello, a pediatrician with a master's in public health, was the first Hispanic and first woman ever to become surgeon general, a position she held from 1990 to 1993.
She said the field of health care is at a crossroads due to changes in disease patterns, demography, and politics. To invigorate the U.S. system, medical care must become more comprehensive and family-centered. Care should be "affordable, available, accessible, accountable, and affable."
"You must address the needs of the community," she said, "and in order to do that you must communicate!"
Novello challenged her listeners to be literate in both the language and culture of the patients they serve, a difficult task in the Latino community since it is composed of those whose lineage may be Cuban, Mexican, Puerto Rican, Central American, or unknown.
Since medicine is practiced in the context of society, effective communication is necessary for quality care. Without a close, ongoing relationship with the community, doctors will become less capable of serving their patients, particularly as minority populations become the majority.
Communication also promotes access and prevention, she said, though the benefits of prevention must be "sold" to the minority community.
In the crosscurrents of debate on health care reform, the image of medicine that has surfaced is one of self- interest. Novello urged doctors to take back control of medical practice by representing the communities they serve. "If we do not speak for our patients as an extension of ourselves, others will."
Among the other critical challenges Novello named were the suffering of children, violence, and AIDS. Doctors "are on the front line," she said, so they must not fail to see, hear, and understand these problems.
The physician and public servant capped her lecture with a fitting commandment: "Thou shalt not be a bystander."
The A. Clifford Barger Hinton-Wright Lecture takes its name from Dr. A. Clifford Barger and the Hinton-Wright Society. Barger, who died last March, was a cherished member of the Harvard community and was instrumental in obtaining support for the Hinton-Wright Society. The Society, an HMS research forum for minority students, is named after two distinguished minority alumni, Drs. William Hinton and Louis Wright. Novello's talk was the first in this annual series, which features a minority leader in the health professions.
-Robert Neal
Key to Institutions:
BBRI-Boston Biomedical Rsrch. Inst.
BIH-Beth Israel Hosp.
BWH-Brigham & Women's Hosp.
B/WRVA-Brockton/W. Roxbury Veterans Administration
CBR-Center for Blood Research
CH-Cambridge Hosp.
CHMC-Children's Hosp.
DFCI-Dana Farber Cancer Inst.
DH-Deaconess Hosp.
FDC-Forsyth Dental Ctr.
HMS-Harvard Medical School
HSPH-Harvard School of Public Health
JBCC-Judge Baker Children's Ctr.
JDC-Joslin Diabetes Ctr.
MAH-Mt. Auburn Hosp.
MEEI-Mass. Eye & Ear Infirmary
MGH-Mass. General Hosp.
MH-McLean Hosp.
MMHC-Mass. Mental Health Ctr.
SERI-Schepens Eye Research Inst.
SRH-Spaulding Rehab. Hosp.
WEDNESDAY,
JUNE 12
Countway Workshops
Wed., June 12, 11 am, Art of Searching the Web
Thurs., June 13, 11 am, Gopher
Tues., June 18, 10 am, Countway Plus
Wed., June 19, 5 pm, World Wide Web
Thurs., June 20, Noon, HOLLIS
For location and to register, call 432-2134.
Anesthesia Grand Rounds
Marc Roberts, HSPH
The Future of Unmanaged Competition Toward Virtual
Integration
7 am, Sherman Aud., BIH
Anesthesia Grand Rounds
Karen Sickenger, BWH
High Risk Pregnancy
7 am, CWN L1 Anesthesia Lecture Hall, BWH
Orthopedic Surgery Shoulder Rounds
Robert Leffert, MGH
Case Presentations
7:30-8:30 am, Clinics 1, Lower Amp., MGH
Anesthesia Clinical Conf.
Stanton Shernan, BWH
Problem-Based Learning Discussion Sessions
8 am, CWN L1 Anesthesia Lecture Hall, BWH
Neurosurgical Grand Rounds
Howard Blume, BIH
Temporal Lobectomy for Epilepsy
8 am, Carnegie Rm., BWH
Surgical Grand Rounds
Thomas Thornhill, NE Baptist Hosp.
Biologic Response to Orthopedic Implants
8 am, Joslin Aud., DH
Academic Teaching Conf.
Deborah Belle, Boston Univ.
Family Strategies for Coping with Poverty
9-10 am, 4th Fl. Aud., JBCC
Pediatric Practice Seminar
Corinne Ertel, Weston Pediatric Physicians & Robert Masland,
CHMC
The Fatigued Adolescent (An Exhaustive Review)
10 am-Noon, Enders Aud., CHMC
Psychiatry Grand Rounds
Jeffrey Weilburg & William Falk, MGH
Managed Care, Medical Necessity and MGH Psychiatry
11 am-Noon, Blake Bldg., Aud., MGH
Medical Grand Rounds
Kenneth Bauer, WR/BVA
The Hypercoagulable State-New Developments in Thrombosis and
Anticoagulation
Noon, Bldg. 1 Aud.,
WRVA
Medical Grand Rounds
John Fletcher, Univ. of Virginia Med. Ctr.
Anencephalic Infants as Sources of Organs
Noon-1 pm, Enders Bldg., Aud., CHMC
Engineering in Medicine Lecture
Michael Shuler, Cornell Univ.
Towards a Surrogate Animal System for In Vitro Toxicology
3:30-5 pm, Wellman Conf. Rm., MGH
Psychiatry Senior Seminar
Anna Holmgren, MGH
Dreams-Do Neurologic and Psychoanalytic Models Conflict?
4-5 pm, Bulfinch Bldg., Hackett Conf. Rm., MGH
THURSDAY, JUNE 13
Anesthesia Lecture
Robert Rubin, MGH
Principles of Antimicrobial Therapy in the Critically Ill
8 am, Clinics 3, Upper Amp., MGH
Medical Grand Rounds
Ik Kyung Jang, MGH
Thrombolysis and Primary Angioplasty for Acute Myocardial
Infarction
8-9 am, Blake Bldg., Aud., MGH
Medical Grand Rounds
Jonathan Edlow, MAH
Tick Bites
8:15 am, Hurwitz Aud., MAH
Ob/Gyn Grand Rounds
Benjamin Sachs, BIH
New Medical Technology SDA & Clinical Practices
8:30 am, Vincent 2, Meigs Conf. Rm., MGH
Dental Medicine Joint Seminar
Lorne Golub, SUNY Stony Brook
Tetracyclines and Their Analogs Inhibit
Collagenolysis-Dental and Medical Therapeutic Implications
Noon, Haigh Aud., FDC
Psychopharmacology Grand Rounds
Alec Bodkin, MH
Treating Negative Symptoms
Noon-1 pm, de Marneffe 132, MH
Katherine Swan Ginsburg
Memorial Lecture
Matthew Liang, BWH
Being Close or Distant-Dealing
With Human Tragedies
5 pm, Sherman Aud., BIH
Cardiovascular Grand Rounds
Bertram Pitt, Univ. of Michigan Med. Ctr.
Future Opportunities for the Renin-Angiotensin System in
Cardiovascular Disease
3-4 pm, Duncan Reid Conf. Rm., BWH
Skull Base Center Tumor Conference
Michael Joseph, MEEI & Norbert Liebsch, MGH
Case Presentations
6-7 pm, Cox 2, ORR Conf. Rm., MGH
FRIDAY, JUNE 14
Cerebrovascular Conference
Christopher Ogilvy & In Sup Choi, MGH
Case Presentations
7-9 am, Gray 2 Reading Rm., MGH
Hematology/Oncology Grand Rounds
John Lindenbaum, Columbia Univ.
Why Bread is Not Red-Changing Concepts of Cobalamin
Deficiency
8-9 am, Trustman Board Rm., BIH
Spaulding Grand Rounds
Hans Carlson, SRH
Snapping Scapula Syndrome
11 am, Conf. Rms. 8A&B, SRH
Medical Grand Rounds
Daniel Podolsky, MGH
Inflammatory Bowel Disease-Bedside to Bench and Back Again
Noon, Bornstein Amp., BWH
Bunting Institute
Book Signing
Karen Fraser Wyche, Bunting Institute Fellow (1994-1995) and
Faye Crosby will sign copies of their book Women's
Ethnicities: Journeys Through Psychology
Friday, June 14, 4:30-6:30 pm
Bunting Inst., Radcliffe College
34 Concord Ave., Cambridge
For more information, call 495-8212.
SATURDAY, JUNE 15
Surgical Grand Rounds
Rosemary Duda, BIH
Management of Malignant Melanoma
9-10 am, Riesman Lecture Hall, BIH
MONDAY, JUNE 17
Retina Service Conference
Michael Tolentino, MEEI
Ocular Neovascularization-The VEGF Story
8-9 am, 3rd Fl., Sloane Teaching Rm., MEEI
Cardiovascular Research Seminar
Greg Elgar, Addenbrookes Hosp., UK
Comparative Genomics with the Pufferfish (Fugo)-Past Issues
and Future Directions
12:15 pm, CRC, Lecture Hall Rm. 4501, MGH-East
Neuroscience Seminar
John Flanagan, HMS
EPH Ligands and Receptors as Positional Labels in Neural Map
Development
4 pm, Enders Bldg., Byers Conf. Rm., CHMC
TUESDAY, JUNE 18
Ob/Gyn Grand Rounds
Silvia Testa, MAH
Intracranial Hemorrhage in the Term Newborn
8-9 am, Parsons Bldg., 1st Fl., Ob/Gyn Conf. Rm., MAH
Primary Care Seminar
Howard Libman, BIH
Ambulatory Management of HIV Infection
8-9 am, Riesman Aud., BIH
Conference on Addictions
Rogelio Bayog, BVA
Case Conference on Intimacy Issues
9:30-11 am, Bldg. 2, Ward 2-1-C Day Rm., BVA
Psychopharmacology Conference
Agnes Suarez, BVA
Literature Presentation
11 am-12:30 pm, Bldg. 2 LRC, BVA
Neuro-Oncology Conference
Griff Harsh, Fred Hochberg & Allan Thornton, MGH
Case Presentations
11:30 am-1 pm, 3rd Fl., Sloane Teaching Rm., MEEI
Division on Aging Seminar
Dorina Abdulah, HMS
Apo E Polymorphisms, Aging and Disease
3:30-4:30 pm, Yamins 4 Conf. Rm., BIH
Neuroscience Seminar
Xandra Breakefield, MGH
Gene Therapy for Brain Tumors Using Virus Vectors
4 pm, de Marneffe 132, MH
Division on Aging Seminar
Robert Llewellyn-Jones, Hornsby Ku-Ring-Gai Hosp., Australia
Depression in the Elderly-A Model of Management
4:30-5:30 pm, Yamins 4 Conf. Rm., BIH
WEDNESDAY, JUNE 19
Anesthesia Grand Rounds
Patrick Vidaver, BWH
Fetal Disposition of Drugs
7 am, CWN L1, Anesthesia Lecture Hall, BWH
Anesthesia Grand Rounds
A.I.J. Brain, Royal Berkshire Hosp., England
The LMA and Related Species
7 am, Sherman Aud., BIH
Orthopedic Surgery Shoulder Rounds
Robert Leffert, MGH
Case Presentations
7:30-8:30 am, Clinics 1, Lower Amp., MGH
Anesthesia Clinical Conference
William Camann, BWH
Spinal "Jeopardy!"
8 am, CWN L1, Anesthesia Lecture Hall, BWH
Neurosurgical Grand Rounds
Simcha Weller, BWH & David Frim, CHMC
Neurosurgical Service Review-1996
8 am, Carnegie Rm., BWH
Surgical Grand Rounds
Susan Briggs, MGH
Challenges of Disaster-Medical Response in the 90's
8 am, Joslin Aud., DH
Medical Grand Rounds
Gregory Priebe & Lauren Smith, CHMC
Cases From the Wards
Noon-1 pm, Enders Aud., CHMC
Alzheimer's Support Group
Andrew Satlin, MH
New Treatments for Alzheimer's Disease
June 19, 3-4:30 pm
de Marneffe 132, MH
This new support group will meet the third Wednesday of
every month. For more information, call 855-3600.
Psychiatry Seminar
Richard Lane, Univ. of Arizona Health Science Ctr., Tucson
Functional Brain Imaging During Induced Emotion
3:30-5 pm, Palmer-Baker Span 4 Conf. Rm., DH
Biomedical Research Institute Seminar
Alan Hollister, Univ. of Colorado Health Science Ctr.
Therapeutic Potential of Atrial Natriuretic Factor (ANF)
4 pm, 2nd Fl. Conf. Rm., BBRI
THURSDAY, JUNE 20
Anesthesia Lecture
Simon Body, BWH
Advances in Thoracic Anesthesia
8 am, Clinics 3, Upper Amp., MGH
Joint Nuclear Medicine Seminar
P.V. Prasad, BIH
Towards Comprehensive Evaluation of Renal Artery Stenosis by
MRI
8 am, Bleibtrieu Rm., DFCI
Medical Grand Rounds
Thomas Ryan, Boston Univ. Med. Ctr.
Approach to Management of Myocardial Infarction
8:15 am, Hurwitz Aud., MAH
Blood Research Special Seminar
Alex Law, Univ. of Oxford, UK
The Role of the Cysteine-Rich Region of the Integrin Beta 2
Subunit in Heterodimer Formation of LFA-1 and Binding to
ICAM-1
Noon, Latham Lib., CBR, 200 Longwood Ave.
Dental Medicine Joint Seminar
Mary Russell, HMS
Known and Novel Macrophage Activation Effectors in
Transplant Arteriosclerosis
Noon, Haigh Aud., FDC
VA Research Seminar
Michael Mendelsohn, NE Med. Ctr.
Estrogen and the Blood Vessel Wall
Noon, Orea Bldg., Bignami Conf. Rm. 2B100, WRVA
Psychopharmacology Grand Rounds
Alan Green, HMS
An Expanded Role for Clozapine?
Noon-1 pm, de Marneffe 132, MH
Cardiovascular Grand Rounds
Oglesby Paul, HMS
Doctors and Their Lives
3-4 pm, Duncan Reid Conf. Rm., BWH
FRIDAY, JUNE 21
Cerebrovascular Conference
Christopher Ogilvy & In Sup Choi, MGH
Case Presentations
7-9 am, Gray 2 Reading Rm., MGH
Hematology/Oncology Grand Rounds
Tamar Barlam, BIH
Rational Antibiotic Choices for Febrile Neutropenic Patients
8-9 am, Trustman Board Rm., BIH
Spaulding Grand Rounds
Robert Krug, SRH
Team Physician Evaluation of Head Injury and Cervical Spine
Injury
11 am, Conf. Rms., 8A&B, SRH
Gene Expression Seminar
Joseph Reese, HHMI
Identification and Analysis of Yeast TATA-Box Binding
Protein Associated Factors (TAFs)
11 am, Bldg. C, Cannon Rm., HMS
Academic Conference
Nancy Andreasen, Univ. of Iowa College of Med.
Brain Imaging and Positive and Negative Symptoms in
Schizophrenia
11 am-Noon, Pierce Hall, MH
Skin Disease Research Center Lecture
Madeleine Duvic, Univ. of Texas Houston Health Science Ctr.
A Translational Research Approach to Psoriasis
Noon-1 pm, CWN L1, Anesthesia Lecture Hall, BWH
MONDAY, JUNE 24
Medical Grand Rounds
Peter Banks, BWH
Pancreatic Disease
Noon, Main Bldg. Lecture Hall, CH
Cardiovascular Research Center Seminar
H. Joseph Yost, Univ. of Minnesota Med. School
Biological Asymmetry-What's down right left up?
12:15 pm, CRC Lecture Hall, Rm. 4501, MGH-East
TUESDAY, JUNE 25
Primary Care Seminar
David Chapin, BIH
Chronic Pelvic Pain
8-9 am, Riesman Aud., BIH
Conference on Addictions
Rogelio Bayog, BVA
Clinical Pathways in Substance Abuse Treatment
9:30-11 am, Bldg. 2, Ward 2-1-C Day Rm., BVA
Neuro-Oncology Conference
Griff Harsh, Fred Hochberg & Allan Thornton, MGH
Case Presentations
11:30 am-1 pm, 3rd Fl., Sloane Teaching Rm., MEEI
Division on Aging
Second-Year HMS Fellows Research Forum
Speakers:
Gohar Azhar, Elisabeth Broderick, Shelley de la Vega,
Jonathan Flacker, Mangadhara Madineedi
Tues., June 25, 3:30-5:30 pm
Yamins 4 Conf. Rm., BIH
Neuroscience Seminar
Florence Lai, E.K. Shriver Center for Mental Retardation
Clinicopathologic Aspects of Alzheimer's Disease and Down
Syndrome
4 pm, de Marneffe 132, MH
