Health Sciences Report (1993)

HealthSciences Report CANCER THE BATTLE OF both SEXES Winter 1993 John M. Matsen, M.D. NEW LEADERSHIP FOR HEALTH SCIENCES The Health Sciences Center welcomed a new vice president in January: John M. Matsen, M. D., professor and chair of the Depart-ment of Pathology in the School of Medicine. Matsen replaced Walter Stevens, Ph. D., who had been acting vice president for health sciences since September 1991, when William A. Gay, Jr., M. D., returned to the Department of Surgery after serving one year as vice president. Stevens, associate dean for research in the medical school and professor of anatomy, was named interim dean of the medical school. A Salt Lake City native, Matsen received his pre- medical educa-tion at Brigham Young University and the University of California at Los Angeles ( UCLA). He earned his medical degree from UCLA, where he also completed his internship and residency. Matsen completed a postdoctoral fellowship in infectious diseases and clinical microbiology at the University of Minnesota School of Medicine and was a postdoctoral trainee at the Clinical Microbiology Laboratories at the University of Washington. In 1968, he joined the faculty at University of Minnesota Hospitals and served as director of the Diagnostic Microbiology Laboratories. In October 1974, Matsen returned to Utah as professor of pathol-ogy and pediatrics in the School of Medicine, and became director of the Clinical Laboratories at University medical center. He also was named director of the Clinical Microbiology Laboratories at Univer-sity Hospital and at the Salt Lake Veterans Administration Medical Center. From 1978- 81, he was associate dean for academic affairs at the medical school. Matsen is past president of both the Academy of Clinical Lab-oratory Physicians and Scientists, and the National Association of Pathology Chairmen. He serves as chair of the Council on Education and Research of the American Society of Clinical Pathologists, and the executive council of the Association of Pathology Chairmen, a HEALTH SCIENCES REPORT UNIVERSITY OF UTAH Vol. 17, No. 1Published by the Community Relations Office, University of Utah Health Sciences Center, 50 North Medical Drive, Salt Lake City, Utah 84132. Telephone ( 801) 581- 7387. Health Sciences Report is mailed to faculty, staff, alumni and friends of the University of Utah School of Medicine; to the staffs of University Hospital and Spencer S. Eccles Health Sciences Library; and to the faculties of the colleges of Pharmacy, Nursing and Health. Articles may be reprinted with permission. Editor: Susan Sample Editorial Consultant: Anne Brillinger Contributing Writers: Anne Brillinger, Mary Chachas, John Dwan Photographer: Brad Nelson, Medical Illustration Service This issue of Health Sciences Report is printed on recycled paper as part of a major recycling campaign at the University of Utah Medical Center. f t t J HEALTH SCIENCES REPORT Headlines 2 People 7 Cancer: The Battle of Both Sexes 9 Prostate Cancer 10 Its potential to spread, not to impair sexual potency, should be the primary focus of treat-ment, says Utah's only urologic oncologist. Breast Cancer 16 More treatment options are available, but they still pose tough dilemmas for physicians and patients. Women's Health: What We Don't Know Hurts Us 22 Neglected in many areas of life, women finally are becoming the focus of medical research in Utah and the nation. From the Bookshelf 26 A panel of University specialists reviews four bestselling drug reference books that you may want to include in your personal library. Research in Brief 27 Gift of Health 30 Contributions provide endowed chairs, student scholarships and medical research. Opinion 32 The debate continues: should the availability of lifesaving procedures, such as organ trans-plants, be based upon one's ability to pay? HEADLINES NATIONAL CANCER INSTITUTE TAPS U MEDICAL SCHOOL FOR MASSIVE CANCER SCREENING RESEARCH The University of Utah School of Medicine was one of 12 institutions nationwide selected last October by the National Cancer Institute to conduct clinical research for the Prostate, Lung, Colorectal and Ovarian Cancer Trial. Saundra S. Buys, M. D., associate professor of internal medicine at the med-ical school, is principal investigator for the 16- year, $ 4.9- million study at the U. " The goal of the study is to determine whether screening actually reduces mortality in these types of cancers," said Buys. " The question is: where should research money go? With few exceptions, research on advanced cancer- which gets much of the funding- hasn't gotten far in saving lives. The answer seems to lie in preventing cancer, or at least detecting it early enough to cure patients." Lung and colorectal cancers are among the most common cancers in Ameri-can men and women. Together, they account for about 46 percent of cancer deaths in men and 34 percent of cancer deaths in women. In men, prostate can-cer accounts for about 11 percent of cancer deaths. In women, ovarian cancer accounts for about 5 percent of cancer deaths. The randomized testing- screening for some and routine care for others- will involve 150,000 individuals nationwide. Locally, Buys will recruit 6,000 men and 6,000 women this spring for the study. The screenings will continue for four years, and participants, who must be between the ages of 60 and 74 when the study starts, will be followed for a total of 10 years. Screening procedures will include yearly rectal exams and the PSA blood test for prostate cancer; annual chest X- ray for lung cancer; sigmoidoscopy the first and fourth years for colorectal cancer; and pelvic exams, trans- vaginal ultrasound and the CA- 125 blood test for ovarian cancer, e NIH AWARDS ANATOMY RESEARCHERS $ 1.6 MILLION Two anatomy professors in the School of Medicine were awarded a five-year, $ 1.6- million grant last June from the National Institutes of Health to study the neural tube defect commonly called spina bifida. Gary C. Schoenwolf, Ph. D., and Richard J. Mullen, Ph. D., are among four teams selected nationwide as part of a cooperative program to study an animal model of the birth defect, which affects approximately one to two newborns per 1,000 live births nationally. In Utah, 35- 40 children annually are born with spina bifida. The defect occurs when the neural tube, the precursor to the spinal cord, doesn't close ( usually at the lower end of the spinal cord) during embryonic development. Primarily, this causes motor defects, such as lower limb paraly-sis and loss of bowel and bladder control, but it also can be associated with hydrocephalus, an accumulation of fluid within the brain; Arnold- Chiari mal-formation ( a compression of the brain); infection; and respiratory problems. The Utah scientists will study mutant mice with a defect virtually identical to that found in humans. They will attempt to determine what goes wrong during the formation of the neural tube, the neurological consequences of the open neural tube and how other genes might affect the disorder. Other schools participating in the cooperative program are Duke Univer-sity, the University of North Carolina at Chapel Hill and Harvard Medical School, B GENE FOR MALIGNANT MELANOMA LOCALIZED BY U INVESTIGATORS Researchers at University of Utah Medical Center localized a gene be-lieved responsible for an increased risk of inherited melanoma, a frequently fatal form of skin cancer that affects one in 100 American Caucasians in their lifetime. Reporting in the Nov. 13,1992, issue of Science, the investigators mapped the gene to a small region on chromosome nine, believed to contain a causal factor in invasive cutaneous malignant mela-noma. The genetic breakthrough is a prod-uct of seven years of collaboration be-tween genetic epidemiologists and der-matologists at the medical school. The study was funded by a National Insti-tutes of Health program grant to map common cancers and a career develop-ment grant from the Veterans Adminis-tration to dermatologist Laurence J. Meyer, M. D., Ph. D., assistant professor of internal medicine. Lead author on the Science article was Lisa Cannon- Albright, Ph. D., research assistant pro-fessor of internal medicine in the Divi-sion of Hematology/ Oncology. Meyer and John J. Zone, M. D., pro-fessor of internal medicine and chief of the Division of Dermatology, began planning the study seven years ago with Mark H. Skolnick, Ph. D., profes-sor of medical informatics and founder of the Utah group that specializes in the genetic epidemiology of cancer. The basic scientists and clinicians teamed up to study 10 extended fami-lies in Utah and one in Texas, analyzing DNA extracted from blood samples and, sometimes, pathologic tissue spec-imens. They found 82 cases of mela-noma. The youngest patient diagnosed was 12 years old; the oldest, 93. Still to be investigated is a sugges-tion in the scientific community that a second gene also may contribute to pre-disposition to melanoma. Issues such as the influence of gender, age and sun exposure also merit ongoing study. The Utah results will need to be rep-licated, but " we have turned a major corner" in our understanding of the 32,000 cases of melanoma anticipated in the United States in 1992, one quar- ter of which will result in death, unlike the less lethal basal cell and squamous cell forms of skin cancer, said Meyer. In addition to Cannon- Albright, Meyer, Zone and Skolnick, other Utah contributors to the study include David Goldgar, Ph. D., associate professor of medical informatics; Cathryn Lewis, Ph. D., research instructor of medical informatics; and Michael W. Piepkorn, M. D., Ph. D., formerly a dermatopathol-ogist at the medical school. Additional authors include research-ers from the University of Texas' M. D. Anderson Cancer Center, University of Chicago, Massachusetts Institute of Technology, Harvard and Yale uni-versities, and the National Institute of Environmental Health Sciences. E SCIENTISTS REPORT DECORIN MAY PREVENT PROGRESSION OF KIDNEY DISEASE Decorin, a natural human proteogly-can, may prove highly effective in pre-venting progression of kidney disease, the second most costly illness in the United States, according to a study pub-lished in the Nov. 26,1992, issue of the international scientific journal Nature. In a collaborative research effort among the University of Utah, the La Jolla Cancer Research Foundation and Telios Pharmaceuticals, decorin was found to prevent scarring in kid-ney disease in animals, indicating that decorin may be capable of preventing kidney scarring in humans, the leading cause of kidney failure. If that proves true, decorin could preserve kidney function in diseases such as glomerulonephritis and dia-betic kidney disease, and may be effec-tive in other organs being destroyed by pathological scarring. This finding follows earlier research conducted by the same collaborators, as reported in a 1990 issue of Nature, showing that excessive production of transforming factor beta ( TGF- P) was the cause of extracellular matrix accu-mulation, or scarring, in kidney disease. " We have been searching for a safe way to block or reduce the action of TGF- P in the human body," said Wayne A. Border, M. D., professor and chief of the Division of Nephrology. " Previ-ously, we discovered that antibodies to TGF- P can reduce the production of extracellular matrix in animals. But antibodies may not be suitable for human use because of the possibility of an allergic reaction." TGF- P stimulates the production of the glue- like material called extra-cellular matrix, a fibrous meshwork that supports cells and allows tissues to regenerate. Excess TGF- P in the kid-neys can cause abnormally high accu-mulation of extracellular matrix in the glomeruli- the kidney's tiny filtering units- causing the filtering apparatus to clog and the kidneys to fail. Excessive production of TGF- P also may cause pathological scarring of the skin, central nervous system, lungs, liver, cardiovas-cular system and other organs. In addition to Border, the research collaboration included teams at the La Jolla Cancer Research Foundation, headed by Erkki Ruoslahti, M. D., and at San Diego- based Telios Pharmaceuti-cals, led by Michael D. Pierschbacher, Ph. D., and John Harper, Ph. D. Funding was provided to Border through a grant from the National Institute of Diabetes and Digestive and Kidney Diseases, E PHARMACEUTICS RESEARCH PROVIDES NOVEL METHOD TO ASSESS DRUG DELIVERY EFFECTIVENESS Scientists in the Department of Pharmaceutics in the College of Phar-macy measured for the first time last fall the flux, or rate of diffusion, of a drug delivered through the skin and related it to its effectiveness in topical drug therapy. William I. Higuchi, Ph. D., distin-guished professor and chair of the pharmaceutics department, supervised the work, which was reported in the August 1992 issue of Pharmaceutical Re-search, published by the American Asso-ciation of Pharmaceutical Scientists. The research offers an excellent way to screen new antiviral agents, accord-ing to Higuchi. Acyclovir ( ACV) was used in the study, but the research could be applied to medications to treat psoriasis and perhaps even acne as well as canker sores inside the cheek, he said. In addition to establishing a system-atic approach to understanding the general relationship between antiviral drug flux and efficacy, a second goal of the scientists was to study the particu-lar problem of herpes simplex disease of the skin. For the study, investigators inocu-lated hairless mice with herpes simplex virus type 1. Within a few days, a lesion formed extending from the inoculation site. Therapeutic amounts of ACV were administered in the area of the lesion, but at some distance from the inoculation site, through specially designed patches that allowed a con-stant flux of the drug through the skin. Patches contained varying amounts of the drug to determine the most effec-tive dose. After five days of treatment, efficacy assessments measured the antiviral ac-tivity of ACV delivered directly to the skin covered by a patch and measured the drug's effectiveness delivered from the patches via systemic circulation to the bottom layer of the epidermis, where the herpes virus proliferates. The dosage was deemed topically effective if the lesion stopped at the patch. Systemic effectiveness was as-sessed in instances where lesions did not appear at all or extended just a short distance beyond inoculation. Assessment of systemic effective-ness showed that ACV flux had to be 10 times greater to provide efficacy equal to the topical efficacy results. The next step in the research will be to study the efficacy of antiviral drugs used in creams and ointments. Higuchi, a member of the University of Utah faculty since 1982 and recipient of many professional honors, has pio-neered work in drug release and drug delivery problems. The numerous basic principles he has elucidated serve as the foundation for much of the current research in drug delivery in pharma-ceutical laboratories throughout the world, E SCULPTURE GARDEN- New landscaping and sitting walls, in addition to several sculptures, were added to the Browning Plaza last fall, inviting students, faculty and staff to relax near the southeast corner of the School of Medicine building. CONSTRUCTION UPDATE FOR HEALTH SCIENCES CENTER As a new revolving door opened into University of Utah Hospital last October, ground was broken for an ad-dition to the MRI ( Magnetic Resonance Imaging) Center. A new credit union office also opened at the medical center, while plans were approved by the University's Board of Trustees for an expansion to the hospital. The new automatically revolving door not only makes the hospital lobby more inviting, but also helps lower winter heating bills and reduces noise from outside, according to Dale Gunnell, interim chief operating officer. To accommodate the demand for another MRI machine, construction began last December on a 5,000- square-foot addition to the MRI Center, located east of the medical center near the walk-in emergency entrance. The project, estimated at $ 1.3 million, is expected to be completed in late spring, said John McNary, campus planning project coor-dinator and medical center liaison. Since last Oct. 5, University employ-ees have had better access to the Uni-versity Credit Union with the opening of a new medical center branch. Locat-ed on the northwest side of the School of Medicine building, the office pro-vides the same services found at other credit union branches. This winter, the State Legislature will consider a proposal for the West Patient Services Building, a four- to- five-story expansion to University Hospital. The project has been approved by the hospital board and the Board of Trustees. The University Board of Regents approved the project " in con-cept": if the Legislature approves the proposal, the regents will review it again after detailed plans for the build-ing's size, location, uses and impact on traffic and parking have been drafted. The 250,000- square- foot building would be built in the parking lot west of the hospital and south of Primary Children's Medical Center. The esti-mated $ 40- million project includes a 400- to 600- space parking terrace. The proposed building will be used primarily for outpatient care, which is increasing about 12 percent a year, according to Gunnell. It will be funded by the medical center departments and agencies that will occupy the facility. Construction will take an estimated three years. Progress continues on two other health sciences construction projects. The five- story John A. Moran Eye Center that is being built on the hillside just northeast of University Hospital is expected to be completed in late spring, according to McNary. Construction of the new Biomedical Polymers Research Facility, located south of the George and Dolores Eccles Institute of Human Genetics, should be completed late next year, he said, E NATIONAL JOURNAL FEATURES HOSPITAL TRAINING PROGRAM University of Utah Hospital's Multidisciplinary Apprentice Program ( MAP) was highlighted last summer in Hospitals, the national journal of the American Hospital Association. MAP is part of the hospital's Pro-gram to Improve Patient Care, one of 20 national projects funded by The Robert Wood Johnson Foundation and Pew Charitable Trusts. The program is intended " to provide a versatile, cross-trained health- care worker, who even-tually will become a health profes-sional," according to Kay Har, Ed. D., R. N., project facilitator. The project targets minorities, workers over 40, recent high school graduates, displaced homemakers and dislocated workers. Registered nurses serve as " care partners," supervising and teaching the apprentices on a one-to- one basis. MAP participants may pursue careers in nursing, pharmacy, physical therapy, respiratory therapy or radiologic technology. With MAP participants helping provide " the extra touch" in patient care, nurses have more time for patient education and other aspects of care, E STUDY LINKS HIP FRACTURES, FLUORIDATED WATER A University of Utah study, pub-lished in The Journal of the American Medical Association, found that men older than 65 who live in a community with fluoridated water had a 47 percent increase in the rate of hip fractures, compared to individuals in similar communities without fluoride in the water. Elderly women in the community with fluoridated water suffered 21 percent more hip fractures, according to the study in the Aug. 11,1992, issue of the journal. Figures for men and women were adjusted for the effect of age, said Christa Danielson, M. D., assistant professor of family and pre-ventive medicine in the medical school and principal investigator in the study. Despite these findings, researchers are not urging communities to stop 4 fluoridating their water. " The overall amount of increase is small, and more studies need to be done to verify these findings," said Danielson. " For these reasons, we continue to advocate sup-plemental fluoride for the prevention of tooth decay, especially for children." The researchers identified hip frac-ture rates in people over 65 in three Utah communities: Logan and Cedar City, which do not fluoridate water; and Brigham City, which does. Hip fracture is a major public health problem, costing approximately $ 7 bil-lion a year in the United States. It is the second most common cause of admis-sion to nursing homes, accounting for about 60,000 admissions annually. It is believed that fluoride causes new bone formation of an inferior qual-ity, especially in the hip. Bone exposed to high concentrations of fluoride has less strength, according to Danielson. There also has been concern that one of the medical treatments for osteoporo-sis- oral ingestion of fluoride- may increase the risk of osteoporosis, a loss of bone mass that contributes to many fractures. E PARKS NAMED ANATOMY CHAIR Thomas N. Parks, Ph. D., was named chair of the Department of Anatomy in the School of Medicine last October. He replaced acting chair Richard J. Mullen, Ph. D. A professor in the anatomy depart-ment and member of the Utah faculty since 1978, Parks also was named the first holder of the George and Lorna Winder Presidential Endowed Chair in Neuroscience and first head of the newly created neuroscience program at the medical school last fall. ( See story on pg. 31.) Parks received a bachelor's degree in biology from the University of California at Irvine and a doctorate in psychobiology at Yale University. His research focuses on developmental neurobiology, the neurobiology of the auditory system and the effects of invertebrate venoms on receptors and ion channels. B Wayne ]. Peay PEAY NAMED TO NATIONA