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- Chronic Fatigue Syndrome Electronic Newsletter
-
- --------------------------------------------------------------------
- No. 41 November 30, 1994 Washington DC
- --------------------------------------------------------------------
-
-
- FLORIDA: FURTHER REPORT /
- IFMEA MEDICAL UPDATE
-
- CONTENTS
-
- >>>1. Report on clinical sessions of Florida conference
- >>>2. I.F.M.E.A. Medical Update
- >>>3. Twins study expands
- >>>4. Networking News
-
-
- -------------------------------------------------------------------
-
- >>>1. Report on clinical sessions of Florida conference
-
- CFS-NEWS number 40 reported on the Florida CFS medical conference and
- emphasized what occurred at the research sessions. This article
- gives a report emphasizing the clinical sessions.
-
- Corrections
-
- In the previous edition's report there were two errors of fact.
- Regarding the speakers bureau for the AACFS (American Association for
- Chronic Fatigue Syndrome), the arrangement regarding speakers fees is
- that the fees that are received will be donated by the speaker to the
- AACFS. Also, the proceedings of only the clinical sessions will be
- published in the Journal of Chronic Fatigue Syndrome, whereas the
- proceedings for the research sessions will appear in another
- peer-reviewed journal.
-
- Treatments
-
- No treatments that were completely new were presented at the
- conference. Some additional light was shed on known treatments, and
- some methods of therapy were given more attention than they had
- received at other recent conferences.
-
- WARNING: General treatments discussed at the conference are reported
- in this article. Many of these treatments are inappropriate in many
- cases and might be harmful. The treatment reports that appear here
- should not be used as medical advice. It is imperative that anyone
- who has or thinks they have CFS should seek treatment from a licensed
- health care practitioner who is familiar with the illness. Also, in
- many instances the conference sessions did not have sufficient time
- to have a full discussion of all issues, therefore important
- disadvantages of various treatments may not have been fully explored.
-
- "Doctor to Doctor"
-
- In a session called "Doctor to Doctor", Drs. Nancy Klimas and
- Jonathan Rest led a general discussion among physician participants.
- Some common problems of CFS management that were discussed included
- collegial acceptance of the illness, and time consuming paperwork.
- Other points that were made included the need to make a diagnosis as
- being quite important for validation for the patient. This is
- important also for the patient's employer, for health insurance, for
- the family, and is particularly important for pediatric cases.
- Treatments that are typically used can be helpful in managing the
- sleep cycle, allergies, secondary infections, pain, fatigue,
- cognitive dysfunction, etc. From the physicians' point of view, it
- seems that a small number of CFS cases take up a larger portion of
- the physician's time, prompting stresses for the clinicians
- themselves. To some degree, managing CFS cases can be become
- volunteer work for the physician.
-
- Regarding treatments, Dr. Klimas recommended against multiple
- prescriptions for nervous system complaints, particularly the
- benzodiazepines such as klonopin. Klimas also said it was important
- to distinguish between those patients who are depressed and those who
- aren't.
-
- Klimas took an informal poll of the physicians present to see what
- methods of treatment they used for CFS management. [See also the
- physicians survey reported by Jonathan Rest in the "Alternative
- Therapies" section below.] Widely used treatments included SSRIs
- ("selective serotonin re-uptake inhibitors" such as Zoloft, Praxil
- and Prozac), low dose TCAs ("tricyclic anti-depressants" such as
- doxepin and amitriptyline), and NSAIDs ("non-steroidal anti-
- inflammatory drugs" such as ibuprofen and naproxen). SSRIs were the
- treatment of first choice, often followed by Wellbutrin. Virtually
- no physicians prescribed depression-level dosages of TCAs (but rather
- low dosages). Also, very few practitioners referred their patients
- to psychiatrists on a routine basis for treatment of depression, but
- rather most applied depression pharmacology directly to their
- patients. Other treatments used less often included intra-muscular
- gamma globulin, kutapressin, interferon, and intravenous gamma
- globulin.
-
- For specific symptoms, various treatments were discussed. Regarding
- fatigue, Dr. Mark Loveless recommended that various behavior
- modifications are quite important. A program of calorie management
- and predictable activities should be developed, which will have
- beneficial effects for the patient and the family as well. The
- importance of re-establishing a normal sleep pattern was discussed.
- Other comments included the usefulness of nutrition therapy,
- particularly B12 and magnesium, and hypnosis. Regarding sleep, there
- was a discussion of behavior modification again, in addition to
- comments on typical prescriptions of low-dose TCAs, avoidance of
- caffeine, and use of valerian root tea.
-
- Regarding pain management there were comments on the use of lidocaine
- gel, topical salicylates, acupuncture and acupressure, and nutrition
- therapy (high dose B vitamins, particularly B12, and iron and
- magnesium). Dr. Charles Lapp mentioned that for many patients hot
- baths often gave short term relief but made symptoms worse later.
- There was a wide discussion on the advantages and disadvantages of
- using narcotics for CFS pain management. There was a similar broad
- discussion on the pluses and minuses of using klonopin.
-
- Again, please note the physicians survey on treatments reported in
- the "Alternative Therapies" section below.
-
- "Ask the Experts"
-
- In a session called "Ask the Experts", a panel of physicians
- experienced in CFS management fielded questions from the audience.
- The panel was chaired by Dr. Anthony Komaroff and included Doctors
- Paul Cheney, Nancy Klimas, David Bell, Mark Loveless and James Jones.
-
- Dr. David Bell described the tragedy of children with CFIDS who may
- develop "identity confusion" while growing up, being unsure about the
- boundary between their personal abilities and the limits imposed by
- the illness. Bell was also asked to comment on an optimal cost-
- effective diagnostic work-up for insurance purposes. He said that a
- clinical work-up should be sufficient, and that other low-cost lab
- tests might include a sed rate, a complete blood count, baseline
- thyroid screen, and routine chemistries for liver function -- unless
- the clinical exam suggested other illnesses besides CFS should be
- considered. Bell said that others might argue for regularly testing
- for hepatitis, HIV, etc. On the other hand, Dr. James Jones stated
- that it has not been shown that a minimal work-up is adequate, and
- that in particular it will be important to consider tests for various
- auto-immune diseases, kidney disease, and others.
-
- For general treatment, Dr. Nancy Klimas recommended lifestyle
- changes, behavior modification and graduated exercise. She
- emphasized that these programs were underrated and yet quite
- important among available CFIDS treatments.
-
- Dr. Mark Loveless was asked whether CFS is contagious. He said there
- is no evidence to support that. Even though there are cases that
- exhibit infectious onset, that does not imply that there definitely
- is an infectious agent. Familial transfer seems unlikely, although
- this remains unproven. Dr. Loveless recommended that it would be
- prudent for CFS patients to refrain from donating blood.
-
- Dr. Klimas was asked whether CFS patients have an increased risk of
- getting cancer. She said that this is not known, and that we need
- longitudinal studies to address this question. The fact that there
- is NK cell dysfunction does give concern about this issue. There
- needs to be studies to measure health outcome issues generally for
- all auto-immune related illnesses. Klimas was also asked about
- endometriosis in CFS patients and she replied the observes this
- anecdotally. Dr. Komaroff commented that a formal study of his shows
- preliminary results that confirms this.
-
- Dr. Paul Cheney was asked about the general effectiveness of known
- CFIDS treatments and said that those who were moderately ill often
- responded better than those were more seriously ill. For central
- nervous system problems, Cheney recommended klonopin, calcium channel
- blockers, and magnesium. He also commented on the general
- therapeutic effects of hydrotherapy.
-
- Cheney was also asked about the value of intravenous gamma globulin
- (IVgG). He said that in his experience some patients have been
- helped by IVgG although these treatments are expensive and are
- usually not reimbursable by insurance. Cheney also said that
- intramuscular gammaglobulin (IMgG) is generally even less useful,
- except for those with recurrent infections of the upper respiratory
- system.
-
- Dr. James Jones commented that he often found in his region
- (Colorado) that many who reported CFIDS-like symptoms responded very
- well to sinusitus treatment, specifically a saline nasal wash.
-
- When the full panel was asked about the advisability of flu shots for
- CFIDS patients, three were in favor and two recommended against.
-
- "Alternative Therapies"
-
- Dr. Paul Levine moderated a panel on "Alternative Therapies". Dr.
- Howard Berman of the NIH Office of Alternative Medicine spoke about a
- recent study which showed a high of alternative therapies by patients
- in the USA. Dr. Wayne Jonas of Walter Reed Army Hospital discussed
- the difficulties in measuring the effectiveness of alternative
- therapies in tho
- scientific controls. Dr. John Renner of the Consumer Health
- Institute in Kansas City discussed the distinctions between folklore,
- quackery, unproven therapies and investigational therapies, and he
- recommended for those interested in herbalism that people read "The
- New Honest Herbal" by Tyler.
-
- Dr. Jonathan Rest presented a formal survey of physicians on what CFS
- treatments are commonly in use. The 16 respondents reported that
- common prescriptions were: selected serotonin re-uptake inhibitors
- (SSRIs, including Zoloft, Praxil and Prozac) used for fatigue,
- cognitive dysfunction and depression; tricyclic anti-depressants
- (TCAs, such as doxepin, amitriptyline) for sleep disorder, and muscle
- and joint pain; non-steroidal anti-inflammatory drugs (NSAIDs, such
- as ibuprofen and naproxen) for headache, and muscle and joint pain.
- Other treatments often prescribed were Klonopin, IMgG, nutritional
- supplements (particularly anti-oxidants, B-vitamins generally and
- B-12 specifically), herbs, and acupuncture. Less often prescribed
- were chiropractic therapy, IVgG, kutapressin, antivirals, interferon,
- and transfer factor.
-
-
- -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
-
- >>>2. I.F.M.E.A. Medical Update
-
- [CFS-NEWS regularly publishes lists of CFS medical citations from
- both I.F.M.E.A. and from the University of California at Irvine
- Science Library. The items shown in these lists will often overlap.]
-
- The International Federation of Myalgic Encephalomyelitis
- Associations (IFMEA) compiles a quarterly medical update which
- contains abstracts and reviews, written by medical professionals, of
- current research on CFS/CFIDS/ME. The full text of the Update is
- available from the national organizations listed at the end of this
- article.
-
- Special notice: I.F.M.E.A. is experiencing financial difficulties and
- is planning on closing down most of its functions in the coming year.
- The March 1995 Update is scheduled to be the last edition for the
- indefinite future. The following is a list of the publications which
- are summarized and reviewed in the most recent edition of the Update:
-
- IFMEA MEDICAL UPDATE Volume 6, number 3 1st September 1994
-
- IMMUNOLOGY/VIROLOGY
-
- Natelson, BH., Ye, N., Moul, DE., Jenkins, FJ., Oren, DA., Tapp, WN
- and Cheng, Y-C. High titres of anti-Epstein-Barr virus DNA
- polymerase are found in patients with severe fatiguing illness.
- Journal of Medical Virology, 1994, 42, 1, 42-46.
-
- NEUROLOGY\NUCLEAR MEDICINE
-
- Costa, DC., Gacinovic, S., Tannock, C and Brostoff, J. Brain stem
- SPET studies in normals, M.E./CFS and depression. Nuclear Medicine
- Communications, 1994, 15, 252-253.
-
- Natelson, BH., Cohen, JM., Brassloff, I and Lee, H-J. A controlled
- study of brain magnetic resonance imaging in patients with the
- chronic fatigue syndrome. Journal of the Neurological Sciences,
- 1993, 120, 2, 213-7.
-
- Schwartz, RB., Garada, BM., Komaroff, AL., Tice, HM., Gleit,
- M., Jolesz, FA and Holman, BL. Detection of intracranial
- abnormalities in patients with chronic fatigue syndrome: comparison
- of MR imaging and SPECT. American Journal of Roentgenology, 1994,
- 162, 4, 935-941.
-
- Schwartz, RB., Komaroff, AL., Garada, BM., Gleit, M., Doolittle,
- TH., Bates, DW., Vasile, RG and Holman, BL. SPECT imaging of the
- brain: comparison of findings in patients with chronic fatigue
- syndrome, AIDS dementia complex and major unipolar depression.
- American Journal of Roentgenology, 1994, 162, 4, 943-951.
-
- REVIEWS
-
- Wilson, A., Hickie, I., Lloyd, A and Wakefield, D. The treatment of
- chronic fatigue syndrome: science and speculation. American Journal
- of Medicine, 1994, 96, 544-550.
-
- MISCELLANEOUS
-
- Ambrogetti, A and Olsen, LG. Consideration of narcolepsy in the
- differential diagnosis of chronic fatigue syndrome. Medical Journal
- of Australia, 1994, 160, 426-429.
-
- Bonner, D., Ron, M., Chalder, T., Butler, S and Wessely, S. Chronic
- fatigue syndrome: a follow up study. Journal of Neurology,
- Neurosurgery, and Psychiatry, 1994, 57, 617-621.
-
- Deale, A and David, AS. Chronic fatigue syndrome: evaluation and
- management. Journal of Neuropsychiatry and Clinical Neurosciences,
- 1994, 6, 2, 189-194.
-
- Downey, DC. Fatigue syndromes revisited: the possible role of
- porphyrins. Medical Hypotheses, 1994, 42, 5, 285-290.
-
- Hauben, M. Quinacrine and chronic fatigue syndrome. American Family
- Physician, 1994, 49, 6, 1354.
-
- Hickie, I and Wilson, A. A catecholamine model of fatigue. British
- Journal of Psychiatry, 1994, 165, 275-276.
-
- Jason, LA and Taylor, SL. Monitoring chronic fatigue syndrome.
- Journal of Nervous and Mental Disease, 1994, 182, 243-244.
-
- Jason, LA., Taylor, SL., Johnson, S., Goldston, SE., Salina, D.,
- Bishop, P and Wagner, L. Prevalence of chronic fatigue
- syndrome-related symptoms among nurses. Evaluation and the Health
- Professions, 1993, 16, 4, 385-399.
-
- Khoury, PB. Chronic fatigue syndrome (CFS) and psychiatric disorders.
- American Journal of Medicine, 1994, 94, 485-6.
-
- Langsjoen, PH., Langsjoen, PH and Folkers, K. Isolated diastolic
- dysfunction of the myocardium and its response to CoQ10 treatment.
- Clinical Investigator, 1993, 71, S140-S144.
-
- Lane, RJM., Woodrow, D and Archard, LC. Lactate responses to
- exercise in chronic fatigue syndrome. Journal of Neurology,
- Neurosurgery and Psychiatry, 1994, 57, 5, 662-3.
-
- Lawrie, SM and Pelosi, AJ. Chronic fatigue syndrome and myalgic
- encephalomyelitis. British Medical Journal, 1994, 309, 275.
-
- Maffulli, N., Testa, V and Capasso, G. Post-viral fatigue syndrome.
- A longitudinal assessment in varsity athletes. Journal of Sports
- Medicine and Physical Fitness, 1993, 33, 4, 392-399.
-
- Martensen, RL. Was neurasthenia a `legitimate morbid entity'?
- Journal of the American Medical Association, 1994, 271, 16, 1243.
-
- McGarry, F., Gow, J and Behan, PO. Enterovirus in the chronic
- fatigue syndrome. Annals of Internal Medicine, 1994, 120, 11,
- 972-973.
-
- Meyers, D. Psychosocial factors and somatisation in chronic fatigue
- and allied disorders. Medical Journal of Australia, 1994, 160, 12,
- 806-7.
-
- Richman, JA., Flaherty, JA and Rospenda, KM. Chronic fatigue
- syndrome: have flawed assumptions been derived from treatment-based
- studies? American Journal of Public Health, 1994, 84, 2, 282-284.
-
- Roberts, L and Byrne, E. Single fibre EMG studies in chronic fatigue
- syndrome: a reappraisal. Journal of Neurology, Neuro-surgery, and
- Psychiatry, 1994, 57, 375-376.
-
- Rosen, SD. Hyperventilation and the chronic fatigue syndrome.
- Quarterly Journal of Medicine, 1994, 87, 6, 373-374.
-
- Zubieta, JK., Engleberg, NC., Yargic, LI., Pande, AC and Demitrack,
- MA. Seasonal symptom variation in patients with chronic fatigue:
- comparison with major mood disorders. Journal of Psychiatric
- Research, 1994, 28, 1, 13-22.
-
- RECOMMENDED
-
- Unpublished article recommended by a member of our medical advisory
- board:
-
- Hyde, B., Cameron, B., Duncker, A., Hall, D., McRobbie, J and Wall,
- L. Epidemiological aspects of myalgic encephalomyelitis/chronic
- fatigue syndrome/postviral fatigue syndrome. Report available from
- the Nightingale Research Foundation, 383 Danforth Avenue, Ottawa,
- Ontario, K2A OE1.
-
- RESEARCH ON CHRONIC FATIGUE.
-
- Manu, P., Lane, TJ., Matthews, DA., Castriotta, RJ., Watson, RK and
- Abeles, M. Alpha-delta sleep in patients with a chief complaint of
- chronic fatigue. Southern Medical Journal, 1994, 87, 4, 465-470.
-
- Wood, GC., Bentall, RP., Gopfert, M., Dewey, ME and Edwards, RHT.
- The differential response of chronic fatigue, neurotic and muscular
- dystrophy patients to experimental psychological stress.
- Psychological Medicine, 1994, 24, 357-364.
-
- RESEARCH ON OTHER DISORDERS.
-
- Craig, AR., Hancock, KM and Dickson, HG. Spinal cord injury: a
- search for determinants of depression two years after the event.
- British Journal of Clinical Psychology, 1994, 33, 221-230.
-
- Cope, H., David, A and Mann, A. `Maybe it's a virus': beliefs about
- viruses, symptom attributional style and psychological health.
- Journal of Psychosomatic Research, 1994, 38, 2, 89-98.
-
- Cunningham, AJ., Lockwood, GA and Edmonds, CV. Which cancer patients
- benefit most from a brief, group, coping skills program?
- International Journal of Psychiatry in Medicine, 1993, 23, 383-398.
-
- Devlen, J. Anxiety and depression in migraine. Journal of the Royal
- Society of Medicine, 1994, 87, 338-341.
-
- Martinsen, EW. Physical activity and depression: clinical
- experience. Acta Psychiatrica Scandinavica, 1994, 377, 23-27.
-
- Paradis, CM., Friedman, S., Lazar, RM and Kula, RW. Anxiety
- dis-orders in a neuromuscular clinic. American Journal of
- Psychiatry, 1993, 150, 7, 1102-1104.
-
- Sullivan, M., Katon, W., Russo, J., Dobie, R and Sakai, C. Coping and
- marital support as correlates of tinnitus disability. General
- Hospital Psychiatry, 1994, 16, 259-266.
-
- Woodall, CJ., Riding, MH., Graham, DI and Clements, GB. Sequences
- specific for enterovirus detected in spinal cord from patients with
- motor neurone disease. British Medical Journal, 1994, 308,
- 1541-1543.
-
- CFS IN BOOKS.
-
- Illis, LS. (Ed.) Neurological Rehabilitation. Second Edition.
- Oxford: Blackwell Scientific Publications. 1994. Hb. 581pp. 69.50
- pounds.
-
-
-
- This Update was compiled by IFMEA's Information Unit with help from
- Dr. EM Goudsmit, Dr. A. Macintyre, Dr. C. Shepherd, Ms. M. Gallacher
- RN, Mr. Guido Toro, Mr. David Axford, Ms. Kate Gardner and Mrs. S.
- Howes. The International Federation of M.E. Associations (IFMEA)
- disseminates information about M.E./CFIDS and related disorders. The
- organisation cannot dispense medical advice, nor does it endorse any
- medical product.
-
- --------------------------------------------
-
- To obtain copies of the full text (not shown here) of the IFMEA
- Medical Update which summarizes and reviews the publications cited
- above, contact one of the member national organizations listed below:
-
- UK: M.E. Association, Box 8, Stanford-le-Hope, Essex SS17 8EX
- annual subscription to quarterly IFMEA Medical Update is #8/yr.
-
- Netherlands: M.E. Stichting, Postbus 57436, 1040 BH Amsterdam
- the IFMEA Medical Update is summarized in the MEdium newsletter
- (printed in Dutch only, 30 guilders/yr.); the full text of the Update
- is available for the cost of copying & postage -- contact the office
- to ask what the exact price is (it is different for each issue)
-
- Norway: Norges M.E. Forening, Eikveien 96A, 1345 Osteras
- for now, the IFMEA Medical Update is provided at no charge to
- members (membership dues are 200 krona per year)
-
- [The Information above was provided by IFMEA and through the
- assistance of Dr. Ellen Goudsmit and David Axford.]
-
-
- -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
-
- >>>3. Twins study expands
-
- A CFS research study of twins, previously announced in CFS-NEWS, is
- expanding its scope. The office of Dr. Dedra Buchwald, M.D. at the
- University of Washington, School of Medicine is developing a registry
- of fraternal and identical twins. The registry is seeking twins
- where one or both of the twins have CFS or FM (fibromyalgia). The
- registry will be used to plan future studies of possible genetic and
- environmental differences between twins. Study areas of interest
- include immunological, virological, psychological, and sleep-related
- disturbances in CFS and FM.
-
- If you know of such a twin (or are yourself a twin) with CFS or FM,
- please feel free to contact Dr. Buchwald's office by any of the
- following means:
-
- Postal mail: Dedra Buchwald, MD
- Harborview Medical Center
- 325 9th Avenue ZA-60
- Seattle, WA 98104
-
- Telephone: 1-206-223-3185
- Ask for research assistant Hayes Lavis, or leave a
- message including your name, address, and a phone
- number. Please state that you are calling about the
- "twin study".
-
- Internet e-mail: hayes@u.washington.edu
-
- Currently, Dr. Buchwald is in the process of collecting names for the
- registry. The registry has over 65 pairs of twins on file. Several
- studies are planned, but their feasibility depends on the number of
- twins with CFS and FM enrolled in the registry.
-
- [Information provided by Dr. Buchwald and Hayes Lavis. Thanks to
- Beth Huneycutt for assistance.]
-
-
- -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
-
- >>>4. Networking News
-
- Several BBSs that have carried CFS information have closed down this
- year, or have announced plans to do so. John Kossowan's CFIDS/CFS
- BBS in Augusta, Maine has closed, which was the world's first CFS-
- oriented BBS. The MEDBASE BBS of Tucson, Arizona is shutting down.
- It's operator, Ms. Molly Holzschlag, continues to run the CFS-FILE
- database on Internet as well as publish the monthly Catharsis
- magazine. The Wellspring BBS of Irvine, California is closing, its
- files likely to be transferred to an Internet site. And the
- MEgahertz BBS in London has closed.
-
- Other BBSs that continue to provide CFS information are as follows:
-
- Smithtown, New York 1-516-736-6810
- Los Angeles, California 1-213-766-1356
- Cross Lanes, West Virginia 1-304-759-0727
- Kansas City, Kansas 1-913-642-7907
- Fleet, Britain 44-252-626233
- Apeldoorn, Netherlands 31-55-337951
-
-
- ===================================================================
- CFS-NEWS (ISSN 1066-8152) is an international newsletter published
- and edited by Roger Burns in Washington D.C. It is distributed:
- through the "CFS echo" (discussion group) on the Fidonet volunteer
- network of BBSs; via the NIHLIST Listserv on Internet; and as USENET
- Newsgroup bit.listserv.cfs.newsletter. Back issues are on file on
- the Project ENABLE BBS in West Virginia USA at telephone 1-304-759-
- 0727 in file area 23, and the valuable patient resource file named
- CFS-RES.TXT is available there too. Suggestions and contributions
- of news may be sent to Roger Burns at Internet CFS-NEWS@LIST.NIH.GOV
- or by Fido NetMail to 1:109/432, or at telephone 1-202-966-8738, or
- postal address 2800 Quebec St NW, no. 1242, Washington DC 20008 USA,
- or post a message to the CFS echo or to the Internet CFS-L group or
- to newsgroup alt.med.cfs. Copyright (c) 1994 by Roger Burns. Per-
- mission is granted to excerpt this document if the source (CFS-NEWS
- Electronic Newsletter) is cited. Permission is also granted to
- reproduce the entirety of this document unaltered. This notice does
- not diminish the rights of others whose copyrighted material as so
- noted may be quoted herein. All trademarks, both marked and not
- marked, are the property of their respective owners.
- ===================================================================
-
- INTERNET users are encouraged to obtain the CFS-RES TXT resource file
- and other CFS files at the NYSDH file server. Send the command GET
- CFS-RES TXT (or for a full list of files, send GET CFS-D FILELIST) by
- Internet e-mail to the address LISTSERV%ALBNYDH2@ALBANY.EDU .
- Distribution of CFS-NEWS on the Internet is sponsored by the NIH
- Computing Utility. However, the content of this independent
- newsletter and the accuracy of the sources which it cites are solely
- the responsibility of Roger Burns. To subscribe, send the command
- SUB CFS-NEWS <your> <name> to the address LISTSERV@LIST.NIH.GOV .
- To get back issues, send GET CFS-NEWS INDEX to either the Listserv at
- list.nih.gov or at the Albany address cited above, and follow the
- instructions in the file. Anonymous ftp available from list.nih.gov,
- directory cfs-news.
- =====================================================================
-