Birth Defect Registry

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"The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease."
- Thomas Edison

Life Magazine reports that 67% of babies born to Gulf-War veterans have been deformed.

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Rich Murray: Holman: Blaylock: ABDC: Elsas:
aspartame toxicity & birth defects  4.3.1 rmforall

This extensive data base contains information about aspartame consumption by parents during pregnancy-- the first such information I've heard about in over two years of studying aspartame toxicity.  Anyone who develops a proposal and attracts funding can mine this data to find correlations with aspartame for birth defects and childhood cancers. See end of post for more info.

http://www.birthdefects.org/
The National Birth Defect Registry was created because of concerns that birth defects, neurobehavioral problems and childhood cancers are increasing each year. The registry collects information about structural birth defects, neurobehavioral birth defects, childhood cancers and other disabilities. The registry also records comprehensive information about the mother and father's exposures to drugs, chemicals, radiation, pesticides, dioxin, lead, mercury, Agent Orange, Gulf War exposures and other environmental agents. These reports are collected through a sixteen-page questionnaire designed by a seven-member advisory board of eminent scientists. Data from the registry are analyzed to look for possible patterns or clusters of birth defects that may be associated with certain environmental exposures. If potential links between birth defects and exposures are identified, BDRC reports these findings to appropriate agencies or regulatory bodies to demonstrate a need for further study of a possible connection.

Recently, the National Birth Defect Registry was spotlighted in, In Harm's Way: Toxic Threats to Child Development. This 140-page report, released in May by the Greater Boston Physicians for Social Responsibility and the Clean Water Fund, explores connections between environmental chemicals and developmental disabilities, including attention deficit/hyperactivity disorder, autism, and related neurodevelopmental diseases that affect millions of American children
.
https://www.birthdefects.org/abstracts/formaldehyde.html
"...Occupational exposures to formaldehyde have been associated with menstrual irregularities, birth defects and chromosomal changes."

https://www.birthdefects.org/abstracts/aspartame.html
"...New research, however, is raising serious  questions about the safety of excessive aspartame exposure especially for the developing  baby."
**********

Date:  Thu, 29 Mar 2001 13:00:28 -0600
From:  "E Bryant Holman" <bryanth@presidiotex.com>
To:  "aspartame support" <aspartame@yahoogroups.com>
[Extracts]
"...phenylalanine is an amino acid that is known to produce seizures and act as a neurotoxin at high levels in the brain as well."

Dr. Russell Blaylock 

"Well, a lot of the book that I wrote about excitotoxins concerns glutamate, MSG and that sort of thing or the glutamate that accumulates naturally in the brain in pathological conditions, but the story of aspartame is that aspartame contains aspartic acid which is also an isolated amino acid that is just as toxic as glutamate. What makes aspartame particularly dangerous is that it contains three neurotoxins. Methanol is a very powerful neurotoxin, in fact the EPA controls methanol exposure very carefully allowing only very minute levels to be found in foods or in environmental exposures. But, it's interesting that the level allowed in NutraSweet is seven (7) times the amount that the EPA will allow anyone else to use. So methanol is an extremely powerful neurotoxin.  It can produce blindness, it can produce cellular destruction in the brain and spinal cord in particular the optic nerves that has to do with our vision.  The second amino acid, aspartic acid of course is an excitotoxin that can product cellular excitation, cell death in the brain, it can alter the way the brain is formed in newborn babies that permanently changes the brain formation, results in behavioral changes in children, hyperactivity.  The phenylalanine can also alter how the brain is formed during the fetal formation of the brain and thereafter, it can produce lowering of the seizure threshold so you're more likely to have a seizure. Phenylalanine and aspartic acid are both well recognized neurotoxins. So this combination by putting three relatively powerful neurotoxins into one combination is just to me unbelievable."

"BETTY MARTINI:  Well, we've heard a lot about the blood brain barrier. Doesn't it prevent these amino acids from entering the brain?

"DR. BLAYLOCK:  Well, this is one of the other things that the defenders of these compounds, food additives, usually bring up is that the brain has a barrier system that would keep these toxic substances from entering the brain, and they are well aware that it's not true. There's an enormous amount of research, particularly recently in which the levels of this glutamic acid, aspartic acid and phenylalanine have been measured inside the brain after ingestion of NutraSweet or MSG. It has clearly shown that these substances accumulate in very high concentrations within the brain.  One study which was recently done indicated that the previous studies that said phenylalanine does not increase in the brain, what it showed is that this really was kind of a deceptive study in that they homogenated or ground up the entire brain of these animals and measured phenylalanine levels.  But, when they repeated this study and measured the amount of phenylalanine in particular areas of the brain they found the phenylalanine tends to accumulate in the critical areas of the brain so that while the whole brain has normal phenylalanine levels, these critical parts of the brain have very high phenylalanine levels. For example, the hypothalamus which controls so many aspects of our functions, not just the endocrine system but it controls our heart rate, it controls the autonomic nervous system, the sleep/wake cycles, your appetite, it controls the emotional system -- this area of the brain has been shown to have very high accumulations of phenylalanine.  The medula oblongota at the brain stem accumulates it, the corpus striadem which is related to Parkinson's Disease, all of these areas are known to accumulate phenylalanine. So this shows that how these studies can be somewhat deceptive until we look closer at them."

"JON BAUM:  Welcome back.
We're here with Betty Martini, myself Jon Baum and Dr. Russell Blaylock.  We were talking about the hypothalamus gland and how it's affected by aspartame.  Dr. Blaylock?

"DR. BLAYLOCK: Yes, basically what we're talking about is the blood brain barrier protecting the brain against these things that are in our diet and what I was showing is that when we measure the actual brain level of these chemicals, they're passing right through the barrier.  We know that there is areas of the brain which have no barrier and that these substances can enter through there and concentrate at very high concentrations and this is not just theoretical but we measure the actual levels in these parts in the brain. The hypothalamus is so important in controlling our endocrine system that has to do with thyroid function, adrenal gland function, reproductive function, growth, so this is a very important area of the brain and we know that phenylalanine can severely alter that and that's one of the components of NutraSweet.  We know that the excitatory type transmitter is critical in that area of the brain so any alteration in its concentration, for example aspartic acid in NutraSweet can alter that function in the hypothalamus and as I said it affects the autonomic system as well and there may be some important connection between the accumulation of these chemicals in the hypothalamus and sudden cardiac death and that's something that I'm researching for this new book that I'm working on at the present time. "

"....phenylalanine is a precursor of the catecholamine neurotransmitters in the brain and elevated levels in the brain have been associated with seizures.  It should also be pointed out that these catecholamines are metabolized to form other excitotoxins and peroxide products that can lead to elevated free radical formation and lipid peroxidation within the neurons.

"Likewise, aspartic acid (an excitotoxin) acts as an excitatory neurotransmitter and can lower the seizure threshold making a seizure more likely.  The  additive effect of aspartic acid and phenylalanine would significantly increase the likelihood of a seizure, especially under hypoglycemic conditions.  This would occur if a diet drink is substituted for  meal, or if one is on a stringent diet.  It is well known that hypoglycemia greatly magnifies the excitotoxic effects of these ingredients."

"The excitotoxins are known to trigger the formation of enormous storms of free radicals, leading to prolonged lipid peroxidation (oxidation of cell membranes and membranes within the cell.). A recent study found that newborns exposed to MSG from day 1-10 still had a free radical elevation of 56% eighty days later. Such chronic free radical generation is known to produce secondary lipid peroxidation products such as 4-hydroxynonenal. This toxic substance is found in increased concentrations in Alzheimer's brains, ALS and Parkinson's disease brains. This secondary toxin has been shown to inhibit the glutamate transporter protein, resulting in chronic, high elevations of glutamate in the brain, which is thought to result in widespread neuron destruction and increased free radical generation.

"Both of these effects, free radical generation and DNA damage, would make the use of food excitotoxins and aspartame hazardous in diseases associated with DNA injury and lipid peroxidation, which would include a large number of diseases such as lupus, cancer, brain injury,  strokes, chronic hepatitis, mitochondrial disorders, nervous system infections, neurodegenerative diseases ( Alzheimer's, Parkinson's and ALS), rheumatoid arthritis, and asthma.


Neurotoxic Interaction of MSG, Aspartame and Other Toxins
by Russell L. Blaylock, M.D. (21 Sept. 1999)

Aspartate, another acidic amino acid, is also considered an excitotoxin.

When ingested, aspartate is converted in the liver into glutamic acid, the toxic component of monosodium glutamate. Aspartate makes up 40% of the molecular structure of the aspartame molecule. When aspartame is absorbed it is broken down into its component parts, phenylalanine (50%), aspartate ( 40%) and methanol (10%). Phenylalanine, a natural amino acid, in high doses, can produce neurotoxicity, especially in the immature nervous system, as is seen with the developing baby and newborns. Elevated phenylalanine levels have been associated with mental retardation, seizures and toxic injury to selected neurons in the brain.

At least one study has shown that 14% of normal people and 35% of PKU hereozygotes will develop blood levels considered unsafe for pregnant women and their babies following ingestion of aspartame products in doses considered not uncommon in the heavy user of diet drinks.

Methanol, also known as wood alcohol, is used to bind the phenylalanine molecule to the aspartate molecule in aspartame. When freed of its bonded state, methanol quickly circulates throughout the body, accumulating especially in the liver and the nervous system. Recent studies, utilizing radiolabeled aspartame, have demonstrated that its methanol has an affinity for cellular DNA and that it tends to accumulate with each dose. This means that each time you consume a diet cola or aspartame sweetened foods, the methanol accumulates near the DNA, resulting in damage to the DNA in the form of deletions and breakage of genes.
*****************************************************

http://www.dorway.com/blayenn.html    dodd@netdoor.com
Russell L. Blaylock, M.D.   russell@misnet.com   601-982-1175
"Excitotoxins, Neurodegeneration and Neurodevelopment"
The Medical Sentinel Journal Fall, 1999 , (95 references)

http://www.dorway.com/doctors.txt
What many informed doctors are saying/have said about aspartame

http://www.dorway.com/betty/dr-elsas.txt
EMORY UNIVERSITY SCHOOL OF MEDICINE
DEPARTMENT OF PEDIATRICS
2040 Ridgewood Drive, N.E.  Atlanta, Georgia 30322
Division of  MEDICAL GENETICS       (404) 727-5840

Statement for the Labor and Human Resources Committee, U.S. Senate

   I have considerable concern for the increased dissemination and consumption of the sweetener, aspartame, (1-methyl N-L-a-aspartyl-L- phenylalanine) in our world food supply.  This artificial dipeptide is hydrolyzed by the intestinal tract to produce L-phenylalanine which in excess is a known neurotoxin.  Normal humans do not metabolize phenylalanine as efficiently as do lower species such as rodents and thus most of the previous studies in Aspartame effects on rats are irrelevant to the question, "Does phenylalanine excess occur with Aspartame ingestion?".

   Preliminary studies in my laboratory provide tentative positive answers to both questions. Many studies of both acute and chronic ingestion of 34mg Aspartame/kg/day have demonstrated a two to five fold increase in semi- fasting blood phenylalanine concentrations (from approximately 50 to 250 M) without concomitant increases in tyrosine or other aminoacids.  The degree of increase by normal humans depends on several variables including the efficiency of the transport, liver utilization, and growth rates. It was thought by many scientists and clinicians that this degree of phenylalanine increase would not affect brain function. However, currently available information indicates that this is not true.

  1.  In the developing fetus such a rise in material blood
      phenylalanine could be magnified four to six fold by
      the concentrative efforts of the placenta and fetal
      blood brain barrier.  Thus a maternal phenylalanine of
      150 M could reach 900 M in the developing fetal brain]
      cell and this concentration kills such cells in tissue
      culture.  The effect of such an increased fetal brain
      concentrations in vivo would probably be much more
      subtle and expressed as mental retardation,
      microcephaly, or potential certain birth defects.

  2.  In the rapidly growing post-natal bran (children of 0-
      12 months) irreversible brain damage could occur by the
      same mechanism.

  3.  In the adult we have found that changes in blood
      phenylalanine in these concentration ranges are
      associated with slowing of the electroencephalogram,
      and prolongation of cognitive function tests.
      Fortunately, these effects on the mature brain are
      reversible but provide clear evidence for negative
      effect on sensitive parameters of brain function.

  In view of these new (and confirmation of old) research
findings I suggest the following:

  1)  Immediate labeling of all aspartame-containing foods,
      so the consumer will know how much phenylalanine
      he/she is ingesting.

  2)  Declare an immediate moratorium on addition of
      aspartame to more foods and remove it from all low-
      protein beverages, foods, and children's medications.

  3) Provide funds not controlled by industry to:

    a.  Allow active surveillance for potential side-effects
        of aspartame on newborns whose mothers dieted with
        Nutrasweet (aspartame) -containing foods.

    b.  Allow active evaluation of other users whose
        complaints cannot be adequately studied at present.

    c.  Clarify the dose relationship and mechanisms by
        which L-phenylalanine affects human brain function.

   Respectfully submitted   Louis J. Elsas, II, M.D.
   Director, Division of Medical Genetics     Professor of Pediatrics
******************

  The above statement was before the Committee of Labor and Human
Resources on the subject
"Nutrasweet: Health and safety concerns", and dated November 3, 1987.
***************************************************************

http://www.biomed.emory.edu/Faculty/Elsas2.html
Louis J. Elsas, II   Professor of Pediatrics
Associate Professor of Biochemistry
Assistant Professor of Medicine     M.D., University of Virginia, 1962
135 studies listed in PubMed
Genet Med 1998 Nov-Dec;1(1):40-8
The molecular biology of galactosemia.
Elsas LJ 2nd, Lai K      lje@rw.ped.emory.edu
Department of Pediatrics
Emory University School of Medicine, Atlanta, Georgia 30322, USA.

http://www.circ.uab.edu/sergg/s95/vip.htm
Louis J. "Skip" Elsas II, Professor of Pediatrics and the Director of the Division of Medical Genetics at the School of Medicine, recently took on the responsibilities of President of the Council of Regional Networks (CORN). Elsas, known for his work in establishing a nationally recognized comprehensive newborn screening program for inherited diseases in Georgia, has been a member of CORN since its inception in 1985. As president of CORN, Elsas will provide a forum for dialogue and national coordination among the 10 regional genetic networks representing all 50 states, the District of Columbia, Puerto Rico and the Virgin Islands.

"CORN is in a position to implement the public health role of medical genetics," Elsas said. "The unique contribution of a genetic approach is to predict and prevent heritable components of rare and common diseases. To accomplish this goal, CORN should continue to focus on a few specific activities which will complement activities of the American Society of Human Genetics and the American College of Medical Genetics."

http://www.choa.org/
Children's Healthcare of Atlanta
Louis J. Elsas, M.D.  Private Practice    Medical Genetics
2040 Ridgewood Drive,    Building Room 130, Emory University
Atlanta, Georgia 30322     404-297-1500      Fax: 404-727-5783
lje@rw.ped.emory.edu      http://www.emory.edu/
Education / Training
Medical School: University of Virginia School of Medicine
Residency: Yale-New Haven Hospital, New Haven, Connecticut
Fellowship: Yale University
Medical Specialty:
Biochemical genetics (inborn errors of metabolism)
Cancer genetics        Medical genetics (clinical); clinical molecular
genetics
Privileges:     Children's at Egleston
**********************************************************

Dr. Woodrow C. Monte, "Aspartame: Methanol, and the Public Health,"
Journal of Applied Nutrition, Volume 36, No. 1, pages 42-54, 1984.
(62 references)   Professsor of Food Science
Director of the Food Science and Nutrition Laboratory
Arizona State University, Tempe, Arizona 85287
6411 South River Drive #61 Tempe, Arizona 85283-3337
602-965-6938    woody.monte@asu.edu
The methanol from 2 L of diet soda, 5.6 12-oz cans, 20 mg/can, is 112 mg, 10% of the aspartame.  The EPA limit for water is 7.8 mg daily for methanol (wood alcohol), a deadly cumulative poison. Many users drink 1-2 L daily. The reported symptoms are entirely consistent with chronic methanol toxicity. (Fresh orange juice has 34 mg/L, but, like all juices, has 16 times more ethanol, which strongly protects against methanol.)   http://www.dorway.com/wmonte.txt

A radioactive tracer study proves that the methanol from a low dose of of aspartame binds formaldehyde, a deadly cumulative poison, into tissues:  Trocho C et al, June 26 1998, Life Sci, 63(5), 337-349. http://www.presidiotex.com/barcelona/index.html

Excellent 5-page review by H.J. Roberts in "Townsend Letter",
Jan 2000,  "Aspartame (NutraSweet) Addiction"
http://www.dorway.com/tldaddic.html
H.J. Roberts, M.D.   hroberts@pb.seflin.org   sunsentpress@aol.com
Sunshine Sentinel Press 6708 Pamela Lane West Palm Beach, FL 33405
800-814-9800 561-588-7628 561-547-8008 fax
900+ page text on aspartame toxicity to be available  March  2001
http://www.sunsentpress.com/
********************************************************

BDRC: Dirth Defect Research for Children, Inc.
ABDC: Association of Birth Defect Children, Inc.
http://www.birthdefects.org/   407-895-0802  9-4 EST  M-F
Betty Mekdeci, Executive Director
930 Woodcock Road     Suite 225    Orlando, FL 32803
800-313-ABDC (Voice - Toll-free, Birth Defect Registry Hotline)
407-895-0824 (FAX)      
The Association of Birth Defect Children provides information and support to families of children with birth defects caused by their mothers' exposure to environmental agents--drugs, chemicals, radiation, and other agents. The Association sponsors a National Birth Defects Registry, which contains demographic data and medical histories from member families in the United States and Canada and matches families of children with similar disabilities. The Association answers inquiries from parents and health professionals on topics such as drug use during pregnancy and the care and rehabilitation of birth defect children. Donations from the public, members and foundations support the Association. Families of children with genetic birth defects are also eligible for membership. Print Resources Serial publication: Association of Birth Defects Children Newsletter, quarterly-- news on the effects of environmental exposures during pregnancy, drugs, chemicals, radiation rehabilitation, prosthetic devices, services, and resources.

Association of Birth Defect Children Newsletter
"The Aspartame Controversy."  Vol.14 Fall 1989: 1-3.
[Exact copy of text, with minor typos corrected.]
The Aspartame Controversy
Aspartame, sold under the brand names NutraSweet and Equal, has been promoted as a safe alternative for those who wish to avoid using sugar or saccharin. Aspartame is made of two amino acids (phenylalanine and aspartic acid) which are also found in all protein-containing foods such as meat. Since these amino acids are natural products, most people assume that they are safe to consume in unlimited quantities.  New research, however, is raising serious questions about the safety of excessive aspartame exposure especially for the developing baby. The aspartame controvery was first brought to ABDC's attention by a pediatric nurse who put us in touch with the Mills family in Georgia.  Their son Brandon was born with serious neurological impairment and developmental delays. Karen Mills was exposed to excessive doses of aspartame and phenylalanine during her pregnancy.

Karen's Story
According to my obstetrician, I had a very normal pregnancy. I was in very good health, did not smoke, drink alcohol or take any drugs. I had a prenatal test to rule out any genetic birth defects they can test for and had sonograms early and late in pregnancy. At the time of pregnancy, I had not seen any proof of harmful effects of aspartame and no consumer warning was given on the use of NutraSweet products during pregnancy. In order to avoid additional sugar intake and weight gain and the fatigue resulting for blood sugar drop after drinking sugared beverages, I chose to drink beverages containing NutraSweet. I drank on the average four to six twelve-ounce cans a day including: Diet 7-Up, Diet Coke, NutraSweet sweetened tea and lemonade. Six weeks into my pregnancy, I also started taking capsules containing 500 to 1000 mg of phenylalinine a day, because I had read that this amino acid could help relieve fatigue. Brandon was born by C-section without any birth trauma or lack of oxygen. I was one week post full-term and was not in labor when the C-section was done."

Brandon has severe neurological problems, causing vocal chord paralysis and swallowing dysfunction.  His muscle spasms and vocal chord paralysis are caused by the brain signals to the muscles being "static" or distorted. He is also diaphoretic, meaning that he has excessive perspiration. Other than this, Brandon is in good health.  He laughs and smiles. He recognizes people and music he has heard before. He has learned to play games with us. Recently, Brandon has been diagnosed as severely retarded due to the severity of the neurological problem. He has to have a trach tube to help him breathe and a GI-tube in his stomach to help him eat since he cannot swallow foods without aspirating.  There is possible brain cell damage, but this cannot be proven by testing and the degree of damage is unknown at this time. Brandon  has had numerous MRI tests, CAT scans, X-rays, a genetics study, and blood testing and all results have come back normal. I am suspicious that NutraSweet could be a contributing factor in Brandon's situation since there are no physical or genetic causes revealed for his neurological problems. I hope that Brandon's situation can be a reason to focus more testing on NutraSweet regarding the possible effects it could have on a developing fetus during pregnancy.  Karen Mills in Georgia

Testing at Emory
Senator Howard Metzenbaum  (D-Ohio) has been a very vocal critic of aspartame and has chaired hearings on its safety. Senator Metzenbaum put the Mills family in touch with Dr. Louis J. Elsas, II, the Director of Medical Genetics at Emory University School of Medicine. Dr. Elsas has co-authored numerous papers on aspartame research. After examining Brandon and reviewing his prenatal history, Dr. Elsas proposed a test to determine whether Brandon might have been exposed to excessive levels of phenylalanine during prenatal development. Karen was given capsules containing L-Phenylalanine which reached concentrations that approximated the highest amount she took during pregnancy.  Blood tests were then made at intervals to determine the concentration of phenylalanine in her bloodstream.  The data showed that her blood plasma concentrations of phenylalanine rose two and 2 1/2 fold over twelve days without an equal increase in other neutral amino acids thus producing an "imbalance".  If this also happened during Karen's pregnancy with Brandon, the placenta could have magnified this imbalance another two fold and his blood brain barrier would magnify it yet another two fold. Therefore  Brandon's developing brain cells could have been chronically exposed to 500-600uM phenylalinine. (Micro-moles) Could this excessive exposure cause the severe problems Brandon was born with?  Since no one knows the level of consumption that might cause damage in a developing fetus, Dr. Elsas recommends that pregnant women avoid aspartame sweeteners.  [The rest of the article discusses other research on aspartame, phenylalanine, methanol exposure from aspartame, and the autosomal recessive genetic disease called PKU, phenylketonuria, an inherited inability to metabolize phenylalanine, resulting in retardation.  About one in every fifty people carry this defective gene, and these people, even without developing PKU, still have a lower capacity to metabolize phenylalanine than normal people. Eight references are listed, including four by Louis J. Elsas.]

Electroencephalogr Clin Neurophysiol 1989 Feb;72(2):133-9
EEG mean frequencies are sensitive indices of phenylalanine effects on normal brain.
Epstein CM, Trotter JF, Averbook A, Freeman S, Kutner MH, Elsas LJ
Department of Neurology
Emory University School of Medicine, Atlanta, GA 30322.

We previously reported that changes in plasma phenylalanine (PHE) concentrations of 1000 microM or more adversely affected cognitive function and reduced mean frequency of the EEG power spectrum. In the present study, we characterized EEG effects of changes in plasma PHE from physiological to supraphysiological concentrations. Subjects were mentally normal children and adult volunteers with 3 different genotypes for phenylalanine hydroxylase (PHY): homozygous deficient, heterozygous, and homozygous normal. Double-blinded crossover studies were performed at equilibrium during PHE restriction and supplementation. The mean frequency of the power spectrum and the mean across a set of alpha-theta factors showed highly significant, reversible, generalized EEG slowing during PHE supplementation in subjects homozygous for PHY deficiency. Smaller but significant changes in EEG mean frequencies occurred in the heterozygous and normal subjects. Spectral profiles of EEG change were similar in both groups; the mean alpha-theta was more sensitive in the second group. Demonstration of EEG changes with PHE supplementation in normal individuals has important dietary implications.
PMID: 2464484

Elsas, Louis J., James F. Trotter, 1988. "Changes in Physiological Concentrations of Blood Phenylalanine Produces Changes in Sensitive Parameters of Human Brain Function," Presented at "Dietary Phenylalanine and Brain Function." Proceedings of the First International Meeting on Dietary Phenylalanine and Brain Function, Washington, D.C., May 8-10, 1987. Center for Brain Sciences and Metabolism Charitable Trust, P.O. Box 64, Kendall Square, Cambridge, MA 02142. Reprinted in "Dietary Phenyalalnine and Brain Function," c1988, Birkhauser, Boston, MA USA, page 187-195.

http://www2.mc.duke.edu/som/rofacmed.html
DIVISION OF GASTROENTEROLOGY
Assistant Clinical Professors
James F. Trotter, M.D. (Emory, 1989)

http://www.uchsc.edu
James F. Trotter, M.D.
University of Colorado
Health Sciences Center and University Hospital
Denver, CO 80262
************************************************

 


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