Treatment of the cancer anorexia-cachexia syndrome: a critical reappraisal.

Cancer anorexia-cachexia syndrome (CACS) is a combination of anorexia, tissue wasting, weight loss and poor performance status. Some CACS symptoms are due to a macrophage production of TNF and IL-1, while the metabolic effects are mainly explained by the release of IL-6 from tumor cells. Clinical treatment of CACS involves progestational agents (medroxyprogesterone acetate, MPA, megestrol acetate, MA) for long term treatment. The use of prokinetic agents (like metoclopramide) is recommended, especially if patients need concomitant opioid treatment for pain; if otherwise indicated, corticosteroids are useful for short periods. The administration of artificial nutrition should be individualized following the clinical condition of the patient and possibly taking into account the wishes of the patient. The practical evaluation criteria of the drugs employed for CACS are based on weight increase and appetite stimulation. Hence, a new approach to the mechanism of action of MPA, MA and of other agents is urgently needed.

[Treatment using traditional acupuncture of early scapulohumeral pains following heart surgery]. / Traitement par acupuncture traditionnelle des algies scapulo-humérales précoces après chirurgie cardiaque.

The purpose of this study was to test the efficacy of traditional Chinese acupuncture in the treatment of scapulohumeral pain during the early stage following heart surgery, by puncture of points not related anatomically or metamerically with the scapulohumeral joint and without any needle stimulation. Reduction of pain and angular gain were almost immediate, durable, measurable and reproducible, which could be explained by possible effects of acupuncture on articular sympathetic mechanoreceptors, then suppressing reflex muscular contractions due to intraoperative postural constraints.