RESUMO
In the anterior lobe of the pituitary gland (AP), non-endocrine cells regulate hormone secretion by endocrine cells. However, the functions of non-endocrine cells in the AP during chronic pain are largely unclear. Here, we show that macrophages, but not folliculostellate (FS) cells, were selectively increased in the AP in the complete Freund's adjuvant (CFA)-induced chronic inflammatory pain model in rats. In addition, IL-1ß expression was increased in the AP, and the IL-1ß-immunopositive cells were identified as macrophages. On the other hand, increased macrophage density and IL-1ß expression were not detected in a neuropathic pain model induced by partial sciatic nerve ligation (PSL). Furthermore, we found c-Fos expression specifically in the somatotrophs under the chronic inflammatory pain condition. Because IL-1ß promotes growth hormone (GH) synthesis and release, our results suggest that AP macrophage contributes to GH release through IL-1ßduring chronic inflammatory pain.ã.
Assuntos
Inflamação/metabolismo , Macrófagos/metabolismo , Neuralgia/metabolismo , Adeno-Hipófise/metabolismo , Animais , Dor Crônica/metabolismo , Dor Crônica/fisiopatologia , Adjuvante de Freund/metabolismo , Hiperalgesia/metabolismo , Neuralgia/fisiopatologia , RNA Mensageiro/metabolismo , Ratos Wistar , Neuropatia Ciática/metabolismoRESUMO
Soil is thought to be important both as a source and a sink of carbonyl sulfide (COS) in the troposphere, but the mechanism affecting COS uptake, especially for fungi, remains uncertain. Fungal isolates that were collected randomly from forest soil showed COS-degrading ability at high frequencies: 38 out of 43 isolates grown on potato dextrose agar showed degradation of 30 ppmv COS within 24 h. Of these isolates, eight degraded 30 ppmv of COS to below the detection limit within 2 h. These isolates also showed an ability to degrade COS included in ambient air (around 500 pptv) and highly concentrated (12 500 ppmv) level, even though the latter is higher than the lethal level for mammals. COS-degrading activity was estimated by using ergosterol as a biomass index for fungi. Trichoderma sp. THIF08 had the highest COS-degrading activity of all the isolates. Interestingly, Umbelopsis/Mortierella spp. THIF09 and THIF13 were unable to degrade 30 ppmv COS within 24 h, and actually emitted COS during the cultivation in ambient air. These results indicate a fungal contribution to the flux of COS between the terrestrial and atmospheric environments.
Assuntos
Florestas , Fungos/metabolismo , Gases/metabolismo , Microbiologia do Solo , Óxidos de Enxofre/metabolismo , Enxofre/metabolismo , Atmosfera , Biomassa , Ergosterol/metabolismo , Fungos/crescimento & desenvolvimento , Fungos/isolamento & purificação , Óxidos de Enxofre/química , Trichoderma/metabolismoRESUMO
Thiocyanate hydrolase (SCNase) of Thiobacillus thioparus THI115 is a cobalt (Co)-containing enzyme that catalyzes the hydrolysis of thiocyanate (SCNâ»), a major component of wastewater from coke oven factories, to carbonyl sulfide and ammonia. Although SCNase exhibits high structural similarities to Co-type nitrile hydratase (NHase), including a unique Co³âº catalytic center with two oxidized Cys ligands, both SCNase and NHase exclusively catalyze only their own substrates. Based on the differences in the substrate-binding pockets of these enzymes, ßArg90 and γArg136 of SCNase, with side chains extending toward the pocket, were separately substituted with Phe and Trp, the corresponding residues, respectively, in Co-type NHase. Both SCNase ßArg90 and SCNase γArg136 mutants showed no SCNâ» hydrolysis activity but did catalyze the hydration of nitriles. The estimated kcat values (â¼2 s⻹) corresponded to approximately 0.2% of that of Co-type NHase for nitrile hydration and approximately 3% of that of wild-type SCNase for SCNâ» hydrolysis. The crystal structure of SCNase γR136W is essentially identical to that of the wild-type, including the Co³âº center having Cys oxidations; the size of the substrate pocket was enlarged because of conformational changes on the side chains of the mutated residue. Discussion of the difference in the environments around the substrate-binding pockets among the wild-type and mutant SCNases and Co-type NHase strongly suggests that ßArg90 and γArg136, positioned at the top of the Co³âº center, predominantly control the substrate selectivity of SCNase.
Assuntos
Arginina/química , Hidrolases/química , Substituição de Aminoácidos , Biocatálise , Cobalto/química , Cisteína/química , Hidroliases/química , Hidrolases/genética , Modelos Moleculares , Oxirredução , Especificidade por Substrato , Thiobacillus/enzimologiaAssuntos
Medula Óssea/patologia , Púrpura Trombocitopênica Idiopática/diagnóstico , Púrpura Trombocitopênica Idiopática/terapia , Doença Aguda , Análise Química do Sangue , Terapia Combinada , Dexametasona/uso terapêutico , Seguimentos , Humanos , Imunoglobulinas/uso terapêutico , Lactente , Masculino , Contagem de Plaquetas , Transfusão de Plaquetas/métodos , Púrpura Trombocitopênica Idiopática/diagnóstico por imagem , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Thiocyanate hydrolase (SCNase) is a member of a family of nitrile hydratase proteins, each of which contains a unique noncorrin cobalt center with two post-translationally modified cysteine ligands, cysteine-sulfenic acid or -sulfenate (Cys-SO(H)), and cysteine-sulfininate (Cys-SO(2)(-)), respectively. We have found that a partially matured recombinant SCNase was activated during storage. The crystal structures of SCNase before and after storage demonstrated that Cys-SO(2)(-) modification of gammaCys131 proceeded to completion prior to storage, while Cys-SO(H) modification of gammaCys133 occurred during storage. SCNase activity was suppressed when gammaCys133 was further oxidized to Cys-SO(2)(-). The correlation between the catalytic activity and the extent of the gammaCys133 modification indicates that the cysteine sulfenic acid modification of gammaCys133 is of primary importance in determining the activity of SCNase.
Assuntos
Biocatálise , Cisteína/metabolismo , Hidrolases/química , Hidrolases/metabolismo , Metais/metabolismo , Ar , Cristalografia por Raios X , Ativação Enzimática , Modelos Moleculares , Conformação ProteicaRESUMO
Gamma knife surgery (GKS) is used for the treatment of various human brain disorders. However, the biological effects of gamma ray irradiation on both the target area, and the surrounding tissues are not well studied. The effects of gamma ray exposure to both targeted and untargeted regions were therefore evaluated by monitoring gene expression changes in the unilateral irradiated (60 Gy) and contralateral un-irradiated striata in the rat. Striata of irradiated and control brains were dissected 16 hours post-irradiation for analysis using a whole genome 44K DNA oligo microarray approach. The results revealed 230 induced and 144 repressed genes in the irradiated striatum and 432 induced and 239 repressed genes in the un-irradiated striatum. Out of these altered genes 39 of the induced and 16 of the reduced genes were common to both irradiated and un-irradiated tissue. Results of semiquantitative, confirmatory RT-PCR and western blot analyses suggested that gamma-irradiation caused cellular damage, including oxidative stress, in the striata of both hemispheres of the brains of treated animals.
Assuntos
Encéfalo/metabolismo , Encéfalo/cirurgia , Corpo Estriado/metabolismo , Corpo Estriado/cirurgia , Perfilação da Expressão Gênica , Expressão Gênica/efeitos da radiação , Animais , Western Blotting , Células Cultivadas , Masculino , Análise de Sequência com Séries de Oligonucleotídeos , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Radiocirurgia , Ratos , Ratos Wistar , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Transcrição GênicaRESUMO
PURPOSE: To evaluate outcomes after pituitary radiosurgery in patients with post-stroke thalamic pain syndrome. METHODS AND MATERIALS: From 2002 to 2006, 24 patients with thalamic pain syndrome underwent pituitary radiosurgery at Tokyo Women's Medical University and were followed at least 12 months thereafter. The radiosurgical target was defined as the pituitary gland and its connection with the pituitary stalk. The maximum dose varied from 140 to 180 Gy. Mean follow-up after treatment was 35 months (range, 12-48 months). RESULTS: Initial pain reduction, usually within 48 h after radiosurgery, was marked in 17 patients (71%). However, in the majority of cases the pain recurred within 6 months after treatment, and at the time of the last follow-up examination durable pain control was marked in only 5 patients (21%). Ten patients (42%) had treatment-associated side effects. Anterior pituitary abnormalities were marked in 8 cases and required hormonal replacement therapy in 3; transient diabetes insipidus was observed in 2 cases, transient hyponatremia in 1, and clinical deterioration due to increase of the numbness severity despite significant reduction of pain was seen once. CONCLUSIONS: Pituitary radiosurgery for thalamic pain results in a high rate of initial efficacy and is accompanied by acceptable morbidity. It can be used as a primary minimally invasive management option for patients with post-stroke thalamic pain resistant to medical therapy. However, in the majority of cases pain recurrence occurs within 1 year after treatment.
Assuntos
Dor Intratável/cirurgia , Hipófise/cirurgia , Radiocirurgia , Doenças Talâmicas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Radiocirurgia/efeitos adversos , Dosagem Radioterapêutica , Acidente Vascular Cerebral/complicações , Síndrome , Doenças Talâmicas/etiologia , Resultado do TratamentoRESUMO
Gamma knife surgery (GKS) is used for the treatment of various brain disorders. The biological effects of focal gamma ray irradiation on targeted or surrounding areas in the brain are not well-known. In the present study, we evaluated protein expression changes in the unilateral irradiated (60 Gy) striatum in rat. Striata of irradiated and control brains were dissected 16 h post-irradiation for analysis by large-format two-dimensional gel electrophoresis (2-DGE). In parallel, we also examined the un-targeted contralateral striatum over the control for potential changes in proteins patterns that may have occurred due to the effects of irradiation to the unilateral striatum. A total of 17 reproducible and differentially expressed silver nitrate-stained protein spots in the irradiated striatum was detected on 2-D gel. Their subsequent analysis by tandem mass spectrometry (nESI-LC-MS/MS) resulted in the identification of 13 nonredundant proteins. Interestingly, out of these 13 changed proteins, 2 proteins were also detected in the contralateral striatum. Some of the significantly changed proteins identified were creatine kinase, protein disulfide isomerase A3 precursor (PDA3), and peroxiredoxin 2 (Prx2). Western analysis with anti-PDA3 and anti-Prx2 antibodies revealed 4 and 2 cross-reacting protein spots on 2-D gel blots. Interestingly, after GKS, in the irradiated and un-irradiated striata, these spots showed a shift toward the acidic side, suggesting post-translational modifications. Taken together, these results indicate that unilateral irradiation during GKS triggers molecular changes in the bilateral striata.
Assuntos
Corpo Estriado/química , Corpo Estriado/efeitos da radiação , Proteínas do Tecido Nervoso/análise , Proteômica , Radiocirurgia , Ratos Endogâmicos WF/metabolismo , Sequência de Aminoácidos , Animais , Corpo Estriado/cirurgia , Citoplasma/química , Eletroforese em Gel Bidimensional , Metabolismo Energético , Expressão Gênica/efeitos dos fármacos , Masculino , Dados de Sequência Molecular , Proteínas do Tecido Nervoso/genética , Proteínas do Tecido Nervoso/metabolismo , Biossíntese de Proteínas , Ratos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Transdução de Sinais , Superóxido Dismutase/análise , Superóxido Dismutase-1 , Espectrometria de Massas em TandemRESUMO
Thiocyanate hydrolase (SCNase) of Thiobacillus thioparus THI115 is a cobalt(III)-containing enzyme catalyzing the degradation of thiocyanate to carbonyl sulfide and ammonia. We determined the crystal structures of the apo- and native SCNases at a resolution of 2.0 A. SCNases in both forms had a conserved hetero-dodecameric structure, (alphabetagamma)(4). Four alphabetagamma hetero-trimers were structurally equivalent. One alphabetagamma hetero-trimer was composed of the core domain and the betaN domain, which was located at the center of the molecule and linked the hetero-trimers with novel quaternary interfaces. In both the apo- and native SCNases, the core domain was structurally conserved between those of iron and cobalt-types of nitrile hydratase (NHase). Native SCNase possessed the post-translationally modified cysteine ligands, gammaCys131-SO(2)H and gammaCys133-SOH like NHases. However, the low-spin cobalt(III) was found to be in the distorted square-pyramidal geometry, which had not been reported before in any protein. The size as well as the electrostatic properties of the substrate-binding pocket was totally different from NHases with respect to the charge distribution and the substrate accessibility, which rationally explains the differences in the substrate preference between SCNase and NHase.
Assuntos
Proteínas de Bactérias/química , Cobalto/química , Hidroliases/química , Hidrolases/química , Motivos de Aminoácidos , Sequência de Aminoácidos , Catálise , Cristalografia por Raios X , Cisteína/química , Ligação de Hidrogênio , Hidrolases/isolamento & purificação , Ligantes , Modelos Moleculares , Dados de Sequência Molecular , Processamento de Proteína Pós-Traducional , Estrutura Quaternária de Proteína , Estrutura Secundária de Proteína , Estrutura Terciária de Proteína , Subunidades Proteicas/química , Homologia de Sequência de Aminoácidos , Análise Espectral Raman , Eletricidade Estática , Especificidade por Substrato , Ácidos Sulfênicos/metabolismo , Thiobacillus/enzimologia , Água/químicaRESUMO
BACKGROUND/AIMS: Manipulation of brain functions via Gamma Knife (GK) irradiation would have numerous applications in clinical and experimental neurology. METHODS: Alteration of brain functions in the unilaterally irradiated striatum was indexed through monitoring freely moving rat behaviors. Spontaneous activity and rotations on the apomorphine test, which can detect dopaminergic function imbalance, were indexed employing our behavior tracking system. The spatial distribution of necrotic lesions was explored using serial sections, and was assumed to represent the real foci of the GK target. RESULTS: Distinct behavioral alterations corresponded to the precise locations of the lesions in various areas of the basal ganglia. Displacement of the irradiation sites in the anteromedial direction increased spontaneous activity, and posterolateral shift provoked circling behavior on the apomorphine test. CONCLUSION: Accurate positioning of the target is crucial for experimental GK irradiation locally focused on domains of a small brain such as that of the rat. Here, we propose a protocol for converting the 'intended' focus, based on brain map coordinates, to a 'planned' focus on the MR imaging coordinate system with the Régis-Valliccioni stereotactic frame.
Assuntos
Comportamento Animal , Mapeamento Encefálico/métodos , Protocolos Clínicos , Radiocirurgia/métodos , Animais , Apomorfina/farmacologia , Gânglios da Base/efeitos dos fármacos , Gânglios da Base/efeitos da radiação , Gânglios da Base/cirurgia , Comportamento Animal/efeitos dos fármacos , Comportamento Animal/efeitos da radiação , Agonistas de Dopamina/farmacologia , Raios gama/efeitos adversos , Imageamento por Ressonância Magnética/métodos , Masculino , Ratos , Ratos Wistar , Técnicas EstereotáxicasRESUMO
Thiocyanate hydrolase (SCNase) is a cobalt-containing enzyme with a post-translationally modified cysteine ligand, gammaCys131-SO(2)H. When the SCNase alpha, beta and gamma subunits were expressed in Escherichia coli, the subunits assembled to form a hetero-dodecamer, (alphabetagamma)(4), like native SCNase but exhibited no catalytic activity. Metal analysis indicated that SCNase was expressed as an apo-form irrespective of the presence of cobalt in the medium. On the contrary, SCNase co-expressed with P15K, encoded just downstream of SCNase genes, in cobalt-enriched medium under the optimized condition (SCNase((+P15K))) possessed 0.86 Co atom/alphabetagamma trimer and exhibited 78% of the activity of native SCNase. SCNase((+P15K)) showed a UV-Vis absorption peak characteristic of the SCNase cobalt center. About 70% of SCNase((+P15K)) had the gammaCys131-SO(2)H modification. These results indicate that SCNase((+P15K)) is the active holo-SCNase. P15K is likely to promote the functional expression of SCNase probably by assisting the incorporation of cobalt ion.
Assuntos
Hidrolases/metabolismo , Sequência de Aminoácidos , Sequência de Bases , Cromatografia em Gel , Primers do DNA , Eletroforese em Gel de Poliacrilamida , Ativação Enzimática , Escherichia coli/genética , Hidrolases/química , Hidrolases/genética , Hidrolases/isolamento & purificação , Dados de Sequência Molecular , Processamento de Proteína Pós-Traducional , Homologia de Sequência de Aminoácidos , Espectrometria de Massas por Ionização por ElectrosprayRESUMO
Thiocyanate hydrolase (SCNase) purified from Thiobacillus thioparus THI115 hydrolyzes thiocyanate to carbonyl sulfide and ammonia. DNA sequences of the cloned genes revealed the close relation of SCNase to nitrile hydratase (NHase). The consensus sequences for coordination of the metal ion found in NHases were also conserved in the gamma subunit of SCNase. Here, we showed that the SCNase contained one cobalt atom per alphabetagamma heterotrimer. UV-vis absorption spectrum suggested that the cobalt exists as a non-corrin ion. Reduced SCNase showed an ESR signal characteristic of low-spin Co2+, which closely resembled that of the Co-type NHases. Mass spectrometry for the peptide fragment containing the metal-binding motif of the SCNase gamma subunit indicated that the cysteine residue at position 131 was post-translationally oxidized to a cysteine-sulfinic acid. From these results, we concluded that SCNases and NHases form a novel non-corrin and/or non-heme protein family having post-translationally modified cysteine ligands.
Assuntos
Cobalto/química , Cisteína/química , Hidrolases/química , Ácidos Sulfínicos/química , Sequência de Aminoácidos , Cobalto/metabolismo , Cisteína/metabolismo , Espectroscopia de Ressonância de Spin Eletrônica , Hidrolases/metabolismo , Ligantes , Espectrometria de Massas , Dados de Sequência Molecular , Espectrofotometria Ultravioleta , Ácidos Sulfínicos/metabolismo , Thiobacillus/enzimologiaRESUMO
OBJECT: Although reports in the literature indicate that thalamic pain syndrome can be controlled with chemical hypophysectomy, this procedure is associated with transient diabetes insipidus. It was considered reasonable to attempt gamma knife surgery (GKS) to the pituitary gland to control thalamic pain. METHODS: Inclusion criteria in this study were poststroke thalamic pain, failure of all other treatments, intolerance to general anesthetic, and the main complaint of pain and not numbness. Seventeen patients met these criteria and were treated with GKS to the pituitary. The target was the pituitary gland together with the border between the pituitary stalk and the gland. The maximum dose was 140 to 180 Gy. All patients were followed for more than 3 months. CONCLUSIONS: An initial significant pain reduction was observed in 13 (76.5%) of 17 patients. Some patients experienced pain reduction within 48 hours of treatment. Persistent pain relief for more than 1 year was observed in five (38.5%) of 13 patients. Rapid recurrence of pain in fewer than 3 months was observed in four (30.8%) of 13 patients. The only complication was transient diabetes insipidus in one patient. It would seem that GKS of the pituitary might have a role to play in thalamic pain arising after a stroke.
Assuntos
Dor/fisiopatologia , Dor/cirurgia , Hipófise/cirurgia , Radiocirurgia/instrumentação , Doenças Talâmicas/cirurgia , Tálamo/fisiopatologia , Idoso , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/cirurgia , Infarto Cerebral/fisiopatologia , Infarto Cerebral/cirurgia , Feminino , Humanos , Hipofisectomia/métodos , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Medição da Dor , Hipófise/patologia , Cuidados Pré-Operatórios , Doses de Radiação , Síndrome , Doenças Talâmicas/fisiopatologia , Tálamo/irrigação sanguínea , Tálamo/cirurgiaRESUMO
OBJECT: An animal model has been developed to study the effect of gamma knife surgery(GKS) on cerebral function. METHODS: A rat was fixed in a newly developed Régis-Valliccioni frame that enables the target region to be planned directly on the magnetic resonance images. The left striatum was irradiated with 150 Gy via a 4-mm collimator of the Leksell gamma knife. Apomorphine (dopamine agonist) was administered to elicit a circling behavior (apomorphine test) after the GKS so as to examine the time course of the changes in dopaminergic functions of irradiated striatum. After a series of behavioral analyses, irradiated brains were subjected to histological examination. Necrosis was observed in the irradiated area surrounded by hemorrhage and gliosis. The distance between the histologically estimated and planned centers of the irradiation areas was 1.0 +/- 0.5 mm. The extent of the distance was due to errors along dorsoventral axis. The distribution of the irradiation areas influenced the activity and the circling behaviors in apomorphine test, which was suggestive of involvement of the nigrostriatal pathway. CONCLUSIONS: Targeting by using the Régis-Valliccioni frame was very accurate compared with targeting with coordinates based on brain maps used hitherto. Although targeting improved the accuracy, further effort will still be necessary to reduce errors along dorsoventral axis. The apomorphine test indicated a reduced dopaminergic function of the irradiated area including striatum, which accompanied histological changes after a high dose of irradiation (150 Gy).
Assuntos
Corpo Estriado/cirurgia , Radiocirurgia/instrumentação , Animais , Apomorfina/administração & dosagem , Apomorfina/farmacologia , Hemorragia Cerebral/etiologia , Corpo Estriado/efeitos dos fármacos , Corpo Estriado/patologia , Agonistas de Dopamina/administração & dosagem , Agonistas de Dopamina/farmacologia , Desenho de Equipamento , Gliose/etiologia , Imageamento por Ressonância Magnética , Masculino , Necrose/patologia , Complicações Pós-Operatórias , Doses de Radiação , Ratos , Ratos Wistar , Substância Negra/efeitos dos fármacos , Substância Negra/patologia , Substância Negra/cirurgiaRESUMO
Effects of spilled oil on microbial communities in tidal flats were examined by use of a simulator for a tidal flat ecosystem. The simulator is composed of a wave generator, a tide control device, and a tidal flat. Sediment for the tidal flat was obtained at a natural tidal flat in Hiroshima Bay, Japan. After stabilizing the benthic organisms, fuel oil C was added to the surface of the flat at 1 lm(-2). Although the total number of micro-organisms remained at 1.5-3.5 x 10(9) cells g(-1) dry sediment irrespective of the addition of oil, bacterial communities which were analyzed based on the 16S rDNA showed clear changes after the addition of fuel oil C and after a subsequent recovery period. Bacterial colonies were randomly isolated from the oil-supplemented sediment during the experiments, and the isolates were examined for susceptibility to hydrocarbons in order to screen the oil-susceptible bacteria. The proportion of oil-susceptible bacteria in the isolates decreased with the addition of the oil. Oil-susceptible bacteria showed an inability to assimilate petroleum compounds as well as an inhibition of growth. The possibility of using oil-susceptible bacteria as an indicator of bioremediation in tidal flats was discussed.
Assuntos
Bactérias , Exposição Ambiental , Sedimentos Geológicos/microbiologia , Petróleo/intoxicação , Adaptação Fisiológica , Bactérias/genética , Bactérias/crescimento & desenvolvimento , DNA Bacteriano/análise , Reação em Cadeia da Polimerase , Dinâmica Populacional , RNA Ribossômico 16S/análiseRESUMO
RATIONALE: Two or three decades ago, cancer pain was treated by surgical/chemical hypophysectomy. In one report, the control of central pain (thalamic pain syndrome) was also approached with chemical hypophysectomy. Although in most of the patients these treatments resulted in a decrease in severe pain, concomitantly severe adverse effects (panhypopituitarism, diabetes insipidus and visual dysfunction) occurred in most patients. This historical evidence prompted us to perform Gamma Knife surgery (GKS) for this kind of intractable severe pain using a high irradiation dose to the pituitary stalk/gland. In the majority of patients, marked pain relief was achieved, surprisingly without any of the complications mentioned above. MATERIALS AND METHODS: A prospective multicenter study was conducted to evaluate the efficacy and safety in patients treated in Prague, Hong Kong and Tokyo. Indications of this treatment were: (1) failure of other effective treatment approaches prior to GKS, (2) good general patient condition (Karnofsky performance status >40%), (3) response to morphine for pain control (cancer pain), and (4) no previous radiotherapy of brain metastases (GKS/conventional radiotherapy). Eight patients with severe cancer pain due to bone metastasis and 12 patients with post-stroke thalamic pain syndrome were treated with GKS. The target was the border between the pituitary stalk and gland. Maximum dose was 160 Gy for cancer pain and 140 Gy for central pain. Follow-up included 6 patients (>1 month) with cancer pain and 8 patients (> 6 months) with thalamic pain syndrome. RESULTS: All patients (6/6) with cancer pain experienced significant pain reduction, and 87.5% (7/8) of the patients with thalamic pain had initially significant pain reduction. In some patients, pain reduction was delayed for several hours. Pain relief was noted within 7 days (median 2 days). No recurrence was observed in the patients with cancer pain. However, in 71.4% (5/7) of the patients with thalamic pain syndrome, disease recurred during the 6-month follow-up. Up to now, other complications have not been observed. CONCLUSION: Our clinical study protocol is only preliminary. Further clinical results on the management of thalamic pain are required to develop this treatment protocol. However, efficacy and safety have been shown in all our cases. In our opinion, this treatment has a potential to control severe pain, and GKS will play an important role in the management of intractable pain.
Assuntos
Hipofisectomia , Dor/cirurgia , Hipófise/cirurgia , Radiocirurgia , Neoplasias Ósseas/complicações , Neoplasias Ósseas/secundário , Neoplasias da Mama/patologia , Feminino , Humanos , Masculino , Dor/etiologia , Dor/fisiopatologia , Hipófise/metabolismo , Estudos Prospectivos , Neoplasias da Próstata/patologia , Tálamo/fisiopatologia , Resultado do Tratamento , beta-Endorfina/metabolismoRESUMO
OBJECT: The authors have treated intractable pain, particularly cancer pain related to bone metastasis, with various protocols. Cancer pain has been treated by gamma knife radiosurgery (GKS), targeted to the pituitary gland-stalk, as an alternative new pain control method. The purpose of this study was to investigate a prospective multicenter protocol to prove the efficacy and the safety of this treatment. METHODS: Indications for patient inclusion in this treatment protocol were: 1) pain related to bone metastasis; 2) no other effective pain treatment options; 3) general condition rated as greater than 40 on the Kamofsky Performance Scale; 4) morphine effective for pain control; and 5) no previous treatment with radiation (GKS or conventional radiotherapy) for brain metastasis. The authors at one institution have treated two patients, who suffered from severe cancer pain related to bone metastasis, by using GKS. The target was the pituitary gland. The maximum dose was 160 Gy with one isocenter of an 8-mm collimator, keeping the radiation dose to the optic nerve less than 8 Gy. At another institution two patients were treated in the same way; an additional five patients were treated similarly with targeting of the pituitary gland with two isocenters of 4-mm collimator. In all nine cases, pain resolved without significant complication. Pain relief was observed within several days, and this effect was prolonged until the day that they died. At a follow up of 1 to 24 months, no recurrences and no hormonal dysfunction were observed. CONCLUSIONS: Despite insufficient experience, the efficacy and the safety of GKS for intractable pain were demonstrated in nine patients. This treatment has the potential to ameliorate cancer-related pain, and GKS will play a more important role in the treatment of intractable pain. More experience and additional refined study protocols are needed to evaluate which parameters are important, to determine what treatment strategy is the best, and to clarify the safest option for patients with intractable cancer pain.