The use of acupunture to control side effects and pain during treatment for childhood cancer

At the Hospital do Câncer in São Paulo, Brazil, appoximately 300 patients per year are diagnosed with childhood câncer. Generally 60 children/adolescents are seen in the outpatient clinics each day (25 receive chemotherapy). The multidisciplinary team includes a consulting acupuncturist (a specialty recognized by the Federal Medical Council of Brazil) to address the side effects of the treatment of childhood cancer. Six children/adolescents, 2 to 20 years of age, were chosen during 2000 to receive this treatment. Diagnoses included soft tissue sarcoma, retinoblastoma, and Hodgkin’s disease, nd one third of the patients were in palliative care. The indications for acupuncture included nause/vomiting, pain, constipation, stress, and aversion to chemotherapy. Children/adolescents, identified by the nurse as appropriate for the treatment, met with the acupuncturist to discuss the indications and carefully explain the procedure. Each needle application took 30 minutes, while the patient was observed by the nursing staff. The nurses removed the needles, gave the discharge instructions, and monitored the child/adolescent during follow-up.

Approximately 70% of the children/adolescents achieved complete relief of their symptoms. An example of the patients’ satisfaction is as follows. &dquo;The first time I was a little worried about the needles, but after that I felt so good that I wanted to repeat the application. Nowadays I set my chemo for the days I can do a session of acupuncture before.&dquo; Acupuncture is more cost effectivethan pharmacologic interventions for our unit. It is particularly welcome in palliative care since we use minimal pharmacology during this phase tobe less invasive. Acupuncture provides better control of side effects and enhances the quality of treatment, and so it improves our nursing practice.From a patient/family perspective it has reduced the psychological damage caused by the side effects,increased oral intake, and given patientsadditional self-confidence.

Effects of calcium channel antagonists on the induction of nitric oxide synthase in cultured cells by immunostimulants.

We investigated whether calcium channel antagonists would alter the induction of nitric oxide (NO) synthesis by bacterial lipopolysaccharide (LPS) alone or in combination with interferon-gamma (IFN gamma) in cultured J774 macrophages, rat vascular smooth muscle cells, rat renal mesangial cells, and rat cardiac myocytes. The induction of NO synthesis was determined by measuring nitrite, the stable end-product. The dihydropyridine calcium channel antagonists, nifedipine, manidipine, nitrendipine, benidipine, barnidipine, perdipine, and nilvadipine all reduced the LPS-induced nitrite production in a dose-dependent manner, each with a differing half-maximal inhibitory concentration, in cultured J774 macrophages. Nifedipine also inhibited nitrite production in vascular smooth muscle cells, mesangial cells, and cardiac myocytes. The half-maximal inhibitory concentrations of nifedipine were ranked as follows: smooth muscle cells < mesangial cells < cardiac myocytes. Diltiazem, at nontoxic concentrations, had no effect on the nitrite formation in the three cell types. Verapamil markedly increased the formation of nitrite in cardiac myocytes in response to LPS and IFN gamma, but not in vascular smooth muscle or mesangial cells. Exposure of cardiac myocytes to LPS and IFN gamma caused the expression of NO synthase mRNA that was significantly increased by verapamil. Thus, certain calcium channel antagonists modulate NO synthesis by altering the induction of NO synthase.

The herbal medicine sho-saiko-to induces nitric oxide synthase in rat hepatocytes.

We have examined the effects of the herbal medicine sho-saiko-to (SST) on nitric oxide (NO) biosynthesis in rat hepatocytes by measuring the stable end-product nitrite and the mRNA of inducible NO synthase (iNOS). Interferon-gamma (IFN) by itself failed to induce NO synthesis (IFN: 1-1,000 u/ml). SST also did not elicit NO synthesis at concentrations up to 300 micrograms/ml when administered alone, but dose-dependently induced NO production in the presence of IFN. Whereas SST or IFN induced barely detectable levels of iNOS mRNA when administered alone, a combination of SST and IFN markedly induced iNOS mRNA in the cells. SST also modestly increased NO synthesis caused by interleukin-1 or bacterial lipopolysaccharide as a single agent, or in combination with IFN. On the other hand, SST had no effects on the NO synthesis produced by iNOS which were already induced. Thus, we found that SST stimulates cultured hepatocytes to produce NO by inducing iNOS gene expression under appropriate conditions. The capability of SST to induce NO biosynthesis might be related to the therapeutic efficacy of SST on the liver diseases.

Effects of epidermal growth factor, phorbol ester, and retinoic acid on hormone synthesis and morphology in porcine thyroid follicles cultured in collagen gel.

Epidermal growth factor (EGF), phorbol esters (PEs), and retinoic acid (RA) inhibit differentiated functions of thyrocytes. In the present study the inhibitory effects of these growth-promoting factors on hormone synthesis were studied in thyroid follicles cultured in type-I collagen gel, and morphologic alteration by these factors was examined by light and electron microscopy (EM). Porcine open thyroid follicles obtained by treatment with 0.1% collagenase were embedded in collagen gel and cultured in Ham's F12 medium supplemented with 6H (insulin, hydrocortisone, somatostatin, transferrin, glycyl-his-lys, and thyrotropin) + 0.5% fetal bovine serum (FBS). After 1 week these open follicles developed to closed follicles, and the medium was changed to one containing 6H + 0.5% FBS + 0.1 microM sodium iodide (NaI). Some media were supplemented with either EGF, phorbol 12-myristate 13-acetate (PMA), or all-trans RA. The closed follicles retained ability for hormone synthesis for 2 weeks after the medium change in the presence of 6H + FBS + NaI. The amounts of T4 and T3 secreted into the culture medium from day 9 to day 12 after the medium change were 60% and 45% of those from day 0 to day 4, respectively. EGF reduced production of T4 and T3 by 61% and 69%, respectively; PMA, by 87% and 99%; and RA, by 55% and 44%. In the medium supplemented with 6H + 0.5% FBS, the follicles exhibited intact polarity. Apical surfaces with microvilli were oriented to the follicular lumen and tight junctions were on the apical side of cell-to-cell contacts. Desmosomes were found on both the apical and basal halves of the cell contacts.(ABSTRACT TRUNCATED AT 250 WORDS)

[Altered alpha atrial natriuretic peptide (ANP) concentrations in plasma, atria and hypothalamus in experimentally induced hyper- and hypothyroid rats].

In order to assess a possible involvement of thyroid hormone in atrial natriuretic peptide (ANP), experimentally induced hyper- and hypothyroid rats were employed, and the immunoreactive rat ANP (IR-ANP) concentrations in plasma, atria and brain regions including the hypothalamus were measured by a specific radioimmunoassay. Plasma IR-ANP concentration in hypothyroid rats was 14.5 +/- 2.9 (mean +/- SD) fmol/ml, significantly lower than that in control rats (p less than 0.05 vs control of 24.9 +/- 9.7 fmol/ml). Plasma IR-ANP concentration in hyperthyroid rats was 66.4 +/- 9.7 fmol/min, significantly higher than that in the controls (p less than 0.01). Atrial IR-ANP concentration in hyperthyroid rats was significantly lower than that in the controls (79.9 +/- 11.1 nmol/g vs 133.5 +/- 21.2 nmol/g (control), p less than 0.05), though no significant change was observed in atrial IR-ANP concentration in hypothyroid rats. While hypothalamic ANP concentration in hypothyroid rats was significantly lower than that in the controls (17.5 +/- 3.5 pmol/g vs 31.9 +/- 1.9 pmol/g (control), p less than 0.05), there was no significant change of that in the hyperthyroid rats. On reverse phase high performance liquid chromatography, the major peak in plasma and hypothalamus extract was thought to be identical to synthetic alpha-rat ANP (1-28). These results may suggest that in the hyperthyroid state an excessive amount of ANP is released from atria into the blood, and that in the central nervous system thyroid hormone involve ANP metabolism being different from the atrium.

[Nutritional assessments in the long-term survivors following massive resection of the small intestine].

Nutritional assessments were measured in the sixteen long-term survivors who had undergone a massive resection of more than two-thirds of the small intestine or less than 170 cm of the remaining small intestine. Prealbumin, retinol binding protein and zinc in serum and arm muscle circumference were significantly lower than the normal range. Serum albumin had a tendency to correlate to the length of the remaining small intestine. Nutritional risk index had a correlation with the length of the remaining small intestine. In this study, nutritional assessments in the patients with a massive resection of the small intestine indicated to be in preclinical malnutritional state. This may support that supplementary nutritional therapy is necessary for such patients. In addition, we reported a patient with sensory polyneuropathy caused by vitamin E deficiency due to short bowel syndrome. The level of vitamin E was low in his serum, 294 micrograms/dl (normal: 1004 +/- 65) and in his red blood cells, 136 micrograms/dl (normal: 176 +/- 9). His symptom was markedly decreased within two weeks after the administration of large doses of vitamin E.

Pituitary, hypothalamic and pancreatic 7B2 concentrations in rats with streptozotocin-induced diabetes and spontaneously diabetic mice.

The pituitary protein, 7B2 has been demonstrated in the pancreas and is known to be present in very high concentrations in pancreatic endocrine tumors. To investigate whether any changes in 7B2 concentrations might be present in the pancreases affected by different types of diabetes and whether the diabetic state itself might affect pituitary and hypothalamic 7B2 concentrations, streptozotocin (STZ)-treated rats and mice with natural-onset diabetes (obese hyperglycemic, or ob/ob, mice and non-obese diabetic, or NOD, mice) were employed. A significant reduction in pancreatic 7B2 concentrations was found in STZ-treated rats. The pancreatic 7B2 concentration was significantly high in ob/ob mice (p less than 0.05, versus the concentration in their lean littermates, and the decrease observed in older NOD mice, appeared to parallel their insulin reserve. Pituitary and hypothalamic 7B2 concentrations were similar in STZ-treated and control rats. A reduction in pituitary and hypothalamic 7B2 concentrations was observed in older NOD mice (both p less than 0.01 versus respective values in younger mice). In ob/ob mice, a significant reduction was also found in hypothalamic 7B2 concentration (p less than 0.01 versus that in control mice). Gel permeation chromatography showed that 7B2 immunoreactivity comprised two molecular components, and the relative proportion in the pancreas differed from that in other tissues. In the pancreas, a smaller molecular component was predominant (elution coefficient, 0.62).(ABSTRACT TRUNCATED AT 250 WORDS)

Improvement in abnormal secretion of thyrotropin and gonadotropin after restoration of serum calcium is pseudohypoparathyroidism.

A 25 yr-old woman patient was admitted because of convulsion. The diagnosis of pseudohypoparathyroidism was made on the basis of typical stigmata, lowered serum calcium, increased serum phosphorus and parathyroid hormone levels, and defective response in urinary excretion of cyclic AMP and phosphorus to exogenous parathyroid extract. Endocrine studies performed in the hypocalcemic state revealed several abnormalities of the pituitary gland such as an exaggerated response of TSH to TRH, high basal levels and exaggerated responses of LH/FSH and a blunted GH response to arginine-HCl, while there was no clinical evidence of hypothyroidism and hypogonadism. These abnormalities of anterior pituitary function were normalized after the restoration of normocalcemia by using 1 alpha-hydroxy-cholecalciferol. These results suggest that some endocrine abnormalities observed in pseudohypoparathyroidism might be functional and reversible disorders secondary to hypocalcemia rather than genetic ones.