Complementary and Alternative Medicine in Cancer Pain Management: A Systematic Review

Quality of life (QoL) encompasses the physical, psychosocial, social and spiritual dimensions of life lived by a person. Cancer pain is one of the physical component has tremendous impact on the QoL of the patient. Cancer pain is multifaceted and complex to understand and managing cancer pain involves a tool box full of pharmacological and non pharmacological interventions but still there are 50-70% of cancer patients who suffer from uncontrolled pain and they fear pain more than death. Aggressive surgeries, radiotherapy and chemotherapy focus more on prolonging the survival of the patient failing to realize that the QoL lived also matters equally. This paper reviews complementary and alternative therapy approaches for cancer pain and its impact in improving the QoL of cancer patients.     

Traumatic neuroma of the bile ducts with intrahepatic extension causing obstructive jaundice

Most traumatic neuromas of the biliary tract occur in the cystic duct stump after cholecystectomy and produce no symptoms. The authors report the rare occurrence of traumatic neuroma of the bile ducts that arose from injury to the duct occurring during cholecystectomy. The neuroma blocked the common hepatic duct and extended into the left hepatic duct, causing obstructive jaundice. The pseudotumor was removed from the common hepatic duct, but intrahepatic extension prevented complete removal. The patient remains well ten years after the surgical procedure.     

“新医科”背景下“医+文”创新通识课建设与实践

随着“新医科”建设的推进,创建学科交叉融合创新课程成为亟需进行的工作和挑战。本文对天津医科大学创建“医+文”创新通识课的目标、思路、内容、实践与反馈进行介绍,并为不同专业交叉融合的通识教育课程建设提供参考和实践依据。     

Immunocytochemical study of the glial fibrillary acidic protein in human neoplasms of the central nervous system

The distribution of the glial fibrillary acidic protein (GFAP) was investigated in sections of 131 paraffin-embedded brain neoplasms obtained at surgery or at autopsy. The unlabeled antibody immunoperoxidase (peroxidase-antiperoxidase, PAP) method was used. Equally good results were obtained from 17-year-old material and from recent material derived at surgery or autopsy and fixed with Bouin fluid or phosphate-buffered formalin. The perikaryons and processes of reactive astrocytes showed the most intense stain for GFAP. Positive reaction to antibody against GFAP of varying intensity was demonstrated in astrocytomas of various grades of malignancy (32 of 32), glioblastoma multiforme (10 of 10), subependymal giant cell astrocytoma (1 of 1), ependymoma (2 of 10), subependymoma (4 of 4), and astrocytes in mixed neoplasms (8 of 8). In two neoplasms diagnosed as malignant astrocytomas and in four neoplasms diagnosed as glioblastoma multiforme, GFAP stain was limited to a few neoplastic cells. Usually the stain was more intense over processes than in perikaryons, with the exception of gemistocytic astrocytomas and the giant cells in glioblastoma multiforme, which showed an equally intense stain over perikaryons and processes. The periphery of Rosenthal fibers was intensely positive for GFAP. In astrocytic neoplasms the number of GFAP-positive cells and the intensity of the stain were inversely proportional to the degree of malignancy. In the following neoplasms the reaction for GFAP was negative: oligodendroglioma (3), oligodendroblastoma (1), medulloblastoma (3), medulloepithelioma (1), neuroblastoma (1), pineocytoma (1), typical teratoma of the pineal (1), fibrosarcoma (1), pituitary adenoma (2), craniopharyngioma (1), chordoma (1), chemodectoma of globus jugulare (1), metastatic carcinoma (17), and lymphoma (8). In one of 18 meningiomas, endogenous peroxidase activity was seen in mast cells. All meningiomas studied were negative for GFAP. In one of six neurinomas a positive reaction for GFAP was detected over processes. The authors concluded that the immunostain for GFAP is useful in the diagnoses of astrocytic neoplasms and of mixed gliomas.     

中西医结合等容血液稀释对血液流变性及甲襞微循环的影响

对102例缺血性脑血管病中西医结合等容血液稀释前后血液流变性和甲襞微循环进行检测。结果表明,缺血性脑血管病患者Hct、全血比粘度、血浆比粘度、纤维蛋白原均明显升高(与健康对照组比较P<0.01),红细胞电泳时间延长(P<0.05),存在不同程度的微循环障碍。提示:中西医结合等容血液稀释能明显降低血液粘度(P<0.001),改善血液流变性和微循环。     

腹康理气汤促进腹部手术后肠道功能恢复临床观察

目的：运用腹康理气汤进行术后肠道功能恢复。方法腹部手术后6~24h给予腹康理气汤口服或保留灌肠。结果治疗组374例患者中，显效272例，有效84例，无效18例，总有效率95.19%；对照组178例患者中，显效70例，有效80例，无效28例，总有效率84.27%。根据统计学处理有统计学意义。结论腹康理气汤具有促进腹部手术后肠道功能恢复的作用。     

Antihypertensive therapy and male sexual dysfunction

Eight hundred sixty-one male patients receiving antihypertensive medication were evaluated for sexual dysfunction by means of a printed questionnaire. A positive history for this problem was found in 9% of patients receiving a diuretic (hydrochlorothiazide) alone, 13% of those receiving methyldopa, 15% receiving clonidine, and 23% treated with propranolol and hydralazine in combination. The incidence of sexual dysfunction in 177 control patients was 4%. Sexual dysfunction thus appears to be a significant problem in male patients being treated for hypertension, regardless of the therapeutic regimen.     

Irritable colon and depression.

Numerous attempts have been made to relate specific emotional conflicts to colonic symptoms in the irritable colon syndrome. Depression has been described as an accompaniment of the illness. This paper investigates the relationship between irritable colon and depression using self-rating symptom scales and the Zung Self-Rating Depression Scale. Thirty-one subjects were followed for two months in a double-blind study employing a tricyclic antidepressant and an inactive placebo. The study demonstrates the frequency of depression in patients with the syndrome; it shows a clearly positive treatment effect with placebo alone for both depressive symptoms and gastrointestinal complaints, and suggests that tricyclic antidepressant therapy results in moderately greater improvement in symptoms than does treatment with placebo alone.     

Histamine suppression of in vivo eosinophil accumulation and histamine release in human allergic reactions

Although it has been shown that histamine inhibits antigen-induced in vitro histamine release from basophils, it is unclear whether histamine inhibits in vivo mediator release in human allergic reactions. We report effects of exogenous histamine on histamine release and inflammatory cell responses in antigen-challenged skin sites in eight ragweed-sensitive individuals. Four heat-suction blisters in each subject were unroofed, and a collection chamber was appended to each blister base. Chamber A contained 1000 PNU/ml ragweed extract; chamber B contained buffered saline (control fluid); chamber C contained 1000 PNU/ml ragweed and 50 ng (5 x 10(-7) M) of histamine; and chamber D contained histamine alone (50 ng). Comparative analyses of chamber histamine levels in individual subjects showed that (1) histamine levels in chamber A were significantly greater than those in chamber B (p less than 0.01) and that histamine levels in chamber C were not significantly different than those in chamber D (p less than 0.5). Likewise, comparison of eosinophils attaching to membrane filters appended to the chamber bases for 2 hr showed that there were significantly more eosinophils in chamber A than in chamber B (p less than 0.01) and that there was no significant difference in eosinophil numbers on filters appended to chamber C vs chamber D. In three of four subjects studied, addition of exogenous histamine (50 ng/ml) to ragweed before intradermal injection inhibited the ultrastructural mast cell alterations seen within 10 min after injection of ragweed alone. In the one subject in which mast cell alterations were not prevented, exogenous histamine also did not inhibit antigen-induced histamine release or subsequent eosinophil accumulation in the skin chambers.     

The fundamental principle of medicine

“Nature, is the physician of all diseases”, the guiding principle of ancient Greek medicine is interpreted in the present paper in a modern way. This fundamental principle of medicine is regarded as a corollary of evolution theory according to which in order to survive the organism has to anticipate the environmental threat. Its genetic pool stores the neceessary programs to withstand all noxae encountered by the species up to the present to be implemented if neccessary into phenotypic strategies. From the medical point of view “Disease” represents the observed interplay between environmental threat and the appropriate strategy recruited by the organism to with-stand it. Thus according to the evolution theory, in order to survive, each species has to “know” how to cure itself otherwise it would have been eliminated. These arguments provide the foundation for the modern interpretation of the fundamental principle: “The organism anticipates all diseases”, which regards further the set of all genetically stored strategies (or anticipations) as the “vis medicatrix naturae”.Such a reasoning excludes the existence of any cause and effect relationship between a pathogen and a strategy. Etiology thus does not search for causes of diseases but assigns to each strategy the pathogens which trigger it.Neoplasia represents according this view an optimal strategy of the vis medicatrix naturae to withstand the harmfull effect of carcinogens.     

Neoplasia--a stem cell pathology

Cell proliferation in the organism is accompanied by cell displacement. Proliferating tissues exhibit three key characteristics: a site of origin of the stem cell, a tissue radius along which all constituents except the stem cell are displaced and a periphery where cells are eliminated. The tissue thus consists of two cell types: Stem and transitional. Since only the first resides permanently in the tissue any lasting change observed in the tissue is directed by the stem cell. Each stem cell division results in two cell types: one replacing the parent cell to remain a stem cell, while the other originates an outward displaced transitional cell clone whose life span is limited. In the normal state, the stem cell pool is constant, although its replenishment capacity is limited. Neoplasia is regarded here as a purposeful tissue alteration originating in a stem cell change manifested by: Aneuploidy, maturation arrest, stem cell pool enlargement and increasing cell turnover. Stem cells are assumed to secrete a substance 'A' necessary for a proper tissue function, whose production is impeded by carcinogens, mainly by stem cell depletion. Since however stem cell replenishment is limited, the organism grows a specialized organ, the neoplasm, producing a less efficient substitute for 'A', denominated here as substance 'B'. Neoplastic growth is indirectly dependent upon the abundance of substance 'A', the supply of which should be followed by a reduction of neoplastic mass. Neoplasia is thus viewed here as a protective function directed by the stem cell and linked with "oncogenes". Each determined stem cell is harbouring a specific oncogene and exhibits a typical neoplasm. Since the theory predicts that neoplastic growth indirectly depends upon the abundance of substance 'A', it may be tested by investigating the effect of substance 'A' producing stem cells upon the growing neoplasm. Their supply to the organism should be followed by a reduction of the neoplastic mass.     

Patterns of mast cell alterations and in vivo mediator release in human allergic skin reactions

Patterns of in vivo histamine release in skin sites challenged with ragweed antigen were compared in five human subjects sensitive to this antigen and four nonallergic individuals, using a newly developed skin-chamber technique. These findings were compared with inflammatory cell responses in the reaction sites and patterns of ultramicroscopic mast cell alterations in biopsy specimens of skin tests in the same subjects. Definite mast cell alterations occurred within 15 sec and appeared maximal within 5 to 10 min after antigen injection. Histamine levels in appended chambers increased after a lag of 10 to 30 min and were elevated for at least 60 min after antigen challenge. Eosinophils accumulated only in antigen-induced reaction sites. However, there was no precise quantitative correlation among the degree of change in these three measurements. These appear to be promising approaches to further in vivo studies of human allergic reactions.     

88例恢复期精神分裂症患者述情障碍的临床研究和中西医对策

目的 探讨恢复期精神分裂症患者述情障碍及相关因素和中西医对策。方法 对88例恢复期精神分裂症患者采用TAS评定，并对不同病程、年龄、文化程度、性别组进行TAS评定和比较。结果 恢复期精神分裂症患者存在着明显的述情障碍．且不同病程、年龄、文化程度、性别组的总均分因子分存在明显差异。结论 恢复期精神分裂症患者存在着严重的述情降碍．中西医结合干预有一定效果。