Analysis of the circumstances at the end of life in children with cancer: Symptoms, suffering and acceptance

BACKGROUND: In an effort to improve the quality of life of children with cancer, this study analyzes the signs and symptoms at the end of life in such children. It is hoped that these data will contribute to the development of appropriate programs to address the challenges faced by these children. PROCEDURE: Between 1994 and 2000, 28 children died after treatment for cancer at Hamamatsu University Hospital, Japan. The circumstances, signs and symptoms at the end of life of these children were analyzed through their medical records. RESULTS: Of the 28 children, the underlying diseases were leukemia/lymphoma (LL group; n=11), brain tumors (BT group; n=7), and other solid tumors (OST group; n=10). Records showed poor appetite (100%), dyspnea (82.1%), pain (75.0%), fatigue (71.4%), nausea/vomiting (57.1%), constipation (46.4%) and diarrhea (21.4%) among these children. Anxiety was reported in 53.6% of the entire group of 28 children; however, no child in the BT group manifested anxiety. However, disturbance of consciousness was reported in all children in the BT group, which was significantly greater than in the other groups. Awareness, fear or acceptance of the imminence of his/her own death as indicated by verbal expression was reported in nine children (32.1%). CONCLUSIONS: Using the data obtained in the present study, we describe situations faced in the terminal care of children. It is important to address the problems revealed by this analysis in order to achieve improvements in both the physical and psychological care of children with terminal cancer.     

Recording of electroencephalograms and electrocardiograms during daytime sleep in trained canines: Preparation of the sleeping dogs

Abstract  Although respiration in trained canines is well investigated, the process of preparing dogs has not been described in any great detail. Moreover, their daytime patterns of sleep and wakefulness during 1 or 2 h of electroencephalogram (EEG) and electrocardiogram (ECG) recordings are not clear. Therefore, we describe the process of selecting and training dogs, in which we recorded EEG and ECG in the laboratory. First, 14 of 1242 dogs dealt with over a 1 year period were chosen. They were trained for 2 h to lie quietly and to sleep in the laboratory; this training procedure was repeated 152 times. Three dogs were then selected and a permanent tracheostomy was performed in one. Finally, EEG and ECG were recorded with the bipolar fine needle electrodes; respiration was recorded simultaneously through a tube inserted to a tracheostomy in one dog. Wakefulness, slow wave sleep (SWS) and rapid eye movement (REM) sleep (REMS) were identified according to the EEG pattern and on the basis of the behavioral criteria. Recordings were performed 12 or 13 times in each dog. Complete sleep cycles, including wakefulness, SWS and REMS in this sequence, were observed 3.9–4.1 times. The mean duration of SWS was 2.2–4.4 min and that of REMS was 3.5–4.6 min. The REMS latency was 33.9–41.8 min. Fluctuation of heart rate with respiration, termed respiratory sinus arrhythmia, was noted in the ECG. Heart beat increased with inspiration and decreased with expiration. The present study demonstrates how to select and train sleeping dogs and shows their undisturbed daytime sleep and wakefulness patterns.     

Endocrine therapy with or without radical prostatectomy for T1b-T3N0M0 prostate cancer

BACKGROUND: We retrospectively compared the 5-year survival rates of T1b-T3N0M0 prostate cancer patients treated either by endocrine therapy plus radical prostatectomy or endocrine therapy alone. METHODS: Clinical T1b-T3N0M0 prostate cancer patients were enrolled at 104 institutions in Japan. They were assigned to study 1 (n = 176), if they were indicated to prostatectomy, if not indicated, they were assigned to study 2 (n = 151). The indication of prostatectomy was based on the clinical judgement of physicians and/or patients. Those assigned to study 1 underwent prostatectomy and adjuvant endocrine therapy with or without preoperative androgen deprivation. Those assigned to study 2 were treated with leuprorelin acetate with or without chlormadinone acetate. They were followed-up every 3 months until death or for 5 years and over. RESULTS: Those assigned to study 1 were younger (mean age 67.2 vs 75.7 years), less advanced in clinical stage, and had lower prostate specific antigen levels (mean 43.8 vs 103.6 ng/mL). Death for any reason was observed less frequently in study 1 (n = 29, 16%) than study 2 (n = 50, 33%), and the 5-year overall survival rate was higher in study 1 (87 vs. 68%). However, prostate cancer deaths were comparatively seldom (9% in study 1 and 7% in study 2), resulting in the identical 5-year cause specific survival rate in both study groups (91%). In both study groups the overall survival was almost equal to the natural survival of age-matched men. CONCLUSIONS: Endocrine therapy offers a reasonable survival rate in T1b-T3 prostate cancer patients within a 5-year follow-up. Observation will be extended to determine 10-year outcomes.     

Abnormal cardiac histology in severe intrauterine growth retardation infants

Four infants with severe intrauterine growth retardation (IUGR) weighing less than 1000 g at birth developed heart failure and died in our unit, where heart failure of IUGR infants is the main reason of death in extremely low birth-weight infants. The causes of their heart failure are one of the main themes in current neonatal medicine. The subjects of this study were four small for gestational age infants; all died due to heart failure 5 to 10 days after birth. Microscopic specimens of hearts from autopsies were evaluated with respect to the following characteristics: thickness of myocardial fibers, maturation of nuclei, presence of dysgenesis or necrosis in myocardium, and amount of glycogen in the heart. Neither dysgenesis nor infarction of the heart was found but hypoplasia in myocardial fibers and decreased glycogen levels were observed. Maturation delay in myocytes' nuclei did not appear to be severe. We conclude that these infants' hearts failed to adapt to postnatal hemodynamic changes because of inadequate myocardial function and inadequate glycogen reserves.     

The Acute and Chronic Toxicities of Nivalenol in Mice

The Acute and Chronic Toxicities of Nivalenol in Mice. Ryu,J.-C, Ohtsubo, K., Izumiy-ama, N., Nakamura, JL, Tanaka, T.,Yamamura, H., and Ueno, Y. (1988). Fundam. Appl Toxicol. 11,38–47. In an attempt to ascertain precisely the toxiceffects of nivalenol (N1V), we conducted the determination ofLD50 values, and interim kills during the carcinogenic studyin mice. LD50 values (mg/kg) of NIV in 6-week-old male ddY micewere determined as 38.9 (po), 7.4 (ip), 7.2 (sc), and 7.3 (iv).Seven-week-old female C57BL/6CrSlc SPF mice were fed diets containing0, 6, 12, and 30 ppm (mg/kg) NIV over 1 year, and were assessedfor effects on body weight gain, feed efficiency, terminai organweights, hematology, and histopathology. The rates of body weightgain and feed efficiency showed a good dose-dependent correlationin all experimental periods. Gross and histopathological evaluationof the liver, thymus, spleen, kidneys, stomach, adrenal glands,pituitary gland, ovaries, sternum, bone marrow, lymph node,brain, and small intestines with or without Peyer's patch portionfrom control and all NIV-exposed mice revealed that these tissueswere normal in appearance and in histopathological structure.Also, no changes were observed in the ultrastructural studieson the bone marrow. Dietary NIV did, however, cause dose-dependentdecreases of absolute organ weights (mg) and increases of relativeorgan weights (mg/g body weight) in the terminal organ weightsrecorded. A significant leukopenia was observed in the 30 ppmgroup at 6 months and in all NIV-treated groups at 1 year. Nomarked changes were observed in the other hematological parameters.These results indicated that 6 ppm or more of dietary NIV for1 year showed a characteristic toxic effect of trichothecenemycotoxins in mice.     

鬼针草化学成分的研究（Ⅰ）

目的 研究鬼针草Bidens bipinnata地上部分的化学成分。方法 采用硅胶、ODS柱色谱并结合HPLC分离纯化，通过理化鉴定和波谱分析鉴定其化学结构。结果 从鬼针草的醋酸乙酯部位得到水杨酸(I)、9，12，13-三羟基-10，15-十八碳二烯酸(Ⅱ)9，12，13-三羟基-10-十八烯酸(Ⅲ)、苄基-O-β-D-吡喃葡萄糖苷(Ⅳ)、苯乙基-O-β-D-吡哺葡萄糖苷(V)、(Z)-3-己烯基-O-β-吡喃葡萄糖苷(Ⅵ)、丁香酚苷(Ⅶ)、3-甲基-2-(2-戊烯基)-4-O-β-D-吡喃葡萄糖基-△^2-环戊烯酮(Ⅶ)。结论 以上8个化合物中除水杨酸外，其余7个化合物均为首次从鬼针草中分离得到。     

Reflex sympathetic dystrophy in childhood: A case report

A case report is presented of a 15-year-old girl with reflex sympathetic dystrophy (RSD). She was referred to hospital because of left upper limb pain. Her left upper limb was cold, edematous and blue with a limited active range of movement. The serum concentration of noradrenaline was lower on the painful side than on the healthy side, and neurotropin, which has an antinociceptive effect to hyperalgesia, was clearly effective. Early diagnosis and management is essential in the treatment of RSD and administration of neurotropin is a useful and non-invasive treatment without severe adverse effects.