RESUMEN
<p>Orengedokuto, a Kampo formulation, has traditionally been used to treat various diseases, including hypertension with neuropsychiatric symptoms, gastritis, dermatitis, hematemesis and hemorrhagic stools. We report 8 cases of intractable hemorrhage that could not be controlled by Western medicine, but were successfully treated with orengedokuto. We elaborate on 3 cases, including 1 case treated by enema administration of orengedokuto, which was found to be a useful method. In a representative case, an 80-year-old man with aplastic anemia who was taking anticoagulants due to a history of mitral valve replacement presented with a chief complaint of black stool. Hemorrhagic gastritis was diagnosed. We repeatedly attempted endoscopic hemostatic therapy, but failed to achieve hemostasis. Oral administration of orengedokuto demonstrated hemostatic effects within a few days of starting treatment. In all 8 these cases, moreover, we observed quick clinical responses with no side effects. Although the hemostatic mechanism of orengedokuto remains unclear, we speculate that orengedokuto contains a short-acting component that affects primary hemostasis. As such, conventional orengedokuto may also have potential as a novel hemostatic agent.</p>
RESUMEN
Patients with cancer cachexia often suffer from psychiatric disorders, severe nausea and vomiting. In the present study, we investigated the changes in monoaminergic activities in the brain in tumor-bearing mice (cachectic clone 20). The dopamine turnover rate in clone-20 mice was decreased markedly, and in contrast, the serotonin and histamine turnover rates were significantly increased. It is concluded that some of the psychiatric disorders in cachectic patients might be ascribable to changes in monoaminergic activities in the brain. The serotonin content of the small intestine in clone-20 mice increased significantly; this was associated with an increase in tryptophan hydroxylase activity. In addition, the increase in histidine decarboxylase (HDC) activity in the spleen occurred in clone 20 mice, and this histamine metabolism might modify the immune status in cancer-burden patients. Serum levels of interleukin-6 (IL-6) and granulocyte-macrophage colony-stimulating factor (GM-CSF) were significantly elevated in clone 20 mice, and these increased inflammatory cytokines might be partly responsible for the changes of monoamine turnover in the brain, in the gut and in the spleen.
RESUMEN
Trezentos e setenta e dois pacientes com tumores colo-retais tratados com intençäo curativa, entre janeiro de 1982 e janeiro de 1992, foram revistos para determinar-se o papel da colonoscopia e os resultados cirúrgicos em 30(8,1 por cento) pacientes com tumores múltiplos, comparando estes resultados com o grupo de lesöes únicas. A idade média dos pacientes era de 57(35-79) anos, sendo 20 homens e 10 mulheres. Dezenove pacientes tinham lesöes sincrônicas e os 11 restantes metacrônicas, sendo o reto e o cólon signóide os locais de apresentaçäo mais freqüentes (73 por cento). O diagnóstico pré-operatório correto foi realizado em 14 dos 19 pacientes com lesöes sincrönicas, e nos cinco pacientes restantes a näo realizaçäo de colonoscopia intra-operatória foi a causa de falha diagnóstica; três deles tinham lesöes previamente despercebidas ao enema baritado. Lesöes sincrônicas tendem a ser menos invasivas que as metacrônicas e a sobrevida de 5 anos (Kaplan-Meier) acha-se reduzida em pacientes com tumores múltiplos, 45 por cento versus 58 por cento, respectivamente (näo significante). Em pacientes com tumores colo-retais o exame do cólon deve ser completado através de colonoscopia intra-operatória, com o objetivo de excluir lesöes colônicas associadas e diminuir a incidência de lesöes metacrônicas "precoces"