Alternative Therapy Methods Research Articles

Characterisation and comparison of health-related quality of life for patients with renal failure

ABSTRACTObjective: The objective of this study was to assess the health related quality of life (HRQOL) in patients with kidney failure who had received renal transplants compared to those receiving haemodialysis, peritoneal dialysis or were waiting to start dialysis.Research design and methods: The study was conducted at the University Hospital of Wales, Cardiff. HRQOL was measured using the EQ‐5D, SF‐36 and the Kidney Disease Quality of life questionnaire (KDQOL). Patients with kidney failure were identified from the renal unit departmental database and were surveyed by postal questionnaire or during their treatment.Results: Of 1251 people surveyed, 416 valid returns were received, a response rate of 33%. For renal transplant patients the mean EQ‐5Dindex was 0.712 (SD 0.272), significantly higher than those in the other treatment groups (haemodialysis mean = 0.443 (SD 317), p < 0.001; peritoneal dialysis mean = 0.569 (SD 329), p < 0.001). This difference remained after controlling for age and co-morbidity. With the exception of pain, the SF‐36 showed significantly higher scores across all domains for transplant patients compared to both dialysis groups. From the KDQOL there were significantly lower scores compared with the transplant patients for both groups of dialysis patients for the effects and burden of kidney disease and general symptoms and problems. However, overall health scores were significantly higher for dialysis patients compared with transplant patients.Conclusion: Kidney failure has a high cost in terms of health related quality of life. There was a large difference between patients who have received a functioning graft following kidney transplant versus the alternative methods of renal replacement therapy, that is, peritoneal dialysis and haemodialysis. Kidney transplant should be the treatment of choice, and every effort should be made to increase the availability of kidneys for transplantation.

Combination of cytosine deaminase suicide gene expression with DR5 antibody treatment increases cancer cell cytotoxicity

Combined treatment using adenoviral-directed enzyme/prodrug therapy and immunotherapy has the potential to become a powerful alternative method of cancer therapy. We have developed adenoviral vectors encoding the cytosine deaminase gene (Ad-CD) and cytosine deaminase:uracil phosphoribosyltransferase fusion gene (Ad-CD:UPRT). A monoclonal antibody, TRA-8, specifically binds to death receptor 5, one of two death receptors bound by tumor necrosis factor-related apoptosis-inducing ligand (TRAIL). The purpose of this study was to evaluate cytotoxicity in vitro and therapeutic efficacy in vivo of the combination of Ad-CD:UPRT and TRA-8 against human pancreatic cancer and glioma cell lines. The present study demonstrates that Ad-CD:UPRT infection resulted in increased 5-FC-mediated cell killing, compared with Ad-CD. Furthermore, a significant increase of cytotoxicity following Ad-CD:UPRT/5-FC and TRA-8 treatment of cancer cells in vitro was demonstrated. Animal studies showed significant inhibition of tumor growth of MIA PaCa-2 pancreatic and D54MG glioma xenografts by the combination of Ad-CD:UPRT/5-FC plus TRA-8 as compared with either agent alone or no treatment. The results suggest that the combination of Ad-CD:UPRT/5-FC with TRA-8 produces an additive cytotoxic effect in cancer cells in vitro and in vivo. These data indicate that combined treatment with enzyme/prodrug therapy and TRAIL immunotherapy provides a promising approach for cancer therapy.

Short-term, high dose enzyme replacement therapy in sialidosis mice

Given the success of enzyme replacement therapy (ERT) in treating the systemic manifestations in a number of lysosomal storage disorders (LSDs), we evaluated the effect of ERT on the mouse model of sialidosis. This glycoproteinosis, which affects primarily the reticuloendothelial (RE) system, is caused by deficiency of lysosomal neuraminidase (NEU1) and consequent accumulation of sialylated glycoconjugates. NEU1 lacks a functional mannose-6-phosphate recognition marker and is not endocytosed by mammalian cells. However, the enzyme produced in insect cells has features that allow its effective uptake by RE cells and macrophages via the mannose receptor, and therefore represent an alternative method of therapy. In this study we tested the therapeutic efficacy of baculovirus (BV) expressed mouse neuraminidase (Neu1) in sialidosis mice. Four-week-old Neu1 −/− mice were first injected intravenously with a single dose of the recombinant enzyme for assessment of the half-life of mannosylated Neu1 in vivo. Afterwards, a short-term ERT with a total of five enzyme injections over a 2-week period was performed for evaluation of phenotype correction. Neu1 infused alone or co-administered with its associated protein, protective protein/cathepsin A (PPCA) was effectively taken up by resident macrophages in many tissues. Restored Neu1 activity persisted for up to 4 days, depending on the tissue, and resulted in a significant reduction of lysosomal storage. However, beyond 2 weeks of treatment, ERT mice developed a severe immune response towards the exogenous Neu1 enzyme. These results may have important implications for ERT in sialidosis patients.

Traditional Chinese medicine in dermatology.

Traditional Chinese medicine (TCM) is an alternative method of therapy that can be administered in oral, topical, or injectable forms. It emphasizes the importance of using many herbs that are combined in different formulations for each individual patient. Since it is not possible to discuss all applications of TCM in every skin disorder, psoriasis and atopic dermatitis are used as the prototypes in illustrating the use of TCM. A number of studies have shown the usefulness of TCM in the treatment of these skin conditions, and thus it is worthwhile for dermatologists throughout the West to gain some familiarity with this method. We attempt to provide a general overview of TCM through a discussion of efficacy, mechanisms of action, and side effects of various TCMs. A warning regarding the possible contamination of TCMs is also included. In the future, perhaps a better understanding of TCM will be gained through more systematic analysis and controlled studies with a placebo arm. It is our hope that this article will provide dermatologists with a more complete understanding of the role and ramifications of TCM therapy.

Exercise

Our feminist perspective is one of empowerment for breast cancer survivors, and we believe that physical activity and exercise have the potential to shift the battle away from fear of living to living fully. In light of the psychosocial and cultural factors that influence the interpretation of the breast cancer experience, rehabilitation efforts have shifted from curing the disease to living with the disease, or survival. This shift is reflected in the selection of quality of life as the primary indicant of treatment efficacy. Interpreted from a feminist, empowerment perspective, evidence is presented demonstrating the positive influence of physical activity and exercise on quality of life in breast cancer survivors. We propose that physical activity has the potential to enhance perceptions of capabilities and control, thus empowering the individual to create her own reality. We conclude that physical exercise can be a safe and effective complementary and alternative method of therapy for breast cancer survivors.

Alternative Therapy of Animals – Homeopathy and Other Alternative Methods of Therapy

Alternative therapy of animals is described, in the meaning of alternatives to veterinary therapy traditionally accepted by veterinary faculties and schools and included in their curricula. Alternative therapy composes of different disciplines, of which homeopathy is emphasised in this presentation. Information is given on the use and interest of such therapy among veterinarians and animal owners. Homeopathy as other alternative therapies, may offer great advances, if they induce any effect. Some of the disciplines are based on a scientifically accepted documentation. Others, and homeopathy in particular, are missing such a documentation of effect. The justification of including alternative therapy in treating animals is discussed. Research in alternative therapy of animals is greatly needed, in particular to evaluate therapeutic methods which are in extensive use without any documented effect. An ongoing research project in Norway on the effect of homeopathic treatment of mastitis in cows is shortly presented.

Obstruktion chirurgischer portosystemischer Shunts in der frühen postoperativen Phase: Interventionelle Behandlung durch Angioplastie und Stentimplantation

Recurrent variceal bleeding in patients treated with surgical porto-systemic shunting is most often due to shunt stenoses or occlusion. Radiological interventional procedures are a possible method of therapy and our experience herein is described in this report. From 1997 to 1999 54 patients with recurrent variceal bleeding were treated with a surgical porto-systemic shunt procedure. Of these early shunt occlusion occurred in 5 patients, which was treated with percutaneous transcatheter techniques. In only one patient was PTA alone sufficient to reestablish shunt patency, in four patient stent placement was necessary in addition. In the follow-up period 1 patient died 26 month after intervention with (autopsy-proven) patent shunt, in one patient shunt reocclusion occurred after 11 months and in 3 patients the shunt is still patent. PTA, if necessary in combination with stent placement, is an attractive alternative method of therapy in case of an early surgical porto-systemic shunt occlusion.

Enhanced proliferation and differentiation of rat hepatocytes cultured with bone marrow stromal cells.

Liver transplantation is the only clinically effective method of treating acute liver failure. However, wider application of this therapeutic modality is restricted primarily by shortage of donor organs. In the search for alternative methods of liver replacement therapy, investigators have focused on transplantation of normal allogeneic hepatocytes and on the development of liver support systems utilizing isolated hepatocytes. Since all human livers suitable for cell harvest are being used for transplantation, hepatocyte therapy using human tissue would require growing of cells in vitro. Unfortunately, although hepatocytes have tremendous capacity to proliferate in vivo, their ability to grow in culture is severely limited. Stromal cells from bone marrow and other blood-forming organs have been found to support hematopoiesis. In this paper, we show that bone marrow-derived stromal cells (BMSCs) enhance proliferation and support differentiation of rat hepatocytes in culture. Further, we demonstrate that in hepatocyte/BMSC co-cultures, clonal expansion of small hepatocytes (SH) is increased. Using semipermeable membrane cultures, we established that direct cell-cell contact is necessary for stimulation of cell proliferation. We also show that BMSCs which are in direct contact with hepatocytes and SH colonies express Jagged1. This suggests a potential role for Notch signaling in the observed effects. Finally, we present evidence that the expression and activity of liver specific transcription factors, CCAAT/enhancer binding proteins and liver specific key enzymes such as tryptophan 2,3-dioxygenase, are improved in hepatocyte/BMSC co-cultures. In conclusion, results of this study indicate that BMSCs could facilitate proliferation and differentiation of primary rat hepatocytes and their progenitors (SH) in vitro.

The ureterosigmoidostomy as an alternative method of therapy for patients with unrepairable vesicovaginal fistulas in a mission hospital in Niger

International Journal of Gynecology & ObstetricsVolume 70, Issue S1 p. A145-A145 Urogynecology The ureterosigmoidostomy as an alternative method of therapy for patients with unrepairable vesicovaginal fistulas in a mission hospital in Niger J. Wacker, J. WackerSearch for more papers by this authorM. Reulecke, M. ReuleckeSearch for more papers by this author J. Wacker, J. WackerSearch for more papers by this authorM. Reulecke, M. ReuleckeSearch for more papers by this author First published: 10 December 2003 https://doi.org/10.1016/S0020-7292(00)83501-8AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume70, IssueS12000Pages A145-A145 RelatedInformation

Adjunctive treatment of congenital pigmented nevi with phenol chemical peel.

The purpose of this study was a retrospective evaluation of the treatment of congenital pigmented nevi using the phenol chemical peel technique. Patients were treated with standard Baker formula in the operating room under general anesthesia or intravenous sedation with continuous electrocardiogram monitoring. A total of 20 patients were reviewed (13 girls and 7 boys, mean age 3.8 years). Eight patients had nevi located on the face, five patients had trunk lesions, and three patients had lesions on the thighs. Two patients had nevi located on both the face and the trunk, and two patients had involvement of the face, trunk, and thigh. Three of the above patients had the classic "bathing trunk" distribution of the nevi. A test area was peeled in four patients, and in five patients preoperative biopsies were performed to rule out malignancy before initiation of therapy. An average of 2.6 treatments were performed per patient. Two patients had adjunctive dermabrasion to increase the depth of peel and to contour surface irregularities. The length of follow-up ranged from 6 to 84 months with a mean of 28 months. Healing of the wounds occurred within 2 to 3 weeks postoperatively. Seventy-five percent of patients had satisfactory cosmetic improvement in the appearance of the lesions following treatment. Four patients had recurrence of the pigmentation after an initial lightening response, three of whom had their nevi subsequently excised. There was no incidence of hypertrophic scarring or cardiac and/or renal complications. There was one death from complications of leptomeningeal melanocytosis. Chemical peeling of congenital pigmented nevi is an acceptable alternative method of therapy for those lesions that are too large for excision and primary closure or for lesions in which excision would result in unacceptable scars in areas such as the face.

Treatment of progressive familial intrahepatic cholestasis: Liver transplantation or partial external biliary diversion

Progressive intrahepatic familial cholestasis (PFIC), previously called Byler's disease, is a syndrome in which children develop severe cholestasis progressing to biliary cirrhosis and chronic liver failure, usually during the first decade of life. Clinical features include jaundice, hepatomegaly, splenomegaly, growth retardation and severe pruritus. Laboratory tests demonstrate elevated bilirubin and bile acids, without an increase in serum gamma-glutamyl-transpeptidase or cholesterol. This study was performed to evaluate our experience with medical therapy as well as two types of surgical treatment used in children with PFIC, particularly partial external biliary diversion (PEBD) as an alternative method of therapy to liver transplantation (OLTx). Between 1979 and 1998 we have treated 46 children with PFIC (27 boys and 19 girls), aged 10 months to 19 yr (at the time of this study). Medical treatment with ursodeoxycholic (UDCA) was used in 39 patients for the period between 6 and 82 months. PEBD (cholecysto-jejuno-cutaneostomy) was performed in 16 patients, OLTx in eight children (including one after unsuccessful PEBD). Retrospective analysis of the clinical course and selected laboratory tests (bilirubin, ASPAT, ALAT, bile acids), and histopathological examinations were performed. Results of treatment were assessed by means of influence of the type of treatment on clinical symptoms, laboratory tests, progress of liver cirrhosis and hepatic failure, as well as physical development and survival. Medical therapy was effective in the long term in four (10%) of the patients resulting in clinical and biochemical normalization. Both surgical methods of therapy of PFIC, PEBD and OLTx, resulted in an 80% success rate and therefore should be used as complementary therapies. In patients before established liver cirrhosis, PEBD should be the first choice of treatment. Patients presenting with cirrhosis or after ineffective PEBD should qualify for OLTx. With this strategy most children with PIFC can be cured.

Traditional Chinese medicine for the treatment of dermatologic disorders.

Traditional Chinese medicine (TCM) is an alternative method of therapy that can be administered in oral, topical, or injectable forms. It emphasizes the importance of using many herbs that are combined in different formulations for each individual patient. Among some segments of the patient population, it has become increasingly popular as a mode for treating dermatologic diseases. As a result, it is now worthwhile for dermatologists throughout the West to gain some familiarity with this method. Yet, dermatologists are largely unfamiliar with TCM and may possess some misconceptions. We attempt to give a general overview of TCM through the discussion of different clinical studies involving various TCMs. Some proposed mechanisms of action of TCM are also presented. A discussion of adverse effects, including hepatotoxic effects and the need for close monitoring is discussed. A warning regarding the possible contamination of TCMs is also included. Since it is not possible to discuss the application of TCM for every skin disorder, psoriasis and atopic dermatitis are used as the prototype in illustrating the use of TCM. In the future, perhaps a better understanding of TCM will be gained through more systematic analysis and controlled studies with a placebo arm. It is our hope that this article will provide an overview of the efficacy, mechanism of action, as well as adverse effects of TCM.

Postoperative nausea and vomiting: results of a multicentre survey

O-33 Introduction: Although an increasing number of studies concerning postoperative nausea and vomiting (PONV) have been performed, only few data are available on how anaesthesiologists routinely handle this problem. Methods: A multicentre survey was performed involving anaesthesiologists at 30 institutions. Four-hundred and seventy-four out of 1000 questionnaires were returned. Results: The question was posed: what kind of general anaesthesia would be best in a woman undergoing abdominal hysterectomy with a history of severe and repeated PONV. The replies were: induction with propofol (78%), thiopentone (17%), etomidate (5%). Maintenance of anaesthesia with an inhalation agent (44%) or with propofol (44%), a combination of these techniques (6%) or neuroleptanaesthesia (6%). Only 10% of respondents would omit nitrous oxide. There is no consensus about the optimal amount of opioids. Fentanyl, alfentanil and sufentanil are thought to contribute similarly to PONV. In the postoperative period piritramide is rated to be less emetogenic than tramadol or morphine. Seventy per cent advocate routine antiemetic prophylaxis for high-risk patients (the most often mentioned risk factors were: female gender: 85%, obesity: 81%, high doses of intra-operative opioids: 72%), and 23% would even advocate them for every patients. Ondansetron and droperidol are suggested as superior to metoclopramide (MCP), triflupromazine, dimenhydrinate, and transdermal scopolamine. However, MCP is the drug of first choice for more than 50% of the respondents followed by droperidol, whereas ondansetron is used by only 29% as a first line drug. Thirteen per cent of the anaesthesiologists had experience with alternative methods of prophylaxis and therapy of PONV, e.g. acupuncture or acupressure. Conclusion: The majority (93%) stated that PONV is a relevant problem that still remains unsolved. Further studies are needed.

Surfactant nebulisation prevents the adverse effects of surfactant therapy on blood pressure and cerebral blood flow in rabbits with severe respiratory failure

Surfactant replacement therapy for the neonatal respiratory distress syndrome has shown beneficial effects on lung function and survival. Recently, rapid fluctuations of haemodynamics and cerebral perfusion following surfactant instillation have been described and an association with the development of intraventricular haemorrhage has been proposed. Therefore, alternative methods of surfactant therapy that reduce the effects on cerebral perfusion have to be explored. Does instillation of surfactant influence blood pressure and cerebral blood flow in rabbits with severe respiratory failure? Can nebulisation of surfactant prevent these adverse effects on blood pressure and cerebral blood flow? Surfactant (Alveofact, 100 mg/kg body weight) was nebulised using the MiniNEB nebuliser, or instilled, in 12 rabbits with severe respiratory failure induced by lung lavage. Assessed were blood gasses, mean arterial blood pressure (MABP) and cerebral blood flow over the left carotid artery, using ultrasonic transit-time flow probes. Partial pressure of oxygen in arterial blood increased quickly after instillation, from 8.7 +/- 1.3 to 24.9 +/- 6.4 kPa after 15 min, and increased gradually during nebulisation from 8.0 +/- 0.5 to 24.5 +/- 4.6 after 120 min. After instillation, MABP decreased 22 +/- 5% (in 8 min) and cerebral blood flow dropped even more: 64 +/- 9% within 8 min. During nebulisation, MABP did not change significantly and cerebral blood flow decreased gradually, 31 +/- 14% over 90 min. Surfactant instillation was followed by a rapid decrease in MABP and an even more pronounced drop in cerebral blood flow, while during nebulisation MABP did not change and cerebral blood flow decreased less and more gradually.

Ventilator management of infants before extracorporeal membrane oxygenation.

The aim of this project was to review the course of infants referred for consideration of extracorporeal membrane oxygenation (ECMO) to identify maximal ventilator settings that, when exceeded, did not provide clinical benefit to the patient. These settings might then be used in defining failure of conventional mechanical ventilation. We reviewed referral records and hospital charts of all infants treated for severe respiratory failure due to meconium aspiration syndrome during the 52.5 month period from March 15, 1985, to August 1, 1989. At an inspiratory pressure > 35 cm H2O, 75% (43/57) of patients eventually required ECMO, and 28% (4/14) of the infants who did not receive ECMO died. When the inspiratory pressure was > or = 40 cm H2O, 39/49 patients required ECMO, and 30% (3/10) of those not treated with ECMO died. Once the inspiratory pressure was > 45 cm H2O, 91% (29/32) of patients required ECMO, and only one third of those not treated with ECMO survived. Although the limitations for conventional therapy suggested in this paper may be helpful to clinicians, each center needs to establish guidelines for maximal conventional ventilator support. If these guidelines are clearly defined, alternative methods of therapy can be used once these criteria are achieved.

Gallstones.

Preview Gallstones, already estimated to occur in 1 of every 10 Americans, may be even more common than that, since many stones are asymptomatic and discovered only incidentally. In an effort to avoid the expense of surgery and the recovery period afterward, investigators have developed pharmacologic, radiographic, and other nonsurgical treatment methods, which continue to be refined. Dr Jaffe summarizes these alternatives, patient selection, success rates, and posttreatment recurrence.

Impact of directional atherectomy on adjacent branch vessels

Balloon angioplasty of bifurcation stenoses may lead to sidebranch compromise, particularly when the sidebranch is diseased and has its origin in the parent vessel occlusion. 1 Although the risk of sidebranch compromise may be reduced with the use of ≥2 protective coronary guide wires, 3,4 it is not eliminated. 2–4 Balloon angioplasty often results in plaque shifting from the parent vessel to the sidebranch, yielding a suboptimal angiographic result; in some cases, simultaneous (“kissing”) inflations of balloons positioned in the parent vessel and sidebranch may be needed. 3,4 Directional atherectomy, which partially or completely excises the obstructive plaque, has been used as an alternative method of therapy, avoiding the “snowplowing” effect of balloon angioplasty. The feasibility of directional atherectomy of bifurcation lesions was recently reported. 5 However, the incidence and risk factors for sidebranch compromise after directional atherectomy have been less clearly defined. To examine these issues, the clinical course of 60 patients undergoing directional coronary atherectomy of bifurcation lesions was reviewed.

Mechanism of insulin aggregation and stabilization in agitated aqueous solutions

Undesirable aggregation of aqueous insulin solutions remains a serious obstacle in the development of alternative methods of diabetes therapy. We investigated the fundamental nature of the aggregation mechanism and proposed stabilization strategies based on a mathematical model for the reaction scheme. Insulin aggregation kinetics in the presence of solid-liquid and air-liquid interfaces were monitored using UV spectroscopy and quasielastic light scattering (QELS). Experimental observations were consistent with our model of monomer denaturation at hydrophobic surfaces followed by the formation of stable intermediate species which facilitated subsequent macroaggregation. The model was used to predict qualitative trends in insulin aggregation behavior, to propose stabilization strategies, and to elucidate mechanisms of stabilization. In the absence of additives, insulin solutions aggregated completely (more than 95% of the soluble protein lost) within 24 h; with sugar-based nonionic detergents, no detectable loss occurred for more than 6 weeks.

Fibrinolytic Therapy of Deep Vein Thrombosis with Continuous Intravenous Infusion of a Recombinant Tissue Plasminogen Activator

Recombinant human rt-PA was administered to 22 patients with deep vein thrombosis at a dosage of 30 to 120 mg/day (0.5 to 1.76 mg/kg body weight/24 hr) over 2 to 10 days. rt-PA induced phlebographically documented substantial recanalization in 18 of 21 patients. The lowest dose of 0.5 mg/kg/24 hr tested here was thrombolytically effective, whereas a dose of 0.95 mg/kg/24 hours and more led to hemorrhagic complications and premature discontinuation of therapy in four of six patients. Blood clotting analysis did not reveal any substantial decrease in fibrinogen concentrations, whereas the euglobulin clot lysis time and thromboelastography demonstrated a systemic fibrinolytic effect. Therapy with rt-PA can thus be considered as an alternative and effective method of therapy in treatment of deep vein thrombosis. The results of this study show that even a dosage of lower than 0.5 mg/kg/24 hr might prove to be effective. Further studies would be required to show whether the fibrin specificity of rt-PA leads to a superiority of this fibrinolytic substance over the conventional thrombolytic agents, streptokinase and urokinase.

Selection of patients for IVF therapy or alternative therapy methods.

Microsurgery is the treatment of choice for most patients with a tubal factor. In-vitro fertilization--embryo transfer (IVF-ET) is performed in patients with the so-called classical indications: bilateral salpingectomy and tubal damage which is not correctable by means of microsurgery. We also discuss IVF in patients who have not conceived within 1 to 2 years following microsurgery. In women with tubal re-occlusion IVF should be performed. In patients with patent tubes following microsurgery, gamete intra-Fallopian transfer (GIFT) forms part of a controlled clinical study. More clinical experience can perhaps solve the dilemma whether it is beneficial to perform GIFT or to offer IVF primarily to these patients. In patients with andrological infertility, GIFT is offered after six unsuccessful attempts of intrauterine insemination (IUI). In long-standing infertility, GIFT is performed when IUI with ovarian stimulation fails. Patients with genital pathology (patent tubes) are treated with GIFT unless it is not technically feasible. In these cases microsurgery or IVF should be discussed.