Lymphoedema of the arm is a disabling complication of surgery for cancer of the breast. It occurs in a significant proportion of patients and tends to occur later after the operation. Radiation increases the incidence. It needs to be differentiated for tumour recurrence and venous obstruction. Aetiology may include surgical technique, radiation and infection. Prevention is important as treatment is difficult. Treatment may include drugs, particularly benzopyrones, and enzymes, physiotherapy, elastic sleeves and surgery.
The short-chain fatty acid butyrate is regarded as a regulative agent in haemostasis of mucosal cell turnover. Inhibition of prostaglandin E2 synthesis is particularly involved in this regulation process. In the present study, proliferation was stimulated in colonic biopsies of 12 healthy subjects (age 51.3 years, range 25-81) by incubation with deoxycholic acid (5 micromol/l DCA). The anti-proliferative and cyclo-oxygenase-inhibiting properties of butyrate (10 mmol/l BUT) and of aspirin (555 micromol/l ASA) were investigated. Colonic cell proliferation was determined by bromodeoxyuridine immunohistochemistry. PGE2 release into the incubation medium was measured by radioimmunoassay. Incubation with DCA/ASA, DCA/BUT and DCA/ASA/BUT revealed a significant reduction in crypt cell proliferation as measured by the labelling index of the whole crypt in comparison to incubation with DCA alone (DCA/ASA: 0.14, P < 0.01; DCA/BUT: 0.15, P < 0.05; DCA/ASA/BUT: 0.15, P < 0.05, versus DCA: 0.18). The labelling index for the upper 40% of the crypt was only lower after incubation with DCA/ASA (0.023) compared to DCA (0.028) (P < 0.05). PGE2 release from biopsy specimens was only significantly decreased in the incubation media where ASA was added (DCA/ASA: 29.0 pg/mg mucosa/h, P < 0.005; DCA/ASA/BUT: 31.4 pg/mg mucosa/h, P < 0.01 versus DCA: 56.9 pg/mg mucosa/h). Butyrate and aspirin showed no synergistic effects. The results indicate a normalization of DCA-induced hyperproliferation of colonic mucosa by butyrate, and, even more efficiently, by aspirin. The data support the hypothesis that butyrate and aspirin can act as chemopreventive agents in colon carcinogenesis.
Alternative Krebsbehandlungsmethoden (verstanden als Methoden unbewiesener Wirksamkeit) sind nicht grundsätzlich harmlos. Direkte schwerwiegende Nebenwirkungen sind zwar selten, doch ist die Gefahr indirekter, oft verhängnisvoller Folgen um so größer. Darunter wird das Verpassen einer erfolgversprechenden Behandlung sowie Verängstigung, Weckung von Schuldgefühlen und Aggression verstanden. Alternative diagnostische und therapeutische Methoden müssen nach den gleichen Kriterien geprüft werden wie Methoden mit bereits nachgewiesener Wirksamkeit.
Complementary methods are requested and used very often by patients suffering from chronic, incurable or terminal illness, expecting strengthened physical and mental resistance, better response to therapy with less side-effects. Unfortunately there is very limited evidence for efficacy of most complementary methods. Nevertheless proven harmless methods should be admitted without rising false hope. The most important remains however loving care.
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