No abstract

The role of ACTH in various clinical disorders has been difficult to ascertain because the available assay methods have lacked the sensitivity necessary for valid quantitation of the hormone in the plasma of normal subjects (1-4). Even the method of Lipscomb and Nelson (5), the most sensitive practical bioassay procedure now available, usually requires the injection of at least 0.05 mU of ACTH per rat, if responses are to be elicited that will be statistically significant without the use of a prohibitive number of animals. It is usually impractical to inject more than 5 ml of crude human plasma into a single rat. Therefore, in order to be accurately measurable by this procedure, the concentration of ACTH in the plasma must be at least 0.05 mU per 5 ml, or 1 mU per 100 ml.Numerous studies indicate that normal plasma levels of ACTH are well below this concentration. Byr the adrenal ascorbic acid depletion assay method, Sydnor, Sayers, Brown, and Tyler (1) were unable to detect ACTH in plasma of normal subjects, even after attempting to extract the hormone with oxvcellulose in preparation for the bioassay. These workers concluded that blood ACTH concentrations of normal human subjects were less than 0.5 mU per 100 ml. Using a similar procedure, Fujita (3) estimated the normal level of ACTH to be about 1 mU per L, i.e., 0.1 mU per 100 ml. Cooper and Nelson (6) were able to detect ACTH in the plasma of only 3 of 10 patients before surgery, by a method that they

We conducted a randomized, controlled study to evaluate whether pharmacists' advice on smoking cessation would result in a higher smoking cessation rate using Nicorette (nicotine gum preparation). Fourteen pharmacies in Tokyo, Kanagawa, and Nagano participated. Smokers who visited pharmacies to buy Nicorette from March 1, 2002, through August 31, 2002, were recruited and randomly assigned to two groups. For the intervention group (A), pharmacists provided both regular instructions on Nicorette use and smoking cessation advice at theˆrst sale and then gave followup advice just before starting a cessation and 1, 3, and 8 weeks and 3 months thereafter. For the control group (B), pharmacists provided regular instructions alone. The primary outcome measure was the self-reported smoking cessation rate and the secondary outcome measure was the relationship between the smoker's egogram and eŠectiveness of intervention. Twenty-eight smokers were enrolled and randomized into group A (n＝11) or group B (n＝17). The absolute abstinence rate in groups A and B at 3 months was 45.5％ and 31.2％, respectively. The odds ratio was 1.83, which was not statistically signiˆcant. There was no diŠerence in egogram score between absolute abstinence subjects and nonabstinence subjects in group A. The egogram scores in Adapted Child of absolute abstinence subjects in group B were signiˆcantly higher than in nonabstinence subjects. In conclusion, instructions and advice given by pharmacists may improve the smoking cessation rate in smokers receiving nicotine replacement therapy.

No abstract

Hypercalcemia and leukocytosis of malignancy have been highlighted over a decade. Wereport a case of a gallbladder cancer with marked hypercalcemia and leukocytosis. A 54-year-old womanwas admitted to the hospital because of remittent fever and left hypochondric pain. The computed tomographic scan of the abdomenrevealed the cancer of the gallbladder with liver metastases. The patient's medical condition deteriorated as the tumor was rapidly growing up. Her medical course was marked by hypercalcemia and an increase in mature neutrophils. Medical therapy with normal saline, furosemide, indomethacin, prednisolone, and calcitonin failed to ameliorate hypercalcemia. Onthe twenty-ninth hospital day the serum calcium was elevated to 17.6 mg/dl which responded to 1000[j.g of mithramycin while leukocytosis continued. Despite the chemotherapy with doxolubicin and tegafur, the tumor continued to grow. Leukocytosis was attributed to the elevated colony-stimulating factor activity which was two-fold of control. The parathyroid hormone and nephrogenouscyclic AMPlevels were normal with low vitamin Dlevels. Hypercalcemiawas attributed to a parathyroid hormone-like substance because of a decrease in %TRPin the presence of normal renal function and the normal parathyroid hormone level. Autopsy revealed an undifferentiated adenocarcinoma of the gallbladder with multiple liver metastases, and bone resorption in the vertebral column and sternum without evident bone metastasis.