Evidence for an interacting quantum-electromagnetic-biochemical response system, similar to radio or microwave relay transmission, is presented. The measurable manifestation of this information transfer system is the Vascular Autonomic System Signal (VAS). The system involves neurohormone sites which relay information by electromagnetic induction to the brain and then by the autonomic nervous system to the smooth muscle of peripheral arteries.

Navach believed that neurohormones facilitate the phenomenon of healing. Part of their influence may be on messenger RNA initiating cell responses involved in accelerated healing. This hypothesized interaction between neurohormones and messenger RNA can be stimulated by the natural current of injury, by other resonating neurohormone clusters and/or by other forms of energy. Neurohormone sites, however, can also serve as an obstacle to healing through either depletion or excessive accumulation. This phenomenon is often caused by autoimmune attack on neurohormone clusters or neurohormone production sites. Such attack can occur more readily if the Omega Immune System is not functioning adequately.

Nogier and Bahr identified obstacles to healing. Navach believed that obstacles are manifestations of excessive accumulation or depletion of neurohormones. These altered concentrations can obstruct the transfer of information between neurohormone clusters, thus inhibiting the activation of the healing process. Treatment in Navach's Phases IV - X can be used to bypass these obstacles.

Obstacles to healing take additional forms. Not infrequently deficiency of digestive enzymes and/or hydrochloric acid lead to insufficient absorption of nutritional substances. Lack of these substances often contributes to a depressed immune system. The use of opiates, certain other medications and even emotions can inhibit the overall chemistry of healing. HLA phenotypes A through D in conjunction with other chemistries can frequently identify individuals sensitive to specific foods. These specific foods, once absorbed, can also lead to an autoimmune process that inhibits healing.


PROGNOSIS AND PREVENTION IN ACUPUNCTURE
M. Mussat, MD
Reprint requests: Dr. M.Mussat, 37 Rue Des Longs Pres, 92100 Boulogne/Seine, France

Every physician knows that one of the fundamental elements of a therapeutic strategy is to predict the possible evolution of a clinical situation. Thus therapy can be adapted much more efficiently. Though, it is practically impossible, and imprudent, to assert with certainty the degree of the evolution of a case. There can be only probability. Indeed, the factors of uncertainty or errors are numerous and hard to determine. Still, some data can be established to allow an evaluation approach that I’ll call "Probability of Prognosis". This will never be a certainty, only an approach. The problem is to reduce as much as possible the range of uncertainty.


CHRONIC CANCER - COULD IT'S BE?
A. Shoutko, MD, PhD and N. Shatinina, MD, PhD
* Reported at the 6 Annual Conference of MSAIMA, November 25, 1998, Tel-Aviv
From the Department of Clinical Radiobiology and WHO Collaborating Center of Radiation Pathology, Central Research Institute of Roentgenology and Radiology, St.Petersburg, Russia

The history of medicine records many examples of the persistence of forms of therapy that owed more to the attractiveness of the tenuous theories underlying them than to any unequivocal demonstration of their effectiveness. In 1977, the distinguished tumor immunologists described Burnet's theory of immunosurveillance as a central fallacy of tumor immunology. Inspite of this, inordinate promotion of this topic was performed during the following decades. It has been attributed, by some experts, to unfortunate sociological influences encouraging premature deduction of clinical relevance from experimental research with viral or chemical-induced tumors, or with their allogenic transplantation apart from isotransplants of spontaneously arising tumors. So despite destructive critical examination of evidence for active host defense against cancer, dating two decades ago, the foundations of immunotherapy for cancer have remained completely unchanged, until now. It should be noted that malignant tumors are very rare in conditions without immunity, as shown in plants. In the evolution, lower vertebrates show a low rate of spontaneous appearance of tumors and a high resistance to carcinogens, while higher vertebrates have progressively lost this assumed tumor defense mechanism. This tendency does not depend on the cell proliferation rate. The tumor antigens are uniformly developmental ones, the tumor cells are essentially self, and their response against easily recognized oncodevelopmental antigens can be clearly autoimmune only. In turn, autoreactive repertoires are prepared and developed to recognize self antigens of somatic cells in vertebrates for a function control system called homeostasis, like ontogenesis, organogenesis, senility, morphogenesis, and regeneration of different kinds as well as a clonal selection. The last one is not specific to tumor cells at all, and mechanism may essentially be prepared to select normal cells in development and organogenesis. Under these conditions, clonal selection theory, wich is used to explain the escape mechanism of tumor cells from the immune system, fuses with the normal developmental process. It should be noted that apoptosis which plays a role in the negative and positive selection of T and B cells development, is not a specific process to immunocyte selection, but rather a universal mechanism of cell death in morphogenesis. The so-called programmed death or clonal deletion of immature lymphocytes is a holocrine pathway of cell secretion for conducting an extracellular microecology in different tissues by the richest spectrum of growth factors. So lymphoid cells are associated with, and probably participate in a number of physiological processes, including chronic inflammation, wound healing, tissue repair and/or regeneration, vascularization, compensatory hyperplasia, and possibly general growth of various organs and neoplastic tissues. It was first suggested more than half a century ago that lymphocytes support the growth of various organs, and experimental evidence this is abound.

Using adoptive transfer studies it was shown that stimulation of in vitro tumor systems and in vivo local tumor growth metastasis by lymphocytes as well as of that many normal tissue proliferation processes can be accomplished by lymphocytes. According to our data, compensatory renal hyperplasia in mice following unilateral nephrectomy, and regrowth of RL-67 carcinoma in mice following its X-irradiation have been provided by immature lymphocytes. Moreover, the tumor growth can be delayed by concomitant skin wound healing, showing the competition between two growth processes for morphogenetic resource of the corresponding lymphocytes subset in the host. It is interesting to mention that the lymphocytes, at early stage of differentiation, have been directed with the help of the enzyme TdT in at least two functional ways:
- by greatly enhancing the diversity of antigen receptor genes (abundant template-independed N region of DNA) or
- by the prevalence of homology - directed recombination (results in invariant receptors to certain tissues) for example, intraepithelial lymphocytes in skin. The presence of quasimonoclonal receptors to specific anatomical locations on immature lymphocytes and their abnormally high sensitivity towards deoxynucleoside level disturbances in extracellular fluid are in concordance with the morphogenetic potentiality of immature lymphocytes, coinciding with earlier predictions. Practicable consequences of the hypothesis for morphogenetic support of tumor growth by a special subset of lymphocytes pose a potentially real danger, the so-called immunostimulation with cancer patients. The evidence, in black and white, that what is not there cannot be stimulated, is a modern therapeutical strategy. In recent years we have witnessed an almost dramatic increase in the use of high-dose chemotherapy followed by autologous cryopreserved circulating hemopoietic progenitor cells-CPC to avoid hematological toxicity or to shorten the aplastic phase after high dose therapy with autografted patients.

While assessment of the anticancer activity of high-dose intensive therapy, total therapy, rapidly cycled chemotherapy employed with CPC support, could not be a primary study objective, and while it is equally unwise to condone or reject high-dose therapy, many centers now consider it an easy way to balance budgets. The much-reduced prime costs of total treatment and unchanged high fees, have brought extraordinary popularity to the use of CPC, regardless of proven clinical benefits. Because this modern strategy has aimed to maximize cytotoxic dose intensity by accelerating the speed with which autografted patients recover, mainly normal granulocyte and platelet counts following myeloablative treatments, it is strange the lymphocytes are not even taken into account. The modern strategy of high-dose therapy with CPC appears incompatible with active host defenses against cancer. But it does not contradict the morphogenetic function of lymphocytes, or the latest hypothesis about cancer as a reactive mechanism, whereby, in order to try to save the life of the body. There must be a voluntary stimulation of certain organ or tissue because the lack of physiological functions of other organs.

According to our point of view, the inhibition of lymphopoiesis during myelotoxic, or even myeloablative therapy, provides indirect tumor growth control and the control of normal tissue growth as well, owing to limitation of the morphogenetic function of lymphocytes. That is why myelotoxic treatment is obviously only applicable to those patients without tumor induced exhaustion of lymphopoietic resources. In the opposite situation, as is often the case, the treatment needs to be aimed at support of somatic well-being at the lowest acceptable level and, consequently, at stimulation of total morphogenetic capacity, or at selective readdressing directly towards critical normal organs and tissues, avoiding the tumor. Such a point of view is in good accordance with the statement made in: for cancer patients the life quality is its quantity. Taking into account the successful competition of the tumor with normal tissues for limited raw substances resource of the host, let us recall the Tumor Necrosis Factor, which was proven inactive as a single agent in clinical trials, but at the same time, is a cachectine. Complete or partial, temporal or permanent, disappearance of all or at least some relevant parameters of a soundly diagnosed malignant disease without any medical treatment or treatment that is considered inadequate for the resulting regression, is defined as spontaneous remission (SR). This definition of SR is unequivocal for tumor regression after treatment failure. It is a rare (1:60000 or 1:100000), but exciting event in oncology, which is seen sporadically in every type of cancer and nowadays there are no more doubts on the validity of the observation. The question is how even advanced cancer may be a reversible process. The known offered explanations of SR are founded on the search for factors which are able to act actively against the tumor. One such factor is called local cellular immune activation, which results in inflammatory necrosis following severe local infection with streptococci, measles, viral hepatitis, herpes zoster or chickenpox during peritonitis, pneumonia, artificial graft versus processes. Another assumed mechanism is the angiogenesis inhibition by some endogenous inhibitors, which is positively regulated by interferone, interleukine-12, and even the so-called psychoneuroimmunological mechanisms. Contrary to the above mentioned, SR was also observed among the patients with HIV-compromised T-cell immunity. Moreover, incomplete resection of the primary tumor or metastases may, in some manner, favorably change the angiogenic processes in the residual tumor and, in rare cases result in further SR.

In most cases of well documented SR it is possible to see the concomitant surgical results in normal tissues like ample excision of abdominal wall, incomplete resection, thoracotomy, bypass surgery with intestine, bowel, followed by a second surgical exploration, postoperative fever, pneumonia, hernia, or prolonged healing of postoperative wounds, and so on. In all such situations the incomplete chronic regeneration of injured normal tissues is the reality (real event) which accompanies SR. According to our data, the life span of advanced patients with renal carcinoma, after its intravascular embolization, can be predicted before treatment by estimation of the level of immature lymphocytes which are responsible for compensatory regeneration of a collateral organ. The level of auto-RFC above the mean normal quantity, but not exceeding its highest limit, was found to be preferable to a good result of treatment. It means the lymphopoiesis needs to be accelerated in a adoptive regime, but not forced over or exhausted before treatment. The frequency of SR for metastasis of renal carcinoma following nephrectomy is relatively high and has been estimated between 0,3 and 4%. The simplest explanation of the SR phenomena for the cases of long-term tumor dormancy and exceptional treatment related survival should be based on the morphogenetic function of lymphocytes. In the competition of normal and tumor tissues for morphogenetic service in the host the privilege belongs to the last one. This privilege has been realized thanks to redistribution of morphogenetic reserve of lymphopoiesis by willingly reorienting hystohomological lymphocytes homing at the special stages of differentiation, to the tumor. This is why the terminal phase of cancer used to be accompanied by loss of body weight. Nevertheless in the presence of acute or chronic damage of normal tissue the additionally challenged lymphocytopoiesis should pledge oneself to share its morphogenetic potential as long as it is demanded for restoration of injured normal structure. Such a simple scheme is able to explain many clinical and biological obscure phenomena in vivo in particular SR (better to say Unexpected Remission - UR), positive result with total body irradiation regardless of incredibly low doses, and so on. In light of the regeneration ability of injured normal tissues to compiete with tumor development, the possible modern mode of tumor control could look like a crazy fantasy. For example, it could be the fracture followed by long-term mechanical stretching of the broken ends to delay the knit-like structure, as used to be done for surgical lengthening of bone with cosmetic aim. There probably are some favorable kinds of normal tissues for morphogenesis support that are the part of a holistic control system, called homeostasis.

The principle advantage of the offered approach, competition therapy, wich is based on the natural switching-over of the morphogenetic lymphocytes to normal host tissues instead of the tumor, is the preservation of a limited lymphopoietic reserve, in contrast with all other kinds of cytotoxic therapy.
So, SR (UR), as well as the positive results of perpetuating many quack treatments, complementary medicine methods, deserve a more scientific systematic registry of cases and sophisticated scrutiny, because a deep understanding of such tumor control may lead to a new, unexpected, unusual therapeutic approach in oncology.
Accordingly, any non-cytotoxic approach, which is able to control the rate of normal tissue renovation and growth at the level of tissue-organ-system interrelations, could be claimed to have an actual ability to indirectly control the cancer.


IS AN "ANGIOMETRIC TEST" AN ADEQUATE TEST FOR REGISTERING THE   VASCULAR AUTONOMIC SIGNAL?
E. Frinerman, MD, PhD * E. Dvorkin, MD
From the E.Wolfson Medical Center, Holon (*), and the Pain Center of Sick Fund "Leumit", Ramat-Gan (**), Israel
Reprint requests: Dr. E.Dvorkin,
P.O.Box 3167, Bat-Yam 59131, Israel
We had read with interest the communication of C. Thalhammer, H. Haller, F.C. Luft "Aurikulomedizin im angiometrischen Test".

These authors measured the movement of the arterial wall of the radial artery by an A-mode ultrasonic device (NIUS 02, Omega, Bienne, Switzerland and Capital Medical Services, Paris, France). The device also incorporated a photoplethysmographic Finapres system that allowed blood pressure to be recorded from a finger ipsilateral to the radial artery examined. This high-resolution echo-tracking device is specially designed to measure noninvasively the vessel's morphology and mechanics. The vascular autonomic signal (VAS) was investigated using light applications on the skin of the arms, face, and forehead (59 experiments), and pain stimulus at the earlobe (4 experiments). In every case the authors did not register any changes in the elastic properties of the arterial wall and/or changes of the arterial lumen.

For many years we have investigated the hemodynamic aspects of the VAS phenomenon and the possibilities for objectivation of VAS. We are pleased with the interest of our colleagues in this very interesting phenomenon, and wish to make the following comments.

The vascular autonomic signal was established by Dr. Paul Nogier more than 30 years ago as a way to detect the movement of the pulse waves by palpation of radial artery smooth muscle tone variation. Nogier had interpreted VAS as a measure of the autonomic response of an integrated biological system, such a body, to any incoming stimuli.

Today the existence of the VAS phenomenon had been proven. Many authors (Bricot, 1978, Navach, 1980, etc.) established the fact, that pulse waveform may demonstrate characteristic changes in consequence with Nogier's conception of VAS. Nevertheless the objective evaluation of VAS for practical needs is a very difficult problem.

In our opinion the main difficulties for objective evaluation of VAS are the following:
1. VAS interpretation is subjective and based on the individual physician's skill. Possible hemodynamic mechanism of palpating VAS are difficult to define in the metrological aspects of VAS objectivation.
2. Attempts at objectivation of VAS were often made using inappropriate technique and equipment.
Possible hemodynamic mechanism of palpating VAS
All objective investigations of the VAS phenomenon identified the subjective perceptions of the stronger and weaker beats when palpating radial artery pulse with objective changes in the diastolic part of the pulse waveform. We do not agree with Nogier's explanation of the VAS in the concept of a standing wave in an artery. Hypothesis of standing waves was proposed by Hamilton and Dow in 1939 as result of analysis of pulse waveform in aorta in experiments on dogs. Today researchers do not accept it at all as a normal state. It is documented that standing waves could occur only if there were a complete reflection of the wave, and if there were no interaction of the reflected waves from scattered arterial terminations. In human arterial trees, the wave reflection is too low and attenuation too high for resonance and standing waves to occur.

From our standpoint, the following interpretation of the VAS is more reliable. The subjective palpating perception depends on the pressure of the palpating finger, and the radial pulse may be found differently "large" in spite of unchanged intravasal pulse pressure.

Korner examined the amplitude of the extravasal volume pulse in relation to a continually diminished coupling pressure of a photoelectric pulse detector. The author consideres that it is exactly the same course one gets by palpating the radial pulse with the finger. However the intravasal pressure amplitudes showed a different kind of course at the same time. These differences between extra- and intravasal pulsation usually can be seen in patients with undistributed circulation. Having a vasoconstriction in the radial artery the course of the extravasal volume pulse-curve appears different and the sensation of the palpating finger, too. In this case the pulse is palpable evenly small. The differences can be explained by the change in the pressure-built elastic tension of the arterial wall and the stronger contraction of the vessel muscles in vasoconstriction. Thus, the diagnosis of vasoconstriction can be made by palpating the radial pulse. On the other hand, smooth muscle relaxation may be solely due to changes in vessel geometry and/or dependent on changes in wall stiffness.

All publications of objective evaluation of VAS demonstrate that VAS is expressed by contour pulse changes in the diastolic part of the arterial pulse wave. Theoretically, those changes in pulse waveform are usually due to changes in vascular muscle tone influencing the compliance and on the velocity of reflected waves.
Could beat-to-beat changes in muscle tone be detected by echo-tracking and Finapres methods?

In clinical practice, the compliance cannot be measured directly. Its indirect determination requires the measurement of the magnitudes of arterial pressure and the fluctuations in volume. The result is thus affected by the specific errors incurred in both these measurements.

In recent years large artery function and structure could be assessment in clinical practice, by means of investigation of artery compliance and arterial wall thickness. For assessment of the radial artery compliance, the radial artery diameter and artery pressure are simultaneously acquired over the systolic-diastolic blood pressure range (beat-to beat finger measurement) and by an echo-tracking device, and compliance is expressed using Langewouters formula as the integral of the area under the compliance/ blood pressure curve normalized for pulse pressure.

Distensibility is obtained as compliance divided by vessel diameter. The method is operator-dependent. Intra-observer variabilies for elastic modulus are near 18%.
The compliance assessment requires accurate measurement of the diameter of the artery during all of the cardiac cycle, not only of the onset of the cardiac cycle, as done usually. The distention must be measured previously during all the cardiac cycle also, which is required of the local pulse pressure measurements instead of the finger pressure measurements.

In clinical practice physicians usually use distensibility as a ratio of the actual radius rise (dR) (as a measure of volume rise) to the accompanying rise in arterial pressure (dPA); dR/dPA is small and very precise methods are required for such measurements. However, the resolution of echo-tracking technique is relative poor for precise and detailed assessment of the changes of the pulse wave contour because the signal-to-noise ratio of the original signal is low. For precise measurements, the echo-tracking signals are sampled over 8 bits and averaged five times. Averaging of the beat-to-beat changes using in echo-tracking devices make them unable to detect changes over one cardiac beat. In addition, cross-sectional dimension of the arterial lumen is also affected by spiral and longitudinal movements of the vessel wall that could not be reflected by the echo-tracking methods correctly. On the other hand, usage of the vascular unloading method as Finapres for beat-to-beat monitoring arterial pressure could not be recommended for precise assessment of beat-to-beat changes in vascular smooth muscle tone. Accuracy and precision can not be guaranteed by Finapres method even for trends in arterial pressure. Correlation between Finapres and direct intra-arterial pressures in artery is only (r = 0.82-0.78; r = 0.68-0.72, and r = 0.78-079 for systolic, diastolic and mean pressures respectively. Moreover, Finapres pressure may be unexplicably increased whilst invasive pressure was decreased (or vice versa) in 17-19% of measurements. The authors who investigated the accuracy of the Finapres concluded, that Finapres cannot be recommended for pressure monitoring in clinical practice or clinical research. Taking into account all those factors, the method used by Thalhammer et al is not adequate for detection of VAS. Consequently, the conclusion of the authors is that they could not register VAS is not wonderful because the echo-tracking method cannot be accepted for VAS-registration. We agree that for registration of the VAS the precise methods for beat-to-beat assessment in real time changes in the pulse waveform, are referable.