Ayurvedic Management of Emesis Gravidarum - A Case Report

Emesis is a common experience in first trimester of pregnancy affecting 70 to 80% of all pregnant women. Altered immunological endocrinological and psychological states are responsible for initiation of symptoms. Mild to moderate emesis gravidarum have a significant adverse effect on quality of women's life. Even though onset is physiological its morbidity has to be reduced to minimize disease burden, enhance maternal health and to prevent hyper emesis gravidarum. Anti-emetic and anti-histamines are used in conventional Allopathic practice. Ayurvedic principle is early intervention and prevention of hyperemesis gravidarum with lifestyle modifications and adopting Pathya ahara. This is a case report of emesis gravidarum managed with pharmaco nutrient product –Malarinji modaka

The Brazilian version of the Health-Related Quality of Life Questionnaire for Nausea and Vomiting of Pregnancy: translation, cross-cultural adaptation and reliability - an observational cross-sectional study

ABSTRACT BACKGROUND: The Health-Related Quality of Life Questionnaire for Nausea and Vomiting of Pregnancy (NVPQOL) is a validated questionnaire assessing quality of life among pregnant women with nausea and vomiting. OBJECTIVE: To translate, cross-culturally adapt and evaluate the reliability of the NVPQOL. DESIGN AND SETTING: Observational cross-sectional study developed in a public university in Brazil. METHODS: The translation, synthesis of translations, back-translation, expert committee, pre-testing and validation were carried out, resulting in a Portuguese-language version. The internal consistency, intra-rater and test-retest reliability and correlation between the total score of the Portuguese-language version of the NVPQOL and the domains of the World Health Organization Quality of Life-bref questionnaire were considered in the data analysis. RESULTS: The instrument went through the process with testing on 104 pregnant women. Strong internal consistency (Cronbach's α: 0.95), strong intra-rater and test-retest reliability (P < 0.0; intraclass correlation coefficient: 0.89; confidence interval: 0.791-0.945) and strong correlation between the total score of the Portuguese-language version of the NVPQOL and the physical health domain of the World Health Organization Quality of Life-bref questionnaire (P < 0.01; R = −0.8) were observed. CONCLUSION: The NVPQOL was translated, cross-culturally adapted and validated for the Portuguese language with satisfactory psychometric properties for assessing quality of life, especially in relation to physical health, among pregnant women with symptoms of nausea and vomiting in the first trimester of pregnancy.

Argemone mexicana extract alleviates gastrointestinal disorders by stimulating muscarinic receptors and blocking voltage-gated L-type calcium channels

Objective: To investigate the pharmacological potential of Argemone mexicana in treating constipation and emesis by using in vitro and in vivo models. Methods: The spasmogenic and spasmolytic effects were evaluated on isolated rabbit jejunum fragments loaded in a tissue organ bath. The response was recorded with an isotonic transducer attached with Power Lab Data Acquisition System. The laxative and antiemetic activities were assessed in BALB-c mice and poultry chicks challenged with carbamylcholine and copper sulphate stimulated emesis, respectively. Results: The total phenolic and total flavonoids contents of the extract were (267.75 ± 5.77) mg GAE/g and (73.86 ± 6.01) mg QE/g, respectively. Argemone mexicana extract exerted spasmogenic effect on isolated rabbit jejunum segments with an EC50 value of 0.016 mg/mL, which was blocked by atropine (0.3 μM). Argemone mexicana extract exerted spasmolytic effect in atropine treated jejunum fragments with an EC50 value of 2.185 mg/mL. Furthermore, Argemone mexicana extract relaxed potassium (80 mM)-induced contractions (EC50: 9.07 mg/mL), similar to a standard drug verapamil. The calcium channel blocker activity was confirmed by a rightward shift of concentration-response curve of calcium in the presence of Argemone mexicana extract (1-5 mg/mL) and verapamil (0.1-1 μM). In addition, the extract increased the distance travelled by a charcoal in the gastrointestinal tract and exhibited antiemetic effect on copper sulphate induced emesis in chicks. Conclusions: Argemone mexicana shows cholinergic agonist and calcium channel blocker activities, as well as antiemetic effect. It may be used as a potential agent for treating gastrointestinal disorders.

Argemone mexicana extract alleviates gastrointestinal disorders by stimulating muscarinic receptors and blocking voltage-gated L-type calcium channels

Objective: To investigate the pharmacological potential of Argemone mexicana in treating constipation and emesis by using in vitro and in vivo models.Methods: The spasmogenic and spasmolytic effects were evaluated on isolated rabbit jejunum fragments loaded in a tissue organ bath. The response was recorded with an isotonic transducer attached with Power Lab Data Acquisition System. The laxative and antiemetic activities were assessed in BALB-c mice and poultry chicks challenged with carbamylcholine and copper sulphate stimulated emesis, respectively. Results: The total phenolic and total flavonoids contents of the extract were (267.75 ± 5.77) mg GAE/g and (73.86 ± 6.01) mg QE/g, respectively. Argemone mexicana extract exerted spasmogenic effect on isolated rabbit jejunum segments with an EC50 value of 0.016 mg/mL, which was blocked by atropine (0.3 μM). Argemone mexicana extract exerted spasmolytic effect in atropine treated jejunum fragments with an EC50 value of 2.185 mg/mL. Furthermore, Argemone mexicana extract relaxed potassium (80 mM)-induced contractions (EC50: 9.07 mg/mL), similar to a standard drug verapamil. The calcium channel blocker activity was confirmed by a rightward shift of concentration-response curve of calcium in the presence of Argemone mexicana extract (1-5 mg/mL) and verapamil (0.1-1 μM). In addition, the extract increased the distance travelled by a charcoal in the gastrointestinal tract and exhibited antiemetic effect on copper sulphate induced emesis in chicks. Conclusions: Argemone mexicana shows cholinergic agonist and calcium channel blocker activities, as well as antiemetic effect. It may be used as a potential agent for treating gastrointestinal disorders.

Bioavailability Study Of Ondansetron Gel In Rabbits And Human Volunteers Appling Uplc As Analytical Tool And Evaluation Of The Antiemetic Effect Of Ondansetron Gel In Cisplatin-Induced Emesis In Rats

Objective: This study was undertaken to determine the bioavailability of ondansetron gel in experimental animals and humans applying UPLC as an analytical tool and evaluation of the antiemetic effect of ondansetron gel in cisplatin-induced emesis in rats. Methods: Ondansetron gel (F13: sodium alginate 7% w/w) was used, marketed I. V. ondansetron (Zofran) ® was chosen as reference. The bioavailability study in rabbits was selected as a parallel design using nine healthy rabbits divided into three groups whereas, bioavailability study in humans was an open-label, wherein 6 healthy subjects administered ondansetron gel. The potential effect of ondansetron gel was evaluated for the prevention of different phases of emesis motivated by exposure to antineoplastic drugs (cisplatin) by determination of body weight loss, water and food intake applying kaolin-pica model in rats using seventy-two rats divided into six groups. Results: Ondansetron gel (0.5%) showed detectable plasma concentration 22.833±2.17 ng/m1 after ¼ h and 419.55±2.17 ng/ml after 1-h post-treatment in rabbits and human respectively and concentration was maintained above-reported minimum effective concentration for more than 2.5 h for rabbits and 7 h for humans compared to 1.75 h after I. V. administration. The ondansetron gel significantly reduces all phases of cisplatin-induced emesis and a decrease in body weight, water, and food consumption was significantly attenuated. Conclusion: Based on the high efficacy of gel on emesis induced by cisplatin, and its high bioavailability, transdermal ondansetron gel could be a promising convenient system to prevent nausea and vomiting following administration of antineoplastic drugs.

Palonosetron for the prevention of chemotherapy induced nausea and vomiting: a comparative study in a tertiary care hospital from India

Background: Despite advances in symptom management, chemotherapy-induced nausea and vomiting (CINV) remains one of the most dreadful consequences of cancer therapy.Methods: The study was carried out at Medical Oncology Department, Vydehi Institute of Medical Sciences and Research Centre, Bangalore. Hundred and forty-four cancer patients of either sex, aged 18-65 years with adequate blood counts requiring moderately emetogenic chemotherapy (MEC) as per Hesketh classification were included. The patients were prospectively divided into two groups before the initial cycle of chemotherapy. Patients in Group A (n=71) received ondansetron, and dexamethasone along with aprepitant capsules, Whereas, Group B (n=73) received palonosetron, and dexamethasone along with placebo capsules, 30 minutes before chemotherapy. Thereafter the patients were administered with the drugs and observed for nausea and vomiting. The efficiency of both regimens was assessed by adopting validated functional living index emesis (FLIE) questionnaire. Analysis of the data was done using the SPSS 21.0 software.Results: The mean age of the patients was 40.5 years and the male to female ratio was 1:2.4. In all the patients, no changes were detected in the ECG readings after MEC. The nausea and vomiting score were comparable in both groups. No significant difference (p>0.05) was noticed between group A and group B in both mm and in FLIE points. No serious adverse events were found relating to antiemetic treatment.Conclusions: Palonosetron in combination with corticosteroids was non inferior to ondansetron in combination with aprepitant and corticosteroids in controlling acute and delayed stages of CINV in patients requiring MEC. Thus, it can be recommended as first-line therapy for patients treated with MEC.

Study on the antiemetic property of methanolic stem extract of Swertia chirata using chick emesis model

Background: Swertia chirata has been an important herb known for centuries for its various medicinal uses and bitter taste. The stem of the plant is used as a traditional medicine in an array of diseases including the treatment of vomiting. Therefore, the study was undertaken to explore the possible antiemetic property of methanolic extract of its stems by using chick emesis model.Methods: 25 male chicks of four days old weighing 25 to 35 grams were fed with copper sulfate anhydride at 50mg/kg body weight to induce emesis. The chicks were grouped into 5 with each group bearing 5 chicks (n=5). Group I (control) received 10ml/kg normal saline; group II (standard) received 150mg/kg chlorpromazine; group III (experimental-1), group IV (experimental-2) and group V (experimental-3) received 50, 100 and 150mg/kg respectively of the extract. All doses are given intraperitoneally. Assessment of antiemetic activity was done by calculating the percentage of inhibition of the number of retches in the chicks.Results: All the three doses of the extract showed antiemetic activity. The dose of 50 mg/kg showed activity comparable to chlorpromazine, while dose of 100 mg/kg and 150mg/kg showed greater activity than chlorpromazine. Highest antiemetic activity (79.26% inhibition) was shown by a dose of 150mg/kg and lowest (42.22% inhibition) by 50mg/kg.Conclusions: Methanolic extract from the stems of Swertia chirata has excellent anti-emetic property which can be further investigated for development of potential antiemetic medicines.

Prophylaxis of postoperative nausea and vomiting after cardiac surgery in high-risk patients: A randomized controlled study

Context: The role of prophylaxis for postoperative nausea and vomiting (PONV) in cardiac surgery is under debate. Aims: To study the risk factors for PONV after cardiac surgery and the role of betamethasone with or without droperidol for its prevention. Setting and Design: Randomized open-label controlled study comparing standard care with PONV prophylaxis from February to November 2016. Methods: Five hundred and two patients with planned nonemergent cardiac surgery were included. Interventions: In the intervention arm, PONV prophylaxis (4 mg betamethasone with/without 0.625 mg droperidol) was administered in high-risk patients (two or more risk factors). Patients in the control arm were treated as per routine hospital practices. Results: Female sex, past history of PONV, and migraines were associated with a significantly increased risk of PONV, while motion sickness, smoking status, and volatile anesthetics were not. Pain and treatment with nefopam or ketoprofen were associated with an increased risk of PONV. PONV was less frequent in the active arm compared to controls (45.5% vs. 54.0%, P = 0.063; visual analogic scale 10.9 vs. 15.3 mm, P = 0.043). Among the 180 patients (35.6%) with ≥2 risk factors, prophylaxis was associated with reduced PONV (intention-to-treat: 46.8% vs. 67.8%, P = 0.0061; per-protocol: 39.2% vs. 69%, P = 0.0002). In multivariate analysis, prophylaxis was independently associated with PONV (odds ratio [OR]: 0.324, 95% confidence interval: 0.167–0.629, P = 0.0009), as were female sex, past history of PONV, and migraines (OR: 3.027, 3.031, and 2.160 respectively). No drug-related side effects were reported. Conclusion: Betamethasone with/without droperidol was effective in decreasing PONV in high risk cardiac surgical patients without any side effect.

Predictors of emesis in children undergoing procedural sedation with intramuscular ketamine in a paediatric emergency department

<p><b>INTRODUCTION</b>Emesis is one of the most common adverse events associated with ketamine sedation. However, its predictors have not been clearly studied among Asian children. This study aimed to determine the incidence and predictors of emesis in children undergoing intramuscular (IM) ketamine sedation in an emergency department (ED) in Singapore and to identify high-risk groups, so that antiemetics may be administered prophylactically.</p><p><b>METHODS</b>In a prospective observational study, all children requiring procedural sedation with IM ketamine in the paediatric ED between 1 April 2013 and 31 January 2015 were included. All cases of emesis following ketamine sedation were prospectively documented. Univariate and multivariate logistic regression analyses were performed to identify the predictors of emesis.</p><p><b>RESULTS</b>2,502 sedations were performed using IM ketamine in the ED during the study period. Overall incidence of emesis associated with IM ketamine sedation was 8.4%. Children aged ≥ 8 years were significantly associated with increased risk of emesis (odds ratio 4.636, 95% confidence interval 3.271-6.570; p < 0.001), with an emesis rate of 19.6%. Other variables such as initial dose (3 mg/kg vs. 4 mg/kg), total dosage (including top-ups), type and site of procedure, gender and ethnicity were not significant predictors. The number needed to treat for antiemetics in children aged ≥ 8 years was five.</p><p><b>CONCLUSION</b>Age is a significant predictor of emesis. We recommend conducting a randomised controlled trial to compare the effects of prophylactic oral ondansetron in patients stratified into the age groups of ≥ 8 years and < 8 years.</p>

Exacerbation of Emesis and Dysphagia with Oxycodone Dose Escalation in a Patient with Lung Cancer, Possibly Associated with Complicated Esophageal Achalasia

<p>Objective: We describe a case of lung cancer complicated with esophageal achalasia (EA), which was successfully treated with endoscopic pneumatic dilation (EPD). Case: A 66-year-old woman was admitted to our hospital because of frequent episodes of emesis and dysphagia after receiving an escalating dose of sustained release oxycodone (SRO) for cancer-related multifactorial back pain. She had been diagnosed with EA and treated with EPD at the age of 50. Her symptoms were refractory to the conventional anti-emetic agents such as prochlorperazine and metoclopramide. Computed tomography imaging showed marked dilatation of the esophagus with food residue. We diagnosed EA based on the presence of rosette-like esophageal folds on endoscopy and narrowing of the esophagogastric junction on esophagography, and subsequently performed EPD, which alleviated the symptoms. Discussion: The effects of opioids on esophageal motility have not been elucidated thus far. Recent studies using high-resolution manometry reported that long-term use of opioids was associated with esophageal dysmotility similar to that observed in EA. Although we have no evidence to directly demonstrate the causal relationship between the use of SRO and anti-emetic agents and EA, we speculate that our patient’s symptoms might be associated not only with SRO-related emesis during the gradual worsening of EA, but also partly with the SRO-induced esophageal dysmotility and the constrictive effect of dopamine D₂ receptor antagonists on the lower esophageal sphincter. Care must be taken to avoid drug-induced esophageal motor dysfunction, which might lead to deteriorate EA. </p>

A Dunnione Compound MB12662 Improves Cisplatin-Induced Tissue Injury and Emesis

The present study was aimed to investigate the effects of MB12662, a synthetic dunnione compound, on cisplatin-induced vomiting reflexes and intestinal, renal, immune system, and hematopoietic toxicities in ferrets and mice, respectively. Male ICR mice were orally administered MB12662 (5, 10, 25 or 50 mg/kg) for 10 days, during which intraperitoneally challenged with cisplatin (3.5 mg/kg) from day 4 to 7, and sacrificed on day 10 for the pathological examination. Male ferrets were orally administered MB12662 (25, 50 or 100 mg/kg) for 7 days, subcutaneously challenged with cisplatin (5 mg/kg), and monitored for vomiting reflexes and survival of the animals. Four-day injection of cisplatin (3.5 mg/kg) to mice caused body weight loss and degeneration and atrophy of intestinal villi, reducing villi/crypt ratio to a half level of control animals. Cisplatin also induced renal and hepatic toxicities, and depletion of splenocytes and bone marrow progenitor cells. The systemic toxicities including decreased villi/crypt ratio, immune system atrophy, splenocyte depletion, and decreased cellularity in bone marrow were improved by MB12662. Cisplatin (5 mg/kg) induced retching and emetic responses of ferrets, which were remarkably attenuated by MB12662 in a dose-dependent manner. All the ferrets pretreated with MB12662 survived the challenge of cisplatin, in comparison with 40% mortality in vehicle-treated animals, and blood parameters of nephrotoxicity and hepatotoxicity were markedly recovered. It is expected that MB12662 could be a candidate for the body protection against burden, including emesis, of chemotherapeutic agents.

Efeitos colaterais da ranitidina aplicada em dose terapêutica em cães saudáveis / Adverse effects of ranitidine applied in therapeutic dosage in healthy dogs

O objetivo deste trabalho foi verificar se a dose de ranitidina 2mg kg-1, aplicada via intravenosa, causa êmese ou hipotensão em cães saudáveis. Foram selecionados 10 cães da raça Retriever do Labrador, 10 da raça Beagle e 10 cães sem raça definida, sendo cinco animais de cada sexo. Os animais foram submetidos ao exame clínico e à avaliação da pressão sanguínea antes da aplicação do fármaco e também 10 minutos e quatro horas após a administração deste. Após a aplicação, observou-se que 13,3 por cento dos animais apresentaram-se normais; 6,7 por cento dos cães apresentaram apatia; 50 por cento dos animais apresentaram salivação e 30 por cento apresentaram apatia, salivação, mímica de vômito ou êmese. Não houve diminuição significativa da pressão arterial após a administração do fármaco. Conclui-se que o uso de ranitidina na dose terapêutica, aplicada via intravenosa, pode provocar apatia, salivação, mímica de vômito e êmese.

The purpose of this study was to verify if the ranitidine dosage of 2mg kg-1 by intravenous path causes emesis or hypotension in healthy dogs. They were selected 10 Labrador Retriever, 10 Beagles and 10 mongrel dogs, five animals of each sex. The animals were submitted to clinical examination and blood pressure evaluation before ranitidine administration and also 10 minutes and 4 hours after administration of it. After administration was observed that 13.3 percent of the animals presented normal; 6.7 percent of the dogs presented apathy; 50 percent of the animals presented salivation and 30 percent presented apathy, salivation, emesis mimic or emesis. There was no significative arterial blood pressure decrease after ranitidine administration. It was concluded that ranitidine useful in therapeutic dosage by intravenous path may provoke apathy, salivation, emesis mimic and emesis.

Therapy procedures of ‘Les Nga’ practised at National Traditional Medicine Hospital.

The Traditional primary purification and detoxification treatment is known as Les Nga. It means the "five therapies". The five therapeutic means of eliminating toxins from the body are Emesis, Purgation, Nasal irrigation, Enema and Bloodletting. These series of five therapies help remove deep rooted stress and illness causing toxins from the body while balancing the three somatic humors. The Les Nga procedures along with its pre-treatments as specified in gSo-ba rig-pa, when provided in the right time and season can help an individual to lead a better life even at an old age. It is suggested that when one undergoes Les Nga therapy for three times annually, in the right seasons, it expels the toxins, revitalizes the body tissues and prevents the body from falling prey to various diseases and keeps an individual healthy during old age. There is a tendency for the rLung to get aggravated in old age and all therapies that are administered should be to prevent the rLung. Les Nga offers one of the most comprehensive methods of removing toxins from the body. They seek to reverse the direction of the diseases. This cleansing process is achieved through several protocols such as special diets, oilation therapy, steam therapy and cleansing therapies. Towards the therapy’s end, special attention is given to purgation, blood donating, or enema therapy. These therapies can help alleviate pain and diseases in human beings and hence may be established in NTMH for the benefit of all citizens.

Effect of Oral Ramosetron for Postoperative Nausea and Vomiting in Surgical Patients using PatientControlled Analgesia / 대한마취과학회지

BACKGROUND: This study was designed to evaluate ramosetron oral disintegrating tablet (ODT), a 5-HT3 receptor antagonist, for prophylaxis and treatment of postoperative nausea and vomiting (PONV) in patients undergoing general anesthesia using patient controlled analgesia (PCA). METHODS: 150 adult, ASA physical status I or II, aged 18-65 yr, patients undergoing elective surgery were enrolled (n = 50 in each). Patients were randomly assigned to one of three groups, group C (no prophylactic antiemetics), groups N (ramosetron ODT 30 minutes before the induction), and group Z (intravenous injection of ondansetron 4 mg at the end of surgery followed by continuous infusion of 8 mg added to the PCA solution). A standard general inhalation anesthesia and IV PCA with fentanyl and ketorolac were used. During the 48 hours after recovery, we assessed pain score by: using a visual analogue scale (VAS), a sedation scale, an incidence of PONV, and monitoring consumption of PCA drug, rescue drug consumption, adverse events, and overall satisfaction. RESULTS: The incidence of nausea and the consumption of rescue drug were significantly decreased in N and Z groups at each time point except 24-48 hours after recovery. There was no significant difference in incidence of vomiting. Overall satisfaction was superior in N and Z groups compared with C group. CONCLUSIONS: Preoperative administration of ramosetron ODT was an acceptable and effective way to prevent PONV in patients using PCA.

Páncreas anular: a propósito de un caso / Annular pancreas: report of a case

El Páncreas Anular es una de las malformaciones congénitas extrínsecas más frecuentes de durante el desarrollo del intestino cefálico, quecausa una obstrucción parcial o completa en la segunda porción del duodeno. Presentamos el caso de una lactante de cuatro semanas deedad, transferida de la ciudad de Oruro al Hospital del Niño de la ciudad de La Paz, por emesis incoercible y bajo peso; estudios radiológicossugieren cuadro duodenal obstructivo, evidenciándose el mismo en el acto quirúrgico, originado por páncreas anular...

The annular pancreas is one of the most frequent congenital malformations that occur during the development of the intestine causing a partial or complete obstruction of the second portion of the duodenum. We present the case of a four weeks old baby girl who was transferred from the city of Oruro to the Hospital del Niño (Children’s Hospital) in La Paz due to incontrollable vomiting and low weight. The abdominal x-ray suggested duodenal obstruction that was evident on surgery, caused by annular pancreas.

Mechanism of Antiemetic Effect of Celecoxib on Cisplatin-induced Delayed Emesis in Rats / 中国药房

OBJECTIVE:To study the action mechanism and effect of celecoxib on cisplatin-induced delayed emesis in rats.METHODS:The rats were divided into control group,cisplatin group,and celecoxib group(cisplatin plus celecoxib).Kaolin intake in the rats after administration of corresponding drugs was observed.Levels of 5-HT and its metabolite 5-HIAA in intestinal tissues,and the activities of tryptophan hydroxylase(TPH)and monoamine oxidase(MAO)were determined,and the morphological changes of the intestinal tissues were observed.RESULTS:In cisplatin group compared with control group,the Kaolin intake increased significantly(P

Estenosis hipertrófica de píloro: presentación de un caso y actualización / Hypertrophic pyloric stenosis: a case report and update

La estenosis hipertrófica de píloro es una anomalía congénita frecuente, caracterizada por la hipertrófia de la capa muscular circular del estomago en la región pílorica, la que requiere de modo obligatorio cirugía para su corrección. La edad usual en la que se presenta el cuadro es de la tercera a la sexta semana, con un cuadro emético no bilioso, progresivamente continuo hasta llegar al estado del vómito permanente e incontrolable. Se publica el caso de un lactante menor de 6 semanas de edad, asintomático hasta dos días previos a su consulta, iniciando su expresión clínica con un cuadro de emésis incoercible que obligó a una ecografía, la misma que no mostraba claramente la patología de base, por lo que se realizó una serie radiográfica esófagogastroduodenal, que revelaba impedimento paso de contraste a duodeno, llegándose al diagnóstico de estenosis y obstrucción pilórica completa, por lo que a las pocas horas de su diagnóstico fue operado con éxito. Por la ausencia de síntomas previos al vómito incoercible, su presentación brusca y la poca ayuda diagnóstica de la ecografía. Se presenta el caso de referencia y se realiza una breve actualización, con énfasis en aspectos de diagnóstico diferencial en casos de vómito para la edad del paciente.

Hypertrophic stenosis of the pylorus is a frequent congenital abnormality, characterized by hypertrophy of the circular muscle layer of the stomach in the region of the pylorus which needs obligatory surgery for correction. The common age at which this alteration appears is from three to six weeks with non bilious vomiting that progresses continuously to a state of permanent and incontrollable vomiting We present the case of a less than six weeks old baby which had shown no symptoms until two days previous to consultation, starting clinical signs with uncontrollable vomiting that required an echography which did not clearly show the underlying pathology. For this reason , a series of oesophagogastroduodenal radiographies was performed which showed an obstructed pass of the contrast to the duodenum. Therefore the diagnosis of stenosis and complete pyloric obstruction was made, and a few hours later the baby underwent successful surgery.Due to the absence of symptoms previous to the uncontrollable vomiting, its sudden appearance, and the little diagnostic help of the echography, we report the present case, and make a short actualisation, emphasizing diagnostic aspects and differential diagnosis in cases of vomiting for the age of the patient.

A Prospective Randomized Comparative Clinical Trial Comparing the Efficacy between Ondansetron and Metoclopramide for Prevention of Nausea and Vomiting in Patients Undergoing Fractionated Radiotherapy to the Abdominal Region / 대한방사선종양학회지

PURPOSE: This study is a prospective randomized clinical trial comparing the efficacy and complication of anti-emetic drugs for prevention of nausea and vomiting after radiotherapy which has moderate emetogenic potential. The aim of this study was to investigate whether the anti-emetic efficacy of ondansetron (Zofran(R)) 8 mg bid dose (Group O) is better than the efficacy of metoclopramide 5 mg tid dose (Group M) in patients undergoing fractionated radiotherapy to the abdominal region. MATERIALS AND METHODS: Study entry was restricted to those patients who met the following eligibility criteria: histologically confirmed malignant disease; no distant metastasis; performance status of not more than ECOG grade 2; no previous chemotherapy and radiotherapy. Between March 1997 and February 1998, 60 patients enrolled in this study. All patients signed a written statement of informed consent prior to enrollment. Blinding was maintained by dosing identical number of tablets including one dose of matching placebo for Group O. The extent of nausea, appetite loss, and the number of emetic episodes were recorded everyday using diary card. The mean score of nausea, appetite loss and the mean number of emetic episodes were obtained in a weekly interval. RESULTS: Prescription error occurred in one patient. And diary cards have not returned in 3 patients due to premature refusal of treatment. Card from one patient was excluded from the analysis because she had a history of treatment for neurosis. As a result, the analysis consisted of 55 patients. Patient characteristics and radiotherapy charcteristics were similar except mean age was 52.9+/-11.2 in group M, 46.5+/-9.6 in group O. The difference of age was statistically significant. The mean score of nausea, appetite loss and emetic episodes in a weekly interval was higher in group M than O. In group M, the symptoms were most significant at 5th week. In a panel data analysis using mixed procedure, treatment group was only significant factor detecting the difference of weekly score for all three symptoms. Ondansetron (Zofran ) 8 mg bid dose and metoclopramide 5 mg tid dose were well tolerated without significant side effects. There were no clinically important changes in vital signs or clinical laboratory parameters with either drug. CONCLUSION: Concerning the fact that patients with younger age have higher emetogenic potential, there are possibilities that age difference between two treatment groups lowered the statistical power of analysis. There were significant difference favoring ondansetron group with respect to the severity of nausea, vomiting and loss of appetite. We concluded that ondansetron is more effective anti-emetic agents in the control of radiotherapy-induced nausea, vomiting, loss of appetite without significant toxicity, compared with commonly used drug, i.e., metoclopramide. However, there were patients suffering emesis despite the administration of ondansetron. The possible strategies to improve the prevention and the treatment of radiotherapy-induced emesis must be further studied.

Ondansetron plus dexamthasone in anti-emesis induced by cisplatin containing chemotherapy / 中国癌症杂志

Purpose:To evaluate the efficacy of ondansetron plus dexamethasone compared with metoclopramide plus dexamethasone against emesis induced by cisplatin (DDP) containing chemotherapy.Methods:53 malignant tumor patients received DDP containing chemotherapy. DDP was 20 mg/m 2 ,qd,from the first day to the fifth day;ondansetron was 4 mg plus dexamethasone 5 mg,qd,from the first day to the fifth day; metoclopramide was 10 mg plus dexamethasone 5mg,qd,from the first day to the fifth day. Results:The anti emetic rate of ondansetron plus dexamethasone was 82.6%,which was higher than that of metoclopramide plus dexamthasone (44.5%, P

Granisetron in the Treatment of Radiotherapy-Induced Nausea and Vomiting / 대한방사선종양학회지

PURPOSE: Granisetron is a potent, the most selective 5-HT3 receptor antagonist and is reported to be effective in treatment of radiation-induced emesis. The antiemetic efficacy and safety of oral granisteron was evaluated in patients with receiving highly emetogenic treatment by conventional fractionated irradiation. MATERIAL AND METHODS: Patients with various cancers who were being treated with irradiation were accrued into the present study. The intensity of nausea was evaluated on first 24 hours and on day-7 by patients according to the degree of interference with normal daily life as followings; a) none; b) present but no interference with normal daily life (mild); c) interference with normal daily life (moderate); and d) bedridden because of nausea (severe). Non or mild state was considered to indicate successful treatment. The efficacy of antiemetic treatment was graded as follows; a) complete response; no vomiting, no worse than mild nausea and receive no rescue antiemetic therapy over the 24h period, b) major response; either one episode of vomiting or moderate/severe nausea or had received rescue medication over 24h period, or any combination of these, c) minor response; two to four episodes of vomiting over the 24h period, regardless of nausea and rescue medication, d) failure; more than four medication. The score of the most sympto m was recorded and the total score over 24 hours was summarized. The complete or major response was considered to indicate successful treatment. RESULTS: A total of 10 patients were enrolled into this study, and all were assessable for efficacy analysis. Total nausea control was achieved in 90% (9/10:none=60% plus mild=30%) of total patients after 7 days. The cotrol of vomiting by granisteron was noted in seven patients (70%) of complete response and three (30%) of major response with a hundred-percent successful treatment over 7 days. The minor response or treatment failure were not observed. No significant adverse events or toxicities from granisetron were recorded in patient receiving granisetron. CONCLUSION: We concluded that granisetron is a highly effective antiemetic agent in controlling radiotherapy-induced nausea or vomiting with a minimal toxicity profile.