Prevention of acute emesis in cancer patients following high-dose cisplatin with the combination of oral dolasetron and dexamethasone.

PURPOSE: Dolasetron is a 5-HT3 antagonist antiemetic with active oral and intravenous formulations. The effects of this class are enhanced when combined with dexamethasone. This study tested the ability of the combination of oral dolasetron 200 mg and oral dexamethasone 20 mg to prevent acute emesis in cancer patients receiving initial cisplatin at doses > or = 70 mg/m2. Additionally, patients were randomly assigned to receive a second dosage of the regimen 16 hours later to improve control of acute symptoms. PATIENTS AND METHODS: A total of 75 patients were entered, with 38 randomized to the two-dose regimen. Thirty-five percent were women and 77% had lung cancer. RESULTS: Overall, the regimen prevented acute vomiting in 76% (95% confidence interval, 65% to 85%), including 74% of 35 patients who received cisplatin at doses > or = 100 mg/m2. There was no observed difference in emesis prevention between the one-dose (76%) and two-dose (76%) regimens (95% confidence interval for the difference, -20% to 19%). The median time to the onset of emesis was 19 hours for the one-dose regimen and 17 hours for the two-dose regimen in those patients with emesis. Headache occurred in 11% who received one dose and 16% who received two doses. CONCLUSION: The combination of oral dolasetron 200 mg and dexamethasone 20 mg given only once prevented acute emesis in 76% of patients who received cisplatin > or = 70 mg/m2. Administration of a second dose of the regimen did not improve the observed prevention rate or delay the time to emesis. This one-dose oral regimen has comparable or better effectiveness than reported results of intravenous combination regimens in preventing cisplatin-induced vomiting and merits further study and use.

Determination of nicotine concentrations in human milk.

A total of 34 samples of human milk from 15 donors was analyzed for nicotine content, using a new method of sample preparation and subsequent quantification by gas chromatography. Nicotine was not found in the six samples of milk from non-smokers. The 28 samples from smokers contained an average of 91 parts per billion (ppb) nicotine (ranging from less than 20 ppb to 512 ppb). While no adverse effects to the infant due to nicotine in human milk have been documented, this method of analysis will allow systematic monitoring of nicotine concentrations in the milk of lactating women. These results should not be used to deter breast-feeding; rather, they offer another reason for mothers to reduce or cease smoking.

DDT levels in milk of rural indigent blacks.

Human milk samples from low-income blacks residing in rural Mississippi and Arkansas and middle-class whites residing in metropolitan Nashville, Tenn, were analyzed for concentrations of DDT and its metabolites. The mean total DDT concentration (DDE [derivative of DDT]+DDT) of 38 samples from the blacks was 447 parts per billion (ppb); the range was 59 to 1,900 ppb. The mean of the 14 samples from Nashville residents was 75 ppb (range, 15 to 133 ppb). The difference in the DDT concentrations in the two populations indicates that rural low-income blacks are still highly contaminated with pesticides, even though the general use of DDT has been banned. Due to the limited amount of information from the donors, no correlation could be made between the DDT concentration and diet, age of child, home pesticide use, or distance of residence from farming fields.