Control of Carboplatin-Induced Emesis with a Fixed Low Dose of Granisetron (0.5 mg) plus Dexamethasone

In an effort to develop a cost-effective antiemetic regimen for carboplatin-based chemotherapy, we examined a fixed (0.5 mg) low dose of granisetron (a new 5-HT₃(serotonin) antagonist) plus dexamethasone (20 mg) in 23 patients with gynecologic malignancies receiving this antineoplastic drug. Nineteen (83%) patients experienced complete control of acute emesis (nausea and vomiting) while 22 (96%) individuals demonstrated complete or major control (≤2 episodes of vomiting, ≤5 episodes of retching, minimal interference with eating) of emetic events. We conclude that this fixed low-dose granisetron plus dexamethasone regimen is a safe, convenient, and cost-effective antiemetic program for individuals receiving carboplatin-based chemotherapy.     

Antiemetic efficacy of high-dose metoclopramide, diphenhydramine, methylprednisolone and diazepam on chemotherapy-induced emesis in gynecological malignancy

The antiemetic efficacy of high-dose metoclopramide (MCP), diphenhydramine (DPH), methylprednisolone (MPL), and diazepam (DZP) was investigated in 40 gynecologic cancer patients for a total of 98 chemotherapy courses, treated with cisplatin (50 mg/m2). With MPL (500 mg i.v. x 2) plus DZP (5 mg i.m. x 2), no vomiting occurred in 0% and mild emesis (vomiting 1-2 times) occurred in 20% of 25 courses. With MCP (2 mg/kg i.v. x 5) plus DPH (40 mg i.v. x 3), no vomiting occurred in 35% and mild emesis occurred in 10% of 20 courses. With a combination of MCP plus DPH and MPL plus DZP, no vomiting occurred in 51% and mild emesis occurred in 25% of 53 courses. These results indicate that high-dose MCP plus DPH are effective in preventing cisplatin-induced vomiting. Furthermore, the antiemetic efficacy of MCP plus DPH (0-2 vomiting episodes: 45%) was significantly enhanced (p less than 0.05) by the combined use of MPL plus DZP (0-2 vomiting episodes: 76%).     

Effectiveness of serotonin-receptor antagonist antiemetic therapy over successive courses of carboplatin-based chemotherapy

PURPOSE: There are extremely limited data available in the general oncology or gynecologic cancer literature to document the effectiveness of antiemetic therapy over multiple courses of cytotoxic chemotherapy. METHODS: To examine this highly clinically relevant issue, we analyzed the complete treatment course of patients with gynecologic cancers receiving carboplatin-based chemotherapy regimens who had participated in one of four institutional serotonin-receptor antagonist antiemetic trials, which had specifically evaluated the benefits of such therapy during only the first treatment course. Medical records were reviewed to examine the development of emesis during subsequent chemotherapy treatment cycles. RESULTS: The 91 patients included in this analysis received a median of 6 courses (range 1-18) of carboplatin (initial AUC dose 4, 5, and 6 in 29, 29, and 32 patients, respectively). All received ondansetron or granisetron plus dexamethasone with every treatment course. Complete control of emesis (no acute or delayed nausea or vomiting) was experienced by 56 (62%) patients during every cycle. Conversely, 20% of women noted one or more episodes of nausea without vomiting and 19% developed at least one incidence of vomiting. In no case was emesis considered to be severe (grade 3), and no patient required either discontinuation of carboplatin or a dose reduction due to the development of emesis. CONCLUSION: In the large majority of patients, serotonin-receptor antagonist antiemetic therapy, administered in combination with dexamethasone, is highly effective over multiple courses in preventing significant carboplatin-induced nausea and vomiting.     

A randomized blinded study of the incidence of postoperative nausea and vomiting in women after major gynecologic laparoscopic surgery

STUDY OBJECTIVE: To estimate the incidence of postoperative nausea and vomiting (PONV) in women undergoing major gynecologic laparoscopic surgery with an expected surgical duration exceeding 1 hour and anticipated overnight hospitalization. DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: This study was set at a university hospital. PATIENTS: One hundred forty female patients with an American Society of Anesthesiology (ASA) physical status I or II and scheduled for gynecologic inpatient laparoscopic surgery. INTERVENTIONS: Patients were randomly assigned to receive 1 mg granisetron (Group A, n=70), or saline solution (Group B, n=70) intravenously after induction of general anesthesia. MEASUREMENTS AND MAIN RESULTS: The endpoints were evaluated by the following parameters: the incidence of PONV, episodes of nausea, retching, vomiting, rescue antiemetics, and complete response. Patients were closely observed for 24 hours after administration of the study drug. The two groups were generally well balanced in terms of demographic variables. The surgical period was longer in the granisetron group compared with the saline solution group. The total incidence of PONV was 41/70 (59%) in patients who underwent inpatient gynecologic laparoscopic surgery when no prophylactic antiemetic was given. Administration of granisetron decreased the incidence of PONV (29/70 [41%] vs 41/70 [59%], p<.05), the incidence of vomiting (18/70 [26%] vs 31/70 [44%], p<.05), and the proportions of patients requiring rescue antiemetics (14/70 [20%] vs 47/70 [67%], p<.01), but these results were not comparable to other studies. CONCLUSION: A long surgical period may have great impact on the PONV in women who undergo gynecologic laparoscopic surgery, which implies the need for skilled gynecologic laparoscopists.     

No Superiority of Granisetron Over Metoclopramide in Prevention of Post-operative Nausea and Vomiting: A Randomized Clinical Trial

Purpose

Post-operative nausea and vomiting (PONV) is considered as one of the most disturbing sequels of surgeries under general anesthesia, which if not controlled appropriately increases post-operative morbidity, nursing burden, and general healthcare costs. In this study, we compared granisetron with its brand Kytril^® and also with metoclopramide regarding PONV management.

Methods

A total of 180 obstetrics and gynecology patients who underwent surgeries under general anesthesia participated in this prospective study at the Dr. Shariati Teaching Hospital, Tehran, Iran. The patients were randomly assigned to single-dose generic granisetron (40 mcg/kg), Kytril^® (40 mcg/kg), or metoclopramide (0.2 mg/kg) at the end of the surgery. Two episodes of emetic symptoms (nausea and vomiting) were recorded by a gynecologist who had no knowledge of which treatment each patient had received. This gynecologist observed the patients at three different intervals: 0–6, 6–12, and 12–18 h post-surgery.

Results

One hundred and thirty-seven patients (76.1 %) underwent hysterectomy and 40 patients (22.2 %) underwent myomectomy. Each group consisted of 60 patients (33 %). The incidence of vomiting in the first 6, 12, and 18 h post-surgery was 22, 15.2, and 13.3 % for granisetron; 18.6, 10, and 8.3 % for Kytril; and 22, 11.9, and 5 % for generic metoclopramide, respectively. There was no significant difference in the incidence of PONV with any of these agents.

Conclusions

All three anti-nausea and vomiting agents, granisetron, its brand (Kytril), and generic metoclopramide, have a similar effect to manage PONV in obstetrics and gynecological surgeries. Trial registration This trial is registered with www.irct.ir, number IRCT201010134927N1.     

Dose-range effects of propofol for reducing emetic symptoms during cesarean delivery.

OBJECTIVE: To evaluate the efficacy and safety of propofol at subhypnotic doses for reducing emetic symptoms in parturients undergoing cesarean delivery under spinal anesthesia. METHODS: In a randomized, double-masked trial, 80 patients received lidocaine intravenously 0.1 mg/kg (for injection pain relief) followed by either placebo or propofol at three different doses (0.5 mg/kg per hour, 1.0 mg/kg per hour, 2.0 mg/kg per hour) (n = 20 in each group) immediately after clamping of the umbilical cord. Emetic episodes and safety assessments were performed during spinal anesthesia for cesarean delivery. To estimate a sufficient sample size, it was calculated that 20 patients per group would be required with alpha =.05 and beta =.2. RESULTS: The rate of patients experiencing no emetic symptoms in an intraoperative, postdelivery period was 45% with propofol 0.5 mg/kg per hour (P =.5), 80% with propofol 1.0 mg/kg per hour (P =.011), and 80% with propofol 2.0 mg/kg per hour (P =.011), compared with placebo (40%). No clinically serious adverse events caused by the study drugs were observed. CONCLUSION: Propofol 1.0 mg/kg per hour is the minimum effective subhypnotic dose for reducing emetic symptoms during cesarean delivery. Increasing the dose to 2.0 mg/kg per hour provides no further benefit.     

Randomized, Placebo-Controlled Trial of Granisetron for Control of Nausea and Vomiting During Cesarean Delivery Under Spinal Anesthesia

Objective(s)

The objective of this study was to evaluate the efficacy and safety of granisetron (5HT₃ receptor antagonist) on the incidence of nausea and vomiting in cesarean deliveries under spinal anesthesia.

Method(s)

In the randomized, double-blind study, 80 parturients received granisetron 40 μg/kg or placebo (n = 40 each) intravenously, immediately after clamping of the fetal umbilical cord. Nausea, vomiting, and adverse events were then observed for 24 h after administration of spinal anesthesia.

Results

A complete response (defined as no postoperative nausea and vomiting) during 0–4 h after administration of spinal anesthesia was achieved in 80 % of patients with granisetron and in 45 % of patients with placebo. The corresponding incidences during (4–24 h) were 82.5 and 55 % (P value <0.05). No difference in adverse events was observed in any of the groups.

Conclusion(s)

Prophylactic use of granisetron is effective for preventing emetic episodes during spinal anesthesia for cesarean delivery.     

Dexamethasone for the prevention of nausea and vomiting after dilatation and curettage: a randomized controlled trial.

OBJECTIVE: To evaluate the efficacy and safety of dexamethasone administered intravenously at three different doses (4 mg, 8 mg, 16 mg) for the prevention of nausea and vomiting after dilatation and curettage. METHODS: In a prospective, randomized, double-masked, placebo-controlled trial, 120 women received placebo or dexamethasone intravenously at doses of 4 mg, 8 mg, or 16 mg immediately before induction of anesthesia (n = 30 in each group). Propofol-based general anesthetic was used. Emetic episodes and safety assessments were performed. To estimate a sufficient sample size, it was calculated that 30 patients per group would be required with alpha =.05 and beta =.2. RESULTS: The rate of patients who were emesis-free (no nausea, retching, or vomiting) 0-24 hours after anesthesia was 57% with dexamethasone 4 mg (P =.796), 87% with dexamethasone 8 mg (P =.005), and 87% with dexamethasone 16 mg (P =.005), compared with placebo (50%). Patients who had received dexamethasone 8 mg or 16 mg were more satisfied than those who had received placebo (P <.05). No clinically important adverse events were observed in any of the groups. CONCLUSION: Dexamethasone 8 mg is an effective antiemetic for preventing postoperative nausea and vomiting 0-24 hours after anesthesia in women undergoing propofol-based general anesthesia for termination of pregnancy. Increasing the dose to 16 mg provided no additional benefit.     

Antiemetic combination for PAC (cisplatin-adriamycin-cyclophosphamide) chemotherapy-induced emesis in ovarian cancer

Twenty-six patients suffering from disseminated epithelial ovarian cancer (FIGO stages III and IV) under treatment with Cisplatin (80-100 mg/m2 in 8 hours) in combination on the same day with Cyclophosphamide (500 mg/m2 IV) and Adriamycin (50 mg/m2), a severely emetogenic regimen, entered a randomized, double-blind, cross-over trial comparing the antiemetic activity of high-dose IV Metoclopramide (1 mg/kg/dose X 5 doses) with that of a combination of Metoclopramide (same schedule) plus Nortriptyline (50 mg PO X 2 doses) plus Thiethylperazine (10 mg IV X 3 doses). The antiemetic combination was designed in an attempt to act simultaneously on gastrointestinal motility and neuroreceptors at the central emetic pathways (dopamine D-2, histamine H-1 and muscarinic cholinergic). This combination significantly reduced the emesis due to chemotherapy when compared with Metoclopramide alone and was also preferred by a significant number of patients after passing through both the antiemetic arms being compared.     

Effect of antepartum glucocorticoid administration upon neonatal respiratory distress syndrome and perinatal infection

A double-blind, randomized study comparing the antepartum use of betamethasone (12 mg), methylprednisolone (125 mg), and hydrocortisone (250 mg) was performed to evaluate effect on neonatal respiratory distress syndrome and perinatal infection. Of 144 mothers and 149 infants entered, 92 mothers and 97 infants were available for analysis. The betamethasone-treated group had a significantly reduced incidence of severe respiratory distress syndrome (4%) compared with the control group (26%; p = 0.038); this effect was confined to patients who received at least two doses. No similar effect was found in the methylprednisolone or hydrocortisone groups. Neonatal infection and neonatal mortality rate were not affected by glucocorticoid use. Maternal infection was significantly increased in hydrocortisone-treated patients who were delivered vaginally compared with control patients (all patients: 50% versus 9.5%, p less than 0.05; with ruptured membranes: 63% versus 15%, p = 0.04). No similar increase in maternal infection was found with betamethasone or methylprednisolone use.     

Effect of combining ultralow-dose naloxone with morphine in intravenous patient-controlled analgesia: the cut-off ratio of naloxone to morphine for antiemesis after gynecologic surgery.

BACKGROUND/PURPOSE: Admixing an ultralow dose of naloxone with intravenous morphine patient-controlled analgesia (PCA) has been shown to decrease postoperative nausea. However, the cut-off ratio of the naloxone-morphine admixture for antiemetic effects has not been investigated. The purpose of this study was to investigate the cut-off ratio of naloxone-morphine admixture in PCA for antiemesis after gynecologic surgery. METHODS: This double-blind study enrolled 120 female patients who were scheduled for gynecologic surgery under general anesthesia. Patients were randomly allocated to one of three groups (n = 40 for each group). The concentration of naloxone and morphine respectively was 0 microg/mL and 1 mg/mL in group 1, 0.1 microg/mL and 1 mg/mL in group 2 (1:10,000), and 1 microg/mL and 1 mg/mL in group 3 (1:1000). Morphine consumption, verbal rating score of wound pain at rest and with exertion, and morphine-related side effects were investigated at 1, 2, 4 and 24 hours postoperatively. RESULTS: A total of 112 patients completed the study (37 in group 1, 36 in group 2, 39 in group 3). The incidence of nausea during the postoperative 4-24 hours was significantly lower in group 3 than in group 1 (23.1% vs. 56.8%, p < 0.05). Furthermore, the overall incidence of severe nausea was significantly lower in group 3 than in group 1 (2.6% vs. 24.3%, p < 0.05) as was the rescue antiemetic requirements (5.1% vs. 24.3%, p < 0.05). However, there were no significant differences between groups 2 and 1. The pain scores (at rest and with exertion) and 24-hour morphine consumption were not significantly different among the three groups. CONCLUSION: The antiemetic efficacy of ultralow-dose naloxone combined with PCA morphine is limited by a cut-off ratio of naloxone to morphine of 1:10,000.     

Experience with single-agent paclitaxel consolidation following primary chemotherapy with carboplatin, paclitaxel, and gemcitabine in advanced ovarian cancer

OBJECTIVE: Twelve cycles of single-agent paclitaxel have been demonstrated to prolong progression-free survival in women with advanced ovarian cancer whom achieved a clinical complete response to a primary platinum/paclitaxel chemotherapy regimen. This trial was conducted to compare the toxicity and disease-free interval of 3 cycles vs. 12 cycles of paclitaxel consolidation in patients treated with an intensive three-drug front-line regimen of carboplatin, paclitaxel, and gemcitabine. METHODS: Following cytoreductive surgery, 26 ovarian cancer patients received primary chemotherapy with carboplatin (AUC = 5, day 1), paclitaxel (175 mg/m(2) over 1 h, day 1), and gemcitabine (800 mg/m(2), day 1 day 8), with treatment repeated every 21 days x 6 cycles. The first 13 patients (group A) received three additional cycles of paclitaxel (175 mg/m(2) over 1 h every 21 days). The second set of 13 patients (group B) also received three cycles of paclitaxel (175 mg/m(2) over 1 h every 21 days) and then received nine additional cycles of paclitaxel (135 mg/m(2) over 1 h every 21 days) consolidation therapy. The change from 3 cycles to 12 cycles of consolidation therapy for group B was made following the published results of GOG 178. RESULTS: In group A, all 13 patients completed three courses of consolidation therapy. One patient experienced grade 3 neutropenia and two patients exhibited both grade 4 neutropenia and thrombocytopenia. Grade > or = 2 neuropathy developed in 3 patients (23%). In group B, 9 of the 13 patients whom were intended to receive 12 total cycles of paclitaxel consolidation were able to complete the program. There was no grade 3-4 neutropenia or anemia in this population, although 1 patient developed grade 3 thrombocytopenia. Grade > or = 2 neuropathy developed in 7 patients (54%). Although not a randomized experience, median progression-free interval was 76 weeks for group B, and 47 weeks for group A. CONCLUSION: Single-agent paclitaxel consolidation therapy can be administered for 12 cycles following first-line carboplatin, paclitaxel, and gemcitabine induction therapy, but there is considerable risk for development of a moderately severe peripheral neuropathy.     

The antiemetic efficacy of oral ondansetron plus intravenous dexamethasone in patients with gynecologic malignancies receiving carboplatin-based chemotherapy

PURPOSE: The purpose of this study was to develop a cost-effective prophylactic antiemetic regimen for the prevention of carboplatin-induced emesis. METHODS: Patients being treated in the Gynecologic Cancer Program of the Cleveland Clinic Taussig Cancer Center with a carboplatin-based chemotherapy regimen received a prophylactic antiemetic program consisting of a single dose of oral ondansetron (16 mg) plus intravenous dexamethasone (20 mg) approximately 30 min prior to chemotherapy. Evaluation of the effectiveness of this antiemetic regimen was performed during a single treatment course. RESULTS: A total of 27 patients (median age, 62; range, 41-83) participated in this phase 2 trial. Three patients received single-agent carboplatin, and 24 were treated with either a carboplatin/paclitaxel or carboplatin/docetaxel regimen. The carboplatin AUC dosing level was 4, 5, or 6 in 6, 5, and 16 individuals, respectively. No patient developed vomiting; 2 (7%) individuals experienced nausea during the 24-h period following chemotherapy administration. CONCLUSION: The combination of a single dose of oral ondansetron (16 mg) plus intravenous dexamethasone (20 mg) is an effective prophylactic antiemetic regimen for patients receiving carboplatin-based chemotherapy.     

Methylprednisolone in cis-platinum induced nausea and emesis: a placebo-controlled trial

In a double-blind, placebo-controlled trial, the antiemetic efficacy of a total of 1-2 g methylprednisolone sodium succinate (MPSS) alone versus placebo was evaluated over the first three courses of chemotherapy in a group of 27 women receiving moderate to high-dose cis-platinum (50-118 mg/m2) for ovarian or cervical carcinomas. Antiemetic protection was classified as total (no emesis), major (one or two bouts), minor (three to five bouts), or minimal (six or more bouts). Total or major protection occurred in 10/26 (38.5%) of the MPSS cycles and in 6/24 (25%) of the placebo cycles (NS). A significant number of placebo patients (7/14 placebo versus 1/13 MPSS, P = 0.02) dropped out of the study due to lack of efficacy. Patient evaluations completed 24 hr before and after each course of chemotherapy indicated no treatment effect on pain, appetite, nausea, drowsiness, anxiety, sense of well-being, or sleep. Physician and patient global evaluations of antiemetic efficacy favored treatment with MPSS. Evidence of the efficacy of single-drug MPSS antiemetic therapy during non-cis-platinum or low-dose cis-platinum (less than 50 mg/m2) chemotherapy can be found in the literature. The results of this study, however, do not support the use of MPSS alone with high-dose cis-platinum chemotherapy.     

黄体期个体化雌激素补充方案对IVF-ET治疗结局的影响

目的:探讨黄体期个体化添加不同剂量雌激素对体外受精-胚胎移植(IVF-ET)胚胎种植率和临床妊娠率的影响。方法:回顾性分析104个长方案控制性促排卵(COH)IVF-ET周期,根据其移植日血清E2水平下降幅度分为4组,A组:E2下降<30%,12个周期,单用黄体酮进行黄体期支持;B组:E2下降30%-39%,18个周期,黄体期支持采用黄体酮+3mg/d雌激素;C组:E2下降40%-49%,16个周期,D组:E2下降≥50%,58个周期,C组、D组患者黄体期支持采用黄体酮+4mg/d雌激素。结果:各组的取卵数目、受精率、卵裂率、优质胚胎数、内膜厚度和移植胚胎数相比差异均无显著性(P>0.05)。A组、B组、C组间胚胎种植率和临床妊娠率无统计学差异;而D组与其余3组比,胚胎种植率和临床妊娠率显著下降(P<0.05)。结论:①在长方案COH的IVF-ET中,当移植日血清E2水平下降幅度≥30%时黄体期支持补充雌激素可以改善胚胎种植率和临床妊娠率;②E2下降幅度大的患者可能需要增加雌激素的添加剂量。     

Effect of medical vagotomy on the CDDP induced nausea and vomiting evaluated by the chemotherapy-vomiting time (CV time)

Twenty-eight patients with gynecologic malignancies receiving combination chemotherapy containing cisplatin (80 mg/m2) entered into a randomized controlled trial to evaluate the effect of medical vagotomy for acute cisplatin-induced emesis. Medical vagotomy consisted of 0.5 mg of atropine and 50 mg of hexamethonium bromide, and was injected three times at two hour intervals intramuscularly. A good antiemetic effect (no emesis during the 24 hours after cisplatin administration) was obtained in 40% (6/15) of patients with medical vagotomy but in 0% (0/13) in controlled cases. The time free of vomiting after cisplatin injection (CV time) was statistically prolonged in patients with medical vagotomy (805 +/- 563 min.) when compared with controlled cases (148 +/- 70 min.) (p less than 0.01). Toxicities with medical vagotomy were slight; mild hypotension and dimness of vision only. Individual differences in responding to medical vagotomy were investigated by the acetaminophen method, which showed that high and low responded cases were among these tested patients who had undergone medical vagotomy. In conclusion, medical vagotomy has an excellent antiemetic effect on acute cisplatin-induced emesis without notable side effects. If combined with other antiemetics, a much better antiemetic effect can be expected.     

盐酸羟考酮复合右美托咪定在子痫前期患者剖宫产术后镇痛、镇静中的临床观察

目的:探讨不同剂量的盐酸羟考酮和右美托咪定复合用于子痫前期患者剖宫产术后镇痛、镇静的有效性和安全性。方法:120例子痫前期患者随机分为A、B、C 3组,各组40例。术后入重症监护病房(ICU)时连接盐酸羟考酮注射液和右美托咪定持续泵注镇痛、镇静治疗。A组采用低剂量盐酸羟考酮每小时0.5 mg+右美托咪定每小时0.3μg/kg持续泵注;B组采用中剂量盐酸羟考酮每小时0.75 mg+右美托咪定每小时0.3μg/kg持续泵注;C组采用高剂量盐酸羟考酮每小时1 mg+右美托咪定每小时0.3μg/kg持续泵注。记录3组患者术毕入ICU时(T0)、入ICU后2小时(T1)、4小时(T2)、6小时(T3)、8小时(T4)、12小时(T5)、24小时(T6)、48小时(T7)静息及按压宫底时的数字疼痛评分法(NRS)评分、按压宫底前后平均血压(MAP)、心率(HR),各时点静息时镇静满意者比例及恶心、呕吐、瘙痒、呼吸抑制、头晕痛等不良反应和子痫、脑出血、心力衰竭等并发症情况。结果:A组中静息NRS评分在T2~T7高于T1(P<0.05);在T2~T5时静息和按压时差异有统计学意义(P<0.05)。A组MAP、HR在T2~T5时点按压前后相比,差异有统计学意义(P<0.05)。B、C两组患者静息、按压NRS评分在T2~T7各时点低于A组(P<0.05);B、C两组间MAP、HR在按压前后各时点比较差异均无统计学意义(P>0.05)。B、C两组镇静满意者例数在T1~T7时点所占比例高于A组(P<0.05)。3组间恶心、呕吐、呼吸抑制发生率差异无统计学意义(P>0.05)。无子痫、脑出血、心力衰竭等并发症发生。结论:盐酸羟考酮每小时0.75mg+右美托咪定每小时0.3μg/kg持续静脉泵注用于子痫前期患者剖宫产术后48小时内镇痛、镇静,安全有效。     

早孕7-9周药物流产的临床观察

目的:探讨提高孕7-9周药物流产的有效性药物剂量。方法:因非意愿妊娠要求终止早孕的孕7-9周妇女256例,随机分为二组,A组(109例)和B组(147例)。d1-2分别分次口服米非司酮150mg或200mg;d3口服米索前列醇600μg,4h后无论胚囊是否排出,均加服米索400μg。结果:A组完全流产率为91.2%,B组为92.5%,P>0.05。药物流产后阴道出血时间、出血量、转经时间、经期及经量二组均无统计学差异。结论:两种方法的完全流产率均达到90%以上,200mg米非司酮配伍米索前列醇,可能减少孕囊排出时的出血量,对孕7-9周的妇女不失为一种安全的药物流产手段。     

间苯三酚复合剂在产程中应用的研究

目的　观察间苯三酚复合剂在产程进展中的作用。方法　选择正常初产妇、宫口开大2～ 3cm伴宫颈水肿者 97例 ,随机分为间苯三酚复合剂组 (4 6例 ) ,待宫口开大 2～ 3cm后 ,给予间苯三酚复合剂 80mg静脉推注 ;阿托品组 (5 1例 ) ,待宫口开大 2～ 3cm后 ,给予阿托品 0 5mg宫颈注射。观察两组产妇用药后的产程变化及围产结局。结果　 (1)用药至宫口开全的时间 ,间苯三酚复合剂组平均为 (3 1± 0 3)h ,阿托品组平均为 (4 4± 0 4 )h ,两组比较 ,差异有极显著性 (P <0 0 1)。 (2 )用药后 2h的宫颈水肿消失率 ,间苯三酚复合剂组为 95 6 % ,阿托品组为 90 2 % ,两组比较 ,差异无显著性 (P >0 0 5 ) ;较用药前平均宫口开大 ,间苯三酚复合剂组为 (4 3± 0 2 )cm ,阿托品组为 (2 5± 0 3)cm ,两组比较 ,差异有极显著性 (P <0 0 1)。 (3)间苯三酚复合剂组产妇及胎儿未发现明显副作用 ;阿托品组用药后 15～ 30min ,8例产妇诉口干 ,2 2例产妇心率每分钟增加 10～ 15次 ,同时伴胎心率基线升高 ,约 6 0min后恢复。 (4 )阴道分娩率 ,间苯三酚复合剂组为 95 6 % ,阿托品组为 90 2 % ,两组比较 ,差异无显著性 (P >0 0 5 )。 (5 )产时羊水情况、新生儿窒息情况及新生儿体重在两组间比较 ,差异均无显著性 (P     

Efficacy and tolerability of the ifosfamide–epirubicin combination in relapsed ovarian cancer

A retrospective study evaluating the efficacy and tolerability of epirubicin-ifosfamide (EI) in patients with relapsed advanced ovarian cancer (ROC) after prior chemotherapy was conducted. A total of 93 patients received epirubicin (50 mg/m(2), day 1), ifosfamide (1500 or 2500 mg/m(2), days 1-3), and mesna monthly. Thirty-five percent had received one line of chemotherapy (platinum 100%, taxanes 8%); 38%, two lines; and 27%, more than two lines. Fifty-three percent received 2500 mg/m(2)/day ifosfamide and 47% received 1500 mg/m(2)/day ifosfamide. Ifosfamide was administered by continuous infusion in 12 patients. Mean number of courses was 4 (1-12). Grade 4 toxicity was 69% neutropenia and 12% thrombocytopenia. Three patients on high-dose ifosfamide as a short infusion had central nervous system dysfunction resulting in death. There were 84 assessable patients: 7 (8%), complete responses; 13 (15%), partial responses; and 20 (24%), stable disease. Median time to progression was 5 months (3 days to 36 months). The EI combination appears to be effective in ROC. However, toxicity with high-dose ifosfamide administered by short infusion is not acceptable. Tolerability can be improved using ifosfamide at 1500 mg/m(2) by continuous infusion. The combination of ifosfamide with newer anthracycline agents such as liposomal doxorubicin may be an alternative and needs further evaluation for use after first-line taxane-based chemotherapy.