Randomised comparison of ondansetron and metoclopramide plus dexamethasone for chemotherapy induced emesis

The serotonin (5HT3) antagonist ondansetron was compared in a randomised study with metoclopramide and dexamethasone for the prevention of chemotherapy induced emesis. Thirty children aged 1-15 years with acute lymphoblastic leukaemia received 'intensification modules' according to the MRC United Kingdom acute lymphoblastic leukaemia regimen UKALL XI. This contains the moderately emetogenic drugs daunorubicin, etoposide, and cytarabine. Fifteen children received an intravenous loading dose of ondansetron followed by intravenous or oral doses 12 hourly for five days. Fifteen children received intravenous metoclopramide every six hours for three days with a loading dose of dexamethasone, repeated every eight hours for three days intravenously or orally. Efficacy was assessed by a diary card documenting the incidence of nausea, retching, or vomiting. In the 24 hour period after starting chemotherapy, ondansetron was more effective, with a complete or major response rate of 93%, compared with 33% using metoclopramide/dexamethasone.     

Increased hepatic microsomal activity after halothane anaesthesia in children

The effect of anaesthesia and surgery on microsomal enzyme activity was studied in 19 children aged 4-9 years, scheduled for tonsillectomy. The children were randomly allocated to either halothane or ketamine anaesthesia. Antipyrine clearance was measured before and 4 days after surgery by a salivary one-sample technique. Statistically significant (p less than 0.001) increases in antipyrine clearance was found in children who received halothane anaesthesia. The antipyrine clearance was increased by a mean of 26% 4 days after surgery, compared with a pre-operative control measurement. No significant change in antipyrine clearance was observed in children who received ketamine anaesthesia. There was also a significant difference in antipyrine clearance changes after surgery between the two groups (p less than 0.05). Halothane has enzyme-inducing properties after a single exposure in children, while a single dose of ketamine does not.     

Diagnosis and Medical Management of Infective Endocarditis: Transthoracic and Transesophageal Echocardiography

The use of echocardiography in the diagnosis of vegetative endocarditis has been a keystone in the diagnosis and treatment of this important clinical syndrome. In addition, with the use of transesophageal echo this modality has now made important advances in not only diagnosis but in evaluation of global cardiac function. A considerable amount of information has been gathered on the vegetation and these data will be discussed.     

医院间接成本分配方法之模拟比较

介绍了医院间接成本的四种分配方法,即:1直接分配法;2.顺序分配法或阶梯分配法;3.双重分配法;4.联立方程法,并进行了模拟比较,认为双重分配法和联立方程法将成为最主要的间接成本分配方法。     

Effect of Extracorporeal Shock Wave Lithotripsy on Prostate Specific Antigen

Purpose

We evaluated the effects of extracorporeal shock wave lithotripsy (ESWL^*) of distal ureteral calculi on serum prostate specific antigen (PSA).

Materials and Methods

A total of 29 consecutive men with distal ureteral calculi at a maximum of 25 mm. from the ureteral orifice, and without any history of urinary tract infection, benign prostatic hyperplasia or prostate cancer underwent ESWL with the Dornier MPL 9000 × lithotriptor. The therapeutic focus size was 48 × 7 mm. PSA was measured exactly 5 minutes before ESWL, as well as 120 minutes, 24 hours and 7 days after termination of treatment.

Results

Fragmentation rate was 100 percent and all patients were stone-free within 1 week of therapy. There was no statistically significant difference between PSA values before and after treatment. Only 15 patients had a slight increase in PSA at 120 minutes after treatment (range 0.01 to 0.41 ng./ml., mean 0.07).

Conclusions

ESWL can be performed in men at risk for prostate cancer without impairing the predictive value of PSA.     

PRELIMINARY STUDY OF A PREGNANOLONE EMULSION (KABI 2213) FOR I.V. INDUCTION OF GENERAL ANAESTHESIA

Pregnanolone emulsion was administered i.v. to 13 healthy malevolunteers to assess its potential as an agent for i.v. inductionof general anaesthesia and to establish a pharmacokinetic profileat two doses. Each subject received 0.5mg kg^–1 0.75mgkg^–1 and 1.0 mg kg^–1 on successive occasions, therate of administration being constant for each dose. Pregnanoloneemulsion was found to produce smooth and reliable inductionof general anaesthesia with cardiorespiratory effects comparableto those of other i. v. induction agents.     

Ultrasound contrast agent Levovist® in colour Doppler sonography of hepatocellular carcinoma in Chinese patients

In a phase IIIb clinical trial of the ultrasound contrast agent Levovist® (Schering AG, Berlin, Germany), the role of Levovist® in the management of patients with clinically suspected hepatocellular carcinoma (HCC) was evaluated and its efficacy was assessed. The assessment included the duration of diagnostically usable Doppler signal enhancement, and safety and tolerance of intravenous administration. All patients with clinically suspected hepatocellular carcinoma were referred for Doppler sonographic examination over a 5-month period and lesions with absent or suboptimal Doppler signals were included in the trial. A total of 300 mg/mL in concentration (8.5 mL) of Levovist® was administered through a peripheral vein while Doppler signal intensity in the lesion, based on a visual score, was recorded. Blood pressure and pulse were recorded before and after injection. Thirty-eight patients were examined, of which 29 were included in the trial. The lesions were subsequently proven histologically to be 19 HCC, one cholangiocarcinoma, two regeneration nodules and one colonic metastasis. For six patients in whom histological proof was not available, the diagnosis of HCC was suggested based on markedly elevated serum alpha-fetoprotein levels. All but one (96%) of the 25 HCC demonstrated increased Doppler signal after Levovist®. There were no Doppler signals before and after Levovist® injection in three non-HCC lesions (two regeneration nodules and one colonic metastasis). Two patients (6.9%) suffered minor adverse reactions of nausea and vomiting. The results show that Levovist® is safe and is able to improve lesion characterization and increase diagnostic confidence of hepatocellular carcinoma by enhancing tumour vascularization Doppler signal intensity.     

A novel system for providing compatible blood to patients during surgery: "self-service" electronic blood banking by nursing staff

BACKGROUND: A good blood bank must be able to provide compatible blood units promptly to operating room patients with minimal wastage. A "self- service" by nursing staff blood banking system that is safe, efficient, and well-accepted has been developed. STUDY DESIGN AND METHODS: Specific blood units are no longer assigned to surgical patients who have a negative pretransfusion antibody screen, irrespective of the type of surgery. A computer-generated list of the serial numbers of all group-identical blood units currently in the blood bank inventory is provided for each patient. The units themselves are not labeled with a patient's name. The group O list will be provided for group O patients, the group A list for group A patients, and so forth. Should the patient require transfusion during surgery, the operating room nurses go to the refrigerator, remove any group-identical unit, and check the serial number of the unit against the serial numbers on the patient's list. If the serial number is on that list, the blood bank will accept responsibility for compatibility. The system was implemented in 1995. RESULTS: Since implementation, a total of 2154 patients have undergone operations at this hospital. Thirty-two patients received more than 10 units of red cells each. There were no transfusion errors. The crossmatch-to-transfusion ratio was reduced from 1.67 to 1.12. Turnaround time for supplying additional or urgent units to patients in operating room was shortened from 33 to 2.5 minutes. There was no incidence of a blood unit's serial number not being on the list. Work by nurses and technical staff was reduced by nearly 50 percent. CONCLUSION: The "self-service" (by nursing staff) blood banking system described is safe and efficient. It saves staff time and can be easily set up.