Comparative efficacy of three 5-HT3 antagonists (granisetron, ondansetron, and tropisetron) plus dexamethasone for the prevention of cisplatin-induced acute emesis: a randomized crossover study

The purpose of this study was to compare the antiemetic efficacy of three 5-HT3 antagonists (granisetron, ondansetron, tropisetron) plus dexamethasone for the prevention of acute emesis induced by high-dose cisplatin chemotherapy. This was a randomized, open label, crossover study. Recruited into the study were 94 chemotherapy-naive patients of whom five were excluded because chemotherapy was not given, noncisplatin regimen was used instead, or presence of anticipatory vomiting. The remaining 89 evaluable patients were mostly (86.5%) male, and were all treated for head and neck cancers. The antiemetic regimens consisted of 1) granisetron 3 mg i.v. and dexamethasone 20 mg i.v. on day 1 (GRADEX); 2) tropisetron 5 mg i.v. and dexamethasone 20 mg i.v. on day 1 (TRODEX); and 3) ondansetron 8 mg i.v. and dexamethasone 20 mg i.v. to be followed by ondansetron 8 mg p.o. x 2 on day 1 (ONDEX). Patients were randomized to receive one of the three regimens in the first cycle, and treatment was crossed over to the other two regimens in subsequent cycles. Antiemetic efficacy was assessed using self-report diaries recording the number of vomiting episodes as well as duration and severity of nausea within the first 24 hours. Complete response was defined as no vomiting with or without mild nausea, and major response was defined as one vomiting episode and/or moderate to severe nausea. Major efficacy refers to either complete or major response. A total of 219 cycles was given to 89 patients: 16 received one cycle only, 16 received two cycles, and 57 received three cycles. No carryover effects were observed between cycles. Using pooled data from all cycles, the complete response rates to GRADEX, TRODEX, and ONDEX were 81%, 68%, and 71%, respectively (p = 0.11); the corresponding major efficacy rates were 91%, 93%, and 86%, respectively (p = 0.36). When only the first cycle was considered, the complete response rates to GRADEX, TRODEX, and ONDEX were 81%, 75%, and 74%, respectively (p = 0.58); the corresponding major efficacy rates were 92%, 94%, and 84%, respectively (p = 0.38). Analysis of the crossover data showed that the majority of patients achieved complete response or major efficacy with the different pairs of regimens, and there were no significant differences between different regimens in terms of complete response or major efficacy. The only exception was GRADEX versus TRODEX, in which 15.5% of patient achieved complete response with GRADEX as compared with 1.7% with TRODEX (p = 0.025). The majority of patients (53%) did not report any preference, whereas 14% preferred GRADEX, 15% preferred TRODEX, and 18% preferred ONDEX. The three 5-HT3 antagonists, when used in combination with steroids, had similar major efficacy for prophylaxis against cisplatin-induced acute emesis. Although GRADEX was superior to TRODEX in terms of complete response, this may not be of clinical significance. The choice of antiemetic regimens should therefore depend on patient preference and drug cost.     

Electrical activity in the gastroduodenal area—Slow waves in the proximal duodenum a comparison of man and dog

Recordings of electrical activity of the smooth muscle in the first and second parts of the duodenum were made from electrodes implanted under the serosa in 15 human subjects and in 4 dogs. Similar records were obtained from mucosal suction electrodes in 5 men. Slow-wave electrical activity in the duodenum of man had a frequency plateau (mean:11.7±0.13 cycles/min) with a time-dependent phase shift. In the dog, slow waves also formed a frequency plateau in this area of the gut but with a constant phase shift. Both patterns could be modelled by variations of couplings between relaxation oscillators set up on an analog computer.Supported in part by a grant from the Medical Research Council.     

特发性脊柱侧凸患者脊柱畸形段凸侧及凹侧关节突松质骨三维微结构比较

目的比较青少年特发性脊柱侧凸(AIS)患者脊柱畸形顶椎区和端椎区两侧关节突松质骨的三维微结构。方法AIS患者9例,均为女性,年龄12～17岁,平均14.9岁;Cobb角48°～84°,平均56°。患者均接受后路矫形融合内固定手术,术前与患者家长签署同意书,在去皮质手术时取下顶椎区和上下端椎区两侧关节突。标本取材后用中性福尔马林固定,然后用解像度为20μm的微焦点CT扫描,三维图像重组进行骨形态计量学测量对比。结果顶椎区凸侧与凹侧相比有显著差异,分别为:骨量容积比BV/TV为0.268/0.354(P<0.05),骨小梁厚度TbTh为0.20/0.24(P<0.05),骨小梁分离度TbSP为0.66/0.56(P<0.05),骨小梁面积体积比BS/BV为12.7/10.4,P<0.05)。端椎区左右两侧关节突松质骨骨小梁无明显差异,上胸椎和胸腰椎关节突骨小梁微结构比较未见差异。结论由于脊柱侧凸凹侧承受不同应力,凹侧关节突出现更多的骨小梁,骨小梁间的连接更紧密,而且骨小梁更粗,从而可使脊椎楔形变的速度变缓,提示脊柱的骨骼本身并不是AIS脊柱侧凸畸形进展的促进因素。     

The effect of early intervention with sumatriptan tablets on migraine-associated productivity loss

OBJECTIVE: Impaired performance, which can considerably impact employee output, occurs when employees attempt to continue work with inadequate treatment while experiencing a migraine episode. This analysis examined productivity loss as a result of migraine after treatment with sumatriptan tablets and patients' usual non-triptan therapy when pain was mild (early intervention) versus when pain was moderate/severe. METHODS: The authors conducted a retrospective analysis of data on 6803 migraine days reported by 251 subjects who participated in a clinical trial. RESULTS: Although early intervention significantly reduced productivity loss compared with treatment when pain was moderate/severe for both sumatriptan and non-triptan therapy, productivity loss was consistently lower for sumatriptan than non-triptan therapy for all predose pain intensity levels. CONCLUSIONS: These findings suggest that the pharmaco-economic benefits of early intervention with sumatriptan tablets, like the clinical benefits, exceed those of delayed intervention.     

Cost of Acute Myocardial Infarction in Hong Kong

Background

Coronary artery disease (CAD) is the second highest cause of mortality in Hong Kong. The most significant manifestation is acute myocardial infarction (AMI). Both treatment and cardiac rehabilitation for AMI are costly. Knowledge of the cost of management of AMI is important for better planning for allocation of medical resources. The present study aims to evaluate and describe the cost of management of patients with explicit Q-wave AMI in a local public hospital in Hong Kong.

Methods

A retrospective study was performed of patients admitted to the United Christian Hospital in Hong Kong. The study cohort consisted of patients who were aged ≥18 years with a diagnosis of Q-wave AMI from 1 January 2000 to 31 December 2000 admitted to the coronary care unit. Cost items studied included hospital stay, outpatient clinic visits, diagnostic tests, medications, and percutaneous coronary interventions.

Results

Ninety-five cases were evaluated. The average annual medical cost per patient for AMI management in the year 2000 was $US9323.4 ± 5792 ($US1 = HK$7.8). The total annual cost per patient increased with the complexity of the disease from $US7745 ± 6245 for non-fatal AMI without procedure to $US12 344 ± 3129 for non-fatal AMI with procedure. Based on the local epidemiological data, the prevalence rate of CAD is 2.2% and assuming 3% of patients with CAD may experience AMI with medical care, the estimated total cost of AMI management in Hong Kong was $US45 million per year or 0.5% of the 2000–2001 total healthcare expenditure.

Conclusion

This study provides information on the cost of AMI management in a local hospital of Hong Kong. Public awareness of CAD and the implementation of appropriate health measures should be reinforced.