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PubMed2006

Colour of bile vomiting in intestinal obstruction in the newborn: questionnaire study.

OBJECTIVES: To identify the colour that different groups of observers thought represented bile in a newborn's vomit. DESIGN: Questionnaires displaying eight colours (pale yellow to dark green). SETTING: General practices in Glasgow, postnatal ward and level III special care baby unit in a university teaching hospital, and mother and toddler groups in Glasgow. PARTICIPANTS: 47 general practitioners, 29 nurses on the baby unit, 48 midwives, and 41 mothers of babies and infants. OUTCOME MEASURES: Participants indicated which colour would represent bile in a baby's vomit. More than one colour could be chosen. Respondents were also asked to indicate one colour that was the best match for bile. RESULTS: When any colour could be chosen, 12 (25%) general practitioners, 1 (3%) nurse on the baby unit, 5 (10%) postnatal midwives, and 23 (56%) parents did not consider green an appropriate colour for a baby's vomit containing bile. Twenty three (49%) general practitioners, 7 (24%) neonatal nurses, 15 (31%) postnatal midwives, and 29 (71%) parents thought yellow was the best colour match. CONCLUSIONS: There is little agreement about the colour of bile vomit in a newborn. It is more pertinent to ask parents about the colour of vomit rather than whether it contained bile. Many general practitioners and parents do not recognise green as an appropriate colour for bile in the vomit of newborns, which may delay surgical referral. Though yellow vomit does not exclude intestinal obstruction, the presence of green vomiting in a baby is a surgical emergency and requires expeditious referral.

Bile↗

PubMed2000

Why do children vomit after minor head injury?

OBJECTIVE: To determine factors associated with vomiting after minor head injury in a paediatric population with the intention of defining the role of vomiting in management decisions. METHODS: A prospective study of all patients presenting with minor head injury to the Royal Hospital for Sick Children, Edinburgh, between 1 May and 30 June 1997. Information regarding basic demographics, features of the head injury and past and family history was noted on a proforma. This included mechanism of injury, site of impact, presence or absence of scalp haematoma, skull fracture or brain injury and intrinsic factors such as age, family history of migraine and a personal history of migraine, its childhood variants and associated conditions. The relation between vomiting and these features was analysed using chi2 and Fisher's exact tests. RESULTS: 563 children aged from birth to 13 years presented with minor head injury. Complete data were obtained on 463 patients. Some 15.8% vomited after minor head injury. Comparing vomiters with non-vomiters the only associated factors that could be identified were a past history of recurrent vomiting or motion sickness (p= 0.0035, p=0.036 respectively). CONCLUSIONS: Vomiting after minor head injury seems to be related to individual intrinsic factors rather than specific features of the head injury and its role in management decisions needs to be explored further.

Adolescent↗

PubMed1999

Novel approaches to the treatment of nausea and vomiting.

Nausea and vomiting are debilitating symptoms complicating many clinical conditions. Conventional antiemetic agents act as muscarinic, histamine, and dopamine receptor antagonists in the central nervous system. In a retrospective analysis, tricyclic antidepressant drugs demonstrated efficacy in long-term treatment of functional nausea. Some cases of vomiting result from impaired gastrointestinal motor activity. Agents which act on gastric serotonin (5-HT4), dopamine, and motilin receptors accelerate gastric emptying and relieve symptoms in gastroparesis. Recent investigations suggest that some patients with refractory gastroparesis may benefit from gastric electrical pacing. The treatment of acute chemotherapy-induced emesis was revolutionized by 5-HT3 receptor antagonists; however, these agents are less efficacious in delayed vomiting. Neurokinin (NK-1) receptor antagonists show promise in treating delayed chemotherapy-evoked emesis. Furthermore, animal studies indicate a broad spectrum of action for NK-1 antagonists in treating diverse causes of nausea and vomiting. The cyclic vomiting syndrome is characterized by discrete episodes of relentless vomiting separated by asymptomatic intervals and is associated with migraine headaches. Antimigraine therapies including the 5-HT1D receptor agonists sumatriptan reduce the severity of cyclic vomiting attacks. Investigations into these and other novel treatments may provide important advances in the care of difficult cases of nausea and vomiting resulting from disparate illnesses.

Antidepressive Agents↗

PubMed1989

Incidence and duration of chemotherapy-induced nausea and vomiting in the outpatient oncology population.

Nausea and vomiting are commonly recognized side effects of chemotherapy. However, the incidence and duration of these effects have not been systematically studied in a large outpatient oncology population. This survey was conducted over two consecutive 6-week periods in the adult oncology clinics of two university teaching hospitals. The objectives were: (1) to document the incidence and duration of chemotherapy-induced nausea and vomiting; (2) to identify variables that influence nausea and vomiting; and (3) to describe patterns of antiemetic prescribing and compliance. One hundred thirty-eight completed patient-maintained diaries were returned (70% response rate). Anticipatory nausea and vomiting were reported by 9.4% and 6.5% of patients, respectively. Fifty percent and 27% of patients reported nausea and vomiting, respectively, on the day chemotherapy was administered (day 1: acute nausea and vomiting phase). Percentages fell to 22% and 11% by day three and 14% and 2.5% on day 5. Of patients who reported nausea and vomiting during the five-day period, 52% and 33% experienced nausea and vomiting, respectively, during the delayed period only (days 2 through 5: delayed emesis phase). Emetogenicity of chemotherapy significantly influenced incidence and duration of those symptoms. Sixty-seven percent of patients reported taking antiemetics on one or more days during the survey period. Of patients who reported antiemetic use, 92% reported antiemetics on day 1, 51% on day 3, and 31% on day 5. At-home antiemetic use was related to the emetogenicity of chemotherapy received. Patients who receive moderate to strong emetogens as defined in this report should receive antiemetic therapy for a minimum of three days. Increasing the dose of antiemetic prescribed both in the clinic and at home may be of benefit.

Adult↗

PubMed1998

Psychogenic vomiting: report of two cases.

Two patients were admitted to our hospital with the diagnosis of psychogenic vomiting of more than 9 months' duration. Both were treated with a combination of pharmacotherapy, relaxation training, cognitive therapy and supportive psychotherapy. Behavioral therapy and verbal catharsis were also used in one of the cases involving bereavement. The intervention was not directly aimed at the vomiting, but at the aspects of the patients' stress and emotional problems. Change in condition was assessed on basis of the frequency of vomiting and the severity of anxiety and depression. Vomiting was found to be positively related to anxiety but not to depression. These 2 patients improved to the extent that the disturbance caused by vomiting was significantly reduced, and the reduction was closely related to the severity of anxiety. Both were also found to have similar personality traits and family types, which have been reported to be related to psychogenic vomiting. We review the characteristics of psychogenic vomiting and relate some important considerations for treating Chinese psychogenic vomiting cases.

Adult↗

PubMedDate not supplied

Swallowing topically administered 4% lidocaine results in nausea and vomiting.

In preparing adult volunteers for insertion of an upper airway device, we observed a high incidence of nausea and vomiting in the first 16 consecutive volunteers who were allowed to swallow topically administered 4% lidocaine (50% and 31%, respectively). We tested the hypothesis that swallowing the topically administered 4% lidocaine caused the nausea and vomiting by comparing the incidence of nausea and vomiting in these first 16 volunteers with the incidence of nausea and vomiting in the next 162 consecutive awake adult volunteers who were not allowed to swallow the 4% lidocaine. All 178 volunteers were prepared by administering 2 mg midazolam and 100 micrograms fentanyl intravenously, spraying 10 to 15 mL of 4% lidocaine into the upper airway, and bilaterally blocking the lingual branch of nerve IX and the superior laryngeal branch of nerve X. The first 16 volunteers were allowed to swallow the 4% lidocaine (swallow/no suction, group A); the next 162 volunteers were not allowed to swallow the 4% lidocaine, and all of the 4% lidocaine was suctioned out of the upper airway (no swallow/suction, group B). Groups A and B were otherwise and subsequently treated identically. The incidence of nausea and vomiting in group A was 50% (8/16) and 31% (5/16), respectively, and in group B, 4% (7/162) and 1% (2/162), respectively. The difference in the incidence of nausea and vomiting between group A and group B was highly significant by chi-square analysis (P < 0.01). We found that swallowing topically administered 4% lidocaine results in a significant increase in the incidence of nausea and vomiting. Our experimental design did not allow us to rule out either of two basic mechanisms, higher blood levels and a direct toxic effect, or to distinguish between them. The clinical implication of this study is that suctioning all topically administered 4% lidocaine will decrease the incidence of nausea and vomiting.

Adolescent↗

PubMed2001

[Postoperative nausea and vomiting--still a problem?].

Based on a questionnaire of the General Hospital of Hamburg-Altona, we asked 738 patients about postoperative complaints such as nausea, vomiting, pain in the operating field and feeling of coldness in order to record the quality of the results of operation and anaesthesia in 1997 and 1998. The incidence of nausea and vomiting amounted to only 29% on average. One of our earlier studies of postoperative vomiting from 1995-1997 and the results gained from a control group of non-treated patients in our ondansetron study from 1995, which was conducted using information drawn from the routinely-used anaesthesia protocol and was therefore limited to data from the immediate pre- and postoperative period up to discharge of the patients from the recovery ward, showed much higher frequencies of nausea and vomiting (44 and even 66% on average, respectively). We cannot definitely evaluate whether the reduction in the average rates of nausea and vomiting in our present study is due to the additional preoperative application of 150 mg vomex supp. and 1.0-2.5 mg dehydrobenzperidol and/or 20-30 mg metoclopramid given i.v. shortly before the end of anaesthesia or to more intensive observation of non-medicinal prophylactic possibilities. But when we look at the frequency of nausea and vomiting in special groups of our present study, we can still find unacceptably high rates of nausea and vomiting, for instance 40% after cholecystectomies and abruptios and even 50% after struma operations. This shows that a satisfactory solution to this problem has not yet been found--partly due, unfortunately, to financial restrictions. Nevertheless, for 15% of the patients postoperative nausea and vomiting were of only minor importance for general satisfaction with the treatment given them. This was probably due to good premedication of amnestic after-effects of narcosis.

Adolescent↗

PubMed2002

Contrary to the literature, vomiting is not a common manifestation associated with plant exposures.

A review of clinical toxicology references and the contemporay literature illustrates that vomiting is reported as a nearly universal symptom associatedwith exposure to cultivated and wild plants. However, the literature fails to put thesymptom of vomiting into a clinical perspectivewith regard to its frequency of occurrence. To clarify this issue a retrospective review of plant exposures was conducted. AAPCC TESS 1997-1999 was queried electronicaly to identify and extract all plant ingestion exposures where vomiting was documented as being related to the exposure. All exposures with documented ipecac syrup use were excluded. Data were stratified through the use through the use of a relational database. Plant ingestion exposures accounted for 229,538 reports and vomiting was reported in 5,917 (2.6%) of exposures. Vomiting was attributed as a related symptom in 753 different plants. It was reported once in 323 plants, 1-3 times in 495 plants (65.7%), and < or = 10 times in 657 (87.4%) of all plants in the database. Ten plants accounted for 32.3% of the reports of vomiting Philodendron, Spathiphyllum, Narcissus, Dieffenbachia, Phytolacca, Epipremnum, Euphorbia, Eucalyptus, Ficus, Hedera) and represented 1.3% of the plants associated with vomiting. Even with the most common plant exposures, vomiting is not a frequent adverse event.

Humans↗

PubMed1992

The role of adrenergic receptors in the initiation of vomiting and its gastrointestinal motor correlates.

We investigated the role of adrenergic receptors in the mechanisms of initiation of vomiting and its gastrointestinal (GI) motor correlates. The effects of clonidine, UK-14304, St-91, naphazoline, phenylephrine and isoproterenol were examined for their ability to initiate vomiting and its GI motor correlates. Only the alpha-2 adrenoceptor agonists UK-14304, clonidine, St-91 and naphazoline activated vomiting and its GI motor correlates. Tolerance of vomiting, but not its GI motor correlates, readily developed to all alpha-2 adrenergic receptor agonists but St-91. The responses to UK-14304 or clonidine were blocked by idazoxan, yohimbine, clonidine tolerance or high doses of phenoxybenzamine, but not by propranolol or prazosin. The responses to UK-14304 or clonidine were also blocked by fentanyl, 1-(1-naphthyl) piperazine, methysergide, SCH 22390 or scopolamine, but not by haloperidol, sulpiride, domperidone or naloxone. Adrenoceptor antagonists, clonidine tolerance or sympathetic blockade did not block vomiting or its GI motor correlates activated by apomorphine, CuSO4 or cholecystokinin-octapeptide. We concluded that alpha-2 adrenergic receptors of the chemoreceptive trigger zone can initiate vomiting and its GI motor correlates, but these receptors do not mediate vomiting induced by another chemoreceptive trigger zone stimulant, apomorphine, or stimulation of the GI tract using CuSO4. However, 5-hydroxytryptamine-2 serotonergic, muscarinic cholinergic and opiate receptors within the central nervous system participate in controlling emesis activated by alpha-2 adrenergic agonists. Peripheral adrenergic receptors do not mediate the GI motor correlates of vomiting.

Adrenergic alpha-Agonists↗

PubMed2006

Self-induced vomiting -- risk for oesophageal cancer?

BACKGROUND: Chronic inflammation of the oesophagus is considered a precursor condition for the development of oesophageal cancer. Identification of the causes of chronic oesophageal irritation is therefore relevant in developing preventive measures. Self-induced vomiting is a cultural practice among the black population of South Africa, particularly those living in the Transkei, a region reported to have one of the highest incidences of oesophageal cancer worldwide. METHODS: We retrospectively examined the association between the practice of self-induced vomiting and the development of cytological features of inflammation in 478 self-selected subjects living in Transkei who underwent early screening for oesophageal cancer. Screening involved brush biopsy, cytological investigation and a questionnaire interview. RESULTS: The prevalence of self-induced vomiting was 80.5% and 79.1% in males and females, respectively, and this was stable across all ages. Furthermore, self-induced vomiting was found to be significantly and independently associated with oesophageal chronic inflammation (odds ratio 1.83, 95% confidence interval: 1.13 - 2.96, p = 0.013). CONCLUSION: While the association between the cultural practice of self-induced vomiting and oesophageal cancer has previously been hypothesised, this is the first study to report on an association between this practice and oesophageal chronic inflammation. Further studies that take into account the method used, frequency and duration of vomiting, age of commencement and fasting state of subjects practicing self-induced vomiting coupled with accurate indicators of inflammation are needed to elucidate the role of self-induced vomiting in oesophageal pathogenesis.

Adult↗

PubMed1992

Mechanisms of vomiting induced by serotonin-3 receptor agonists in the cat: effect of vagotomy, splanchnicectomy or area postrema lesion.

The locations of serotonin-3 (5-HT3) receptors involved in initiating vomiting (emesis) were assessed by cutting visceral afferents or lesioning the area postrema. The 5-HT3 receptor agonists phenylbiguanide (PBG) and 2-methyl-5-HT were shown to induce vomiting and related prodromal signs (e.g., licking, swallowing) in nonoperated cats. Two-methyl-5-HT, but not PBG, also usually produced defecation and sometimes urination. Most studies were conducted using PBG, which induced vomiting in 40/49 (82%) cats at doses of 8.0 mg/kg i.p. or less (thresholds ranged from 2-8 mg/kg, median 5 mg/kg). Latencies to the first episode ranged from 4 to 21 min (median 7.5 min). PBG-induced vomiting was blocked by the 5-HT3 receptor antagonist MDL 72222. Lesions of the area postrema had no apparent effect on vomiting induced by PBG or by electrical stimulation of abdominal vagal afferents. In contrast, the threshold of PBG-induced vomiting was increased by supradiaphragmatic vagotomy and greatly increased by splanchnic nerve section. Thus, abdominal visceral afferents, but not the area postrema, play an important role in mediating vomiting induced by i.p. injection of the 5-HT3 receptor agonist PBG. The mechanisms by which vomiting is induced by PBG as compared to the cancer chemotherapeutic drug cisplatin are discussed.

Animals↗

PubMed1991

[The prevention of postoperative vomiting following strabismus surgery in children].

Children recovering from anaesthesia for strabismus surgery are particularly prone to nausea and vomiting as a result of intraoperative vagus irritation. Besides being disturbing to the patient, vomiting can be dangerous during emergence from anesthesia and can result in delayed discharge. Droperidol is a powerful antiemetic drug that has been shown to reduce the incidence and severity of postoperative nausea and vomiting in pediatric strabismus patients, although the best timing for administration is not clear. MATERIAL AND METHODS. We compared three randomized groups totalling 61 patients. Droperidol 0.075 mg/kg i.v. was given either at induction of anesthesia after intubation (n = 20) or during the last muscle suture (n = 21). The third group received no antiemetic treatment. The patients' ages ranged from 3 to 14 years (mean 5.9 +/- 2.84 years). There was no difference in age or sex between the three groups. Anesthesia was standardized with rectal midazolam premedication, atropine, thiopental, succinylcholine, O2/N2O = 1:2, enflurane, intubation, and a gastric tube. RESULTS. Nausea, retching, or vomiting occurred in 2/20 children (10%) given droperidol preoperatively, 4/21 children (19%) with droperidol during the operation, and 9/20 children (45%) with no antiemetic treatment. The difference between groups I and III was significant (p less than 0.05). Comparison of groups II and III and groups I and II showed no statistical significance. Operation time was similar in each group and there was no delay in time of extubation. In each group 1 case of hypotension occurred. No child showed extrapyramidal symptoms. The lower incidence of vomiting in all study groups compared to the literature is thought to be due to three factors: (1) emptying the stomach at the end of the operation by a gastric tube, which is removed before extubation; (2) avoidance of opioids; (3) surgical procedure being done by a very experienced surgeon in 57/61 children (12 vomiting versus 45 not vomiting) in contrast to 3/4 children vomiting postoperatively after surgery by a less experienced surgeon. CONCLUSIONS. We recommend preoperative droperidol 75 micrograms/kg i.v. as the best prophylaxis of postoperative emesis without severe side effects in pediatric strabismus surgery.

Adolescent↗

PubMed1974

Epimeletic (care-giving) vomiting in dogs: a study of the determinating factors.

Epimeletic vomiting fails to occur in a bitch when she is kept in en isolated box apart from her puppies and their nest-pen. However, vomiting is elicited immediately after the bitch is allowed to contact her puppies in the nest-pen. If the contact occurs in a new, unfamiliar place, vomiting is disrupted but reappears again after several contacts in the same place. When after feeding, a bitch is put into her own nest-pen where alien puppies are substituted for her own, their care-soliciting (et-epimeletic) behavior induces in her aggression or avoidance rather than vomiting. Vomiting is not disrupted when some of the exterior features of puppies have been changed. Epimeletic vomiting may occur some days prior to the proestrus of the bitch and, sometimes, even during proestrus and estrus periods. Under special environmental conditions epimeletic vomiting may occur even in male dogs. The appropriate care-soliciting behavior of properly reared, not satiated puppies, and their own nest-pen are the main factors which elicit epimeletic vomiting in dogs.

Animals↗

PubMed1984

Methodology in behavioral and psychosocial cancer research. The assessment of nausea and vomiting. Past problems, current issues and suggestions for future research.

Given the diversity of assessment methodologies in previous studies, and given the increasing attention being shown in studies in which nausea and vomiting are used as outcome measures, it is reasonable to expect that there are more questions on the assessment of nausea and emesis than there are answers. There is little consensus on the efficacy of various approaches used to help control chemotherapy-induced nausea and emesis. There is also little consensus on the appropriate assessment techniques for their measurement. While there is room for much controlled experimentation and study of the ways to assess nausea and emesis, a review of past studies indicates several guidelines that should be kept in mind. The first of these is that nausea is a subjective phenomenon. It exists only insofar as it is defined by the patient. The clinical reality is that patients' decisions to delay or terminate chemotherapy are based on their subjective evaluations of the side effects, not on evaluations made by a clinician or others. With this in mind, a self-report approach to the assessment of nausea appears the most reasonable at this time. On the other hand, while vomiting does have subjective aspects, it represents a behavior that may be reliably observed by others. Thus, it is appropriate that observer ratings be obtained whenever feasible. The use of such indirect measures of nausea and vomiting as time to food intake, appetite change, and other measures of patient well-being should be considered whenever feasible. As with all measures, the cost in patient time needs to be balanced against the scientific needs of any study quantifying nausea and vomiting. While direct, physiologic measures would provide an important external reference to the assessment of nausea and vomiting, at the present time, these appear useful only in animal studies. The fact that nausea and vomiting can occur independently points to the validity of their assessment as separate behaviors. It is also important to note that their frequency, severity, and duration are separable phenomena. A complete assessment of nausea and vomiting responses should include separate measures of frequency, severity, and duration. Anticipatory nausea and vomiting are clinical phenomena that appear to occur with a reasonable enough frequency so that their measurement would be important in clinical studies.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1982

The course of nausea and vomiting after high-dose cyclophosphamide.

We studied the course of nausea and vomiting after high-dose cyclophosphamide (50-75 mg/kg) in 25 patients. Nausea was assessed with a visual analog scale and vomiting by patient report. The reliability and validity of these methods of assessment were established in separate studies of oncology patients. Nausea and vomiting developed between 6 and 12 hours after the start of a 1-hour cyclophosphamide infusion in about two thirds of the patients. Peak symptoms were at 12 hours. Vomiting had subsided in most of the patients by 24 hours, but nausea persisted. Although there was significant individual variation in the course of nausea and vomiting, we could identify no demographic, disease, drug, or treatment factors which were associated with more significant nausea and vomiting. Some of the variability in the onset, severity, and duration of nausea and vomiting may be related to individual differences in the metabolism of and susceptibility to cyclophosphamide. The visual analog scale may provide information about nausea not obtained by the more frequently employed categoric verbal rating scales. Suggestions for the treatment of nausea and vomiting after high-dose cyclophosphamide are made on the basis of the findings.

Adult↗

PubMed1982

Vomiting induced by cyclophosphamide and phosphoramide mustard in cats.

Cyclophosphamide and phosphoramide mustard produce significant vomiting. Cyclophosphamide is metabolized to phosphoramide mustard, which may ultimately contribute to vomiting after cyclophosphamide administration. The role of the chemoreceptor trigger zone (CTZ) in vomiting caused by these agents is unknown. We studied the emetic syndromes produced by iv and intracerebroventricular cyclophosphamide and phosphoramide mustard in unanesthetized normal and CTZ-ablated cats. Iv cyclophosphamide produced vomiting unpredictably, with a mean latency of 54 +/- 9 mins (mean +/- SE) in cats that vomited. A dose-response relationship was found for phosphoramide mustard-induced emesis. A dose of 200 mg/kg was consistently effective, with a mean latency of 127 +/- 6 mins. Neither agent produced predictable emesis by the intracerebroventricular route of administration. One of four CTZ-ablated cats vomited after 300 mg/kg of cyclophosphamide. Since cyclophosphamide was an unpredictable emetic stimulus, it was not possible to further evaluate the effect of CTZ ablation on cyclophosphamide-induced vomiting. However, CTZ-ablated cats given 200 mg/kg of phosphoramide mustard vomited significantly less frequently (P = 0.05 by chi-square test) and with a longer latency than nonablated animals. A temporary, severe neurotoxic reaction was observed in cats receiving greater than or equal to 3400 mg/kg of cyclophosphamide, which may have had an inhibitory effect on emesis. Phosphoramide mustard was found to be a potent emetic stimulus in cats and may contribute to the emetic response following cyclophosphamide administration. Analysis of latency data suggests that in the cat other cyclophosphamide metabolites may also contribute to the emetic syndrome.

Animals↗

PubMed1993

[Persistent vomiting].

Vomiting is a physiological reflex to protect the body from harmful influences, whereas "pathological vomiting" occurs irrespective of its primary purpose or causes secondary disturbances. Artificially induced vomiting and enemas were prophylactic and therapeutic procedures to purge the body that were employed in ancient times and reached their zenith by the end of the 18th century. The act of vomiting is regulated by the vomiting centre, where neural afferents from the chemoreceptor trigger zone, vagal and sympathetic nerve system, and from other trigger areas, are coordinated. Differential diagnosis of vomiting, emphasizing metabolic/endocrine and psychogenic vomiting--including anorexia nervosa and bulimia--are briefly discussed. Symptomatic treatment of vomiting primarily consists of the use of receptor antagonists, e.g. dopamine, histamine and 5-hydroxytryptamine-3 antagonists. Acupuncture/-pressure are also discussed as an alternative treatment method.

Acute Disease↗

PubMed1996

[Effects of an anti-emetic tropisetron capsule on QOL of patients with delayed nausea and vomiting induced by cancer chemotherapy. Group for Investigation of QOL Questionnaire for Anti-Emetics used in Cancer Chemotherapy. Joint Research Group for Tropisetron Double-Blind Comparative Study].

We have reported our "new questionnaire of QOL (quality of life) in anti-emetic therapies during cancer chemotherapy" and demonstrated its reliability and validity. In the present study we investigated the utility of tropisetron capsules for delayed nausea and vomiting induced by cancer chemotherapies with CDDP single administration in a placebo-controlled double-blind comparative study using the questionnaire. The questionnaire was composed of the following scales: a physiological scale (appetite, feeling, vomiting, nausea), a psychological scale (sleep, mental fatigue, anxiety, pain, abdominal condition), a respiratory condition related scale (sputum, respiratory distress), an active scale (daily life in a hospital), a social relation scale (understanding of the family), a linear analogue scale for evaluation of the influence of nausea and vomiting in patient's life during 24 hours, and a face scale as the global scale. First, all patients were administered a preventive dose of tropisetron capsule on day 1 (the day of CDDP administration) and then allotted to once-daily oral administration of either a tropisetron (T group) or a placebo (P group) capsule during days 2 to 5 by a double-blind method. Chronological changes of QOL during the study period were measured by the area under the curve (AUC) generally used for calculation of blood levels of drugs. The maximum fluctuation (Difmax) of QOL scores throughout the whole study period was also evaluated. The data were collected from 114 cases, and 98 cases (51 in P group, 47 in T group) were analyzed. 1) The total score or 13 items (a modified linear analogue scale with 5 graduations), the face scale and linear analogue scale of T group were higher (better) than those of P group. 2) As for the total score of each scale, the physiological, psychological and active scales in the T group showed higher (better) levels than the P group. 3) As for the AUC values, the T group was lower (better) than the P group in most items. In AUC of the total score of 13 items, the face scale, the physiological and the psychological scales, the T group was significantly superior to the P group. 4) AUC levels of each item belonged to the physiological and the psychological scales in the T group tended to be lower (better) than the P group, and "sleep" and "pain" in the psychological scale were significantly lower (better) in T group than P group. 5) In Difmax values, all scales except respiratory condition related scale showed lower levels (better) in T group and the total score of 13 items, the face scale and the physiological and psychological scales showed significantly lower levels than P group. 6) Difmax values in each item belonging to the physiological and psychological scales showed lower levels in the T group, while "appetite" and "vomiting" in the physiological scale and "sleep" in the psychological scale showed significantly lower levels (better) than those of the P group. 7) In the stratified analysis performed for patients without nausea and vomiting on the 1st day of chemotherapy, there was no significance in AUC levels of all items in both groups. In patients with nausea and vomiting on the 1st day, the total score of 13 items, the face scale, the physiological and the psychological scales in the T group were significantly better than in the P group. 8) It was suggested that the anti-emetic efficacy of tropisetron for delayed nausea and vomiting might reduce the undesirable influence of chemotherapy on QOL, especially on the physiological and the psychological effects. These results suggested that this new questionnaire is applicable for evaluation of the utility of anti-emetics in patients in cancer chemotherapy, and that tropisetron capsules could reduce the decrease of QOL in delayed nausea and vomiting induced by chemotherapy.

Adolescent↗