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Biomedical subjects

R M Stern

Publications and source records attributed to R M Stern.

At least 37 records · Page 2Linked to original sources
PubMed1998

Initial control of chemotherapy-induced nausea and vomiting in patient quality of life.

The side effects commonly experienced by patients receiving chemotherapy for the treatment of cancer can challenge many aspects of daily life. Nausea and vomiting, the most common side effects reported by patients, affect the ability to continue with usual life activities and, thus have a pronounced impact on quality of life. This paper reviews studies of the impact of nausea and emesis on quality of life, and highlights the importance of prevention of these side effects by presenting new data on how persistent uncontrolled nausea and vomiting can be. The Morrow Assessment of Nausea and Emesis (MANE) was used to collect information on symptoms experienced by consecutive patients starting chemotherapy between September 1987 and December 1995 at any of 18 geographically diverse member sites of the University of Rochester Cancer Center Community Clinical Oncology Program. Data from 1,413 patients were collected after each of four successive chemotherapy treatments. Reported incidences of posttreatment nausea and posttreatment vomiting after the first treatment were 59.4% and 28.6%, respectively. Occurrence of nausea/vomiting at the first treatment was a strong predictor of nausea/vomiting at later treatments. Of the 839 patients reporting initial nausea, 763 (90.9%) reported nausea at at least one subsequent treatment, and approximately 59% reported nausea after all three subsequent treatments. Fewer than half (45.6%) of the patients who had no nausea at the first treatment developed it later. The majority (72.0%) of patients reporting vomiting at the first treatment also reported subsequent vomiting, 30.7% of whom experienced emesis at all remaining treatments. Conversely, 76.2% of patients who were emesis-free at the first treatment remained so for all later treatments. These findings show a continuing need for further progress in controlling nausea and vomiting, and demonstrate the importance of aggressive nausea/vomiting control at the first treatment. In addition, more emphasis on controlling chemotherapy-induced nausea after its initial occurrence is necessary.

Antineoplastic Agents↗
PubMed1998

Optokinetic nystagmus correlates with severity of vection-induced motion sickness and gastric tachyarrhythmia.

PURPOSE: The present study investigated the relationship of the frequency of nystagmus to the severity of optokinetic rotation-induced motion sickness. METHODS AND RESULTS: Eighty-seven subjects viewed a vertically striped, rotating drum for 16 min. Subjects' electrooculograms, ratings of vection, and subjective symptoms of motion sickness (SSMS) were measured during the drum rotation period. Subjects' electrogastrograms (EGGs) were recorded throughout the baseline and drum rotation periods. The ratios of the spectral intensity of EGG 4-9 cycles per minute (cpm) between drum rotation and baseline periods were calculated. The results indicated that the frequency of nystagmus was positively correlated with the ratings of vection (r = 0.40, p < 0.0001), scores of SSMS (r = 0.61, p < 0.0001), and ratios of EGG 4-9 cpm spectral intensity between drum rotation and baseline periods (r = 0.54, p < 0.0001). CONCLUSION: These results demonstrated that more rapid eye movement indexed by higher frequency of optokinetic nystagmus are related to the development of symptoms of motion sickness and gastric tachyarrhythmia.

Adolescent↗
PubMed1997

Comparison of marezine and dramamine in preventing symptoms of motion sickness.

BACKGROUND: The most common pharmacological agents for alleviating symptoms of motion sickness in the U.S. are over-the-counter antihistamines. Two example are dimenhydrinate (Dramamine) and cyclizine (Marezine). HYPOTHESIS: Dramamine and Marezine suppress overall motion sickness symptoms with equal effectiveness, but Dramamine affects the central nervous system (CNS), while Marezine affects the stomach directly. METHODS: This study employed a double-blind, within-subject design to compare the effectiveness of Marezine (50 mg) and Dramamine (50 mg), in preventing subjective symptoms and gastric dysrhythmias associated with motion sickness. The sedative effects of the two drugs were also compared. Electrogastrograms (EGGs) were recorded from 23 subjects during 2 counterbalanced sessions for 3 trial periods: an 8-min pre-drug baseline, an 8-min pre-rotation baseline, which began 30 min after drug ingestion, and a 16-min period of exposure to a rotating optokinetic drum. Subjects reported any subjective symptoms of motion sickness (SSMS) and drowsiness before and during induction of motion sickness. RESULTS: There were no statistically significant differences between the two drug conditions for the overall mean SSMS scores. However, when the scores were divided into symptom groups, Marezine was associated with significantly lower scores than Dramamine for gastrointestinal (GI) symptoms. Also, Marezine was associated with significantly less drowsiness than Dramamine 30 min after ingestion. Power in both the normal (3 cpm) and tachyarrhythmia (4-9 cpm) ranges of the EGG increased significantly more during rotation compared to baseline in the Dramamine condition than in the Marezine condition. CONCLUSIONS: Marezine and Dramamine are similarly effective in preventing the overall subjective symptoms of motion sickness. While Dramamine's effectiveness may be related to its sedative properties, Marezine may work more directly on the stomach and thus be more effective in preventing gastric dysrhythmias and reports of GI symptoms.

Adolescent↗
PubMed1996

Cardiac spectral power reflects parasympathetic but not sympathetic nervous system activity in a clinical population.

The purpose of this short communication is to report our clinical findings regarding the use of the low frequency (LF, 0.02-0.15 Hz) and high frequency (HF, > 0.15 Hz) components of the spectral decomposition of heart-rate as indices of sympathetic (SNS) and parasympathetic nervous system (PNS) activity, respectively. Thirty-two females with histologically confirmed ovarian cancer, ranging in age from 46-72 years, participated in an autonomic assessment protocol consisting of a resting heart rate recording and several ANS function tests. The LF, HF and total power measures from the spectral decomposition were highly correlated with one another. In addition, the spectral components were most highly correlated with measures of PNS activity, i.e. standard deviation of heart rate at rest and the ratio of the six longest to the six shortest R-R intervals during deep breathing (E:I ratio). It is concluded, as other researchers have stated, that the use of the HF component of the HR spectrum as a measure of PNS activity is warranted, but caution must be used when interpreting the LF component.

Aged↗
PubMed1996

Effects of vection-induced motion sickness on gastric myoelectric activity and oral-cecal transit time.

The purpose of this study was to investigate the effects of vection-induced motion sickness on three cycle per minute gastric myoelectric activity and oral-cecal transit time. Forty-five subjects were exposed to a rotating optokinetic drum while electrogastrograms and subjective reports of symptoms were monitored. Prior to exposure, baseline breath hydrogen levels were established and subjects ingested vanilla pudding containing 10 g of lactulose. Breath hydrogen measurements were obtained before drum rotation and every 10 minutes after rotation, for 3 hr. Based on the severity of motion sickness symptoms reported, subjects were divided into two groups: a group susceptible to, and a group not susceptible to, vection-induced motion sickness. Averaged across subjects, the percentage of three cycle per minute activity decreased from baseline to rotation (3.6%) and from rotation to recovery (3.0%) [F(2/70)=2.43,P<0.1], with the susceptible group showing a greater overall decrease from baseline to recovery (8.9%), than the nonsusceptible group (4.2%) [F(1/35)=11.16,P<0.01]. The susceptible group had longer average oral-cecal transit times (144 min) than the nonsusceptible group (107 min) [t(36)=3.27,P<0.01]. Furthermore, symptom reports were positively correlated with oral-cecal transit times (r = 0.43, P < 0.05). In conclusion, vection-induced motion sickness is accompanied by decreased gastric three cycle per minute activity and prolonged oral-cecal transit times.

Adult↗
PubMed1996

Assessment of the multiple dimensions of nausea: the Nausea Profile (NP).

Nausea, unlike emesis, is a subjective experience that is difficult to describe to others, be they clinicians or researchers. Previous research has been limited to examining the frequency, severity, and duration of nausea. The goal of this study was to design a questionnaire that would allow for the evaluation of the characteristics of nausea across individuals and situations. This study consisted of 4 stages: descriptors were generated, categorized into 3 dimensions, and reevaluated to verify their reliability; in the final stage, the developed checklist was compared to a visual-analogue-scale (VAS) report of nausea in subjects exposed to a rotating optokinetic drum to stimulate nausea. The overall nausea checklist score and the VAS score were highly correlated (r = 0.71, p < 0.01). The development and use of the nausea checklist are discussed.

Adult↗
PubMed1996

Constricted expressiveness and psychophysiological reactivity in schizophrenia.

The present study investigated flat affect in schizophrenia within a multicomponent model of emotions in which affects were identified with the expression or display of feelings. Display, as well as other components of emotion, such as subjective experience and psychophysiological reactivity, were examined as 24 schizophrenic inpatients (12 with flat affect) and 12 depressed inpatients were guided through imagery of personal emotional experiences. It was hypothesized that display variables would show a relationship with flat affect, whereas physiological and subjective variables would not. Increased flatness of affect was associated with longer pauses and reduced dyadic interaction and less zygomatic (cheek) electromyogram activity. The flat affect patients unexpectedly showed more corrugator (brow) electromyogram activity compared with the depressed group, which perhaps reflects difficulty in self-expression. The flat affect group had faster heart rates at baseline. The groups did not, however, differ in self-report of the intensity of experienced emotion. These results support the view that flat affect patients show a reduction in emotional display, whereas other subsystems of emotion processing appear normally engaged.

Adult↗
PubMed1996

Functional disorders of the stomach.

Disorders of stomach function refer to neuromuscular abnormalities of gastric motility that involve the fundus, corpus, antrum, pylorus, and antroduodenal coordination. Symptoms related to disorders of stomach function are commonly meal-related; "dyspepsia" symptoms of epigastric fullness; or bloating, discomfort, and nausea in the postprandial period. Early satiety and prolonged stomach fullness are often present, and in severe cases the patient may vomit undigested food. Neuromuscular disorders of stomach function should not be considered until structural and metabolic diseases that may also cause these nonspecific symptoms are excluded. A thorough history, routine laboratory studies, ultrasound of the gallbladder and pancreas, and upper endoscopy will exclude the majority of diseases that may cause dyspepsia symptoms. Disorders of gastric neuromuscular function may be detected by solid-phase gastric emptying studies which detect gastroparesis and by electrogastrography which detects abnormalities of gastric myoelectrical activity termed gastric dysrhythmias. Invasive tests to determine abnormalities in gastric motility include intraluminal pressure and gastric tone/compliance recordings. Treatment approaches are limited at the present time and include dietary counseling and gastroprokinetic agents such as metoclopromide, cisapride, and erythromycin. Increased understanding of the pathophysiology of disorders of gastric neuromuscular function will lead to an improved and more rational armamentarium for the treatment of symptoms related to functional disorders of the stomach.

Diagnosis, Differential↗
PubMed1996

The effect of tilted stripes in an optokinetic drum on gastric myoelectric activity and subjective reports of motion sickness.

BACKGROUND: The effects of tilted and vertical optokinetic drum stripes on self-reports of motion sickness and electrogastrograms (EGG's) were measured to investigate possible differences in the effects of stripe orientation. The EGG is a non-invasive measure of gastric myoelectric activity. The normal frequency is 3 cpm, and dysrhythmic 4-9 cpm activity, gastric tachyarrhythmia, has been found to be associated with motion sickness symptoms, particularly nausea. It is theorized that these symptoms are related to a sensory mismatch between the visual and vestibular systems elicited by the drum's rotation. HYPOTHESIS: We hypothesized that tilted stripes would elicit more symptoms than vertical stripes due to an additional sensory mismatch between the visual and vestibular verticals. METHODS: We divided 45 subjects into 2 stripe orientation groups: Vertical, and Tilted 15 degrees in the direction of drum movement. After the subject sat inside the stationary drum for a 6-min baseline, the drum was rotated (10 rpm) for a maximum of 16 min, followed by a 6-min recovery period. Throughout the experiment we measured the subjects' EGG's and subjective symptoms of motion sickness (SSMS). RESULTS: During rotation and recovery, gastric tachyarrhythmic activity was higher for subjects in the Tilted condition; the difference between stripe conditions was significant during rotation (p < 0.05). There were, however, no differences between SSMS scores. CONCLUSIONS: Off-vertical stripes increase the dysrhythmic activity of the stomach that often precedes or accompanies nausea and other symptoms of motion sickness.

Adult↗
PubMed1995

P6 acupressure reduces symptoms of vection-induced motion sickness.

PURPOSE: The purpose of the study was to examine the effectiveness of P6 acupressure on nausea associated with visually-induced motion sickness. METHOD: There were 64 subjects randomly divided into 4 groups: P6 acupressure, dummy-point acupressure, sham P6 acupressure, and control. Each subject sat in an optokinetic drum for a 12-min baseline and 12-min drum rotation period. Subjects' electrogastrograms (EGG's) and subjective symptoms of motion sickness were obtained. RESULTS: The results indicated that the subjects in the P6 acupressure group reported significantly less nausea [F(3,60) = 8.16, p < 0.0001] during drum rotation period than those in the dummy-point acupressure, sham acupressure, and control groups. The scores for symptoms of motion sickness of the P6 acupressure group were significantly lower than those in the sham acupressure and control groups [F(3,60) = 3.49, p < 0.02]. Also, the subjects in the P6 acupressure group showed significantly less abnormal gastric myoelectric activity, tachyarrhythmia, than those in the sham acupressure and control groups [F(3,60) = 2.78, p < 0.04]. However, the subjects in the dummy-point acupressure group did not report significantly fewer symptoms and show less tachyarrhythmia than those in the sham acupressure and control groups. CONCLUSION: We conclude that P6 acupressure reduces the severity of symptoms of visually-induced motion sickness and gastric tachyarrhythmia.

Acupuncture Points↗
PubMed1995

Effects of dimenhydrinate on gastric tachyarrhythmia and symptoms of vection-induced motion sickness.

BACKGROUND: Previous research in our laboratory has shown that symptoms of motion sickness are accompanied by the loss of normal 3 cpm activity and the development of tachyarrhythmia in the electrogastrogram (EGG). HYPOTHESIS: We hypothesized that dimenhydrinate would prevent the development of gastric tachyarrhythmia and reduce symptoms of motion sickness. METHODS: Twenty health volunteers were tested in a counter-balanced, within-subject, double-blind design. Subjects were exposed to a rotating optokinetic drum to induce vection after receiving either dimenhydrinate (100 mg) or a placebo on two separate occasions. EGG's were recorded immediately before ingestion of capsules, 1 h after ingestion, and during rotation. Motion sickness symptom reports (SSMS) were obtained prior to and during rotation. RESULTS: The average SSMS score was 5.9 points higher after placebo administration than after dimenhydrinate administration (t[19] = 4.87, P < 0.001). Significantly more subjects requested early termination of the rotating drum due to severe symptoms after placebo administration than after dimenhydrinate administration (McNemar's chi 2[1] = 6.00, p < 0.05). Drowsiness reports were significantly higher after dimenhydrinate administration than after placebo administration (t[19] = 2.65, p < 0.05). Analysis of EGG's showed a significant decrease in normal 3 cpm and tachyarrhythmic activity after dimenhydrinate, but no change after placebo (SR[19] = 53, p < 0.02 and SR[19] = 68, p < 0.01 respectively). During drum rotation gastric tachyarrhythmias increased significantly in the placebo condition (SR[18] = -0.61.5, p < 0.01), but not in the dimenhydrinate condition. EGG's were not significantly different between conditions. CONCLUSIONS: We conclude that dimenhydrinate reduced motion sickness symptoms at least in part by depressing central nervous system activity and possibly by suppressing abnormal gastric myoelectric activity.

Adolescent↗
PubMed1994

Effects of phenytoin on vection-induced motion sickness and gastric myoelectric activity.

The purpose of this study was to test the prophylactic effects of a single low dose of phenytoin on motion sickness. In this double-blind study, fasted male subjects who were susceptible to motion sickness were given either a 200-mg tablet of phenytoin (N = 19) or a placebo (N = 16). Electrogastrograms (EGG's) were recorded predrug, postdrug (4 h after ingestion of drug), before drum rotation, and during drum rotation. During testing, subjects were exposed to an optokinetic drum which was stationary for 8 min and which then rotated at 10 rpm for 16 min. The results showed that the phenytoin subjects had a lower mean subjective symptom score than the placebo group (5.8 vs. 7.1), but the difference was not significant. However, 6 of 16 placebo subjects requested early termination of drum rotation due to symptom severity, whereas only 2 of 19 phenytoin subjects terminated testing prematurely (X2 = 3.89, p < 0.05). The phenytoin group showed no increase in gastric tachyarrhythmia, the pattern of gastric myoelectric activity that usually accompanies nausea, during drum rotation, whereas tachyarrhythmia doubled for the placebo group. In conclusion, we have demonstrated that a single low dose of phenytoin prevents the development of gastric tachyarrhythmia and decreases the intensity of motion sickness symptoms.

Adult↗
PubMed1993

Hypothalamic and gastric myoelectrical responses during vection-induced nausea in healthy Chinese subjects.

The physiology of nausea, a uniquely human symptom, is poorly understood. The purpose of this study was to measure the temporal sequences of neurohormonal responses and gastric myoelectrical activity in healthy subjects during the rotation of an optokinetic drum that produced nausea and other symptoms of motion sickness. Plasma catecholamines, vasopressin, and cortisol were measured at baseline, during minutes 1-5, 6-10, and 11-15 of drum rotation, and after rotation stopped. Electrogastrograms were recorded throughout the study. Twelve subjects (80%) developed nausea and 4-9 cycles/min of gastric tachyarrhythmias; three subjects had no nausea and no gastric dysrhythmias. Tachyarrhythmias began 3.4 +/- 0.8 min after the onset of drum rotation, and nausea was reported, on average, 3 min later. During minutes 6-10 of drum rotation, vasopressin levels significantly increased in the subjects with nausea compared with subjects without nausea (P < 0.04). In the subjects with nausea, epinephrine and vasopressin increased significantly (P < 0.05) compared with baseline during minutes 6-10 and 11-15 of drum rotation. As nausea resolved during recovery, vasopressin decreased by 74%, whereas epinephrine increased 13%. We conclude that 1) in nauseated subjects, endogenous vasopressinergic and sympathetic circuits are activated before hypothalamic-pituitary-adrenal pathways, 2) plasma vasopressin levels correlate most closely with the temporal onset and resolution of nausea, and 3) peripheral gastric dysrhythmias may have a role in activating central vasopressinergic neurons.

Adult↗
PubMed1993

Chinese hyper-susceptibility to vection-induced motion sickness.

Little is known about the factors that control individual differences in susceptible to motion sickness. A serendipitous observation in our laboratory that most Chinese subjects become motion sick prompted this study. We used a rotating optokinetic drum to provoke motion sickness and compared gastric responses and symptom reports of Chinese, European-American, and African-American subjects. There was no difference in the responses of European-American and African-American subjects; however, Chinese subjects showed significantly greater disturbances in gastric activity and reported significantly more severe symptoms. We suggest that this hyper-susceptibility presents a natural model for the study of physiological mechanisms of nausea and other symptoms of motion sickness.

Adult↗
PubMed1993

Effects of scopolamine on autonomic profiles underlying motion sickness susceptibility.

The purpose of this study was to examine the effects of scopolamine on the physiological patterns occurring prior to and during motion sickness stimulation. In addition, the use of physiological profiles in the prediction of motion sickness was evaluated. Sixty subjects ingested either 0.6 mg scopolamine, 2.5 mg methscopolamine, or a placebo. Heart rate (HR), respiratory sinus arrhythmia (an index of vagal tone), and electrogastrograms were measured prior to and during the exposure to a rotating optokinetic drum. Compared to the other groups, the scopolamine group reported fewer motion sickness symptoms, and displayed lower HR, higher vagal tone, enhanced normal gastric myoelectric activity, and depressed gastric dysrhythmias before and during motion sickness induction. Distinct physiological profiles prior to drum rotation could reliably differentiate individuals who would develop gastric discomfort from those who would not. Symptom-free subjects were characterized by high levels of vagal tone and low HR across conditions, and by maintaining normal (3 cpm) electrogastrographic activity during drum rotation. It was concluded that scopolamine offered motion sickness protection by initiating a pattern of increased vagal tone and gastric myoelectric stability.

Adult↗
PubMed1992

Electrical acustimulation relieves vection-induced motion sickness.

The aim of this study was to examine the effects of electrical acustimulation on gastric myoelectric activity and severity of symptoms of motion sickness. In experiment 1, 16 Chinese subjects received electrical acustimulation in one of two sessions. In experiment 2, 45 white and black American subjects were randomly divided into three groups: acustimulation, sham acustimulation, and control. Each subject sat in an optokinetic drum for 15 minutes baseline and 15 minutes of drum rotation. Subjects' electrogastrograms and subjective symptoms of motion sickness were obtained. In experiment 1, the mean symptom score and tachyarrhythmia during acustimulation sessions were significantly lower than during no-acustimulation sessions. In experiment 2, the mean symptom score of the acustimulation group was significantly lower than that of the sham-stimulation group and the control group; tachyarrhythmia in the acustimulation group was significantly less than that of the control group but not the sham-stimulation group. In conclusion, electrical acustimulation reduces the severity of symptoms of motion sickness and appears to decrease gastric tachyarrhythmia.

Adult↗
PubMed1992

Effects of eating on vection-induced motion sickness, cardiac vagal tone, and gastric myoelectric activity.

This study investigated the effect of food ingestion on motion sickness severity and its physiological mechanisms. Forty-six fasted subjects were assigned either to a meal group or to a no-meal group. Electrogastrographic (EGG) indices (normal 3 cpm activity and abnormal 4-9 cpm tachyarrhythmia) and respiratory sinus arrhythmia (RSA) were measured before and after a meal and during a subsequent exposure to a rotating drum in which illusory self-motion was induced. The results indicated that food intake enhanced cardiac parasympathetic tone (RSA) and increased gastric 3 cpm activity. Postprandial effects on motion sickness severity remain equivocal due to group differences in RSA baseline levels. During drum rotation, dysrhythmic activity of the stomach (tachyarrhythmia) and vagal withdrawal were observed. Furthermore, high levels of vagal tone prior to drum rotation predicted a low incidence of motion sickness symptoms, and were associated positively with gastric 3 cpm activity and negatively with tachyarrhythmia. These data suggest that enhanced levels of parasympathetic activity can alleviate motion sickness symptoms by suppressing, in part, its dysrhythmic gastric underpinnings.

Adult↗