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PubMedDate not supplied

Survey ranking of emetogenic control in children receiving chemotherapy.

PURPOSE: To determine the effect of standard antiemetic treatment in children receiving various combination chemotherapy regimens. METHODS: A validated nausea/vomiting survey was administered to 78 patients receiving 13 different emetogenic chemotherapy regimens. Patients received antiemetic prophylaxis with ondansetron (0.3 mg/kg/day) alone for moderately emetogenic chemotherapy regimens or ondansetron (0.45 mg/kg/day) and methylprednisolone (4 mg/kg/day) for severely emetogenic chemotherapy regimens. A total of 324 different courses of chemotherapy were surveyed. Nausea and vomiting severity, duration, number of emetic episodes, appetite, daily activity interference, and rates of both complete and good antiemetic protection were determined for each chemotherapy protocol. Differences between genders and ages were analyzed. RESULTS: Chemotherapy combinations containing platinum compounds were found to be highly emetogenic and nauseating despite antiemetic therapy with ondansetron plus a corticosteroid. In addition, complete antiemetic protection for the combination of vincristine, cyclophosphamide, and dactinomycin was poor. For most of the severely emetogenic chemotherapy protocols, patients experienced good protection from nausea and vomiting less than 60% of the time, despite the use of ondansetron plus methylprednisolone. Significant differences were found in rates of residual nausea and vomiting and failure of antiemetic protection among the severely emetogenic chemotherapy protocols despite identical antiemetic therapy. Good protection rates were higher for moderately emetogenic chemotherapy treated with ondansetron alone. CONCLUSIONS: The currently recommended prophylactic therapy for pediatric patients receiving severely emetogenic chemotherapy fails to provide protection for many patients receiving commonly administered chemotherapy regimens and for most pediatric patients receiving platinum-containing chemotherapy combinations. New and refined antiemetic strategies are needed to improve efficacy in the pediatric population.

Age Factors↗
PubMed1960

Apomorphine-induced pecking in pigeons.

Apomorphine produced persistent pecking in pigeons, the latent period, intensity and duration of which were related to the dose. The ED50 was estimated as 78.1+/-11.1 mug./kg. On chronic administration of apomorphine there was a significant decrease in latent period and weight which quickly returned to normal on stopping the drug. No conditioning and no tolerance were observed. The uncertain emetic effect of apomorphine in pigeons has been confirmed. Ten other centrally acting agents tested (caffeine, cocaine, 5-hydroxytryptamine, lysergic acid diethylamide, methamphetamine, morphine, nalorphine, pentylenetetrazol, strychnine, and yohimbine) failed to produce similar effects in pigeons.

Animals↗
PubMed1961

Antagonism of apomorphine-induced pecking in pigeons.

Central nervous system stimulants, tranquillizers and other central nervous system depressants, antiemetics, antihistamine drugs and autonomic blocking agents were examined for their ability to prevent the pecking response in pigeons induced by apomorphine (250 mug/kg intramuscularly). Reduction in the proportion of positive responses or significant increase in the latent period of pecking were taken as the criterion of effectiveness. Protection was afforded by caffeine, lysergic acid diethylamide, morphine, rauwolscine, triflupromazine and yohimbine. In addition, a significant increase in latent period was produced by artane, pentobarbitone, benactyzine, 2-bromolysergic acid diethylamide, cyclizine, diphenhydramine, ergotoxine, hyoscine, promethazine, 5-(2-chloroethyl)-4-methylthiazole and trimethobenzamide. Most of these drugs influenced the pecking and emetic responses to apomorphine in an identical manner. It is possible that identical receptors may be concerned with apomorphine pecking (in pigeons) and emesis (in other species).

Animals↗
PubMed1968

Role of the chemoreceptor trigger zone in histamine-induced emesis.

1. In unanaesthetized dogs, the emetic action of histamine was studied after its injection into the cerebral venricles through chronically implanted cannulae in order to elucidate the role of the chemoreceptor trigger zone (CT-zone), situated in the area postrema, for this emesis.2. On injection into the lateral cerebral ventricle, about 10 times larger doses of histamine (3 mg) were required regularly to produce emesis, and it occurred after a longer latency than on injection into the fourth ventricle. This is in accord with an action of histamine on the CT-zone.3. After bilateral ablation of the CT-zone, intraventricular injections of histamine no longer produced emesis even when injected in doses which were three to four times greater than those which regularly elicited vomiting in dogs with intact CT-zone. The emesis produced in dogs by intraventricular injections of histamine is thus fully accounted for by an action on the CT-zone.4. Injections of chlorpromazine intramuscularly or of the two antihistamines cyclizine and mepyramine, either intramuscularly or into the lateral ventricle, prevented the emesis caused by histamine injected into the lateral ventricle. This protective action of the antihistamines-which did not extend to the emesis produced by oral copper sulphate-suggests the presence of histaminergic receptors in the CT-zone.

Animals↗
PubMed1972

Variation in cardiac glycoside content of monarch butterflies from natural populations in eastern North America.

A new spectrophotometric assay has been used to determine the gross concentration of cardiac glycoside in individual monarch butterflies. Adults sampled during the fall migration in four areas of eastern North America exhibited a wide variation in cardiac glycoside concentration. The correlation between spectrophotometrically measured concentrations and emetic dose determinations supports the existence of a broad palatability spectrum in wild monarch butterflies. The cardiac gylcoside concentration is greater in females than in males and is independent of the dry weight of the butterflies; contrary to prediction, both the concentration mean and variance decrease southward. The defensive advantage of incorporating cardiac glycosides may be balanced by detrimental effects on individual viability.

Analysis of Variance↗
PubMed1990

Swallowed button batteries: is there a consensus on management?

The optimum management of ingested button batteries was ascertained by postal questionnaire sent to 608 members of the endoscopic and paediatric sections of the British Society of Gastroenterology. Some 312 returns were suitable for analysis: 36.2% of the respondents were not concerned about ingested button batteries and gave no treatment, 6.4% used medical treatment, 48.4% removed them under certain circumstances, and 9% did not know how to manage the problem. Emetics and H2 antagonists or antacids were often used for batteries in the oesophagus, stomach, and duodenum and laxatives were commonly prescribed for batteries in the small and large bowel. Of the 48.4% who felt batteries should be removed under certain circumstances, 78%, 72%, and 48% extracted them from the oesophagus, stomach, and duodenum respectively within 24 hours of ingestion. The main reason for operative removal from the small and large bowel was failure of the battery to progress. Current management is therefore variable. Heavy metal poisoning may be occurring more frequently than is suggested in the published reports.

Antacids↗
PubMedDate not supplied

Medically unexplained myopathy due to ipecac abuse.

The use of ipecac, once recommended as an emetic for use in toxic ingestions, has more recently been discouraged for use in home and emergency room settings. It remains readily available, and has been associated with abuse in eating disorders and Munchausen syndrome by proxy. This case discusses an adolescent boy who surreptitiously abused ipecac in the context of distress over parental conflict, and the extensive medical workup undertaken to evaluate unexplained symptoms of proximal muscle weakness, abdominal pain, and, eventually, cardiomyopathy that are sequelae of ipecac toxicity. Clinicians should be alerted to ipecac ingestion with similar presentation.

Abdominal Pain↗
PubMed1975

[Reproducibility of copper sulfate emesis by oral administration in dogs].

Twelve dogs were administered oral threshold doses of copper sulfate every week. In 66 out of 85 cases, dogs vomited. One dog vomited in 1st and 2nd tests, but did not respond in the other 6 tests. Excluding this one, the reproducibility was 82%. The following method is thus proposed for application in evaluating an antiemetic for oral copper sulfate. Small dogs, weighing 7-14 kg, are to be kept in a constant condition during the quarantine and tests and given the emetic once a week. The threshold dose is determined in three dose levels; 20, 40, 80 mg/head. The dogs with a threshold of more than 80 mg or latency of less than 5 min or of more than 45 min are to be excluded. Inhibition of emesis or a considerable prolongation of latency is the sign of an antiemetic action. A positive action of an antiemetic must be followed by another test with the threshold dose of copper sulfate alone. If the dog does not respond to the threshold dose after 2 administrations, the case must be excluded. To evaluate an antiemetic at least 5 cases are needed. Inhibition of more than 50% appears to be the positive response.

Administration, Oral↗
PubMed1982

[Pharmacological properties of buprenorphine, a new analgesic agent. Part II. (author's transl)].

Pharmacological properties of buprenorphine were compared with those of morphine and pentazocine. Buprenorphine scarcely showed any effects on spontaneous EEGs and sleep-wakefulness cycles. Buprenorphine tended to depress the recruiting and augmenting responses and the spindle burst, and it also inhibited the hypothalamic arousal response. Buprenorphine had weaker emetic action than morphine and protected against apomorphine-induced emesis in the same manner as morphine. Buprenorphine scarcely affected respirations, blood pressure, heart rate, blood flow, ECG, cardiac contractile force, cornary flow, and intracranial pressure. However, morphine and pentazocine caused depressed respiration, decreased blood pressure, increased blood flow and cardiac contractile force, and elevated intracranial pressure. Buprenorphine, morphine, and pentazocine did not affect bile secretion, but produced contraction of the sphincter of Oddi. Buprenorphine had very little effect on renal function, but morphine and pentazocine reduced this function to depress urine flow. Buprenorphine and morphine inhibited carrageenin-induced edema. Buprenorphine had no effect on blood histamine level, but morphine increased the concentration of histamine. These results indicate that buprenorphine has little effect on the central nervous system, respiratory and cardiovascular system, and renal function.

Analgesics, Opioid↗
PubMed1981

Emergency induction of emesis using liquid detergent products: a report of 15 cases.

Solutions of liquid detergent products were used to induce emesis in 15 patients who could not or would not obtain syrup of ipecac. Four patients refused to drink any of the solution and two others refused part, one of whom vomited. In the patients who drank all or part of the solution, 91% (10/11) vomited with a mean time to the onset of emesis of 6.5 min. None of these patients developed symptoms attributable to the ingested poison or the detergent solution. Liquid detergent solutions may be a useful alternative emetic for the poison center when a patient cannot be given syrup of ipecac.

Adult↗
PubMed2000

Augmentation, not blocking, in an A+/AX+ flavor-conditioning procedure.

An A+/AX+ Pavlovian conditioning design typically produces weakened or blocked conditioning to stimulus X. Two experiments were conducted in which rats first received an odor (A+) paired with an emetic US, and then received odor and taste (AX+) paired with the US. In both experiments, the preconditioned odor facilitated conditioning to the taste. In Experiment 1, a group that received two odor-illness pairings in A+ conditioning had a stronger taste aversion than a group that only had a single odor-illness pairing. Experiment 2 demonstrated that the strengthened taste aversion in the A+/AX+ condition was not due to stimulus generalization. The results represent a unique outcome in the flavor-aversion literature that is similar to potentiation. We propose that this facilitated conditioning to X in the A+/AX+ design be termed augmentation.

Animals↗
PubMed1999

Noxious stimulation of emesis.

This review will focus on the mechanisms of emesis initiated or inhibited from receptors located in the periphery or activated by a peripherally released humoral factor. Excitatory and inhibitory receptors have been found in the thorax. Nausea and vomiting sometimes occur after coronary artery occlusion or with vasovagal syncope, and the receptors of this emetic response are probably tension receptors of the left ventricle. The thorax is also source of antiemetic receptors. Vagal section above the level of the heart causes an intractable vomiting syndrome and central cervical vagal stimulation inhibits vomiting. In addition, respiratory maneuvers that decrease activation of pulmonary afferents enhance the sensitivity to motion sickness. Therefore, pulmonary vagal afferent fibers may tonically inhibit retching and vomiting. Abdominal stimulation by irritants or toxins can activate nausea and vomiting through mechano- or chemoreceptors. Mechanoreceptors have been found in the stomach, jejunum and ileum, but the location of these receptors in the gut wall or the type of mechanical stimuli most effective in exciting these receptors is unknown. The chemoreceptors have a similar distribution and are probably located in the mucosa and respond to a variety of noxious agents, eg, CuSO4. CuSO4-induced vomiting is mediated by peripheral 5-HT4 receptors. Two clinically relevant toxic stimuli, x-irradiation and chemotherapeutic agents, have been found to activate vomiting through 5-HT3 receptors in the digestive tract. Regardless of the stimulus, the afferent neural pathways mediating emesis from the abdomen may be the same. The noxious stimulus may cause release of serotonin from enterochromaffin cells of the digestive tract, which activates visceral afferents. The vagus nerves mediate responses from the stomach and proximal small intestine and the splanchnic nerves and spinal cord mediate responses from the entire small intestine. Emesis-related afferents from the periphery terminate primarily in the nucleus tractus solitarius and area postrema. The area postrema contains the chemoreceptive trigger zone that can be activated by endogenous agents released into the circulation from the periphery. The role of peripheral receptors or peripherally released agents in the etiology of cyclic vomiting is unknown, but multiple pathways have been identified that can form a brain-gut interaction to provide a possible mechanism of cyclic vomiting.

Adult↗
PubMed2000

Pharmacological aspects of ipecac syrup (TJN-119)-induced emesis in ferrets.

In order to elucidate the precise mechanism of ipecac syrup (TJN-119) on the occurrence of vomiting, we examined the effects of ipecac syrup on the abdominal afferent nerve activity as well as on the 5-HT levels of the ileum and area postrema in ferrets. Oral administration of TJN-119 (0.5 mg/kg) produced a significant increase in afferent abdominal vagus nerve activity which lasted approximately 1 hour. The maximum response induced by TJN-119 was estimated to be 219 +/- 18% of the pre-injection level. Cephaeline or emetine, the main alkaloids of ipecac syrup, also demonstrated similar effects on afferent vagus nerve activity. TJN-119 increased the 5-HT content in the ileum but not in the area postrema. These observations illustrate possible mechanisms that may act at peripheral sites. It was recently reported that TJN-119 has a high affinity to 5-HT4 receptors (Hasegawa et al., unpublished data). These results suggest that 5-HT4 receptors may be involved in the emetic action of TJN-119.

Afferent Pathways↗
PubMedDate not supplied

Early toxicity of recombinant interleukin-2 in cats.

Studies were conducted in cats to determine whether this species could serve as an animal model for the therapeutic toxicity of recombinant interleukin-2 in humans, and to establish the role of the area postrema in the causation of recombinant interleukin-2-induced vomiting. Injections of recombinant interleukin-2 (3.6 x 10(6) IU/kg, i.m.), given once every 24 hr for one to three days, evoked repeated vomiting in 4 out of 6 area postrema intact cats and in 3 out of 3 area postrema-ablated cats. These results suggest that the area postrema is not essential for the emetic action of recombinant interleukin-2. In anesthetized intact cats, no remarkable changes in ventilation, blood pressure, heart rate or blood pH were observed over 4.5 to 54 hr of continuous physiological recording after i.v. injections of recombinant interleukin-2 to a total dose as high as 27 x 10(6) IU/kg. Cat lymphocytes responded appropriately to the cytokinetic action of human recombinant interleukin-2.

Animals↗
PubMed1989

Preclinical studies on quinelorane, a potent and highly selective D2-dopaminergic agonist.

Quinelorane (LY163502) has the endocrine, neurochemical and behavioral profile of a potent and highly selective D2-dopaminergic agonist. The administration of quinelorane produced dose-related decreases in serum prolactin concentration of reserpinized, male rats and increases in serum corticosterone concentration of male rats. The minimum effective doses (MED) for these effects were 10 and 30 micrograms/kg i.p., respectively. Quinelorane induced increases in 3-methoxy-4-hydroxyphenylglycol-sulfate levels in the brain stem (MED, 30 micrograms/kg i.p.) and decreases in hypothalamic epinephrine levels (MED, 100 micrograms/kg i.p.) in male rats as determined by high-pressure liquid chromatography with electrochemical detection methods. Quinelorane induced increases in extracellular ascorbic acid as determined by in vivo voltammetry in the nucleus accumbens and striatum of male rats. Quinelorane produced concentration-dependent suppression of K+-evoked release of acetylcholine from superfused caudate slices, with an IC50 of approximately 10(-8)M. Quinelorane administration produced dose-related increases in compulsive, contralateral turning in male rats with unilateral nigrostriatal lesions and increases in locomotor activity and stereotypic behavior in male rats. In dogs, quinelorane administration produced dose-related increases in emetic response with an ED50 of 7 micrograms/kg i.v. Quinelorane administration also produced dose-related decreases in the striatal concentrations of the dopamine metabolites, 3,4-dihydroxyphenylacetic acid and homovanillic (MED, 1 microgram/kg i.p. for both metabolites) as determined by high-pressure liquid chromatography with electrochemical detection methods and decreases in extracellular concentrations of homovanillic acid in the nucleus accumbens and striatum as determined by in vivo voltammetry., Quinelorane produced concentration-dependent decreases in K+-evoked dopamine release from superfused striatal slices (IC50 = 3 X 10(-9) M).(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylcholine↗
PubMed1978

[On the pharmacological treatment of acute spasmodic laryngitis (Pseudo-Croup) (author's transl)].

Three aspects of the pharmacological treatment of pseudo-croup are discussed in this article. Sedatives should be given only when close clinical supervision is guaranteed. Otherwise the apparent drowsiness observed in patients passing from stage III to stage IV of the disease may be masked or misinterpreted due to these sedatives. Emetics used occasionally in the USA, and also frequently administered in Europe to the turn of the present century, are no longer used for treatment in Germany. There are no controlled studies showing their effectiveness. In contrast to the common practice in Germany, glucocorticosteroids are less frequently used in the USA. Theoretical considerations suggest their usefulness, but to data there is still no convincing proof of their clinical effectiveness.

Acute Disease↗
PubMed1983

[Prognostic factors in acute paraquat poisoning. A retrospective study of cases registered by the Poison Control Center of Paris in 1981].

Twenty years after the publication of the first cases, the intoxication with the herbicide Paraquat still has a low prognosis because of no efficient treatment. But many studies have allowed the definition of prognostic factors. Nearly, BISMUTH and als(2) demonstrated that the following criteria are significant: the oral route, the gastric lesions, the organic renal failure, the plasma-Paraquat concentration. Through a series of cases collected in 1981 at the Poison Control Center of Paris, the following prognostic factors have been studied: route of administration, sex of patient, circumstances of the poisoning, ingested volume, concentration of the solution, existence of an emetic in the commercial solution, gastric content, lesions of the upper digestive tract (mouth, oesophagus, stomach), renal impairment, hepatic failure, blood gasometry, lung function tests, plasma and urine paraquat concentrations. Forty-one cases were collected during this period, with thirty-four concerning acute Paraquat poisonings in humans. We studied twenty-seven of them caused by acute oral poisoning, with accidental circumstances in nine cases (two died) and intentional circumstances in eighteen cases (all died) (other cases concerned two ocular projections, four inhalations and one skin projection). The interest of this new investigation is the particularity of our series. Because of our recruitment (larger geographic distribution of patients, larger diversity of circumstances, of routes of administration, of ingested quantities, of treatments...). This series of cases is quite different from others previously published. This study confirms the validity of prognostic factors defined by BISMUTH and als(2). The factors, which look significant, strictly depend on the ingested quantity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[Abuse of body weight reducing agents in bulimia nervosa].

Abuse of dieting agents is a frequent, but often unrecognized, problem in patients with eating disorders. Especially women suffering from bulimia nervosa tend to abuse diet pills containing amphetamines and laxatives, diuretics, caffeine and emetics. In this review the frequency of substance abuse in bulimic women, the side effects and possible health risks of this abuse are discussed.

Alcoholism↗