This patient may have experienced cisplatin-induced liver damage. Metoclopramide and ondansetron may have contributed to this effect.
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We describe the use of the method and demonstrate its applicability for captive breeding in 3 different anuran families. We tested several combinations of GnRH agonists with dopamine antagonists using Lithobates pipiens. The combination of des-Gly10, D-Ala6, Pro-LHRH (0.4 microrams/g body weight) and metoclopramide (10 micrograms/g BWt. MET) was most effective. It was used in-season, after short-term captivity and in frogs artificially hibernated under laboratory conditions. The AMPHIPLEX method was also effective in 3 Argentinian frogs, Ceratophrys ornata, Ceratophrys cranwelli and Odontophrynus americanus.
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Glucocorticoid administration is associated with reduced basal thyroid-stimulating hormone (TSH) levels and a blunted TSH response to thyrotropin-releasing hormone (TRH), despite thyroid hormone levels within the normal range. In light of the inhibitory effect of somatostatin and dopamine on TSH secretion, we examined whether this condition is caused by glucocorticoids through an increased hypothalamic somatostatinergic and/or dopaminergic inhibitory control of TSH. We measured the TSH response to TRH and serum-free T4 and T3 levels. The study group comprised 18 normal men (age 24-35) within 10% of the ideal body weight, randomly divided into 3 groups of six.
We analyzed National Hospital Ambulatory Medical Care Survey data from 2010, the most current dataset available. The National Hospital Ambulatory Medical Care Survey is a public dataset collected and distributed by the Centers for Disease Control and Prevention. It is a multi-stage probability sample from randomly selected emergency departments across the country, designed to be representative of all US emergency department visits. We included in our analysis all patients with the ICD9 emergency department discharge diagnosis of migraine. We tabulated frequency of use of specific medications in 2010 and compared these results with the 1998 data. Using a logistic regression model, into which all of the following variables were entered, we explored the independent association between any opioid use in 2010 and sex, age, race/ethnicity, geographic region, type of hospital, triage pain score and history of emergency department use within the previous 12 months.
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We have studied the antiemetic efficacy of droperidol alone, and in combination with metoclopramide in first trimester termination of pregnancy in day surgery. The aim was to determine whether the addition of metoclopramide could further reduce the incidence of postoperative nausea and vomiting (PONV) but avoid excessive sedation. Group I (control, n = 40) received i.v. droperidol 0.625 mg at induction. Group II (study, n = 40) received i.v. droperidol 0.625 mg and i.v. metoclopramide 10 mg at induction. The incidence of nausea at 1 and 2 hours postoperatively was 23% and 10% in group I, and 5% and nil in group II respectively. The difference in the incidence of nausea was significant at p < 0.05 at one hour but not at two hours postoperatively. No patients vomited. There was no difference in the sedation and pain score between them. We did not observe any significant side effects attributable to either drug. All patients were discharged home within 3 hours. We conclude that in the prevention of PONV, the combination of metoclopramide and droperidol is superior to the use of droperidol alone at one hour but not at two hours postoperatively.
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Despite the use of the most efficacious antiemetic treatment, delayed emesis remains an unsolved problem in cisplatin-treated patients. Efforts should be directed to obtain better control of acute and delayed emesis, since they have a mutual influence.
The influences of serotonin (5-hydroxytryptamine) on the action of melatonin (N-acetyl-5-methoxytryptamine) in MIH (maturation inducing hormone)-induced meiotic resumption were evaluated in the oocytes of carp Catla catla using an in vitro model. Oocytes from gravid female carp were isolated and incubated separately in Medium 199 containing either (a) only melatonin (MEL; 100 pg/mL), or (b) only serotonin (SER; 100 pg/mL), or (c) only MIH (1 microg/mL), or (d) MEL and MIH (e) or MEL (4 h before) and MIH, or (f) MEL and SER, (g) or SER and MIH, or (h) SER (4 h before) and MIH, or (i) luzindole (L-antagonist of MEL receptors; 10 microM) and MEL, or (j) MEL, L and MIH, or (k) MEL (4 h before), L and MIH, or (l) metoclopramide hydrochloride (M-antagonist of SER receptors; 10 microM) and SER, or (m) M, MEL, SER, or (n) M, SER and MIH, or (o) M, SER (4 h before) and MIH, or (p) M, MEL SER and MIH, or (q) MEL, L, SER and M, or (r) MEL, L, SER, M, and MIH, or (s) MEL, SER, L and MIH. Control oocytes were incubated in the medium alone. Oocytes were incubated for 4, or 8, or 12, or 16 h and effects were evaluated by considering the rate (%) of germinal vesicle breakdown (GVBD). At the end of 16 h incubation, 93.24+/-1.57% oocytes underwent GVBD following incubation with only MIH, while incubation with only MEL or only SER resulted in 77.15+/-1.91% or 14.42+/-0.43% GVBD respectively. Interestingly, incubation with MEL 4 h prior to addition of MIH in the medium, led to an accelerated rate of GVBD (92.58+/-1.10% at 12 h). In contrast, SER, irrespective of its time of application in relation to MIH, resulted in a maximum of 64.57+/-0.86% GVBD. While L was found to reduce the stimulatory actions of melatonin, M suppressed the inhibitory actions of serotonin. In each case, both electrophoretic and immunoblot studies revealed that the rate of GVBD was associated with the rate of formation of maturation promoting factor (a complex of two proteins: a regulatory component--cyclin B and the catalytic component--Cdk1 or cdc2). Collectively, the present study reports for the first time that SER not only inhibits the independent actions of MIH, but also the actions of MEL on the MIH-induced oocytes maturation in carp.
We examined the in vivo and in vitro production of prolactin (PRL) in 20 untreated HIV-infected men compared to 14 uninfected men and its association with the cell cycle and apoptosis. Compared to uninfected men, the HIV-infected men had: (i) higher fasting serum bioactive (BIO) PRL; (ii) lower serum immunoreactive (RIA) and BIO-PRL responses to intravenous metoclopramide; (iii) greater BIO-RIA PRL ratio both fasting and during intravenous metoclopramide; (iv) lower percentage of non-stimulated PBMC in the G0/G1 phase, but a higher percentage in the S phase, of the cell cycle with normal response to Concanavalin-A; and (v) higher in vitro production of BIO-PRL by non-stimulated PBMC, which was blocked after Concanavalin-A. Fasting serum BIO-PRL positively correlated with the percent of non-stimulated PBMC in S + G2/M phases. The percentage of apoptotic PBMC negatively correlated with CD4+ T lymphocytes and with the area under the serum RIA-PRL curve, but positively correlated with the area under the curve for the BIO/RIA ratio. These results suggest that in these HIV-infected men: (i) a diminished dopaminergic tone may exist, as an adaptive mechanism attempting to survive; and (ii) BIO-PRL may participate as a cofactor in the stimulation of T-cell proliferation.
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One of the challenges facing veterinarians and investigators who use rabbits (Oryctolagus cuniculus) as a surgical model in biomedical research is choosing an appropriate and efficacious postoperative analgesic without systemic complications and side effects. The objective of this study was to evaluate the gastrointestinal side effects associated with the postoperative use of buprenorphine in Dutch Belted rabbits. We also evaluated the analgesic meloxicam as an alternative to opioid administration during the postoperative period. Rabbits were assigned to 1 of 3 treatment groups during the postoperative period after routine ovariohysterectomy: buprenorphine (n = 10), meloxicam (n = 10), and incisional infiltration with bupivicaine (no treatment control; n = 10). Feed intake, fecal production, weight loss, urine output, and other physiologic parameters were monitored and behavior and pain assessments were performed for 7 d after surgery and compared with baseline values collected before surgery. All rabbits showed decreased pellet consumption, fecal production, and weight on day 1 after surgery. This effect was severe in some rabbits that received bupivicaine; therefore treatment of this entire group with metoclopramide, fluids, and hay was instituted to reverse gut stasis. No significant difference in feed consumption and fecal production was present between the buprenorphine- and meloxicam-treated groups. On the basis of these results, meloxicam appears to be a suitable alternative or adjunct to buprenorphine for alleviating postoperative pain with minimal risk of anorexia and gastrointestinal ileus.
The incidence of vomiting was 9.32% for group D and 33.61% for group M during the first 4 PO hours, and 1.69% with dexamethasone and 3.36% with metoclopramide between 4 and 24 PO hours. RRR of dexamethasone related to metoclopramide in the first 4 hours was 72%. The number necessary to treat (NNT) for dexamethasone was 3.25 and for metoclopramide it was 15.66.
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Endoscopic balloon dilation of benign esophageal strictures was performed in 18 dogs and 10 cats with a median age of 4 years. Stricture formation was associated with a recent anesthetic episode in 18 patients. Regurgitation was the most common clinical sign and was present a median of 4 weeks before dilation. Most animals had a single stricture; median diameter was 5 mm, and median length was 1 cm. Esophagitis and mucosal fibrosis were detected in 9 patients each. Dilation was performed with progressively increasing diameter balloons, from 6 to 20 mm. After dilation, mucosal hemorrhage was mild to moderate in most patients. Esophageal perforation was the only serious complication and occurred in 1 patient. Postdilation therapy consisted of administration of cimetidine, metoclopramide, sucralfate, and prednisone in most animals. The median number of dilation procedures performed in each animal was 2, with a range of 1-5. The median interval between dilations was 13 days. Stricture diameter markedly increased with subsequent dilations. Median duration of follow-up was 131 weeks. A successful outcome occurred in 88% of patients, with most animals able to eat canned, mashed, or dry food without regurgitation. Mucosal fibrosis was associated with a better clinical response score, while increasing age was weakly associated with fewer dilations. The dilation protocol used in this group of animals was safe and efficacious.
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One-hundred and twenty-one consecutive cisplatin-based chemotherapy treatments for ovarian carcinoma were randomly assigned to receive standard plus no adjuvant (control, n = 24), high-dose metoclopramide (HDM, n = 33), very high dose metoclopramide (VHDM, n = 50) and very high dose metoclopramide plus droperidol (VHDM+DP, n = 14) antiemetic treatment. The number of vomiting episodes up to 4 h after the treatment were recorded and compared in the four different antiemetic groups. The effect of the number of previous chemotherapy cycles, the strength of previous antiemetic treatments, age and stage of disease on the number of vomiting episodes was also assessed.
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The present trial with high oral doses of metoclopramide was undertaken to (a) determine a well-tolerated dosage of oral metoclopramide; (b) measure the blood levels achieved with these oral doses; (c) determine the side effects of high doses; and (d) observe for antiemetic efficacy. Thirty-six patients receiving emesis-producing chemotherapy consisting primarily of high intravenous (i.v.) doses of cyclophosphamide plus adriamycin or cisplatin received 48 courses of oral metoclopramide. The metoclopramide dosage was escalated in six steps from 0.5 to 3.0 mg/kg and was given 1/2 h before chemotherapy, then 1 1/2, 3 1/2, 7 1/2, 11 1/2, and 15 1/2 after chemotherapy. Diphenhydramine (50 mg orally) was given with the first, third, and fifth dosages. Toxicity was generally mild, not dose related, and similar to that observed with the i.v. drug with the exception of an increased incidence of acute dystonic reactions. Antiemetic effects were observed at each dose level. In patients receiving oral metoclopramide doses of 2 or 3 mg/kg, all achieved serum levels greater than 1,000 ng/ml. High-dose oral metoclopramide was well tolerated and demonstrated antiemetic effects at the dose levels explored. We recommend 2-3 mg/kg oral metoclopramide doses with 50 mg diphenhydramine for use in future trials.
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Diabetic gastropathy is a term that encompasses a number of neuromuscular dysfunctions of the stomach, including abnormalities of gastric contractility, tone, and myoelectrical activity in patients with diabetes. These abnormalities range from tachygastrias to antral hypomotility and frank gastroparesis. Diabetic gastropathies may be acutely produced during hyperglycemia. Symptoms of chronic diabetic gastropathy include chronic nausea, vague epigastric discomfort, postprandial fullness, early satiety, and vomiting. Because these symptoms are nonspecific, other disorders such as mechanical obstruction of the gastrointestinal tract, gastroesophageal reflux disease, cholecystitis, pancreatitis, mesenteric ischemia, and drug effects should be considered. Neuromuscular abnormalities of the stomach may be assessed noninvasively with gastric emptying tests, electrogastrography, and ultrasound. Gastrokinetic agents such as metoclopramide, cisapride, domperidone, and erythromycin increase fundic or antral contractions and/or eradicate gastric dysrhythmias. Diet and glucose control also are important in the management of diabetic gastropathy. As the pathophysiology of diabetic gastropathy is better understood, more specific and improved treatments will evolve.
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To compare the effects of metoclopramide infusion in emergency department (ED) patients complaining of nausea to determine the changes in its therapeutic effect and prevention of side effects such as akathisia and sedation.
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Propofol is an intravenous (IV) drug recently introduced into the United States for induction and maintenance of anesthesia. In spite of extensive laboratory evaluation, it is not possible to predict all the potential side effects that might be associated with a new drug. Because malignant hyperthermia (MH) remains a serious and potentially life-threatening complication of anesthesia, all new anesthetic drugs should be considered potential triggering drugs until proven otherwise. We report the use of IV propofol for the induction and maintenance of general anesthesia in an MH patient and review the literature on this subject.
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In searching for reliable animal models of negative schizophrenic symptomatology, we considered the possibility that a deficient response to rewarding stimuli might be the basis for some features of the disease. Apomorphine (0.015 and 0.03 mg/kg) and 3-PPP (1 mg/kg) caused such a reward deficit when rats were shifted from continuous reinforcement to a fixed ratio (FR4) schedule of food delivery. Further experiments indicated that this effect could be accounted for by a decreased ability of secondary reinforcers to sustain responses, rather than by motor impairment, appetite loss, or reduced reward value of the food. If this deficit is due to decreased dopaminergic transmission produced by low doses of dopamine agonists, our model might suggest that some symptoms of schizophrenia (anhedonia for instance) are not incompatible with deficient dopaminergic transmission. Low to moderate doses of sulpiride, amisulpride, pimozide, and pipotiazine, but not fluphenazine, metoclopramide, haloperidol, thioridazine, and chlorpromazine, reversed the apomorphine-induced reward deficit. Although any extrapolation from animal data requires caution, it may be tentatively proposed that only some neuroleptics, at dosages insufficient to block dopamine transmission postsynaptically, can be effective in reducing negative schizophrenic symptoms.
To study whether central dopaminergic activity influences TSH responsiveness to TRH in normal individuals and in patients with hyperthyroidism, three experiments (A, B and C) were carried out in 8 normal subjects, and two experiments (A and B) in 8 patients with untreated thyrotoxicosis. In experiment A oral placebo (PBO) preceded iv administration of 200 micrograms TRH by 90 min. In experiment B dopamine receptor blockade with 15 mg oral metoclopramide (MET) was given 90 min before iv administration of 200 micrograms TRH. In experiment C two oral doses (each dose 2.5 mg) of bromocriptine (BCT), known for dopamine agonistic properties, were given 9 and 1 hour before ingestion of 15 mg MET which, in turn, preceded iv injection of 200 micrograms TRH by 90 min. In the healthy subjects experiment A revealed a TSH responsiveness, as reflected by the TSH incremental area, which was 430 +/- 74. The corresponding TSH responsiveness was significantly larger in experiment B (661 +/- 138; P less than 0.02). In experiment C the TSH incremental area (332 +/- 102) did not differ significantly from the one obtained in experiment A. The thyrotrophs responded quite different to TRH in the group of thyrotoxic patients, where the TSH incremental area was zero regardless of whether PBO or MET were given as oral pretreatments. These results imply that central dopaminergic activity inhibits the pituitary thyrotrophs and modulates the TSH response to TRH in healthy subjects, but does not contribute significantly to the blocked TSH responsiveness in patients with untreated hyperthyroidism.
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Rectal indomethacin was compared with placebo in a randomised, double-blind study of 100 patients undergoing spinal surgery, in which postoperative pain scores, pethidine, diazepam and metoclopramide consumption, bleeding time, blood loss and oral fluid and food tolerance were measured. Side-effects of indomethacin and pethidine were compared in the two groups. In the indomethacin group, pain scores were significantly less for all measurements made during the first three postoperative days, pethidine and diazepam consumption were significantly less on all three days, bleeding time was significantly increased, although still within the clinically normal range, intraoperative and postoperative blood losses were not significantly affected, coagulation was not significantly impaired as assessed clinically, patients tolerated oral feeding significantly earlier, there was no significant increase in the incidence of gastro-intestinal side-effects except for diarrhoea, and there was no significant reduction in the incidence of side-effects associated with the use of pethidine.
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As a first step in an extensive project planned to determine serum PRL levels in response to oral metoclopramide in women with a diverse gyneco-obstetric history, it was decided to study 51 clinically healthy nulliparous women, aged 15.8 to 48.2 years, with history of regular menses at least one year before the study (except the three postmenopausal women), with no regular drug ingestion during the last six months. Women were studied on days 18 to 22 of menstrual period, after a 30 minute rest on basal conditions (3 samples) at 60, 90, and 120 minutes after a single 10 mg. oral dose of metoclopramide. Duplicate PRL determinations were performed in all samples and progesterone(P) only in a pool of the three basal samples by radioimmunoanalysis. All women had serum P levels > or = 4.0 ng/ml. A significant linear positive correlation (r > or = 0.6795, p < 0.001) was observed between chronologic age (CA) and serum PRL levels, regardless the way they were expressed. Considering the individual responses it was decided to divide the group according to CA and it was observed that serum PRL levels--expressed in any form were always significantly greater in women aged > 25 years (Group 2) in contrast with women aged < or = 25 years (Group 1). Since differences were evident, percentiles 3, 50 and 97 for serum PRL levels were calculated during each test time for both groups.(ABSTRACT TRUNCATED AT 250 WORDS)