[en] Regulatory concern about potential QT-interval prolongation by serotonin-receptor antagonist antiemetics prompted product-label changes. The first-generation serotonin-receptor antagonist granisetron is available in oral (PO), intravenous (IV), and transdermal formulations. APF530 is a formulation that provides sustained release of granisetron when administered as a single subcutaneous (SC) injection. The Phase I study reported here evaluated effects of APF530 on electrocardiographic intervals. This single-site, double-blind, placebo-controlled, four-period crossover trial randomized healthy men and women to receive varying sequences of APF530 1 g SC, granisetron 50 μg/kg IV, moxifloxacin 400 mg PO, and placebo. Subjects were assessed for 49 hours after each treatment. The primary objective was to evaluate differences between baseline-adjusted, heart rate-corrected QT-interval change using the Fridericia rate correction (dQTcF) for APF530 1 g SC and placebo. Electrocardiograms were performed at various times throughout the assessment period. Pharmacokinetics and safety were evaluated. The upper one-sided 95% confidence interval (CI) for mean baseline-adjusted dQTcF at each post-dose time point between APF530 and placebo excluded 10 ms, indicating that APF530 1 g SC had no clinically significant effect on QTcF. Maximum observed QTcF change was 4.15 ms (90% CI, 0.94 to 7.36) at Hour 3. No clinically significant changes in other electrocardiogram intervals were observed. APF530 SC pharmacokinetics were as expected, with slow absorption (maximum plasma concentration 35.8 ng/mL, median time to maximum plasma concentration 11.1 hours) and slow elimination (mean half-life 18.6 hours; systemic clearance 20.2 L/hour) of granisetron versus the expected early peak concentration and elimination of granisetron IV. APF530 SC was well tolerated. Adverse events, most commonly constipation and SC injection-site reactions, were generally mild and quickly resolved. APF530 1 g SC did not induce clinically significant QTcF interval prolongation or changes in the other electrocardiogram intervals, and was well tolerated at twice the recommended dose

[en] 5-HT_3 antagonists have been available as oral and intravenous preparations for decades. The availability more recently of transdermal granisetron and the anticipated availability of a subcutaneous granisetron preparation have provided helpful alternatives to patients, and these preparations have been shown to have less potential to prolong QT than other drugs in the class

[en] We are reporting two neonates with isolated pyloric atresia, with an objective to emphasize the importance of considering this rare condition in the differential diagnosis of upper intestinal atresias. Both had no-bilious vomiting and epigastric fullness. X-ray showed a dilated gastric shadow with no evidence of gas in the rest of the abdomen. On exploration they had pyloric atresia which was corrected with gastroduodenostromy. Congenital pyloric atresia is a rare condition, which presents with features of gastric outlet obstruction. It can be diagnosed antenatally but the picture can mimic other conditions. Epidermolysis bullosa has a strong association with it and require skin biopsy for diagnosis. (author)

[en] Radiotherapy of abdominal and pelvic tumours is frequently associated with acute radiation enteritis. Predominant symptoms include diarrhea, watery stools, abdominal pain, nausea and vomiting. There are very few effective interventions available for this condition. Enteral oligomeric nutrition has been used in bowel diseases with functional failure similar to radiation enteritis. The aim of presented work was to observe occurrence of symptoms of radiation enteritis in patients undergoing abdominal or pelvic radiotherapy. Apart from diet and pharmacological therapy, oral oligomeric enteral nutrition (Peptisorb Powder Nutricia) at the dose of 1000 - 2000 ml per day was administered for minimum of 4 days. Planned period of administration was 14 days and longer. Symptoms of radiation enteritis were evaluated at the beginning and in the end of administration. Prevalence of all evaluated symptoms of radiation enteritis was decreased and difference was statistically significant for diarrhea, watery stools, abdominal pain, nausea and vomiting. The use of evaluated oligomeric nutritional support might, in conjunction with pharmacotherapy and diet, alleviate symptoms of acute radiation enteritis and maintain nutritional status of patients. (author)

[en] Twenty two young infants presenting with non-bilious vomiting were examined by ultrasonography in order to evaluate the diagnosis value of ultrasonography in hypertrophic pyloric stenosis. We analysed the ultrasonographic findings in 16 cases of the hypertrophic pyloric stenosis, which were compared with operative findings. Our results were as follows: 1. Hypertrophic pyloric stenosis were mostly diagnosed between 3 and 8 weeks of age, and had high incidence in first male baby, also pyloric mass were palpated in 80% of cases. Eight cases who were diagnosed within 4 weeks of age had early onset of symptom with short duration, many had no palpable mass. 2. All cases with hypertrophic pyloric stenosis demonstrated the pyloric muscle thickness to be 4 mm or greater, the pyloric diameter to be 1.0 cm or greater, and the pyloric channel length to be 1.6 cm or greater, therefor when ultrasonographic measurement were compatible with the above, the definite diagnosis of hypertrophic pyloric stensis could be made. 3. Operative measurement of the pyloric muscle thickness was between 4 and 7 mm (mean, 5.0 mm), the pyloric diameter was 1.0 and 2.0 cm (mean,1.67 cm), the pyloric channel length was between 2.0 and 3,0 cm (mean, 2.24 cm), showing good correlation with ultrasonographic measurements. 4. Other findings on ultrasonography which could help diagnosis of hypertrophic pyloric stenosis included delayed gastric emptying, hyperperistalsis, teat and beak sign, failure of passage or little passage of fluid, target and doughnut sign, cervix sign, and double tract sign

[en] Granisetron is a potent, the most selective 5-HT3 receptor antagonist and is reported to be effective in treatment of radiation-induced emesis. The antiemetic efficacy and safety of oral granisteron was evaluated in patients with receiving highly emetogenic treatment by conventional fractionated irradiation. Patients with various cancers who were being treated with irradiation were accrued into the present study. The intensity of nausea was evaluated on first 24 hours and on day-7 by patients according to the degree of interference with normal daily life as followings; a) none; b) present but no interference with normal daily life (mild); c) interference with normal daily life (moderate); and d) bedridden because of nausea (severe). Non or mild state was considered to indicate successful treatment. The efficacy of antiemetic treatment was graded as follows; a) complete response; no vomiting, no worse than mild nausea and receive no rescue antiementic therapy over the 24h period, b) major response; either one episode of vomiting or moderate/severe nausea or had received rescue medication over 24h period, or any combination of these, c) minor response; two to four episodes of vomiting over the 24h period, regardless of nausea and rescue medication, d) failure; more than four medication. The score of the most symptom m was recorded and the total score over 24 hours was summarized. The complete or major response was considered to indicate successful treatment. A total of 10 patients were enrolled into this study, and all were assessable for efficacy analysis. Total nausea control was achieved in 90% (9/10:none=60% plus mild=30%) of total patients after 7 days. The control of vomiting by granisteron was noted in seven patients (70%) of complete response and three (30%) of major response with a hundred-percent successful treatment over 7 days. The minor response or treatment failure were not observed. No significant adverse events or toxicities from granisetron were recorded in patient receiving granisetron. We concluded that granisetron is a highly effective antiemetic agent in controlling radiotherapy-induced nausea or vomiting with a minimal toxicity profile

[en] The intestinal malrotation is one of disease representing jaundice and intermittent vomiting in neonatal period and its clinical manifestation varies from no symptom to fatal symptom requiring emergency operation. We report one case of malrotation with midgut volvulus representing 'whirl pool sign' on color ultrasound image.

[en] Bowel obstruction is a frequent complication in patients with advanced tumor disease. It is a complete or partial disruption of bowel contents movement. Most frequent clinical symptoms are pain, nausea, vomiting and obstipation. In differential diagnostics it is necessary to exclude primarily benign cases of bowel obstruction. Due to overall conditions or disease advance some patients are not suitable candidates for surgical procedures and could benefit from symptomatic treatment. One of the main aims of MBO (malignant bowel obstruction) symptomatic treatment, that include also antiemetics, antisecretory treatment and analgetics, is the nasogastric tube removal, ev. management of symptom palliation without a use of the tube. Home parenteral nutrition should be considered for specific patient group, beside others when the patient is in danger of dying as a result of starving not due to the progression of tumor disease. Key words: malignant bowel obstruction, nausea and vomiting, antisecretory treatment, octreotide, home parenteral nutrition. (author)

[en] The author presents modern ideas about physiology of vomiting reflex during the treatment of oncological patients; the former are used to create the tactics of anti-emetic therapy. Introduction of highly effective specific anti vomiting medicines of serotonine receptor blockers group (5-HT3-blockers), the use of which during radiotherapy is analysed in the paper, is a great achievement of clinical pharmacology during recent years

[en] Prevention of chemotherapy-induced nausea and vomiting (CINV) is a key component of treatment for patients with cancer. Guidelines are available to assist prescribers in the management of CINV associated with single-day chemotherapy regimens. However, currently there are no clear guidelines for management of CINV in patients receiving multiple-day chemotherapy regimens. Serotonin (5-HT_3) receptor antagonists are a mainstay in preventing CINV, and palonosetron, given its longer half-life and duration of action relative to other 5-HT_3 receptor antagonists, may be a useful option for managing CINV in multiple-day chemotherapy. Here we provide an overview of CINV and CINV treatment options, with a focus on palonosetron. We describe existing challenges in managing CINV, and discuss two patients receiving multiple-day chemotherapy, in whom CINV was managed successfully with palonosetron