Background: Retching, an early component of the emetic reflex, is a common and distressing symptom in children after Nissen fundoplication. Alimemazine (trimeprazine, Vallergan; Castlemead, Herts, UK) is a phenothiazi...Background: Retching, an early component of the emetic reflex, is a common and distressing symptom in children after Nissen fundoplication. Alimemazine (trimeprazine, Vallergan; Castlemead, Herts, UK) is a phenothiazine derivative histamine1 antagonist, which anecdotally relieves the retching symptoms. Material and Methods: A prospective, double-blind, randomized, crossover, placebo-controlled study of 15 neurologically impaired children with retching after Nissen fundoplication over a period of 1 year (December 2002- December 2003). Patients were randomly allocated to receive 1 week each of alimemazine and placebo with crossover. A diary was maintained of retching episodes 1 week before, during, and 1 week after the trial. Dosage of alimemazine used was 0.25 mg/kg 3 times a day (maximum, 2.5 mg per dose). Statistical analysis was done using a paired Student’s t test, where P value of less than .05 was considered significant. Results are presented as mean ± SD. Results: Twelve parents completed the diaries (9 open, 3 laparoscopic Nissen fundoplication). Median age of the child was 36 months (8- 180 months), median duration of retching was 4.5 months (1- 52 months), and mean number of retching episodes per week was 60 ± 29.40. Mean number of retching episodes with alimemazine was 10.42 ± 9.48 vs 47.67 ± 27.79 with a placebo (P < .0001). No adverse effects were reported in those cases that completed the study. Conclusion: At low dose, alimemazine (Vallergan) is a safe and effective drug in the management of retching after Nissen fundoplication.展开更多
Purpose: The Spitz classification of oesophageal atresia (OA)-based on the birth weight and the presence of a major cardiac anomaly was proposed 1994. Advances in neonatal care have led us to question if these outcome...Purpose: The Spitz classification of oesophageal atresia (OA)-based on the birth weight and the presence of a major cardiac anomaly was proposed 1994. Advances in neonatal care have led us to question if these outcome figures are still valid. We tested the hypothesis that the outcome of neonates with OA has improved during the last decade. Methods: The records of all neonates (n = 188) born with OA and treated in a single institution between 1993 and 2004 were reviewed and compared with data from the original Spitz study. Data were obtained on the birth weight,presence of a major cardiac anomaly,and survival. Differences in survival were compared using the Yates-corrected χ 2 test. Results: In the early period,326 neonates survived (87.6% ) compared with 174 (91.5% ) in the most recent decade (P = 0.10). Based on Spitz classification,the outcome comparing both periods was the following: group I,97% (283/293) and 98.5% (130/132) (P = 0.44); group II,59% (41/70) and 82% (41/50) (P = 0.01); group III,22% (2/9) and 50% (3/6) (P = 0.57),respectively. Conclusions: The Spitz classification remains valid. It may be of use when counselling parents and in comparing outcome among centres. In our centre,the overall survival of neonates with OA has not significantly changed in the recent decade. The improvement in survival of neonates in group II,however,demonstrated the recent advances in neonatal。展开更多
文摘Background: Retching, an early component of the emetic reflex, is a common and distressing symptom in children after Nissen fundoplication. Alimemazine (trimeprazine, Vallergan; Castlemead, Herts, UK) is a phenothiazine derivative histamine1 antagonist, which anecdotally relieves the retching symptoms. Material and Methods: A prospective, double-blind, randomized, crossover, placebo-controlled study of 15 neurologically impaired children with retching after Nissen fundoplication over a period of 1 year (December 2002- December 2003). Patients were randomly allocated to receive 1 week each of alimemazine and placebo with crossover. A diary was maintained of retching episodes 1 week before, during, and 1 week after the trial. Dosage of alimemazine used was 0.25 mg/kg 3 times a day (maximum, 2.5 mg per dose). Statistical analysis was done using a paired Student’s t test, where P value of less than .05 was considered significant. Results are presented as mean ± SD. Results: Twelve parents completed the diaries (9 open, 3 laparoscopic Nissen fundoplication). Median age of the child was 36 months (8- 180 months), median duration of retching was 4.5 months (1- 52 months), and mean number of retching episodes per week was 60 ± 29.40. Mean number of retching episodes with alimemazine was 10.42 ± 9.48 vs 47.67 ± 27.79 with a placebo (P < .0001). No adverse effects were reported in those cases that completed the study. Conclusion: At low dose, alimemazine (Vallergan) is a safe and effective drug in the management of retching after Nissen fundoplication.
文摘Purpose: The Spitz classification of oesophageal atresia (OA)-based on the birth weight and the presence of a major cardiac anomaly was proposed 1994. Advances in neonatal care have led us to question if these outcome figures are still valid. We tested the hypothesis that the outcome of neonates with OA has improved during the last decade. Methods: The records of all neonates (n = 188) born with OA and treated in a single institution between 1993 and 2004 were reviewed and compared with data from the original Spitz study. Data were obtained on the birth weight,presence of a major cardiac anomaly,and survival. Differences in survival were compared using the Yates-corrected χ 2 test. Results: In the early period,326 neonates survived (87.6% ) compared with 174 (91.5% ) in the most recent decade (P = 0.10). Based on Spitz classification,the outcome comparing both periods was the following: group I,97% (283/293) and 98.5% (130/132) (P = 0.44); group II,59% (41/70) and 82% (41/50) (P = 0.01); group III,22% (2/9) and 50% (3/6) (P = 0.57),respectively. Conclusions: The Spitz classification remains valid. It may be of use when counselling parents and in comparing outcome among centres. In our centre,the overall survival of neonates with OA has not significantly changed in the recent decade. The improvement in survival of neonates in group II,however,demonstrated the recent advances in neonatal。
