Background: Postoperative vomiting (POV) after pediatric strabismus surgery remains a major problem. Objective:To evaluate the efficacy and safety of a single dose of ramosetron, a new serotonin antagonist, for preven...Background: Postoperative vomiting (POV) after pediatric strabismus surgery remains a major problem. Objective:To evaluate the efficacy and safety of a single dose of ramosetron, a new serotonin antagonist, for preventing POV in children undergoing strabismus surgery. Method: In a prospective, randomized, double-masked, placebo-controlled study, 80 children (38 boys and 42 girls), aged 4 to 10 years, scheduled for strabismus surgery, received intravenously either placebo or ramosetr-on at 1 of 3 different doses (3 μ g/kg, 6 μ g/kg, or 12 μ g/kg) (n=20 each) at the end of the surgical procedure. A standard general anesthetic technique was used. Main Outcome Measures: Emetic episodes were recorded and safety assessments performed during the first and second 24- hour periods (ie, 0- 24 and 24- 48 hours) after receiving anesthesia. Results: The rate of patients who were emesis-free (defined as no retching and no vomiting), during the 0- to 24- hour period after anesthesia was 35% with3 μ g/kg of ramosetron (P=.37), 90% with 6 μ g/kg of ramosetron (P=.001), and 90% with 12 μ g/kg of ramosetron (P=.001) compared with placebo (25% ). The corresponding rate during the 24- to 48- hour period after anesthesia was 40% (P=.371), 90% (P=.001), and 90% (P=.001), respectively, compared with placebo (30% ). No clinically important adverse events were observed in any group. Conclusions: A 6- μ g/kg dose of ramosetron is sufficient, but a 3- μ g/kg dose is insufficient for preventing POV during the 0- to 48- hour period after anesthesia in children undergoing strabismus surgery. Increasing the dose to 12 μ g/kg of ramosetron provides no demonstrable additional benefit.展开更多
PURPOSE: Colonoscopy can be painful for patients and difficult for colonoscopists; however, it is hard to predict how painful or difficult the examination will be. This study was designed to identify factors that pred...PURPOSE: Colonoscopy can be painful for patients and difficult for colonoscopists; however, it is hard to predict how painful or difficult the examination will be. This study was designed to identify factors that predict pain and difficulty during sedation-free colonoscopy. METHODS: A total of 848 consecutive sedation-free colonoscopies were evaluated in a prospective manner. Factors were recorded, including patient pain, intubation time, demographic data, history of abdominal surgery, bowel preparation status, diverticular disease, bowel habits, anxiety level, and number of previous colonoscopies. These factors were analyzed to determine their association with pain and difficulty. RESULTS: Almost all colonoscopies (845/848; 99.6 percent) were successful. Univariate analyses showed that lower body mass index, younger age, female gender, anxiety level, first time, intubation time, preparation status, previous hysterectomy, and previous gynecologic surgery were predictors of patient pain, and lower body mass index, female gender, anxiety level, preparation status, previous hysterectomy, previous gynecologic surge-ry, and constipation were predictors of difficulty of intubation. Multivariate logistic regression analyses revealed that lower body mass index, younger age, intubation time, preparation status, previous hysterectomy, and antispasmodic agent use were predictors of patient pain, and lower body mass index, female gender, constipation, preparation status, and previous hysterectomy were predictors of difficulty of intubation. CONCLUSIONS: By use of intubation time and patient pain, several patient characteristics were identified that may predict technical difficulty and pain associated with the procedure. These findings have implications for the practice and teaching of colonoscopy.展开更多
Although several cohort studies have been reported in individuals with chronic hepatitis C virus (HCV) infection, little is known about liver-related mortality among the elderly. We conducted a cohort study in 302 pat...Although several cohort studies have been reported in individuals with chronic hepatitis C virus (HCV) infection, little is known about liver-related mortality among the elderly. We conducted a cohort study in 302 patients with tuberculosis sequelae who had received a blood transfusion at a young age and had subsequently been treated at a chest clinic. The cohort consisted of 147 patients with antibody to HCV (anti-HCV), of whom 81%were positive for HCV RNA, and 155 without anti-HCV. The cohort was followed for a mean duration of 5.7 years. There were no differences between the two groups in the mean age of the patients at the time of transfusion (31 vs 34 years) or at the time of entry into the study (65 vs 66 years). The outcome of 143 patients with, and 145 without, anti-HCV could be traced; 92 (64%) and 82 (57%) had died, respectively. The main cause of death was tuberculosis sequelae in 61 (42%) and 66 (46%) patients, respectively. Eight (6%) of the 143 patients with anti-HCV died of liver disease (hepatocellular carcinoma: seven; rupture of varices: one). The average annual mortality from liver disease from study entry in the patientswith anti-HCV was 9.8 per 1,000 person-years. The patients with anti-HCV had a significantly lower cause-specific survival probability for liver disease (92%vs. 100%at 10 years, P < .005). In conclusion, in our study, liver-related mortality appeared to be high among elderly HCV-infected individuals.展开更多
文摘Background: Postoperative vomiting (POV) after pediatric strabismus surgery remains a major problem. Objective:To evaluate the efficacy and safety of a single dose of ramosetron, a new serotonin antagonist, for preventing POV in children undergoing strabismus surgery. Method: In a prospective, randomized, double-masked, placebo-controlled study, 80 children (38 boys and 42 girls), aged 4 to 10 years, scheduled for strabismus surgery, received intravenously either placebo or ramosetr-on at 1 of 3 different doses (3 μ g/kg, 6 μ g/kg, or 12 μ g/kg) (n=20 each) at the end of the surgical procedure. A standard general anesthetic technique was used. Main Outcome Measures: Emetic episodes were recorded and safety assessments performed during the first and second 24- hour periods (ie, 0- 24 and 24- 48 hours) after receiving anesthesia. Results: The rate of patients who were emesis-free (defined as no retching and no vomiting), during the 0- to 24- hour period after anesthesia was 35% with3 μ g/kg of ramosetron (P=.37), 90% with 6 μ g/kg of ramosetron (P=.001), and 90% with 12 μ g/kg of ramosetron (P=.001) compared with placebo (25% ). The corresponding rate during the 24- to 48- hour period after anesthesia was 40% (P=.371), 90% (P=.001), and 90% (P=.001), respectively, compared with placebo (30% ). No clinically important adverse events were observed in any group. Conclusions: A 6- μ g/kg dose of ramosetron is sufficient, but a 3- μ g/kg dose is insufficient for preventing POV during the 0- to 48- hour period after anesthesia in children undergoing strabismus surgery. Increasing the dose to 12 μ g/kg of ramosetron provides no demonstrable additional benefit.
文摘PURPOSE: Colonoscopy can be painful for patients and difficult for colonoscopists; however, it is hard to predict how painful or difficult the examination will be. This study was designed to identify factors that predict pain and difficulty during sedation-free colonoscopy. METHODS: A total of 848 consecutive sedation-free colonoscopies were evaluated in a prospective manner. Factors were recorded, including patient pain, intubation time, demographic data, history of abdominal surgery, bowel preparation status, diverticular disease, bowel habits, anxiety level, and number of previous colonoscopies. These factors were analyzed to determine their association with pain and difficulty. RESULTS: Almost all colonoscopies (845/848; 99.6 percent) were successful. Univariate analyses showed that lower body mass index, younger age, female gender, anxiety level, first time, intubation time, preparation status, previous hysterectomy, and previous gynecologic surgery were predictors of patient pain, and lower body mass index, female gender, anxiety level, preparation status, previous hysterectomy, previous gynecologic surge-ry, and constipation were predictors of difficulty of intubation. Multivariate logistic regression analyses revealed that lower body mass index, younger age, intubation time, preparation status, previous hysterectomy, and antispasmodic agent use were predictors of patient pain, and lower body mass index, female gender, constipation, preparation status, and previous hysterectomy were predictors of difficulty of intubation. CONCLUSIONS: By use of intubation time and patient pain, several patient characteristics were identified that may predict technical difficulty and pain associated with the procedure. These findings have implications for the practice and teaching of colonoscopy.
文摘Although several cohort studies have been reported in individuals with chronic hepatitis C virus (HCV) infection, little is known about liver-related mortality among the elderly. We conducted a cohort study in 302 patients with tuberculosis sequelae who had received a blood transfusion at a young age and had subsequently been treated at a chest clinic. The cohort consisted of 147 patients with antibody to HCV (anti-HCV), of whom 81%were positive for HCV RNA, and 155 without anti-HCV. The cohort was followed for a mean duration of 5.7 years. There were no differences between the two groups in the mean age of the patients at the time of transfusion (31 vs 34 years) or at the time of entry into the study (65 vs 66 years). The outcome of 143 patients with, and 145 without, anti-HCV could be traced; 92 (64%) and 82 (57%) had died, respectively. The main cause of death was tuberculosis sequelae in 61 (42%) and 66 (46%) patients, respectively. Eight (6%) of the 143 patients with anti-HCV died of liver disease (hepatocellular carcinoma: seven; rupture of varices: one). The average annual mortality from liver disease from study entry in the patientswith anti-HCV was 9.8 per 1,000 person-years. The patients with anti-HCV had a significantly lower cause-specific survival probability for liver disease (92%vs. 100%at 10 years, P < .005). In conclusion, in our study, liver-related mortality appeared to be high among elderly HCV-infected individuals.
