No abstract

Silmmary A double-blind, randomized, crossover study was conducted to compare the efficacy and safety of high-dose dexamethasone (Protocol D) with a combination of dexamethasone, metoclopramide and diphenhydramine (Protocol DMD) in the management of chemotherapy-induced nausea and vomiting in cancer patients. All entered patients had received no prior chemotherapy. During the study chemotherapy was administered on an inpatient basis. The majority of patients (94%) were treated with cytotoxic drugs of significant emetogenic activity and 40% of the study group received cis-platin-containing combinations.Of DMD and 9 (15%) found no difference between the two regimens.We conclude that, while the short DMD protocol has an antiemetic activity equivalent in its effectiveness to D, its associated adverse reactions would minimize its usefulness. Therefore, further investigations should be conducted to find a safer and more potent combination of antiemetics suitable for therapy in an outpatient setting.Nausea and vomiting are the most common and potentially grave complications of anticancer therapy (Laszlo & Lucas, 1981;Morran et al., 1979;Seigel & Long, 1981). Moreover, emesis is an important limiting factor in the administration of cytotoxic therapy (Seigel & Long, 1981). Total prevention of chemotherapy-induced nausea and vomiting is paramount in improving patients' acceptance of cytotoxic drugs.Various groups of antiemetics with varying degree of efficacy and modes of action have been tested (Laszlo, 1983;Moertel & Reitemeier, 1969;Moertel et al., 1963;Wampler, 1983). Dexamethasone has been shown to exhibit significant antiemetic activity in the past few years (Aapro & Plezia, 1983;Cassileth et al., 1983Cassileth et al., ,1984Markman et al., 1984). Recently also, in a randomized, double-blind, crossover study, we demonstrated conclusively that high-dose dexamethasone is more effective as an antiemetic and safer than high-dose metoclopramide in patients who are mainly receiving non-cis-platin emetogenic chemotherapy (Ibrahim et al., 1986). However, the dosages and schedule of the antiemetics used in that trial were not suitable for outpatient management.The administration of combinations of antiemetic drugs which would act at different receptor sites should improve their antiemetic potential through complete neuroreceptor blockade (Bruera et al., 1983;Krebs et al., 1985;Mason et al., 1982;Morran et al., 1979). Furthermore, combining two or more antiemetics should minimise the adverse effects produced by the constituent agents given singly in higher doses. The efficacy and safety of a short course of the combination of dexamethasone, metoclopramide and diphenhydramine (Protocol DMD) have been demonstrated recently (Kris et al., 1985). However, the DMD regimen has never been tested in a double-blind and randomized trial against the well established antiemetic protocols.We now present the outcome of a randomized, doubleblind, crossover study comparing the effectiveness of highdose dexamethasone (Protocol D) with a short...

The outcome in 159 cases of head injury was evaluated in terms of the Glasgow Coma Scale (GCS) score, age, and computed tomographic (CT) findings. Children below the age of 10 accounted for 30% of the head-injured patients, and 69% were Saudis. 81% of the patients had a GCS score of 8 or higher, and in this group the outcomes were favorable. In contrast, 19% had an initial GCS score of 7 or less, tended to be older, and had worse outcomes, with a mortality rate of 68%. The initial GCS score, age, presence or absence of associated injuries, and the degree of midline shift according to CT were useful prognostic indices in patients with head injury.

In a randomized, double-blind, crossover study the antiemetic effect of cimetidine was compared with that of dexamethasone in cancer patients receiving emetogenic chemotherapy. Thirty-two patients were evaluable and all were chemotherapy-naive. Eight patients (25%) received high doses of cisplatin, 17 (53%) had cyclophosphamide in combination treatment, 2 (6%) received adriamycin, and 1 another chemotherapy of less emetogenic potential. Complete protection (CR) rates of 59.4% and 62.5% were achieved with cimetidine and dexamethasone, respectively. In addition, three (9.4%) and 1 (3%) patients attained partial protection with cimetidine and dexamethasone, respectively. No significant difference was noted between the two antiemetic therapies (p = 0.07). Although CR has not been achieved in any of those patients who received cisplatin, a comparable antiemetic effect was attained. Both antiemetic regimens were well tolerated with minimal side effects. We conclude that the antiemetic potential of cimetidine and its safety deserve further investigation in a larger study, perhaps in combination with other antiemetic agents.