Autosomal dominant pure cerebellar ataxia. A clinical and genetic analysis of eight Japanese families

We carried out linkage analysis and clinical assessment on 41 patients with autosomal dominant pure cerebellar ataxia (ADCA) type III from eight Japanese families. The presenting symptom was gait ataxia in all patients, with the average age of onset at 46.0 +/- 9.0 (SD) years. The mean age of onset was 3.2 +/- 7.7 years earlier in offsprings than in their parents, suggesting mild, but not dramatic, anticipation. Other neurological features were restricted to cerebellar symptoms in spite of a long duration of illness of up to 41 years. The disease progression was uniformly slow, and earlier onset did not show different or severe clinical phenotype. Linkage analysis using four microsatellite markers (D11S905, D11S903, GATA2A01 and D11S913) excluded the first gene locus for ADCA type III [spinocerebellar ataxia (SCA) type 5]. The present study provides new genetic evidence, in addition to that suggested by clinical difference, that ADCA type III represents a group of heterogeneous conditions.

A brief review of epidemiological studies on ischemic heart disease in Japan

The age-adjusted death rate from ischemic heart disease in Japan is the lowest among developed countries and the rates have decreased since 1970. The incidences of myocardial infarction in selected populations ranged between 0.12 and 2.56 per 1,000 for middle-aged males, and between 0.00 and 1.52 per 1,000 for females. The incidences of sudden death within 24 hours were from 0.00 to 1.58 per 1,000 for males and from 0.00 to 0.76 per/1,000 for females. The incidences in Japanese populations appeared to be far below those in Western populations. In the Cox proportional hazard regression model, hypertension and smoking were selected as independent risk factors for myocardial infarction in an agricultural district. It was noteworthy that the level of serum cholesterol was not associated with development of myocardial infarction in rural areas. No positive relation between dietary fat and serum cholesterol was observed in school children, suggesting that growth, sexual maturation and others might be confounding variables between them. The levels of serum cholesterol for females were more affected by menopause than those of blood pressures and body mass index. Although some polymorphisms in selected candidate genes appeared to be associated with some serum lipids and apolipoproteins, the effect of individual RFLP on the inter-individual variations in serum traits was relatively subtle in comparison with that of lifestyle factors.

[A case report of active aortic prosthetic valve endocarditis due to methicillin-resistant Staphylococcus epidermidis]

A 71-year-old woman with active aortic prosthetic endocarditis due to Methicillin-resistant Staphylococcus epidermidis (MRSE) and subannular mycotic aneurysm and paravalvular leakage and acute mitral regurgitation underwent emergent surgical treatment. The mycotic aneurysm was closed using a prosthetic patch after surgical debridement. Re-aortic valve replacement with a 21-mm Hancock II prosthesis was performed at the paraannular position by utilizing the patch. Mitral valve was also replaced with a 27-mm Hancock II prosthesis. Antibiotic therapy was provided by vancomycin combined with rifampicin and gentamicin. The following regimen was given, vancomycin 1 g i.v. q12h for 6 weeks plus gentamicin 80 mg/day i.v. for 4 weeks plus rifampicin 450 mg/day orally for 6 weeks. Vancomycin and gentamicin doses were modified appropriately according to the monitored serum levels in the patient with renal failure. Postoperative course was uneventful. The patient is doing well 11 months after surgery and no recurrence of infection has been seen. We conclude that prompt surgical removal of the infected sources and appropriate antibiotic therapy based on the bacteriology may be the only curative treatment for uncontrolled infection at the active phase of MRSE prosthetic endocarditis.

Transient expression of collagen type XIV during muscle development and its reappearance after denervation and degeneration

In the formation of muscle pattern, the architectural arrangement is believed to be controlled by the local connective tissue cells. In this study we examined the immunohistological localization of Type XIV collagen recognized by a monoclonal antibody, MAb DBM, in embryonic chick hind limbs from stage (St.) 27 to 2 weeks post hatching. DBM staining was transiently observed in the epimysium from St. 30, in the perimysium of the dorsal region from St. 37, and in the entire perimysium from St. 39. After hatching, DBM staining was notably diminished in both epimysium and perimysium. In contrast, DBM staining and in situ hybridization signals for Type XIV collagen mRNA increased in the muscle connective tissues after denervation and around the regenerating muscle fibers. Therefore, Type XIV collagen expression appears to coincide with muscle activity and muscle regenerating conditions, and Type XIV collagen is considered to play roles in muscle development and regeneration.

Association study between schizophrenia and dopamine D3 receptor gene polymorphism

Crocq et al. [1992: J Med Genet 29:858-860] reported the existence of an association between schizophrenia and homozygosity of a BalI polymorphism in the first exon of the dopamine D3 receptor (DRD3) gene. In response to this report, further studies were conducted; however, these studies yielded conflicting results. In the present study, we examined 100 unrelated Japanese schizophrenics and 100 normal controls to determine any association between this polymorphism and schizophrenia. Results suggest that neither allele nor genotype frequencies of the DRD3 gene in the schizophrenics as a whole are significantly different from those of the controls. Further, we found no association between any allele or genotype and any clinical subtype based on family history of schizophrenia and age-at-onset. A significantly high frequency of homozygosity of a dopamine D3 receptor gene allele was not observed in the schizophrenics as a whole, or in clinical subtypes. Our results suggest that an association between the dopamine D3 receptor gene and schizophrenia is unlikely to exist.

Relative selectivity for negative chronotropic and inotropic effects of a novel dihydropyridine derivative CD-832

The effects of CD-832 [(4R)-(-)-2-(nicotinoyl-amino) ethyl 3-nitroxypropyl 1,4-dihydro-2,6-dimethyl-4,3-nitrophenyl, 3,5-pyridine dicarboxylate], a novel dihydropyridine derivative, on various guinea-pig myocardial preparations were compared with those of nifedipine, verapamil and diltiazem. CD-832 decreased the action potential duration of isolated papillary muscles without substantially affecting other parameters. In voltage-clamped single ventricular myocytes, CD-832 decreased the L-type Ca2+ current amplitude while having little effect on outward currents. CD-832 and other Ca2+ channel antagonists produced negative chronotropic effects in isolated right atrial preparations and negative inotropic effects in right ventricular papillary muscles, respectively, in a concentration-dependent manner. The potency order for the negative chronotropic effect was CD-832 > nifedipine > verapamil > diltiazem, while that for the negative inotropic effect was nifedipine > verapamil > or = CD-832 > diltiazem. The ratio, EC20 for negative inotropic effect divided by EC20 for negative chronotropic effect, which was considered to be an index of selectivity for negative chronotropic effect was highest for CD-832, the ratio for CD-832, nifedipine, verapamil and diltiazem being 5.4, 0.11, 0.25 and 0.37, respectively. These results indicate that CD-832 is an L-type Ca2+ channel antagonist with relative selectivity for a negative chronotropic effect rather than for a negative inotropic effect. This 'chrono-selective' cardiosuppressive effect of CD-832 could be of value in the treatment of cardiovascular diseases such as angina pectoris.

NF-kappa B is induced in the nuclei of cultured rat aortic smooth muscle cells by stimulation of various growth factors

We investigated whether induction of transcription factor NF-kappa B is involved in the proliferation of cultured rat aortic smooth muscle cell using electrophoretic mobility shift assay and immunocytochemistry. NF-kappa B was induced in the nucleus in a dose-dependent manner when the smooth muscle cells were stimulated by various growth factors such as PDGF-BB, bFGF, EGF and IGF-1, but not growth inhibitors such as TGF-beta and IFN-gamma. Among growth factors, PDGF-BB and bFGF, more potent growth stimulators, induced higher kappa B binding activity than EGF or IGF-1. These evidences were also supported by the results obtained with immunocytochemistry. Immunocytochemistry also showed that the induced NF-kappa B contained p50 and p65. These results suggest that NF-kappa B induction may be involved in the proliferation of vascular smooth muscle cell.

The equilibrium CO2 rebreathing method does not affect resting or exercise blood pressure

The equilibrium CO2 rebreathing technique has been widely used for the noninvasive determination of cardiac output. Recently, several investigators have used this technique in conjunction with auscultatory blood pressure measurements to calculate total peripheral resistance. To examine the validity of this approach, we attempted to determine whether the CO2 rebreathing procedure has a significant effect on blood pressure. The participants in the present study were 10 male subjects, 24 +/- 1 yr of age (mean +/- SE). Each subject performed two trials-one with CO2 rebreathing and one without. Both trials consisted of three stages (rest, 25%, and 50% VO2peak), each stage lasting 15 min. During the rebreathing trial, the CO2 rebreathing technique was administered at 10 min into each stage. There were no statistically significant differences in the heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure responses between the two trials. These results indicate that the equilibrium CO2 rebreathing technique does not alter auscultatory blood pressures at rest and during exercise up to intensities of 50% VO2peak.

Intergenerational instability of the CAG repeat of the gene for Machado-Joseph disease (MJD1) is affected by the genotype of the normal chromosome: implications for the molecular mechanisms of the instability of the CAG repeat

Machado-Joseph disease (MJD) is an autosomal dominant neurodegenerative disorder caused by unstable expansion of a CAG repeat in the MJD1 gene at 14q32.1. To identify elements affecting the intergenerational instability of the CAG repeat, we investigated whether the CGG/GGG polymorphism at the 3' end of the CAG repeat affects intergenerational instability of the CAG repeat. The [expanded (CAG)n-CGG]/[normal (CAG)n-GGG] haplotypes were found to result in significantly greater instability of the CAG repeat compared to the [expanded (CAG)n-CGG]/[normal (CAG)n-CGG] or [expanded (CAG)nGGG]/[normal (CAG)n-GGG] haplotypes. Multiple stepwise logistic regression analysis revealed that the relative risk for a large intergenerational change in the number of CAG repeat units (< -2 or > 2) is 7.7-fold (95% CI: 2.5-23.9) higher in the case of paternal transmission than in that of maternal transmission and 7.4-fold (95% CI: 2.4-23.3) higher in the case of transmission from a parent with the [expanded (CAG)n-CGG]/[normal (CAG)n-GGG] haplotypes than in that of transmission from a parent with the [expanded (CAG)n-CGG]/[normal (CAG)n-CGG] or [expanded (CAG)n-GGG]/[normal (CAG)n-GGG] haplotypes. The combination of paternal transmission and the [expanded (CAG)n-CGG]/[normal (CAG)n-GGG] haplotypes resulted in a 75.2-fold (95% CI: 9.0-625.0) increase in the relative risk compared with that of maternal transmission and the [expanded (CAG)n-CGG]/[normal (CAG)n-CGG] or [expanded (CAG)n-GGG]/[normal (CAG)n-GGG] haplotypes. The results suggest that an inter-allelic interaction is involved in the intergenerational instability of the expanded CAG repeat.

Muscle histopathology in spastic cerebral palsy

We studied the histopathology of spastic muscles in patients with spastic cerebral palsy using specimens obtained from the gastrocnemius muscles during orthopedic operations. Though there was no disease-specific abnormality, we found changes in fiber type distribution, i.e., type-1 fiber predominance and type-2B fiber deficiency. These changes were not found in the patient with brain infarction at age 1 year 5 months. Variation in fiber size, especially in type-1 fibers, was also detected in older patients and at the more severely affected sides. We speculated that the influence on the spinal motor unit from upper motor cortex might be applicable to the muscle histological findings and the time of the onset of the brain damage might be important.

Usefulness of auditory brainstem responses at high stimulus rates in the diagnosis of acoustic neuroma

The effects of the stimulus rate on the auditory brainstem responses (ABRs) of acoustic neuroma (AN) patients were studied. Ninety-decibel click stimuli at a normal hearing level were delivered at stimulus rates of 9.5, 20, 40 and 90 Hz, and ABRs were recorded of 40 AN patients (40 ears) at each stimulus rate. Subjects with normal hearing (42 ears) and patients with sensorineural hearing loss (30 ears) were also studied to obtain normative data. The following two parameters were examined: the interpeak latency difference between wave I and wave V (IPL I-V) at each stimulus rate, and the increase in IPL I-V (delta IPL I-V) when the stimulus rate was increased from 9.5 Hz. AN patients showed significantly larger values for both parameters at all stimulus rates compared to those of the control groups. Among 6 AN patients with normal ABRs at 9.5 Hz, 5 showed abnormal IPL I-V or abnormal delta IPL I-V at 90 Hz, when the upper normal limits of both parameters were defined as the mean plus 2 SD of the group with normal hearing. These results suggest that recording ABR at high stimulus rates provides valuable information for detecting AN patients with normal ABRs.

Minute hepatocellular carcinoma originating in the caudate lobe with a long-term surviving of 9 years 6 months after surgical resection: a case report

An extremely rare case of minute hepatocellular carcinoma originating in the caudate lobe who was resected and surviving for 9 years 6 months is presented. A 52 year-old male patient was diagnosed as having a minute hepatocellular carcinoma originating in the caudate lobe by lipiodol computed tomography and celiac angiography. Although the caudate lobectomy was successfully performed, refractory ascites developed for 4 months after surgical procedure. After remission of ascites, the patient is well and surviving for 9 years 6 months without recurrence of hepatocellular carcinoma. This case suggests that early detection and treatment of hepatocellular carcinoma can lead to a long-term survival even when the caudate lobe of the liver is involved.

X-linked nonprogressive congenital cerebellar hypoplasia: clinical description and mapping to chromosome Xq

We examined a large family in which an X-linked recessive congenital ataxia manifested in 7 males from three generations. The affected boys first exhibited a marked delay of early developmental motor milestones. A neurological syndrome became evident by 5 to 7 years of age and included cerebellar ataxia, dysarthria, and external ophthalmoplegia; there were no symptoms of mental retardation, spastic paraparesis, or sensory loss. Neuroimaging studies revealed hypoplasia of cerebellar hemispheres and vermis. The disease showed no progression beyond early childhood. The unique heredity and clinical features clearly distinguish this new entity from a variety of previously described familial ataxias. Pairwise linkage analysis and haplotype reconstruction allowed us to map the gene responsible for this disorder to a 38-cM interval on chromosome Xp11.21-q24 flanked by the loci DXS991 and DXS1001. Upon multipoint linkage analysis, the disease gene was determined to be located most likely in the proximal part of chromosome Xq, with the maximal lod score of 4.66 at the locus DXS1059 (Xq23). This is the first example of the genetic mapping of a pure congenital cerebellar hypoplasia syndrome.

[A study of utilization and imitation behavior in cases with striatocapsular infarction]

Utilization behavior (UB) and imitation behavior (IB) were first described by Lhermitte (1983; 1986) for neurobehavioral disorders due to the frontal lobe damage. Recently, the similar symptoms were also observed in several reports of subcortical lesion cases without any lesion of the frontal lobe. We studied 16 consecutive patients with unilateral striatocapsular infarction (SCI), and found 7 patients (44%) presenting UB and/or IB. Characteristics of patients with UB and/or IB revealed the following factors: older age, higher frequency of right-sided lesion, absence of severe aphasia or apraxia, higher frequency of unilateral spatial neglect and/ or psychic change, and no evidence of significant large cerebral artery lesion on angiography. In most of SCI cases, whether IB and/or UB was present or not, the single-photon emission CT demonstrated decreased perfusion in the ipsilateral frontotemporal areas, and the result of neuropsychological assessment was compatible with frontal lobe dysfunction. UB and IB observed in our patients are not only considered to have resulted from secondary impairment of frontal lobe, but also regarded as one of the right hemispheric syndromes associated with such background factors as aging, neglect and general inattention.

Immunofluorescence analysis of trihexosylceramide accumulated in the hearts of variant hemizygotes and heterozygotes with Fabry disease

An immunofluorescence method was applied to detect trihexosylceramide accumulated in the cardiac tissues from a variant hemizygote and a heterozygous female with Fabry disease, the incidence of which had been suspected to be high.

Chlovalicin, a new cytocidal antibiotic produced by Sporothrix sp. FO-4649. II. Physicochemical properties and structural elucidation

A new growth inhibitor of IL-6 responsive MH60 cells, chlovalicin (MW; 332, C16H25O5Cl), was found in cultures of Sporothrix sp. FO-4649, together with a known sesquiterpene, ovalicin. The structure of chlovalicin was elucidated by spectroscopic methods. Chlovalicin possesses a chlorinated methylene moiety at the C-1 position, and it corresponds to halogenated products derived from the epoxide ring attached to the C-1 position of ovalicin. The absolute configuration of chlovalicin was clarified as 1S, 2R, 3S, 1'S, 2'R by chemical transformation from ovalicin.

Indications for, and effectiveness of, a second hepatic resection for recurrent hepatocellular carcinoma

BACKGROUND/AIMS

Second hepatic resection (SHR) for recurrent hepatocellular carcinoma (HCC) appears to have a better prognosis than other treatments; however, it is not clear whether this is the result of the procedure, or of the underlying condition of patients undergoing this treatment.

MATERIALS AND METHODS

Consecutive hepatic resection for 13 years, many patients suffered from recurrence in the remnant liver. After detection of recurrence, these lesions were treated in various ways including SHR. In this communication, recurrent patients were divided into SHR patients and non-SHR patients. In these two groups, we analyzed clinicopathologically.

RESULTS

After 341 curative hepatic resections for HCC, recurrences presented in 193 patients (57%). SHR was performed in 31 patients (16%), while the other 162 patients (84%) underwent other treatments. At first resection, the group did not significantly differ in sex, age, evidence of hepatitis infection, liver function tests, tumor size, presence of portal vein invasion and evidence of histologic cirrhosis. SHR patients had more tumor-free days following first resection than non-SHR patients (p < 0.05). The survival rate following recurrence for SHR patients was better than that of non-SHR patients (p < 0.05). Among the non-SHR patients, 23 patients met criteria for the procedure. Survival rate for the 31 SHR patients also was better than that of these 23 patients (p < 0.05).

CONCLUSION

Since SHR is safe, effective, and offers an improved prognosis for recurrent HCC, it should be the treatment of choice whenever possible.

Visual form agnosia in multiple sclerosis

We report a case of multiple sclerosis with visual form agnosia and callosal syndromes. Initially, the patient's visual recognition of object form was severely disturbed at the perceptual stage, in association with left-sided ideomotor apraxia and agraphia. Magnetic resonance imaging showed large white matter lesions in the bilateral frontal and occipital lobes, the latter extending to the occipitotemporal junction, and widespread corpus callosum lesions. Over the course of one year follow-up, neuropsychological examinations indicated that the patient's visual recognition defects occurred not only at the early substage of form perception, but also at the stage of reproducing the shape of objects from visual memory store. The present case suggests that neural connections between the striate cortex and occipitotemporal visual areas are crucial for both the perceptual and associative stages of visual object recognition.

Developmental and denervation changes in c-ret proto-oncogene expression in chick motoneurons

Receptor tyrosine kinases (RTKs) play important roles in cellular differentiation, survival, and proliferation. To search for genes involved in the survival of motoneurons, we isolated the RTKs specifically expressed on them. We used RT-PCR, by which RNA was obtained from purified embryonic day 5 (E5) chick motoneurons, and screened by in situ hybridization. Of 17 RTK cDNA clones, c-ret expression gradually increased in the motoneurons of the spinal cord during development. Compared with the expression of the neurotrophin receptor, TrkC, that of c-ret was very high in motoneurons from around E17 to adulthood. The level of c-ret expression on the motoneurons was unaffected by deafferentation at E2, but changed after denervation at post-hatching day 2. The in situ hybridization signal for c-ret mRNA increased slightly at day 1, then decreased progressively up to day 8, and increased again 2 weeks after sciatic nerve denervation in the motoneurons of the lumbar spinal cord. There were also changes in the signal of the lesioned sciatic nerve. In the most distal part from the lesioned site, the signal for c-ret mRNA significantly increased from day 3 on after denervation. These results suggested that the c-ret gene may encode the receptor for a factor involved in motoneuron differentiation and the promotion of regeneration of injured peripheral nerves.

Role of endogenous ouabain-like substance during graded exercise in hypertensive individuals

Changes in plasma endogenous ouabain-like substance (EOLS) and plasma noradrenaline, along with changes in blood pressure (BP), heart rate, and blood lactate concentration, were investigated in hypertensive individuals during strenuous exercise testing. Thirteen (4 men and 9 women) middle-aged (34-63 years, mean 50 +/- 2 years) patients with mild essential hypertension underwent graded multistage submaximal exercise testing on a cycle ergometer. The workload in each exercise test was increased depending on the individual's physical fitness until they reached 75-80% of the predicted age-adjusted maximal heart rate prescribed by the American College of Sports Medicine. Systolic (S) BP rose by 67 +/- 9 mm Hg (P < 0.001), mean (M) BP by 28 +/- 3 mm Hg (P < 0.001), diastolic (D) BP by 9 +/- 2 mm Hg (P < 0.005) and heart rate by 79 +/- 6 beats/min (P < 0.001) after submaximal graded exercise. The blood lactate concentration and plasma noradrenaline increased significantly (+3.40 +/- 0.34 mmol/l and +895 +/- 94 pg/ml respectively, P < 0.001). Although the change in EOLS was not significant, it showed a strong positive correlation with the change in plasma noradrenaline (R = 0.760, P < 0.001). These results suggest that EOLS may participate in modifying sympathetic vasoconstriction during submaximal graded exercise.

Persistent increased threshold of electrical stimulation selective to motor nerve in multifocal motor neuropathy

In multifocal motor neuropathy (MMN) the threshold of electrical stimulation showed a persistent, marked increase for the motor nerve which decreased after treatment with intravenous immunoglobulin or oral cyclophosphamide; whereas, the threshold was normal for the sensory nerve. This discrepancy of the thresholds for motor and sensory nerves indicates that the increased threshold for motor nerve is not caused by change in perineural capacitance, such as subperi- and endoneural edema or perineural thickening. Inching studies showed that the site of the elevated motor nerve threshold was closely associated with conduction slowing and block. For the cause of the increased threshold, therefore, we suppose the presence of a factor which interferes with reorganization of the nodal property in the remyelinative process or which directly blocks sodium channels where the blood-nerve barrier is impaired in MMN.

Synthesis and inhibitory activities of isochromophilone analogues against gp120-CD4 binding

Several isochromophilone analogues were synthesized from sclerotiorin (1) by Wittig reactions and aldol condensation reaction. The structures of the products were elucidated from MS, elemental analysis, 1H NMR and 13C NMR spectra, and their inhibitory activities against gp120-CD4 binding were determined.

Developmental changes in action potential and membrane currents in fetal, neonatal and adult guinea-pig ventricular myocytes

Developmental changes in electrophysiological properties were investigated in enzymatically isolated ventricular cardiomyocytes from fetal (45-55 days after conception), neonatal (1-5 days after birth) and adult (45-60 days after birth) guinea-pigs. Action potentials were elicited at 1 Hz in current-clamp mode, and membrane currents were measured using whole cell voltage clamp method. Action potential durations at 50% and 90% repolarization decreased between fetal and neonatal periods and increased between neonatal and adult periods, while there was no substantial age-related change in resting membrane potential and action potential overshoot. Because cell membrane capacitance increased with age, indicating a developmental increase in cell size, current density was normalized to membrane capacitance for each cell. The L-type calcium current (lCaL) density at 0 and + 10 mV was significantly smaller in fetal and neonatal cells than in adult ones, although the voltage dependence and inactivation kinetics were similar among the three age groups. The delayed rectifier K+ current (lK) density at 0 and + 30 mV was significantly smaller in fetal cells than in neonatal and adult ones. No significant difference in the inward rectifier K+ current (lK1) density was observed among the three age groups. Thus, the electrophysiological properties of the guinea-pig ventricular myocytes were demonstrated to change during pre- and postnatal development. The observed changes in action potential duration could be explained by changes in the balance between lK and lCaL.

Chlovalicin, a new cytocidal antibiotic produced by Sporothrix sp. FO-4649. I. Taxonomy, fermentation, isolation and biological activities

Selective growth inhibition against IL-6 dependent cells was detected in fermentation extracts of a fungal strain FO-4649 which was characterized as Sporothrix species. An active metabolite (1) termed chlovalicin was isolated together with ovalicin and two other ovalicin derivatives (compounds 3 and 4). Chlovalicin, a ovalicin derivative with a chlorinated methylene moiety at the C-1 position of the cyclohexane ring, dose-dependently inhibited the growth of IL-6 dependent MH60 cells (IC50, 7.5 microM) in the presence of 0.2 U/ml IL-6 and, to a lesser extent, the growth of B16 melanoma cells (IC50, 38 microM). Among the other three compounds, only ovalicin showed inhibitory activity (IC50, 27 microM) against MH60 cells. These four compounds did not show any antimicrobial activity at a concentration of 1000 micrograms/ml.

Effective dose of granisetron for preventing postoperative emesis in children

PURPOSE

This study was to identify the minimum effective dose of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, to prevent postoperative vomiting in children who have undergone strabismus repair, tonsillectomy or tonsillectomy with adenoidectomy.

METHODS

In a randomized, double-blind fashion, 80 healthy children aged 4-10 yr were assigned to receive either placebo (saline) or granisetron in a dose of 20, 40 or 80 micrograms.kg-1 iv immediately following the induction of anaesthesia. All subjects received a standardized anaesthetic, which consisted of sevoflurane in nitrous oxide and oxygen. Rescue antiemetics were administered if two or more episodes of vomiting occurred. Postoperative pain was treated with acetaminophene pr or pentazocine iv. During the first 24 hr after anaesthesia, the frequencies of retching and vomiting were recorded in a standardized fashion by nursing staff while subjects were in a hospital.

RESULTS

There were no differences among four treatment groups with regard to subject characteristics, surgical procedures, anaesthetic and postoperative management or adverse effects. The frequencies of these symptoms were as follows: 65%, 60%, 20% and 15% after administration of placebo, granisetron 20, 40 or 80 micrograms.kg-1. Three children who had received either placebo or granisetron 20 micrograms.kg-1 required another rescue antiemetic drug, whereas none who had received granisetron 40 or 80 micrograms.kg-1 needed rescue drugs.

CONCLUSION

Granisetron 40 micrograms.kg-1 is an effective antiemetic for preventing retching and vomiting following strabismus repair and tonsillectomy in children. Increasing the dose to 80 micrograms.kg-1 provided no demonstrable benefit in reducing postoperative emesis.