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Query: UMLS:C0027497 (nausea)
 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Physicians who provide primary care for the elderly are spending more time caring for terminally ill patients. Although curing these patients' illnesses is impossible, it is often possible to improve their quality of life and give them more control over their illness. Communication with the patient and family members, advance directives, and planning for death are important. Symptoms such as pain, dyspnea, and nausea can usually be controlled. Other health care professionals and hospice care when appropriate can also be helpful.
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PMID:Clinical management of the terminally ill. 170 83

A 50-year-old female was admitted because of nausea, vomiting, and cerebellar ataxia. Computed tomography scan revealed an enhanced mass accompanied with a cyst in the right cerebellar hemisphere. The mass situated in the subcortical region was removed. Histologically, highly vascular tumor cells lined the cavities. Postoperative radio- and chemotherapy were administered and the clinical symptoms improved gradually. Two months later, the patient complained of dyspnea. Chest X-ray on second admission demonstrated cardiomegaly. Hemorrhagic pericardial effusion amounting to 1000 ml was aspirated by pericardial puncture. Papillary clusters of tumor cells were demonstrated in the pericardial effusion. The patient died of cardiac failure. At necropsy solid tumors were located in the heart, lung, left inguinal region, and cerebellum. Histological diagnosis was mesothelioma arising from the heart. Primary pericardial mesotheliomas are rare; approximately 106 cases have been reported. Pericardial mesothelioma frequently spreads to the adjacent pleura and mediastinum, but distant metastases are extremely rare because patients with pericardial mesothelioma tend to die early due to cardiac failure or cardiac tamponade.
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PMID:[Brain metastasis from primary pericardial mesothelioma. Case report]. 170 70

Histamine, the main amine released during allergic reactions, can provoke coronary arterial spasm manifested as angina pectoris. This has been shown during clinical and laboratory studies. The effects of histamine on cardiac function are mediated via H1- and H2- receptors situated on the four cardiac chambers and coronary arteries. Coronary arteries of cardiac patients are hyperactive and contain stores of histamine which can initiate coronary artery spasm. Clinical observations indicate that angina pectoris or acute myocardial infarction can be provoked by acute allergic reaction. The coincidental occurrence of chest pain and allergic reaction accompanied by clinical and laboratory findings of classical angina pectoris seems to constitute the syndrome of allergic angina. The clinical symptoms of allergic angina include chest discomfort, dyspnoea, faintness, nausea, pruritus and urticaria. They are accompanied by signs such as hypotension, diaphoresis, pallor and bradycardia. There are also electrocardiographic findings indicating myocardial ischaemia, arrhythmias and conduction defects. Thus, in patients undergoing acute allergic reaction, the development of chest pain could be explained by the mechanism of coronary arterial spasm provoked by the release of histamine, which constitutes the syndrome of allergic angina.
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PMID:Histamine-induced coronary artery spasm: the concept of allergic angina. 179 97

Therapeutic local anaesthesia, although a seemingly simple procedure, requires informed consent by the patient as well as proper indication and careful execution. Four cases selected from a medico-legal experience illustrate some severe complications. Nausea, dyspnoea and respiratory arrest (anaphylactic shock) occurred in a 34-year-old woman shortly after injection of 0.5% Bupivacaine into the paravertebral musculature for the treatment of acute neck pain. She had to be hospitalized for 18 days, at times requiring mechanical ventilation. Three other patients (women aged 40, 43 and 52 years, respectively) developed a pneumothorax after supposedly intramuscular injection of a local anaesthetic. They were hospitalized for 7 to 12 days for treatment by drainage. Anatomical variations were excluded by ultrasound in the 40- and 43-year-old patients. These case reports demonstrate that doctors performing such procedures do not always possess the necessary anatomical knowledge, and the possible occurrence of complications is underestimated.
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PMID:[Negligence of the physician's duty to care during "therapeutic local anesthesia"]. 182 69

Arterial oxygen saturation (SaO2) was monitored continuously during and immediately after sputum induction in 41 HIV positive patients with respiratory symptoms and in 20 symptomless medical and nursing staff, who acted as control subjects. Arterial oxygen desaturation (defined as SaO2 less than or equal to 92%) occurred during sputum induction and persisted for up to 20 minutes after the end of the procedure in 11 of the 20 patients with Pneumocystis carinii pneumonia and in nine of the 21 patients with other respiratory diagnoses. None of the control subjects showed oxygen desaturation. Neither the severity of chest radiographic abnormalities, the alveolar-arterial oxygen gradient (both measured before sputum induction), nor baseline SaO2 prospectively identified the patients who developed oxygen desaturation. Two patients, one with pneumocystis pneumonia, developed dyspnoea and had a fall in arterial oxygen saturation to 84% within 10 minutes of starting sputum induction. The procedure was abandoned in both patients and in two further patients, who developed severe nausea and reaching but no oxygen desaturation. Sputum induction in HIV positive patients with respiratory symptoms may induce a fall in SaO2 that persists after this procedure. This may be important if other procedures are performed soon after sputum induction.
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PMID:Arterial desaturation in HIV positive patients undergoing sputum induction. 185 86

Platelet 5-hydroxytryptamine (5-HT) is diminished during migraine headache and the injection of reserpine, which releases 5-HT from body stores, induces a typical headache in migrainous subjects. The intravenous injection of 5-HT relieves established migraine headache, but causes side-effects of nausea, faintness, paraesthesia and dyspnoea. The 5-HT1-like agonist sumatriptan exerts the beneficial effects of 5-HT with minimal side-effects. Receptors for 5-HT are present in cranial arteries and are also widely distributed in the central nervous system, where they play a role in the neural control of the cranial circulation and endogenous pain control system. The pathophysiology of migraine involves interaction between these central pathways and cranial blood vessels. It is probable that many prophylactic agents exert their action by central 5-HT2 antagonism, whereas termination of an established attack of migraine depends upon constriction of cranial vessels mediated by 5-HT1 receptors.
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PMID:5-Hydroxytryptamine and its role in migraine. 188 18

Intravenous fluorescein angiography is a commonly performed and extraordinarily valuable diagnostic procedure. The frequency of adverse reactions after angiography has varied considerably in previous reports. In a prospective study of 2789 angiographic procedures in 2025 patients, the authors found that the percentage of adverse reactions depended strongly on the patient's angiographic history. Overall, adverse reactions followed 4.8% of the angiographic procedures. These reactions included nausea (2.9%), vomiting (1.2%), flushing/itching/hives (0.5%), and other reactions (dyspnea, syncope, excessive sneezing) (0.2%). No cases of anaphylaxis, myocardial infarction, pulmonary edema, or seizures occurred. The percentage of reactions was 1.8% for patients who had had previous angiography without ever having had an adverse reaction. In contrast, the percentage of reactions was 48.6% for patients who had had an adverse reaction to angiography previously.
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PMID:Frequency of adverse systemic reactions after fluorescein angiography. Results of a prospective study. 189 Dec 25

Within the health care of the elderly with prevention, diagnosis, therapy, rehabilitation, nursing care and social service, diagnostic procedures are of great importance to avoid under- and over-diagnosis. Many diagnostic difficulties exist in elderly patients such as changed reference values, changed normal values and changed signs and symptoms. Well-known examples of conditions which are likely to be under-diagnosed include depression and urinary incontinence. Examples are given from the cardiopulmonary field where e.g. dyspnoea showed to be very common, but in only 36% of males and 52% in females related to cardiac failure or pulmonary disease. The most common symptom of acute myocardial infarction in elderly patients was shown to be dyspnoea, whereas chest pain occurred in only one fifth of the cases. In another study of patients with ulcer disease loss of appetite and weight, nausea and anemia were more common than abdominal pain and heartburn. In peritonitis patients, abdominal pain was observed in only just more than half of the cases and guarding and/or abdominal rigidity in about one third. In patients with suspect age dementia a detailed investigation showed the prevalence of organic dementia to be 89% whereas 3% had treatable dementia and 8% non-dementia conditions. In geriatric long-term patients the mean hearing loss in the speech area was about 50 dB, in spite of the fact that only about 10% of the patients had hearing aids. The need for nursing diagnosis is also obvious. It is concluded that a detailed multidisciplinary diagnostic investigation procedure is very important in geriatric medicine.
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PMID:The importance of diagnostic procedures to ensure quality of health care in geriatric medicine. Examples from recent studies. 198 60

A recent report suggested that more than 50% of terminal cancer patients have physical suffering that requires sedation in the last days of life. To evaluate this finding on our 14-bed palliative care unit, a retrospective analysis of 100 consecutive patients admitted for 6 days or more was carried out. Information was collected on major symptoms requiring treatment, symptom control at admission and during each of the last 7 days of life, medications used, and changes that may have contributed to sedation. Of the 100 patients, 99 had pain, 46 had dyspnea, 71 had nausea, and 39 experienced delirium. Visual Analogue Scores (VAS) were done twice a day in all patients; mean pain showed a change from 31 +/- 24 on Day 6 to 24 +/- 19 on day of death (DOD) (p less than 0.05); nausea from 19 +/- 18 on Day 6 to 13 +/- 9 on DOD (p less than 0.01); drowsiness from 51 +/- 28 on Day 6 to 85 +/- 45 on DOD (p less than 0.001); symptom distress score from 49 +/- 11 on Day 6 to 52 +/- 9 on DOD (p less than 0.01). On the day of admission (DOA), 69% of VAS were done by the patient and 28% by the nurse as compared to 8% by the patient and 90% by the nurse on DOD. Level of consciousness on DOA was alert (72%), drowsy (28%), unresponsive (0%) and by DOD was alert (2%), drowsy (41%), unresponsive (57%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Symptom control during the last week of life on a palliative care unit. 204 96

The aim of this study was to investigate the relation between Antabus dosage and the disulfiram-alcohol reaction (DAR) after ethanol challenge. Fifty-two healthy volunteers, 29 men and 23 women, aged 20-61 years, were treated with increasing doses of Antabuse (1, 100, 200, 300 mg) for 14 days each. At the end of each 14 days the volunteers were challenged with 0.15 g ethanol/kg body weight. Blood pressure, pulse rate, respiration rate, and symptoms such as flushing, heat sensation, nausea, vomiting, palpitations, breathlessness, and headache were monitored for the next 50 min. The volunteers left the study when they had experienced a valid DAR. A valid DAR, which was principally defined on the basis of the patients' feeling of discomfort, but for safety reasons also on the basis of unacceptable circulatory changes, was reached in 21 out of 52 volunteers after 100 mg Antabuse, in 27 after 200 mg, and in 4 after 300 mg. Most of them left the study after flushing and circulatory changes, but did not feel ill enough to be convinced that they should abstain from drinking. Ten volunteers with weak subjective symptoms, but with a valid DAR, were therefore rechallenged after the next increased dose and experienced a somewhat stronger reaction. We conclude that a daily dose of 200 mg Antabuse brings about a substantial reaction in volunteers in the presence of alcohol. The possible need for a 300 mg dose of Antabuse to prevent a patient from drinking was discussed.
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PMID:Dose-effect relationship of disulfiram in human volunteers. I: Clinical studies. 205 46


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