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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Mallory-Weiss syndrome is defined as bleeding from longitudinal tears in the gastro-oesophageal junction. The characteristic history consists of repeated vomiting followed by sudden haematemesis. During the past 4 1/2 years, 23 patients, 17 males and 6 females with the diagnosis of Mallory-Weiss syndrome were treated in our institution. An aetiological factor has been sought for. In a review of the case-records, we discovered that many patients had coagulation defects on admission. This was verified with extended coagulation tests at later follow-up. It is proposed that non-bleeding lacerations in the cardiac orifice in conjunction with vomiting is a common occurence, and that the Mallory-Weiss syndrome may be regarded as a complication occuring predominantly in patients with some coagulation defect.
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PMID:The Mallory-Weiss syndrome. A review of 23 cases with special reference to coagulation defects. 27 41

This chapter addresses the role of health professionals in providing abortions and examines the dynamic technology of this field. Once the decision to perform an abortion is made, the proper procedure must be selected. Gestational age is the fundamental determinant but the experience and capability of the practitioner are also crucial. Suction curettage is the safest and most effective procedure available for abortions performed within 10 weeks of conception. Evaluation of the abortion patient should include, at a minimum, tests for hemoglobin, presence of gonococci, and Rh type. One of the most important parts of preparation for an abortion is sensitive and searching counseling. A potentially serious complication of suction curettage is perforation of the uterus. Dilatation and evacuation (D and E), is similar to the suction curettage procedure. This method may be used for gestations of 20 or more weeks after conception and requires greater operator expertise and experience. The complications of D and E are similar to those of suction curettage but are more frequent. Amnioinfusion is currently the most widely used method of pregnancy termination after 14 weeks in the US. The abortifacient agent that has had the greatest use is hypertonic saline. Morbidity associated with saline amnioinfusion includes hemorrhage requiring transfusion, retained tissue requiring manual or surgical removal infection, coagulopathy, and hypernatremia. Prostaglandins are alternative abortifacient agents. A disadvantage of using prostaglandins to induce abortion is that they frequently require repeat doses to be effective. Other disadvantages include nausea, vomiting, diarhea, and bronchospasm. Urea is anther effective abortifacient agent.
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PMID:Abortion. 38 51

The increased prevalence of rodents resistant to warfarin led to the development of the hydroxycoumarin anticoagulant brodifacoum. A 25-year-old man attempted suicide by consuming four boxes of d-CON Mouse-Prufe II; each box contains 42 g of bait that is 0.005% brodifacoum. He presented to a hospital nine days later with syncope, hematochezia, gross hematuria, epistaxis, anemia, and a severe coagulopathy. Radiographic studies were consistent with pleural, pericardial, and mediastinal hemorrhages. Vitamin K and fresh frozen plasma were given, and he was later discharged on oral phytonadione (vitamin K1). The patient's coagulopathy recurred, necessitating multiple plasma transfusions and prolonged treatment with oral phytonadione. Fifteen weeks after hospital discharge, he presented again with a history of additional brodifacoum ingestion. Neurologic status was initially normal, but in the emergency department he suddenly became comatose soon after emesis was induced with syrup of ipecac. Computed tomography of the brain revealed a subarachnoid hemorrhage that led to brain death less than 24 hours later. This case demonstrates the severe and prolonged coagulopathy that can result from ingestion of brodifacoum, a compound that has a toxic potency about 200-fold that of warfarin and a half-life as much as 60 times longer.
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PMID:Fatal rodenticide poisoning with brodifacoum. 134 54

Three residents of New Jersey suddenly developed vomiting, abdominal pain, and watery diarrhea 12 h after ingesting five to 13 hand-picked Amanita phalloides-type mushrooms. The group was led by an amateur mycologist who had been eating hand-picked mushrooms without complications for 20 years. The patients developed mild to severe acute hepatic injury, with a peak serum aspartate aminotransferase level ranging from 133 to 826 Karmen U/L, and a peak serum alanine amino-transferase level ranging from 163 to 1176 Karmen U/L. One of the patients developed a transient severe coagulopathy, but no one developed renal failure or hepatic coma, and all rapidly improved. These three cases demonstrate that mycetismus can occur in the heavily urbanized northeastern United States, that consuming hand-picked mushrooms even under the guidance of an experienced amateur may be dangerous, and that Amanita phalloides ingestion produces a biphasic illness with early gastrointestinal symptoms and subsequent hepatic injury.
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PMID:Gastrointestinal and hepatic effects of Amanita phalloides ingestion. 147 67

A 39-year-old woman was evaluated for possible liver transplantation due to rapidly developing hepatic failure 4 weeks after initiation of oral minocycline 100 mg twice a day for the treatment of acne. The patient developed a maculopapular rash, malaise, fever, nausea, and vomiting 2 weeks prior to admission to the hospital. On admission, her symptoms rapidly progressed to liver failure characterized by rapidly rising liver enzyme levels, worsening encephalopathy, and coagulopathy. Viral hepatitis serologies and blood cultures were all negative. After intensive supportive care for 2 weeks, the patient's condition gradually improved and she was discharged with mildly elevated liver enzyme levels and pruritus, without need of liver transplantation. Minocycline-induced hepatic injury is an idiosyncratic reaction with a sensitization period that appears to be 3-4 weeks in duration. The characteristic features include rash, fever, lymphadenopathy, and eosinophilia, as well as severe alterations in liver function. The high liver enzyme levels and the significant prolongation of the prothrombin time suggest massive hepatocellular damage. In light of the profound liver damage that occurs with this adverse reaction, care should be taken in administering minocycline to patients who have concomitant liver disease. It is recommended that patients should be instructed as to the possible signs and symptoms of toxicity and be monitored for evidence of idiosyncratic reaction or liver failure.
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PMID:Acute hepatic failure associated with oral minocycline: a case report. 153 50

Twenty-two evaluable patients with advanced adenocarcinoma of the pancreas, but without prior chemotherapy or immunotherapy, received recombinant tumor necrosis factor (rTNF). rTNF was given as an intravenous infusion over 30 min daily x 5, every 14 days, at a starting dose of 150 micrograms/m2/day. Toxicities included fevers/rigors, nausea/vomiting/anorexia, flu-like symptoms, hypotension, hyperglycemia, anemia, coagulopathy, hepatotoxicity, and hypertriglyceridemia. Laboratory evidence of disseminated intravascular coagulopathy occurred in 11 patients, with only 3 of these patients having clinical manifestations. Two patients suffered from pulmonary emboli. The high incidence of coagulopathy was felt to be, at least in part, disease related. No objective responses were observed with a 95% confidence interval of 0-15%.
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PMID:A phase II trial of recombinant tumor necrosis factor in patients with adenocarcinoma of the pancreas: a Southwest Oncology Group study. 179 Jan 46

The medical literature includes reports of necrotizing fascitis after Bartholin abscesses, vaginal delivery, cesarean section, abdominal hysterectomy, sterilization by bilateral total salpingectomy, and diagnostic laparoscopy. This paper presents the 1st documented report of necrotizing fascitis after sterilization by bilateral partial salpingectomy. The patient, a healthy 41-year-old, presented with severe abdominal pain, nausea, and vomiting 1 day after undergoing bilateral partial resection and ligation of the fallopian tubes through a suprapubic minilaparotomy incision (Pomeroy procedure). Disseminated intravascular coagulopathy developed soon after admission. Surgery, performed once the patient has been stabilized through corticosteroids and broad-spectrum antibiotics, revealed extensive necrotizing fascitis involving the entire abdominal wall. There was no perforation of the bowel or uterus. Escherichia coli was cultured from the patient's abdominal wall, urine, and blood. The patient was treated successfully with piperacillin, gentamicin, and clindamycin. 15 days later, multiple reconstructive procedures were initiated to close the abdominal defect. This patient's good recovery was due to the speed of the diagnosis and wide surgical debridement of all devitalized tissue. Since she showed no evidence of salpingitis at the time of the sterilization procedure, the source of bacterial inoculum in this case was most likely the patient's skin.
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PMID:Necrotizing fasciitis of the total abdominal wall after sterilization by partial salpingectomy. Case report and review of literature. 214 53

Recurrent, bilateral, and severe conjunctival hemorrhages mandate the search for an underlying etiology, such as a blood dyscrasia, blood clotting disorder, or recurrent increased intrathoracic pressure caused by repetitive vomiting or coughing spells. Medical and ophthalmic management is discussed in a case of subconjunctival and external hemorrhage from the eye secondary to prolonged prothrombin time in oral anticoagulation therapy.
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PMID:Subconjunctival and external hemorrhage secondary to oral anticoagulation. 224 71

This prospective study was undertaken to determine the incidence, severity, time of onset, and duration of coagulopathy in children following accidental ingestion of long-acting anticoagulant rodenticides, often called "superwarfarins." Of 110 children, who ingested superwarfarins and in whom one or more prothrombin time values were obtained, 8 had a prothrombin time ratio (patient to control) of greater than or equal to 1.2, indicative of anticoagulation. Prothrombin time values obtained 48 hours after ingestion were more likely to be prolonged (6/34, 17.6%) than values obtained 24 hours after ingestion (2/104, 1.9%) (P less than .005). The occurrence of an abnormal prothrombin time could not be predicted based on the history of amount ingested or on the presence of the characteristic green-blue product dye in or around the child's mouth. Acute toxicity was evidenced by transient abdominal pain, vomiting, and heme positive stools in 2 patients. The duration of prothrombin time prolongation could not be determined because of the few values obtained after 48 hours. To detect all possible abnormal prothrombin time values, 24- and 48-hour determinations are recommended after a child has ingested a superwarfarin.
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PMID:Superwarfarin poisoning in children: a prospective study. 277 52

Five cases of acute fatty liver of pregnancy are described. These are the only recognized cases of this disorder occurring in a 2 year period in Western Australia. Clinical and laboratory features are presented. There was no maternal death. Of the six babies, there were three intrauterine deaths, including the only set of twins. All the babies were male. Vomiting in the third trimester was the chief presenting feature in all cases, often accompanied by a systemic illness with malaise and tiredness. Extreme polydipsia was noted as a prominent symptom in all cases. The combination of moderately abnormal liver function tests, extreme leucocytosis with other blood film abnormalities, hypoglycaemia, impaired renal function, coagulopathy and gross elevation of uric acid level is regarded as highly suggestive of the diagnosis. Features of a preeclamptic illness were present in several cases. Three of the patients have since had uneventful pregnancies. The constellation of clinical and laboratory features is sufficiently characteristic to allow accurate clinical diagnosis in most cases of this disorder. The chances of both maternal and fetal survival are enhanced by early diagnosis allowing intervention in the form of prompt delivery of the infant.
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PMID:Acute fatty liver of pregnancy: clinical features and diagnosis. 321 85


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