Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of extragenital choriocarcinoma which produces human chorionic gonadotropin (HCG) in the small intestine of a 48-yr-old Japanese women is reported. Only seven such cases have been reported. The patient complained of postprandial upper abdominal pain and vomiting of 5 months' duration. Nine years before, right upper lobectomy was performed because of lung undifferentiated carcinoma. Double-contrast examination of the small intestine showed irregular ulceration in the lower jejunum. Celiac angiography demonstrated a hypervascular tumor stain in the branch of the jejunal artery. The serum HCG level was elevated. Gynecological examination revealed nothing abnormal. A small intestinal neoplasm was diagnosed, and a partial resection of the jejunum was performed. Endoscopy on the operating table showed a large, irregularly shaped sessile ulcer. Histologically the tumor was diagnosed as choriocarcinoma, composed of syncytiotrophoblastic cells and cytotrophoblastic cells. Immunohistochemical staining for HCG was positive. No metastasis was present. Although extragenital choriocarcinoma in the small intestine is rare, it should be included in the differential diagnosis of small intestinal neoplasm.
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PMID:A case of extragenital choriocarcinoma in the jejunum. 185 45

Molar pregnancy, which results from an anomaly in the development of the trophoblastic tissue, is now easy to diagnose based on clinical evidence, beta hCG level, and sonography, although it must be histologically confirmed. Treatment remains difficult because of the danger of hemorrhage or trauma during uterine evacuation. Hydatidiform mole was diagnosed in the 1st pregnancy of a 27-year-old woman on the basis of a routine 1st trimester sonogram. Clinical examination revealed a voluminous uterus and a long, closed, very tonic cervix. Sulprostone was administered to aid cervical dilatation. An initial intramuscular injection of sulprostone caused uterine contractions without cervical modifications. 5 hours later an intravenous perfusion of sulprostone was started, during which significant contractions and cervical modifications were observed. An aspiration curettage was performed, in which numerous vesicles typical of the hydatidiform mole were evacuated. There was no need for further cervical dilatation and the curettage was rapid and nonhemorrhagic. The postoperative course was uneventful, and a test of beta hCG levels 6 weeks later was negative. The patient complained of pain during uterine contractions despite use of high doses of pethidine. The frequency of hydatidiform mole varies in different countries. It has been estimated at 1/85 in Indonesia and 1/2000 in the US. The clinical picture of hydatidiform mole includes vomiting often nonresponsive to treatment and metrorrhagia of varying volume, a large uterus for the gestational age, and often bilateral ovarian cysts. A vasculorenal syndrome may also begin at 13-16 weeks of amenorrhea. Beta hCG levels are high for the gestational age. Sonography reveals no embryonic structures. Biopsy shows a complete absence of embryo and amniotic sac. The karyotype is diploid and almost always XX. The mechanism is fertilization of an ovocyte whose nucleus is absent or inactive. The 2 chromosome sets are contributed by the father, a circumstance incompatible with embryonic development. Trophoblastic proliferation occurs without embryonic development. Hydatidiform moles may be transformed to invasive moles or chorioepithelioma. Treatment includes uterine evacuation by aspiration under sonographic control if possible. Many authors recommend oxytocin and antibiotic cover. The use of prostaglandin analogs to facilitate uterine evacuation is controversial, with some authors citing the increased risk of trophoblastic embolism. The mole should be histopathologically and cytogenetically studied, and postmolar follow-up is essential.
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PMID:[Use of sulprostone in the evacuation of molar pregnancies]. 206 88

Etoposide is a semisynthetic podophyllotoxin derivative with a broad spectrum of antitumor activity and a relatively high therapeutic index. The synergism in animal with cis-platinum, cyclophosphamide, BCNU, and cytosinarabinoside is interesting for combination regimen. Mechanisms of action are inhibition of nucleoside transfer and of DNA and RNA synthesis, single stranded breaks, inhibition of protein synthesis and of microtubular assembly. While in lower concentrations etoposide is acting cell-cycle-dependent with accumulation of cells in the G2-phase it has, in high concentrations, also a cellcycle-phase-unspecific lethal effect. Most suitable is the oral and i.v. application of etoposide in fractionated doses of 80--120 mg/m2 on 3--5 consecutive days and repetition after 21 [14--28] days. Side effects are dose-limiting bone marrow toxicity, nausea, vomiting, fever, hypotension, phlebitis, mucositis, neuropathy, cardiotoxicity, alopecia. Etoposide is one of the most active single agents in small-cell bronchus carcinoma with a remission rate of 37% (10% CR), and is very active in NHL (36%), testicular carcinoma (37%), AMML (35%), choriocarcinoma (35%), and neuroblastoma (29%). The role of etoposide in combination with other active drugs in these tumors is currently investigated in bronchus and testicular carcinoma and NHL, where etoposide will belong to the drugs of the first choice in the future.
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PMID:[Etoposide VP 16--213)--a podophyllotoxinderivative with high antitumor activity (author's transl)]. 703 50

Seventeen patients with germ cell tumours of ovary were treated with 4 cycles of cisplatin, bleomycin and vinblastine (PVB) chemotherapy (CT). All patients had undergone prior surgery: hysterectomy + bilateral salpingo-oophorectomy + omentectomy-5, salpingo-oophorectomy + debulking surgery-10 and biopsy alone in 2 patients. Four of seventeen patients had relapsed earlier and received PVB as second line therapy. FIGO staging revealed: stage IIB in one, III C in 12 and stage IV in 4 patients. Gross residual disease (> 2 cm) was present in 13 patients. The most common cell types were dysgerminoma-5, endodermal sinus tumour-5, immature teratoma-5, choriocarcinoma and mixed germ cell tumour in one patient each. Twelve patients (70.5%) achieved significant response; complete response-11, partial response in one patient. The common side effects of CT were nausea/vomiting, myelosuppression, fever, mucositis, diarrhoea and alopecia. One patient died due to CT toxicity. Three complete responders underwent second look surgery and were found free of disease. This study confirms that PVB is an effective combination in the treatment of advanced and recurrent germ cell tumours of ovary and can be given over brief period. The toxicity of the regimen is moderate.
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PMID:Cisplatin, vinblastine and bleomycin in advanced and relapsed germ cell tumours of ovary. 769 Oct 50

Twenty-eight patients with choriocarcinoma have received the three kinds of combination chemotherapy since 1983 at our department, i.e., MOA consisting of moderate dose methotrexate (MTX), actinomycin-D (Act-D) and vincristine, MEA (moderate dose MTX, Act-D and etoposide) and FA (high dose 5-Fluorouracil and Act-D). The clinical and laboratory data obtained in the 28 patients were summarized as follows; 1. The MOA regimen was administered to 4 patients primarily and to 2 secondarily. All of the 6 patients attained remission, but finally two (33.3%) developed relapse. 2. The MEA regimen was administered to 12 patients primarily and to 12 secondarily. Of the 24 patients, five (20.8%) were found to be resistant to the MEA regimen. Nineteen patients (79.2%) attained remission, but 2 (10.5%) developed recurrence. 3. The FA regimen was attempted in one patient primarily and in 6 secondarily. Although one patient died, the remaining 6 achieved remission and one relapse has been observed in the 6 cases. 4. By applying the above mentioned 3 combination chemotherapy regimens, the overall survival rate was pushed up from 64% to 90% in choriocarcinoma patients. 5. Three patients finally died of the disease but not from the side effects of the combination chemotherapies. The major adverse effects were alopecia, nausea, vomiting and myelosuppression. In particular, serious myelosuppression was caused by the MEA or FA regimen in 5-7% of all chemotherapy courses.
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PMID:[A study of first and second line chemotherapies in gestational choriocarcinoma]. 825 29

This is report regarding a 28-year-old woman who conceived and delivered a healthy child following treatment for brain metastasis of choriocarcinoma in 1980 and a prolonged postoperative disease-free period. The patient had delivered a hydatidiform mole. Eight months afterwards she was admitted to our hospital with occipital pain, vomiting and stupor, and upon CT examination was found to have a brain tumor. The surgically removed tumor was pathologically diagnosed as choriocarcinoma. Postoperative methotrexate chemotherapy rapidly lowered the preoperative urinary human chorionic gonadotrophin (19 IU/ml), and allowed restoration of the preoperative LH level, consciousness, ambulation, and manifest ovulation. Occasional mild cramps were received by continuous use of anticonvulsants which did not affect her daily life. Four and one-half years postoperatively she conceived, and had a healthy boy weighing 2,294 g at the 39th week of gestation in June 1985. Both mother and baby have been doing well for 7 postpartum years.
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PMID:A case of successful pregnancy and delivery after brain metastasis of choriocarcinoma. 848 64

Methotrexate, a folic acid antagonist, is approved by the US Food and Drug Administration for use in rheumatoid arthritis, psoriasis, and various types of cancer, including choriocarcinoma, and has also been used to terminate ectopic pregnancies. Misoprostol, a prostaglandin, is approved for the prevention of gastric ulcers induced by nonsteroidal anti-inflammatory drugs. In France, the UK, and Sweden, misoprostol and another prostaglandin is used with mifepristone (RU486) to induce abortion in early pregnancy. Recent articles in the press have suggested that in early pregnancy, an intramuscular injection of methotrexate and oral or vaginal administration of misoprostol offers a medical alternative to a surgically induced abortion. This paper describes the mechanisms of action, pharmacokinetics, clinical use, and adverse effects of the two drugs. It is concluded that an intramuscular injection of methotrexate followed up to seven days later by the intravaginal administration of misoprostol can terminate an early intrauterine pregnancy. Headache, nausea, vomiting, diarrhea, and prolonged bleeding have occurred. However, in the few studies published to date, no serious complications have been reported.
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PMID:Methotrexate and misoprostol for abortion. 860 22

There is abundant evidence that human chorionic gonadotropin (hCG) is a weak thyrotropin (TSH) agonist. In FRTL-5 rat thyroid cells, hCG increases cyclic adenosine monophosphate (cAMP), iodide transport, and cell growth. hCG has thyroid-stimulating activity in bioassays in mice and in clinical studies in man. In cultured cells transfected with the human TSH receptor, hCG increases generation of cAMP. Molecular variants of hCG with increased thyrotropic potency include basic molecules with reduced sialic acid content, truncated molecules lacking the C-terminal tail, or molecules in which the 47-48 peptide bond in the beta-subunit loop is nicked. In normal pregnancy, when hCG levels are highest at 10 to 12 weeks gestation, there is suppression of serum TSH levels, presumably due to slight increases in free thyroxine (T4) concentration. In twin pregnancies, hCG levels tend to be higher and suppressed TSH levels are more frequent. Hyperemesis gravidarum, defined as severe vomiting in early pregnancy that causes 5% weight loss and ketonuria, is usually associated with increased hCG concentration. A high proportion of patients with hyperemesis gravidarum, about one-third to two-thirds in different series, have evidence of increased thyroid function. Only a small proportion of these patients have clinical hyperthyroidism, termed gestational thyrotoxicosis. These patients probably secrete a variant of hCG with increased thyroid-stimulating activity. Trophoblastic tumors, hydatidiform mole, and choriocarcinoma often cause hyperthyroidism because they secrete very large amounts of hCG. When the serum hCG exceeds about 200 IU/mL, hyperthyroidism is likely to be found. There is a correlation between the biochemical severity of hyperthyroidism and the serum hCG in these patients. Removal of the mole or effective chemotherapy of the choriocarcinoma cures the hyperthyroidism. In conclusion, hCG has thyroid-stimulating activity that influences thyroid function early in pregnancy when hCG levels are high. Excessive hCG secretion may cause hyperthyroidism in patients with hyperemesis gravidarum or trophoblastic tumors.
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PMID:Human chorionic gonadotropin and the thyroid: hyperemesis gravidarum and trophoblastic tumors. 1044 9

We report an unusual hepatoid adenocarcinoma in Barrett's esophagus with achalasia, which developed in a 44-year-old Japanese woman. The patient received an esophago-gastrectomy after diagnosis of the tumor and achalasia at the lower esophagus, 4 months before her death due to multiple metastatic tumors of the liver. The main granular tumor removed surgically was a hepatoid adenocarcinoma, mainly composed of clear cancer cells (alpha-1 antitrypsin, albumin and alpha-fetoprotein positive), with elements of choriocarcinoma and tubular adenocarcinoma. Non-neoplastic specialized columnar epithelium was present extensively near the oral side of the tumor edge in the esophagus, indicating Barrett's esophagus. This unusual tumor was therefore considered to have originated in Barrett's esophagus. The gastroesophageal reflux was presumed to have occurred for a long period, as there was a well-preserved fundic gland in the stomach and a history of frequent vomiting from the patient's youth, accounting for the appearance of achalasia.
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PMID:Hepatoid adenocarcinoma in Barrett's esophagus associated with achalasia: first case report. 1194 Feb 19

A 60-year-old man was admitted with pain in the abdomen and vomiting for one day; radiography revealed pneumoperitoneum. Laparotomy with excision of ulcer-bearing portion of the jejunum was done. Histology revealed choriocarcinoma with syncytiotrophoblastic and cytotrophoblastic cell differentiation. Postoperatively, urine and serum showed high levels of beta-human chorionic gonadotrophins. The patient expired after an unsatisfactory postoperative course.
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PMID:Primary choriocarcinoma of jejunum. 1199 Mar 34


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