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

Cerebral abscess is a classical complication of cyanotic congenital heart disease. The authors report 7 cases of cerebral abscess diagnosed since 1982. One asymptomatic patient died of a postoperative cerebral haemorrage. The child was repatriated from Africa for complete correction of his cardiac lesion. The presentation of the other 6 cases was quite typical : headaches, pyrexia and vomiting with a neurological deficit in 4 cases : two hemiparesias and two homonymous lateral hemianopsia. These 6 patients recovered without sequeilae. Four underwent surgical drainage of the abscess with antibiotic therapy. Two recovered with antibiotic therapy alone. The causal organism was only identified in patients undergoing surgical drainage and then only in 3 cases. They were gram positive cocci, in particular the streptococcus. The association ampicillin-chloramphenicol has often been proposed as the treatment of first intention. Adaptation of antibiotic therapy then depends on clinical, biological, bacteriological (CSF, blood cultures, portal of entry) outcomes and the results of CT scanning. The association of a third generation cephalosporin and an imidazole may be proposed as treatment of second intention. The minimal duration of treatment is generally acknowledged to be 4 weeks for intravenous therapy in cases of medical therapy alone, and 2 to 3 weeks in cases with surgical drainage. The age of apparition of this complication seems to be increasing as the average age was 16 in this series (cerebral abscess is classically described as occurring between 8 and 12 years of age). This may be due to palliative surgery which reduces systemic hypoxia and polycythaemia. It also appears that neurological drainage is not systematic now because of early diagnosis of this complication. Finally, in the last few years, a new population of patients is becoming more common : patients repatriated by humanitary organisations in the third world, which should incite great vigilance in the preoperative period in this pathology.
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PMID:[Cerebral abscess and cyanotic congenital heart disease]. 929 46

Paroxysmal supraventricular tachycardia (SVT) may have numerous electro-physiologic mechanisms. The most common type of SVT is AV-nodal reentry tachycardia (60%) followed by the bypass tract-mediated SVT (preexcitation. 30%) and a smaller group (10%) comprising paroxysmal atrial flutter or fibrillation and atrial ectopic tachycardia. In persons with otherwise normal hearts symptoms are usually mild and include palpitations or an uneasy feeling in the chest. But some describe precordial pain. Weakness, dizziness, nausea, vomiting, and even syncope. Whenever possible a 12-lead-ECG during an episode of SVT should be obtained. If not possible the use of several Holter-ECG or of an event-recorder may be helpful. Conversion of a SVT can be accomplished by vagal maneuvers or intravenous adenosine (6-18 mg bolus injection). Further diagnostic procedures should prove or rule out a significant structural heart disease. Therapeutic options (expectative, pharmacological prophylaxis, invasive electrophysiologic testing and catheter-mediated modification or ablation) are chosen according to the objective threat (e.g. ventricular fibrillation due to 1:1 conducted atrial fibrillation in a preexcitation syndrome) and the subjective complaints. Definitive healing of the AV-nodal reentry tachycardia and the bypass tract-mediated SVT can be achieved by use of catheter-mediated modification or ablation in 95 to nearly 100%.
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PMID:[Modern therapy of paroxysmal supraventricular tachycardia]. 1009 47

Transthoracic echocardiography (TTE) is a painless, noninvasive and risk-free diagnostic method in children with known or suspected congenital heart disease. Sedation is frequently required for an optimal achievement of this procedure. The purpose of this study was to determine the safety and efficacy of chloral hydrate (CH) sedation in undergoing TTE. The study population included 360 patients with a median age of 19 months. (2 weeks to 8 years). The median dosage of CH given was 75 mg/kg (ranging 50 and 100 mg), with either oral or rectal administration. Oral administration could not be achieved successfully in 90 patients (20%) because of the bitter taste of the drug, in the other 108 patients (30%), vomiting occurred immediately after drug administration. Prior to CH administration and until discharge; respiratory rate; heart rate, blood pressure and oxygen saturation were recorded. Sedation was successfully achieved in 342 (95%) of the patients. No child had a clinically significant change in heart rate, blood pressure and respiratory rate during sedation. There were also no significant differences in heart rate, respiratory rate, blood pressure and oxygen saturation before and after sedation. Although CH has a bitter taste and is a gastric irritant for oral medication, because of the minimal side effects and efficacy for sedation, it remains as a safe and successful drug for use in children for TTE.
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PMID:Chloralhydrate in children undergoing echocardiography. 1137 Apr 37

The association between long haul travel and the risk of venous thromboembolism are suspected for long time. Mostly air travel related thrombosis series have been reported in the literature. Risk factors can be classified as: 1. travel related factors (coach position, immobilization, prolonged air travel, narrow seat and room, diuretic effect of alcohol, insufficient fluid intake, dehydration, direct pressure on leg veins, rare inspiration). 2. air plane related risk factors (low humidity, relative hypoxia, stress). 3. patient related factors (hereditary and acquired thrombophylia, previous deep venous thrombosis, age over 40, recent surgery or trauma, gravidity, puerperium, oestrogen containing pills, varicosity, chronic heart disease, obesity, fever, diarrhoea, vomiting, smoking). No patient related factors were found in some cases. To reduce the hazards air travellers are rightly concerned to know the level of the risk and the airlines should be responsible for this information. People should discuss with their physician what prophlylactic measures should be taken, such as compression stockings or low molecular weight heparin. Not only flight but car, bus and train travellers are also at risk of developing venous thromboembolism. Long haul travel alone is a separate risk factor for venous thromboembolism.
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PMID:[Thromboembolism in travelers]. 1177 54

Syncope is defined as a temporary interruption of cerebral perfusion with a sudden and transient loss of consciousness and spontaneous recovery. Approximately one third of the population experiences syncope at least once during a lifetime. Presyncopal signs and symptoms, including weakness, headache, blurred vision, diaphoresis, nausea, and vomiting are sometimes present for seconds or minutes prior to loss of consciousness. After syncope, the patients may present with persisting drowsiness, headache, dizziness, nausea, but not usually confusion. Causes of syncope have been categorized as cardiovascular, non-cardiovascular, and unexplained. Cardiovascular causes can be subdivided into structural heart disease, coronary heart disease, and arrhythmia. Non-cardiovascular causes include neurological, metabolic, psychiatric and other disorders.Orthostatic hypotension - one of the most frequent causes of syncope - has manifold etiologies comprising various neurological and internal diseases. Orthostatic hypotension usually can be attributed to an impairment of peripheral vasoconstriction or to a reduction of the intravascular volume. Signs and symptoms, including the above prodromi are often present just after rising from a supine or sitting position. Frequently, blood pressure decreases significantly without an increase in heart rate. Autonomic cardiovascular modulation is often reduced. Many of the patients with "unexplained" syncope experience neurally mediated (i. e. neurocardiogenic or vasovagal) syncope. In these patients, cardiovascular control may be stable for an extended period of time during orthostatic stress, then there is a sudden decrease in blood pressure and heart rate. Neurocardiogenic or neurally mediated syncope can be associated with painful or emotionally stressful situations such as anxiety or fear, with prolonged standing or specific trigger situations such as micturition, defecation, coughing or sneezing, visceral or carotid sinus stimulation, or with trigeminal or glossopharyngeal neuralgia. So far, the mechanisms of neurocardiogenic syncope are not completely understood. The passive 60 degrees to 70 degrees head-up tilt test is useful for the diagnosis of orthostatic and neurally mediated syncope. The sensitivity of the test can be improved by additional pharmacological provocation, e. g. by isoproterenol, or by increased orthostatic stress using lower body negative pressure stimulation. For the treatment of syncope one should first consider non-pharmacological options. Patients with orthostatic hypotension should avoid rapid changes of the body position from supine to standing, as well as high room temperature or other situations inducing peripheral vasodilatation. An increased intake of sodium and fluids, mild physical exercise or so-called postural counter-maneuvers can improve orthostatic tolerance. Among the drugs recommended for pharmacologic treatment are mineralocorticoids (e. g. fludrocortisone), vasoconstrictor agents (e. g. ephedrine, midodrine), adenosine receptor blockers (theophylline) and beta2-blockers (propanolol), anticholinergic agents, e. g. scopolamine or disopyramide, and negative cardiac inotropes, e. g. beta1-adrenergic blockers or disopyramide. Serotonin reuptake inhibitors (e. g. fluoxetine, sertraline), alpha2-adrenergic agonists (clonidine), central nervous system stimulants such as methylphenidate or phentermine are thought to be beneficial in specific cases. Cardiac pacemakers often seem to be recommended without adequate indication. The antidiuretic, V2-receptor specific, vasopressin analogue desmopressin increases the intravascular volume. Erythropoietin improves anemia and red blood cell decrease and augments blood pressure and cerebral oxygenation. In postprandial hypotension, octreotide, a somatostatin analogue, prostaglandin inhibitors such as indomethacin or ibuprofen, as well as metoclopramide or two cups of coffee per day might be beneficial.
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PMID:[Syncope - a systematic overview of classification, pathogenesis, diagnosis and management]. 1182 26

Modern medicine 1st made the oral contraceptive (OC), a combined OC, available to women in 1960, and much progress in improving OCs and reducing risks associated with them has occurred. Approximately 200 million women have used OCs worldwide and about 60 million women are currently using this contraceptive method. OCs are efficacious because the hormones in the OCs alter the physiology of the hypothalamo-pituitary-ovarian/uterine axis at 6 sites, e.g., altering the endometrium so implantation of the blastocyst cannot occur. Despite the effectiveness of OCs (virtually 100% effective) in comparison with other contraceptive methods, they often cause side effects and complications. Some side effects and complications from estrogen and predominantly estrogen OCs include vomiting, hypertension, and venous thrombosis/pulmonary embolism. Possible progestogen and predominatly progestogen OC side effects and complications are leucorrhea, urinary tract infections, epilepsy aggravation, and cholestatic jaundice. In addition, pregnancy, venous thromboembolism, heart disease, and malignancies of the breast and genital tract are absolute contraindications to OCs. On the other hand, OCs provide health benefits, in addition to preventing unwanted pregnancies, such as lowered incidence of pelvic inflammatory disease, acne improvement, and protection against endometrial carcinoma and ovarian epithelial neoplasia. In order to ensure that health benefits of OCs are maximized and the risks minimized, family planning practitioners worldwide must monitor OC users for side effects. Recent OC formulations now include the progestogen only OCs, multiphase OCs, low dose OC called gestodene, and the "morning after pill".
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PMID:Oral steroidal contraception: scientific basis and recent development. 1234 71

In several ancient systems of medicine including Ayurveda, Greek, Roman, Siddha and Unani, Ocimum sanctum has vast number of therapeutic applications such as in cardiopathy, haemopathy, leucoderma, asthma, bronchitis, catarrhal fever, otalgia, hepatopathy, vomiting, lumbago, hiccups, ophthalmia, gastropathy, genitourinary disorders, ringworm, verminosis and skin diseases etc. The present review incorporates the description of O. sanctum plant, its chemical constituents, and various pharmacological activities.
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PMID:Validation of traditional claim of Tulsi, Ocimum sanctum Linn. as a medicinal plant. 1259 45

Daunorubicin (DNR) is one of the most important cytotoxic agents in the treatment of acute myeloid leukemia (AML). Its use is usually limited by drug-induced cardiotoxicity depending on the cumulative dose administered. Liposomal encapsulation of DNR (DaunoXome, DNX) seems to reduce the risk of this severe side effect. To investigate the toxicity of DNX in heavily pretreated patients, we conducted a phase I trial, including patients (pts) older than 60 years with relapsed or refractory AML. DNX was used at doses of 40, 60, 75 and 90 mg/m(2), biweekly. Fourteen patients with a median age of 69 years (range, 63-77) were enrolled. A total of 49 courses of DNX were administered [3 pts at 40 mg/m(2) (for a total of 13 courses), 5 at 60 mg/m(2) (20 courses), 4 at 75 mg/m(2) (12 courses), and 2 at 90 mg/m(2) (4 courses)]. The mean cumulative dose of DNX administered was 340 mg (range, 120-1200). A 20% decline in the left ventricular ejection fraction (LVEF) without clinical signs and symptoms of heart failure was noted in 2 patients after a cumulative DNX dose of 480 mg, both with pre-existing heart disease. Even at the highest cumulative doses of DNX, no further decline in LVEF was noted. Nausea, vomiting, alopecia and mucositis were absent. All patients had significant myelosuppression requiring transfusion support. During treatment, 3 patients showed a 25% reduction of leukemic blasts in the bone marrow, 3 patients had to be excluded due to AML progression after the 2nd DNX course, and 7 patients died during the first 6 weeks of treatment. We conclude from these data that DNX offers a less toxic alternative to DNR and other anthracyclines. Using DNX dosages of 40 to 90 mg/m(2) biweekly seems to have little anti-leukemic activity in a patient population heavily pretreated with anthracyclines.
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PMID:Phase I study of liposomal daunorubicin in relapsed and refractory acute myeloid leukemia. 1279 45

Coronary artery aneurysms are uncommon and the prevalence in patients undergoing coronary artery angiography is 1.5-4.9%. The most common cause of coronary artery aneurysm is arteriosclerosis, followed by Kawasaki disease, periarteritis nodosa, systemic lupus erythematosus, syphilis, rheumatic fever, congenital heart disease and trauma. Most coronary aneurysms remain asymptomatic. Patients may present symptoms of angina or myocardial infarction due to thrombosis within the aneurysm. This would lead to occlusion of the coronary artery or to distal thromboembolisms. There is no consensus on how to manage coronary artery aneurysms. Medical therapies include aspirin as well as warfarin. Surgery may be performed in patients with a large aneurysm, i.e. when the risk of rupture or thrombosis is high. We present a 60-year-old female patient with symptoms of a transient ischaemic attack followed by a period of fever, nausea, vomiting and ecchymoses on the lower extremity. Transthoracic and transoesophageal echocardiography was suggestive of a tumour located at the basis of the lateral wall of the right atrium. Heart surgery revealed, however, a large right coronary aneurysm and an atrial septum defect of the secundum type.
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PMID:[A 60-year-old woman with asthenia and dyspnoea]. 1576 62

The authors undertook a retrospective study of the modes of prescription, the tolerance and efficacy of prostaglandin E1 in 62 consecutive neonates with congenital heart disease (average Age 1.6 days: 35 boys: weight: 3.1 +/- 0.6 Kg) admitted to the paediatric intensive care unit of Nancy University Hospital between 1998 and 2002. The infusion time and cumulative dosage were 134 +/- 112 (6-480) hours and 111 +/- 94 (4-396) microg/Kg respectively. The side effects that were observed were: Apnoea (19%), abdominal distension (16%), bradycardia (13%), enterocolitis (6.5%), hypotension (6.5%), vomiting (5%), fever (1.6%) and skin rash (1.6%). Gastrointestinal disturbances are associated with a low body weight (p<0.04), to prolonged treatment (p<0.02) with no influence of initial or cumulative dosages (P=NS), with respiratory assistance (p<0.03) and longer hospital stay (p<0.01). Hypotension was commoner in cases of poor neonatal adaptation. Mortality was correlated with severe initial acidosis (p<0.02), a low Apgar score, the initial prolonged use of high doses of prostaglandin (p<0.04), and the presence of severe valvular aortic stenosis or hypoplasia of the left heart (p<0.002). The authors conclude that treatment with prostaglandin is effective in the majority of cases despite the use of low maintenance doses (0.01 microg/Kg/min). Gastrointestinal disturbances favourised by the perinatal context, the cardiac disease, and prolonged treatment are significant factors for morbidity and mortality. The beneficial role of early neonatal enteral feeding was not demonstrated in this high risk population.
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PMID:[Complications of prostaglandin E1 treatment of congenital heart disease in paediatric medical intensive care]. 1596 3


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