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)

Chemotherapy of neuroendocrine tumors must be improved. The most widely used regimen, which combines streptozotocin with fluorouracil, commonly obtains poor results. The best response rate that has been reported for carcinoid tumors is 33%. From July 1991 through September 1994, 18 patients who had advanced neuroendocrine tumors-including nine carcinoid tumors, seven neuroendocrine tumors of unknown primary site, one insulinoma, and one paraganglioma-were treated with a regimen of dacarbazine, 400 mg/m2/day, plus fluorouracil, 1 g/m2/day, with leucovorin, 200 mg/m2/day, for 2 days every 21 days (DTIC-LVFU2 protocol). The results were assessed according to the World Health Organization criteria of toxicity and response. Toxicity was moderate. The most severe side effects were grade 3 vomiting in two patients, grade 3 leukopenia in three patients, and grade 3 mucositis in one patient. The overall response rate was 27%, with only one partial response for carcinoid tumors but one complete and three partial responses for the other tumor types. Efficacy was insufficient in patients who had carcinoid tumors but the combination of dacarbazine with fluorouracil and leucovorin could be an effective regimen for the treatment of neuroendocrine tumors of unknown primary site.
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PMID:Dacarbazine, fluorouracil, and leucovorin in patients with advanced neuroendocrine tumors: a phase II trial. 962 88

A 5-year-old female Collie dog showed excessive salivation, vomiting and neurological signs, including hind-limb weakness, mental dullness and subsequent recumbency with paddling movements of the limbs. Blood glucose and insulin concentrations were 35 mg/dl and 70.0 microU/ml, respectively. At necropsy, two masses, one at the caudal edge of the pancreas and the other in the omentum, were found and diagnosed as insulinoma. Histological examination of the brain showed early signs of acute neuronal necrosis exclusively in the superficial layers of the cerebral cortex, in addition to spongy changes in the dentate gyrus of the hippocampus. The light microscopical findings were identical in character and distribution with those of naturally occurring hypoglycaemia in humans and experimentally induced hypoglycaemia in animals.
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PMID:Hypoglycaemic brain lesions in a dog with insulinoma. 1062 92

Multiple endocrine neoplasms, including an insulinoma, bilateral adrenocortical adenocarcinomas and an aortic paraganglioma, were diagnosed after euthanasia in a 12-year-old spayed female dog of mixed breed with a history of progressive anorexia, vomiting, diarrhoea, weight loss, polyuria and polydipsia, regenerative anaemia and hypoglycaemia. The clinical, gross pathological, microscopical, immunohistochemical and ultrastructural findings were consistent with the human syndrome of multiple endocrine neoplasia.
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PMID:Multiple endocrine neoplasia in a dog. 1103 79

We report a rare case of symptomatic hypoglycemia in a patient with intra-abdominal recurrence of a previously resected gastrointestinal stromal tumor (GIST). The patient is a 65-year-old woman who underwent resection of a large abdominal mass arising from the stomach, histologically diagnosed as a high-grade leiomyosarcoma. She was lost to follow up. Five years later, the mass recurred; core biopsy demonstrated a CD 117-positive, spindle-cell tumor, consistent with a GIST. She was placed on Gleevec, as there was evidence of multifocal disease, but imaging revealed only mild improvement. Subsequently, her clinical status deteriorated, and she was hospitalized for dehydration, vomiting, and mental status changes. Her blood glucose on admission was 22 mg/dL, and a dextrose infusion (50%) was necessary to maintain adequate blood glucose levels. Measurements of insulin, proinsulin, c-peptide, beta-hydroxybutyrate, and thyroid-stimulating hormone were normal, as were cosyntropin stimulation and glucagon response tests. Suspicions arose for tumor-secreted insulin-like factor. She underwent resection of the dominant 44-cm recurrence, with immediate rebound hyperglycemia, followed by complete normalization of her blood glucose levels. She was discharged on postoperative Day 5 without symptoms or insulin, and is alive with disease at 20 months. Paraneoplastic syndromes occur in only 15 per cent of patients with known malignancies (e.g., lung cancer and metastatic carcinoid), and are rarely reported in the setting of GIST. Hypoglycemia is most often observed in presence of insulinoma and only isolated case reports in GIST patients exist. Overexpression of insulin-like growth factor II is thought to be the mechanism of action. Supportive management and palliative resection or debulking is recommended when possible.
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PMID:Hypoglycemia in the setting of advanced gastrointestinal stromal tumor. 1721 25

A patient was presented with four days of vomiting, abdominal pain and sweating. At presentation the Capillary Blood Glucose (CBG) was 1.7 mmol/L, the Blood Pressure (BP) was 182/102 mmHg, and the pulse 100 bpm. On examination, he was sweaty, pale and cold. The initial differential diagnosis was hypoglycaemia secondary to insulin abuse, hypoadrenalism or insulinoma, the transient hypertension being considered a consequence of sympathetic stimulation. He remained clinically well overnight with a CBG of 10-14 mmol/L following intravenous glucose. The next morning he complained of nausea and abdominal pain. The BP had risen to 203/127 mmHg when he was later reviewed, having been given 10mg intramuscular metoclopramide. Shortly afterwards, he developed acute pulmonary oedema and had become hypoglycaemic again; a phaeochromocytoma crisis was suspected. Treatment with alpha-adrenoceptor blockade with intravenous phenoxybenzamine was advised. However, the patient deteriorated and died in the Intensive Care Unit within two hours. Autopsy examination confirmed a phaeochromocytoma in the left adrenal, with haemorrhage within the head of pancreas, but no evidence of a pancreatic tumour.
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PMID:Phaeochromocytoma crisis presenting with profound hypoglycaemia and subsequent hypertension. 1926 23

This report presents the case of a 47-year-old female patient with fulminant type 1 diabetes mellitus and myocarditis. Following a high fever, nausea, vomiting and diarrhea, diabetic ketoacidosis occurred and she was transferred to the hospital. The plasma glucose level was 63.6 mmol/L and HbA1c was 7.0%. C-peptide was undetectable in her plasma. Blood gas analysis showed a pH of 6.99. Antibodies to glutamic acid decarboxylase nor insulinoma associated antigen-2 were not detected. She was diagnosed to have fulminant type 1 diabetes mellitus. Her electrocardiogram showed diffuse ST-segment elevations on the second day of admission, along with a positive troponin test. However coronary angiography revealed neither occlusion nor stenosis of the cardiac arteries. An endomyocardial biopsy revealed hypertrophic cardiomyocytes with a disarrangement of myofibers and the focal accumulation of mononuclear cells in the stroma, thus suggesting myocarditis or mild myocarditic change. Viruses are an important cause of myocarditis and the preceding flu-like symptoms indicate the association of viral infection with myocarditis in this case. The mechanisms by which fulminant type 1 diabetes mellitus occurs is still uncertain, but the presence of islet injury accompanied by myocardial inflammation in the current case suggested that a viral infection accounted for the onset of this type of diabetes.
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PMID:A case of fulminant type 1 diabetes mellitus accompanied by myocarditis. 2155 59

Digestive cancers diagnosed during pregnancy are rare and are sporadically reported. The shift of pregnancy towards the age interval of 30-39 years old (and even 40-49 years old) could explain the more and more frequent superposition of pregnancy and cancer. Pancreatic Neuroendocrine Tumours (PNET) originate in the insular endocrine tissue and are extremely rare; they have a slow, less aggressive neoplastic development, with the capacity of secreting and storing different peptides and neuroamines. From the large group of NET tumours, approximately 70% have a gastroenterohepatic (GET) localisation and represent less than 2% of the digestive tract tumours. PNET incidence is extremely reduced, of approximately 1/100.000. The association of pregnancy and PNET in literature is exceptional until now only 39 cases were reported. The most frequent PNET in pregnant patients is the insulinoma with the starting point in pancreatic B-cells, with 27 out of 39 PNET worldwide reported cases until 2012. Establishing a diagnosis in pregnant patients is difficult in the first period of pregnancy because physiologically, the glucose tends to be low. This may be a consequence of the increased secretion of insulin and sensibility to insulin, probably as an effect of increased oestrogen levels. Furthermore, there are other signs which could suggest the existence of a "problem", which are relatively common during the first trimester of pregnancy: unexplained fatigue, vomiting, hypotension, rare episodes of hypoglycaemia. Performing paraclinical tests on these patients is difficult; an essential indicator of the opportunity for the investigation is the pregnancy trimester. The precaution about a foetal injury when indicating an invasive exploration (imaging, endoscopy, etc.) delays the diagnosis. The insulinomas have a rather benign potential than an aggressive nature, and their prognosis is usually favourable, with therapeutic possibilities easy to administrate and control in pregnant patients. Medical treatment is used in patients when there is a positive diagnosis but the topography of the insulinoma was not identified, when the symptomatology is easy to control through conserving therapy until the foetus is mature enough or immediately after birth, in pregnant patients who refuse the surgical procedure, or in the case of metastasis of malignant insulinoma. Surgical treatment indeed remains the only therapeutic method, but most often it is scheduled usually after birth, or if the situation requires, as late as possible after the foetus has a convenient age (after 28 weeks).
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PMID:Pancreatic Neuroendocrine Tumour in Pregnancy - Diagnosis and Treatment Management. 3167 Jun 30