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

Since severe obesity is frequently associated with serious metabolic, cardiovascular and psychological co-morbid conditions, and given the usually unsuccessful results of conservative therapeutic approaches, surgical treatment based on gastric restriction procedures is increasingly recognized as a treatment of choice for morbidly obese persons. Among several surgical approaches designed to promote a substantial loss of weight, two gastric restriction procedures, i.e. the vertical banded gastroplasty and the gastric bypass, have been increasingly used during the past years. Both techniques induce an impressive loss of weight, and are surprisingly well tolerated, even by severely obese persons. The usual 50-75% reduction of initial weight excess, is followed by a clear-cut reduction, or even disappearance of, obesity-related co-morbidity, such as hypertension, diabetes mellitus or sleep apnea syndrome. While serious peri- and postoperative risks are very limited, the intractable vomiting occurring after gastroplasty, and potential sequelae related to iron and calcium malabsorption after the gastric bypass, represent much more frequent complications of the surgical treatment of obesity. There is also a tendency towards a late regain of weight, but the benefit in terms of improvement in the obesity-associated co-morbidity is in general maintained despite this partial increase in weight. Gastric procedures are, therefore, an effective treatment of severe obesity and of its co-morbid conditions. However, careful medical and nutritional supervision is necessary during the follow-up after surgery, to prevent potential nutritional or digestive complications.
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PMID:Surgical treatment for morbid obesity. 924 44

The surgical treatment of pathological obesity has been rapidly developing in France over recent years. The growing demand for operation raises a number of questions concerning the indications and the factors predictive of success. Patients are increasingly referred for a psychiatrist's or psychologist's opinion in order to detect psychiatric contraindications and to select patients who are able to comply with their weight reduction programme with the help of the operation and who are able to obtain a lasting improvement in their quality of life. The author starts by describing the explicit demand formulated by candidates for gastroplasty, characterized by a high degree of information and motivation. In view of the uncertainties concerning the right advice to be given to this population, an open prospective study was conducted among 109 gastroplasty candidates. Evaluation of somatic and psychological parameters was performed before the operation and at 6 months, 1 year, 2 years and 5 years. The preliminary results are based on 98 operated patients. The mean BMI (Body Mass Index) decreased from an initial value of 42.08 +/- 0.7 kg/m2 to 29.96 +/- 6.68 kg/m2 at one year. The frequency of vomiting decreased with successive evaluations, but nevertheless constituted the major disadvantage of the operation. Evaluation of depression scores, using the MADRS (Montgomery and Asberg Depression Rating Scale), did not reveal any depressogenic effect of gastroplasty. The other assessment instruments (visual analogue scales and Subjective Quality of Life Profile) indicated a favourable change in numerous dimensions of quality of life. Although it is too early to define any predictive criteria, the author proposes a list of empirical criteria in line with those reported in the literature and defines the role of psychiatrists before and after the operation.
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PMID:[The psychiatrist's point of view on the treatment of morbid obesity by gastroplasty]. 929 77

Gastric reduction operations are designed to control body weight by establishing a small, meal-size juxtaesophageal, gastric pouch that empties into the jejunum (gastric bypass) or the larger portion of the stomach (gastroplasty). If the outlet of the pouch is too small, a patient may be limited to ingesting clear liquids. Vomiting then occurs if heavier liquids or normal foods are taken. An occasional patient has difficulty eating properly and vomits even though the pouch volume and outlet are of optimum size. For a patient who reports vomiting, a distinction must be made between episodic improper eating and uncontrolled starvation. Three types of starvation injury are described: (1) sudden death from protein malnutrition; (2) refeeding syndrome; and (3) Wernicke-Korsakoff syndrome. The mechanisms of the development, manifestations, prevention, and treatment of these complications are explained. Surgeons who treat severe obesity should be aware of these complications and be prepared to manage patients who have uncontrolled vomiting so that such complications either do not develop or are recognized and treated as early as possible before serious and irreversible injury occurs.
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PMID:Starvation injury after gastric reduction for obesity. 971 29

Mortality from radical cystectomy is still high, in some series accounting for 1-10% deaths. Morbidity is even higher and can reach 50%. This paper contributes the case of a 66-year old male patient diagnosed with an infiltrant tumour of the bladder following TUR. The patient's background included prior surgery for gastroduodenal ulcus, alcohol consumption, and obesity. Following routine pre-operatory investigations, the patient underwent radical cystectomy using routine techniques and urinary by-pass via transcolonic ureterosigmoidostomy. Increased transaminases, leucocytosis, vomiting, jaundice and extended intestinal ileum were noted during the patient's post-operative period, while blood and urine amylase concentrations were moderately high. Following CAT study, laparotomy was performed and the diagnosed confirmed. The patient died on day 14 of surgery due to secondary pulmonary complications. Post-operative pancreatitis is a low-frequency, high-mortality acknowledged complication. Even though most cases are secondary to biliarypancreatic and surrounding pancreas area surgery, it has also been described in some instances of distant surgery such as the present case. Alcohol consumption, biliary lithiasis, prior cholecystectomy and diabetes are predisposing factors. High amylase values do not always accompany this condition. Early diagnosis and treatment are crucial for the patient's prognosis. Respiratory complications are the usual cause of death in these patients.
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PMID:[Necrotizing pancreatitis following radical cystectomy for infiltrating bladder carcinoma]. 988 16

A recent meta-analysis showed that omitting N2O significantly reduced postoperative vomiting (POV) compared with a N2O regime. Our study was designed to evaluate the effect of the combination of desflurane with N2O versus desflurane alone on postoperative nausea and vomiting (PONV) in a subgroup of female patients and PONV was considered as the primary endpoint. After approval of the local Ethics Committee and informed consent 60 female in-patients (ASA I & II), aged 18-65 y, scheduled for breast surgery with a duration of 1-3 h were included. Obese patients or patients with a history of PONV and motion sickness were excluded. No prophylactic anti-emetic therapy was allowed during the study. Patients received a standardized anesthetic technique consisting of propofol for induction, vecuronium and fentanyl for intubation, followed by desflurane with or without N2O (randomisation list) and fentanyl supplements if required for maintenance of anesthesia. At the end of anesthesia PONV was recorded during 24 h in different periods. There were no significant differences between the groups with respect to demographic data and duration of anesthesia. In addition, there were no significant differences in the amount of intraoperative fentanyl or postoperative narcotics. The incidence of PONV was significantly higher in the group of patients receiving desflurane in N2O-O2 mixture compared with the group receiving desflurane in AIR-O2 mixture. The combination of desflurane with N2O in female patients undergoing breast surgery is associated with a significantly higher incidence of PONV and a higher need of antiemetic drugs, when compared to a N2O free regime.
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PMID:The impact of nitrous oxide on postoperative nausea and vomiting after desflurane anesthesia for breast surgery. 1041 46

This study examined the prospective relations of naturalistic weight-reduction efforts to growth in relative weight and onset of obesity with data from a community study of female adolescents (N = 692). Initial self-labeled dieting, appetite suppressant/laxative use, incidental exercise, vomiting for weight-control purposes, and binge eating predicted elevated growth in relative weight over the 4-year period. Dietary restraint, self-labeled dieting, exercise for weight-control purposes, and appetite suppressant/laxative use predicted an increased risk for obesity onset. Data imply that the weight-reduction efforts reported by adolescents are more likely to result in weight gain than in weight loss and suggest the need to educate youth on more effective weight-control strategies.
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PMID:Naturalistic weight-reduction efforts prospectively predict growth in relative weight and onset of obesity among female adolescents. 1059 18

BACKGROUND: Few papers assess quality of life after vertical banded gastroplasty (VBG). METHODS: 100 patients with severe obesity (preoperatively mean BMI 41.7 kg m(2)) answered an interview 60 (+/- 2.5) months after VBG. RESULTS: There was no fatal outcome. Nine patients had pulmonary embolus; ten patients required reoperation because of stomal stenosis. Of the 89 patients that still bore a gastroplasty at the moment of the interview, 65 had lost more than 40% of their excess weight (= "success'). Improvement in quality of life of these 89 patients was reflected by significant diminution of depression and back pains. Significant diminution of arterial hypertension and improvement of professional satisfaction, and of social, physical, and sexual activity was significantly related to weight loss. CONCLUSION: VBG resulted generally in a favorable long-term effect on quality of life. However, patients should be informed preoperatively about potential side-effects such as possible persistent vomiting after several years, esophagitis and gastritis, restriction in the choice of foods and prolongation of meals.
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PMID:Long-term Results on Quality of Life of Surgical Treatment of Obesity with Vertical Banded Gastroplasty. 1073 32

After obesity surgery, the primary measurement of success is the amount of weight lost. There has, however, been little assessment of how patients cope with the dietary constraints imposed by gastroplasty. Similarly, dietary patterns adopted to cope with these constraints have not been studied fully. These factors are of great importance in terms of nutritional adequacy, patient acceptability and long-term success. A study involving 32 patients was conducted to ascertain whether practical nutritional intervention and extensive follow-up would improve the overall outcome of the gastroplasty operation with respect to the type of foods tolerated and the incidence of regurgitation or vomiting experienced. To quantify success in terms of frequency of regurgitation and variety of food intake a vomiting/eating (V/E) score was devised. The results showed that the group of patients with more intensive practical education and counseling had a more varied intake of food and coped better with a wider variety of solid foods in the long term. Despite a more solid diet they did not regurgitate food as frequently as patients with less education, and over half the study group of patients reported no regurgitation at all. From this study, it is proposed that patients can be assessed and categorized postoperatively using a V/E scale. This scale numerically scores success with diet after gastroplasty, which, when recorded in conjunction with subsequent weight loss, can give a better quantification of success after obesity surgery.
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PMID:The Effect of Practical Dietary Counseling on Food Variety and Regurgitation Frequency after Gastroplasty for Obesity. 1075 99

From 1984 in N.N. Burdenko Surgical clinic of I.M. Sechenov MMA more than 500 horizontal gastroplasties (HGP) were performed for the treatment of patients with extreme degree of alimentary-constitutional obesity. In 1996 for the first time in our country HGP was performed, including laparoscopic method, with use of regulated silicon bandage "Lap-Band" (LB) made by "Bioenterics", USA. Laparoscopic HGP was performed in 29 patients (7 males, 22 females), aged from 23 to 60 years, mean age was 34.2 +/- 10 years. Minimal body weight was 85 kg, maximal--180 kg, mean--131 +/- 27.2 kg. Mean body mass index was 47 +/- 9.9 kg/m2. Open operations were performed in 14 cases, laparoscopic operations--in 15 cases. 11 laparoscopies were performed in initial stages in very stout patients and in the absence of laparoscopic equipment. In 3 cases the conversion from laparoscopic to open operation was necessary: in 1st case because of hemorrhage from lesser omentum's vessels, when hemostasis cannot be performed by laparoscopy; in 2nd case as a result of bronchospasm associated with tense pneumoperitoneum in the patient with bronchial asthma; in 3rd case because of significant enlargement and rigidity of liver left lobe, which didn't permit to create the space for manipulations in cardial portion of the stomach. The mean bed day turnover after traditional HGP with LB and after laparoscopic HGP was 12.2 and 5.4 respectively. Intraoperative complication was observed in one case--hemorrhage from lesser omentum's vessels. One complication was observed in immediate postoperative period, on the 6th day after traditional HGP: the eventration as a result of hard diarrhea due to antibacterial treatment was diagnosed. One more complication was observed in a year after traditional HGP: small stomach evacuatory function disorders as a result of its significant dilatation. These disorders occurred because of gastric mucosa inflammatory edema, decrease of anastomosis diameter and frequent vomiting due to aspirin taking. In this case the repeated operation--bandage's reposition was performed. There were no other complications. The rate of repeated operations was 4% which agrees with literature data.
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PMID:[Use of regulated silicone bandage in horizontal gastroplasty in patients with morbid obesity]. 1107 Jun 65

Benign intracranial hypertension is known to be associated with obesity, endocrine abnormalities, various medications, and cerebral venous sinus thrombosis. We report a patient presenting with headaches and vomiting attributed to benign intracranial hypertension. The diagnostic work-up revealed Langerhans' cell histiocytosis of the occipital bone. There was no evidence for cerebral vein thrombosis by cranial computed tomography scan, Doppler ultrasonography, planar and single photon emission computed tomography technetium 99m-labelled red blood cell scintigraphy, and magnetic resonance angiography. Excision of the occipital bone lesion and a short course of acetazolamide and prednisone were curative. We hypothesize that cytokines secreted by the tumor were responsible for the development of intracranial hypertension.
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PMID:Langerhans' cell histiocytosis presenting as intracranial hypertension. 1141 6


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