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

The author questions the conventional assumption that the pneumoperitoneum must be established before insertion of the laparoscope and its trocar. Complications commonly associated with establishment of a needle-induced pneumoperitoneum include subcutaneous emphysema, blood vessel penetration, retroperitoneal emphysema, bowel distention, overdistention, gas embolism, and omental emphysema. This paper summarizes the author's experience with 301 outpatient laparoscopies performed in 1976-77 using the method of direct trocar insertion without prior pneumoperitoneum. The process of pneumoperitoneum was visualized directly through the Needlescope. 54 cases were performed under general anesthesia and 247 under local anesthesia. Complications were encountered in only 3 cases (1 uterine perforation and 2 cases requiring postoperative hospitalization for nausea and vomiting). There were no cases of technical failure. Comparison of recovery times for 250 consecutive patients treated without preliminary pneumoperitoneum and 117 patients treated with the conventional technique indicated that the recovery time was 19 minutes shorter on average in the former group because of a lessened degree of postoperative discomfort, nausea, and vomiting. Although further research is necessary to confirm the findings in this series, it seems plausible to suggest that a reduction of complications associated with needle-induced pneumoperitoneum may be possible with this technique.
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PMID:Direct laparoscope trocar insertion without prior pneumoperitoneum. 15 Nov 44

A report is given on four patients with spontaneous mediastinal and skin emphysema. In three cases younger patients from 14 to 21 years were concerned, in the fourth case a 63-year-old patient was concerned. Two of the younger patients revealed a long lasting malnutrition. As favouring or triggering factor, respectively, for the pathogenesis of the mediastinal emphysema in accordance with Macklin an increase of the intrathoracic pressure by retching, pressing or vomiting is regarded. Apart from this a vasoconstriction of the alveolar vessels (due to decrease of the plasma volume) and nutritional disease might be of importance. In all patients the mediastinal and skin emphysema receded under symptomatic therapeutic measures within some days.
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PMID:[The spontaneous mediastinal and skin emphysema]. 121 Apr 59

Foreign bodies aspirated into respiratory tract may produce severe lung damage and threaten life. We have analysed retrospectively symptoms, physical findings, chest roentgenograms and bronchoscopy reports in 20 children with foreign body aspiration. Boys dominated in this group. Foreign body aspiration often accompanied by coughing, wheezing and vomiting. In chest X-ray examination it was revealed unilateral body trapping and obstructive emphysema. Foreign body aspiration should be considered in children with prolonged respiratory tract problems even when no adequate history is present and with negative chest roentgenograms.
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PMID:[Foreign bodies in respiratory tracts of children treated at the Institute of Pediatrics in Krakow during the years 1987-1991]. 134 57

76 year-old man was transferred to emergency room because of severe epigastralgia and dyspnea. He was well until 5 hours before admission, when he suddenly felt severe epigastralgia followed by vomiting. He was found to be in warm shock state. Chest X-ray film showed dilation of mediastinum, pneumo mediastinum, left pleural effusion and subcutaneous emphysema, which were consistent with esophageal perforation. Esophageal contrast study was diagnostic. Emergency operation was performed in which rupture of the lowest esophagus causing remarkable mediastinitis and pleuritis was observed. Esophageal tear was primarily closed and chest drains were placed. Despite severe post-operative complications, he was discharged with recovery 5 months later.
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PMID:[A case of idiopathic esophageal perforation (Boerhaave's syndrome)]. 213 Jul 99

Spontaneous esophageal perforation (Boerhaave syndrome) is a life-threatening emergency. It usually has misleading clinical manifestations and causes severe complications. In the presence of the clinical manifestations: vomiting, pain, emphysema, this diagnosis must be considered and confirmed by radiological evaluation of the chest and the esophagus. We report two cases and we describe the severity of this syndrome, its cause, its pathogenesis, and its characteristic clinical features and radiological signs.
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PMID:[Boerhaave's syndrome]. 222 78

Paraquat, a useful contact herbicide is now used in over 130 countries of the world, including Sri Lanka. The number of cases of accidental poisoning reported with paraquat is small, relative to instances of suicide. When a clear history is not available, accidental paraquat poisoning is sometimes difficult to diagnose. A 9-year-old boy was admitted to a peripheral hospital with a history of diarrhoea and vomiting. He later developed abdominal pain, subcutaneous emphysema and difficulty in breathing. Following transfer to a district hospital and then to a teaching hospital, poisoning with paraquat was suspected only on day 11 of the illness. On persistent questioning, on day 13 of the illness the child remembered that the day prior to the onset of illness, on his way from a shop, he felt thirsty and having found an empty bottle of Gramoxone (paraquat) on the wayside he used it to drink water from a water tank. The child died on day 17 and the histology of the lung showed typical changes of paraquat poisoning. This tragic episode emphasises the need for proper disposal of empty containers of all poisonous substances.
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PMID:An unusual case of fatal accidental paraquat poisoning. 230 5

A 67-year-old woman was admitted to our hospital with chest pain and dyspnea which occurred suddenly after vomiting. She was well until admission except for cholelithiasis and hypertension which had been pointed out 3 years earlier. Arterial blood gas analysis showed hypoxemia without hypercapnea. Chest X-ray examination on admission revealed intra-mediastinal air with a niveau behind the heart which compressed the vasculature of the left lower lobe and a small amount of air in the regions adjacent to the trachea, left main bronchus and aortic arch. The serial chest radiographs showed pneumomediastinum, subcutaneous emphysema, pneumothorax and pleural effusion in that order within 16 hours after the onset. The diagnosis of esophageal rupture was made by CT scan of the chest performed after oral administration of Gastrografin, which demonstrated extravasation of contrast medium into the mediastinum. Surgical treatment including eversion stripping and esophagogastrostomy was performed 23 hours after the onset. Pathological examination of the removed specimens revealed a rupture of the lower portion of the esophagus originated in the gastric ulcer of the cardia. In spite of intensive care, she died 45 days after surgery because of renal failure. It was considered that the most important point in the early diagnosis of esophageal rupture was to suspect this disease based on the gastric symptoms followed by the respiratory symptoms and to demonstrate pneumomediastinum in chest X-ray. Chest CT scan performed after the oral administration of contrast medium could be an useful and non-invasive diagnostic procedure.
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PMID:[A case of esophageal rupture confirmed by chest CT: characteristic changes in chest radiographs]. 261 3

This retrospective review of 34 patients with spontaneous rupture of the esophagus, which spans a 30-year period, attempts to identify areas in diagnosis and therapy that might alter the dismal prognosis. The diagnosis and definitive surgical repair of Boerhaave's syndrome were frequently delayed. Delay resulted in a significant increase in complication rates. Pain (85%) and vomiting (71%) were the only common historical events suggesting the diagnosis. Physical examination was of aid in the diagnosis in only the 9 patients (27%) who demonstrated cervical or mediastinal emphysema. The initial chest roentgenogram was abnormal in 97% of the patients, but was interpreted as "compatible with perforation of the esophagus" in only 27%. Esophagography was diagnostic in 23 of 24 patients in whom it was used. Thoracentesis was of little diagnostic aid, but pleural fluid pH was measured in only 15% of the patients. Prompt surgical repair, regardless of time after onset, appears to be the indicated therapy.
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PMID:Spontaneous rupture of the esophagus: a 30-year experience. 273 Jan 90

Spontaneous transmural esophageal perforation is a rare condition with high morbidity and mortality. It is traditionally associated with alcohol abuse. Experience of the syndrome at a large medical center in Israel, a country where alcohol is not a national problem, is reviewed, and eight cases are described. The clinical picture was varied and confusing, only one patient presenting with the classic triad of vomiting, chest pain and subcutaneous emphysema, though abdominal pain occurred in six cases. The diagnosis consequently was delayed (average 2.8 days) in three patients and two died undiagnosed. Contrast studies, when performed, were diagnostic. Early rupture (less than 24 hours) was treated with primary repair (n = 3). Late rupture (greater than 24 hours) was successfully managed by drainage alone (without esophageal exclusion) in three cases, but required long hospital stay (mean 52 days). Five of the six patients diagnosed ante mortem survived. Late reconstructive procedures were not required. The key to successful outcome is awareness of the condition, with early diagnosis and aggressive surgical intervention--repair or drainage.
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PMID:Spontaneous transmural rupture of esophagus--Boerhaave's syndrome. 281 19

Eighteen patients (16 men and two women), aged 20 to 77 years, were admitted to the University hospital between 1973 and 1984 for a Boerhaave's syndrome. Fourteen over eighteen were more than forty years old. Other particular features were the frequency of alcoholism (11 patients) and the lack of preexisting gastrointestinal symptomatology. The cardinal symptom, pain, occurred in 17 cases. It was preceded in 10 subjects by vomiting. Subcutaneous emphysema was only found in five patients, but standard chest X-ray showed seven times a pneumomediastinum. Pleural effusion was present in 14 subjects. Thirteen patients underwent thoracotomy: five within 48 h (1 death) and eight after 48 h (4 deaths); two further deaths were due to withholding surgery, and a third by performing bipolar oesophageal exclusion at a late stage (8th day); six of these deaths were related to local infection. The clinical and radiological features of Boerhaave's syndrome are presented in a review of the literature; particular attention is paid to the various methods of treatment.
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PMID:[Spontaneous rupture of the esophagus]. 372 88


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