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

Medical methods of 2nd trimester abortion are reviewed from recent large studies comparing intramuscular and vaginal application of synthetic prostaglandins (PGs) with natural PGE2 and PGF2alpha, and standard hypertonic saline. The available synthetic PGs for abortion are Sulprostone (Schering) and Carboprost (Upjohn), both PGF analogs for intramuscular injection and Gemeprost (May & Baker, Dagenham, UK) a PGE analog for intravaginal use. Beside these 9-deoxo-16, 16-dimethyl-9-methylene PGE2 and 15(S)-15-methyl-PGF2alpha methyl ester have been evaluated in clinical trials. Best results were obtained in women receiving intramuscular PG analogs by priming the cervix the laminaria tents. All 3 commercially available PGs are more effective than their parent PGs and saline in terms of success rates, 95% or more vs. 85 and 80%. While the abortion interval was 18-20 hours with intraamniotic PGF2alpha, it was about 23 hours with the intramuscular PG analogs, but only 19.3 hours with vaginal Gemeprost. Side effects of vomiting and diarrhea tended to be lower with the PGE analog Gemeprost. Gemeprost was highly acceptable for patients and staff because of the simplicity of administration of the vaginal gel, and also because it caused much less cramping, judging by half as many analgesic injections. The PGE analog in gel form also permits a much lower dose and allows administration by non-physicians, and reduces risk of complications resulting from invasive administration routes. A preliminary study suggests that pretreatment with RU-486 in early 2nd trimester facilitates termination by intraamniotic PGE2.
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PMID:Non-invasive methods for termination of second trimester pregnancy. 222 4

In the present investigation we compared two different techniques of anaesthesia--total intravenous anaesthesia (TIVA) versus balanced anaesthesia--with and without antiemetic prophylaxis, with regard to postoperative nausea, strangling irritation and vomiting and their influence upon postoperative complications (intraocular bleedings) and postoperative intraocular pressure after pars plana vitrectomia. For this investigation four groups were formed. The anaesthesias were carried out as orotracheal intubational anaesthesia following two standard techniques, which only differ in the choice of the narcotics. Half the patients in each group were treated with an antiemetic prophylaxis of 2.5 mg DHBP. With regard to the occurrence of postoperative nausea and vomiting, the TIVA-groups proved to be better than those with balanced anaesthesia (16% to 43.5%; p < 0.05): DHBP in both methods led to a reduction of postoperative vomiting and nausea, but the differences showed not to be significant (p > 0.05). Best results were achieved with a combination of TIVA (propofol, alfentanil, atracurium, air/O2) and DHBP (4.7%). The total rate of postoperative complications in form of intraocular bleedings amounted to 8.6%. The appearance of complications increased when postoperative nausea and vomiting or increased intraocular pressure were observed (16.6% to 6.3%; 21.2% to 6.1%). Intraocular pressure, measured for four hours postoperatively, was significantly lower in the TIVA-groups than in the balanced anaesthesia-groups (15.5 +/- 7.7 mmHg to 18.3 +/- 8.2 mmHg). Therefore, we conclude that TIVA with propofol appears to be especially suitable for intraocular surgery.
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PMID:[Postoperative vomiting after pars plana vitrectomy]. 867 45

The paper is devoted to review literature data on intravenous and oral antiemetic effectivity of granisetron (GRAN) a selective 5HT3 antagonist and to determine the optimal dose for the prophylaxis of chemotherapy-induced acute emesis. The drug was put on the market in the injectable form in 1994 and in the oral form in 1995, so a sufficient number of reports have been published for the evaluation. According to the summarized data on 6095 patients treated with intravenous GRAN, on average 66% antiemetic complete response (CR) rate was reached (i.e. no vomiting in the first 24 hours of chemotherapy). Best results were observed with the dose of 40 microg/kg intravenous GRAN, on average 70% CR (range 47-93%) were achieved in 4182 of the 6095 patients with this dose. In 942 patients treated with the mostly applied oral dose of GRAN (1 mg twice daily), on average 61% CR (range 52-82%) were reported. Side effects were weak and transient, mostly headache and constipation were observed. Headache appeared in 13% with the use of 40 microg/kg intravenous dose GRAN and in 18% with 1 mg oral dose twice daily Constipation was observed in 5.3% and 17% with the injection and oral dose, respectively.
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PMID:About the antiemetic effectivity of granisetron in chemotherapy-induced acute emesis: a comparison of results with intravenous and oral dosing. 1046 29

Comparative clinical investigation was performed in 80 ASA I/II patients undergoing cataract surgery on one eye. Patients were randomly divided in to four groups, according to the method of anesthesia. Intraoperatively (T0-T6), decreasing of intraocular pressure (IOP) to the optimal values at the start of the operation (T3), and the hemodynamic stability of patients after the induction (T1) were evaluated. Postoperatively, the recovery rate, and the incidence of vomiting were measured. Optimal decreasing of IOP was noticed in the second group (75% of patients). Best hemodynamic stability was observed in the second group (80% patients). Fast recovery rate was noticed in the first and the second groups (13.9 +/- 1.1 and 14.4 +/- 0.8 min). Vomiting was noticed in 5% patients in the first group, 15% in the third group, and in 20% in the 4th group. The authors have concluded that TIVA fourth propofol and coinduction with midazolam is anesthesia of choice in the cataract surgery.
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PMID:[Total intravenous anesthesia with propofol with midazolam coinduction--the anesthesia of choice in cataract surgery]. 1093 30

The decision for antireflux surgery is often made on an individual basis. How symptom patterns and therapeutic suggestions relate is debatable. There is a long list of differential diagnoses for vomiting not caused by disturbances of the lower esophageal sphincter. Guidelines for the clinical practice in gastroesophageal reflux have been established for children and for adult patients by the Genval Workshop Report and the Trondheim Consensus statement. Endoscopy is indicated if macroscopically visible lesions are to be expected. Routine endoscopic biopsy is not used in the diagnosis of gastroesophageal reflux disease (GERD). pH monitoring is performed in 33 to 77% of patients. If the most prominent symptoms are respiratory, radiographic studies and pH monitoring prove that the symptoms are really related to GERD. Best results with drugs are achieved by effective initial therapy. The effects of long-term treatment are little known. Failed long-term therapy, complications of esophagitis, recurrent aspiration, apnea or "near miss" sudden infant death syndrome, failure to thrive and anatomical abnormalities are indications for surgery. The superiority of laparoscopic antireflux surgery over open surgery depends on the experience of the surgeon. Some surgeons choose a "tailored approach", ie, perform a partial wrap in children with normal peristalsis, an extrashort "floppy" Nissen or a partial wrap for those with impaired peristalsis, and a slightly tighter 360-degree wrap in neurologically impaired children. Partial wraps allow vomiting, which is considered risky in neurologically impaired children.
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PMID:Indications for laparoscopic antireflux procedures in children. 1240 21

Premature rupture of membranes (PROM) occurs in 8% of term deliveries. In this situation labour induction with prostaglandins, compared with expectant management, results in a reduced risk of chorioamnionitis, neonatal antibiotic therapy, neonatal intensive care (NICU) admission, and increased maternal satisfaction. The use of prostaglandin is associated with an increased rate of diarrhoea and use of analgesia/anaesthesia. Compared with oxytocin, prostaglandin induction results in a lower rate of epidural use and internal fetal heart rate monitoring but a greater risk of chorioamnionitis, nausea, vomiting, more vaginal examinations, neonatal antibiotic therapy, NICU admission and neonatal infection. Women should be informed of the risks and benefits of each method of induction.Misoprostol is gaining increasing interest as an alternative induction agent. It appears to be an effective method of labour induction with term PROM. Further research is needed to identify the preferred dosage, route and interval of administration, and to assess uncommon maternal and neonatal outcomes. There has been limited research on the use of prostaglandins, including misoprostol, for induction of labour with a favourable cervix and intact membranes. Compared with intravenous oxytocin (with and without amniotomy), labour induction using vaginal prostaglandins in women with a favourable cervix (with and without PROM) results in a higher rate of vaginal delivery within 24 hours and increased maternal satisfaction. In women with a favourable cervix, artificial rupture of membranes followed by oral misoprostol has similar time to vaginal delivery compared with artificial rupture of membranes followed by oxytocin. Further research with prostaglandins, including misoprostol, is needed to evaluate other maternal and neonatal outcomes in women being induced with a favourable cervix. No form of prostaglandin induction in women with PROM or favourable cervix has proven clearly superior to oxytocin infusion.
Best Pract Res Clin Obstet Gynaecol 2003 Oct
PMID:Induction of labour with a favourable cervix and/or pre-labour rupture of membranes. 1297 15

Human chorionic gonadotropin (hCG) is a glycoprotein hormone that has structural similarity to TSH. At the time of the peak hCG levels in normal pregnancy, serum TSH levels fall and bear a mirror image to the hCG peak. This reduction in TSH suggests that hCG causes an increased secretion of T4 and T3. Women with hyperemisis gravidarum often have high hCG levels that cause transient hyperthyroidsm. In the vast majority of such patients, there will be spontaneous remission of the increased thyroid function when the vomiting stops in several weeks. When there are clinical features of hyperthyroidism, it is be reasonable to treat with antithyroid drugs or a beta-adrenergic blocker, but treatment is rarely required beyond 22 weeks of gestation. Hyperthyroidism or increased thyroid function has been reported in many patients with trophoblastic tumors, either hydatiditform mole or choriocarcinoma. The diagnosis of hydatidiform mole is made by ultrasonography that shows a 'snowstorm' appearance without a fetus. Hydatidiform moles secrete large amounts of hCG proportional to the mass of the tumor. The development of hyperthyroidism requires hCG levels of >200 U/ml that are sustained for several weeks. Removal of the mole cures the hyperthyroidism. There have been many case reports of hyperthyroidism in women with choriocarcinoma and high hCG levels. The principal therapy is chemotherapy, usually given at a specialized center. With effective chemotherapy, long-term survival exceeds 95%. A unique family with recurrent gestational hyperthyroidism associated with hyperemesis gravidarum was found to have a mutation in the extracellular domain of the TSH receptor that made it responsive to normal levels of hCG.
Best Pract Res Clin Endocrinol Metab 2004 Jun
PMID:Physiological and pathological aspects of the effect of human chorionic gonadotropin on the thyroid. 1515 39

The term 'Functional diseases' implies symptoms arising from an organ without overt pathology. However this is more apparent than real since inflammation often leaves changes in nerves and mucosal function only apparent with specialised techniques. Acute onset functional dyspepsia accounts for around 1/5 of functional dyspepsia and is characterised by early satiety, nausea, vomiting and weight loss. Impaired postcibal fundal accommodation may underlie some of these symptoms. Post infectious gastroparesis is much rarer and is associated with markedly delayed gastric emptying and antral hypomotility. Approximately 1/10 of IBS cases describe a post infectious onset. Post infectious IBS is typically of the diarrhoea-predominant type. Post inflammatory functional diseases tend to be associated with less psychological abnormalities and have a better prognosis than other functional diseases. There are isolated anecdotal reports of symptom response to anti-inflammatory treatments but larger controlled trials are needed.
Best Pract Res Clin Gastroenterol 2004 Aug
PMID:Inflammation as a basis for functional GI disorders. 1532 5

Functional dyspepsia is a highly prevalent symptom complex and a heterogeneous disorder. Recent studies showed potential associations between specific pathophysiologic disturbances and dyspeptic symptoms. Delayed gastric emptying reported in about 30% of patients with functional dyspepsia is associated with the symptoms of postprandial fullness, nausea, and vomiting. Impaired gastric accommodation present in 40% of functional dyspepsia patients is found to be associated with early satiety. Hypersensitivity to gastric distension is observed in 37% of functional dyspepsia patients and associated with the symptoms of postprandial pain, belching, and weight loss. Psychosocial factors and altered response to duodenal lipids or acid have also been identified as pathophysiologic mechanisms.
Best Pract Res Clin Gastroenterol 2004 Aug
PMID:Pathophysiology of functional dyspepsia. 1532 9

Significant improvement towards a better control of postoperative nausea and vomiting have been achieved in recent years. Today, we understand better who is likely to vomit or to be nauseous after surgery. Significant amounts of the huge literature on anti-emetic interventions have been systematically reviewed, critically appraised and quantitatively synthesized. Thus, we know what anti-emetic interventions work, and how well they work, and we know their adverse effect profile. We also know which interventions have no worthwhile efficacy. A rational approach to postoperative nausea and vomiting includes three steps: identification of patients at risk, keeping the baseline risk low, and prophylactic administration of anti-emetics in those patients who are most likely to need them. For patients who are identified as high-risk patients, all measurements should be simultaneously initiated (multimodal anti-emesis).
Best Pract Res Clin Anaesthesiol 2004 Dec
PMID:Strategies for postoperative nausea and vomiting. 1546 May 53


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