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

We experienced a case of spontaneous rupture of the esophagus which was successfully managed by suture of the ruptured site and pedicled omental covering. A 47-year-old male was referred to our department in unstable condition 60 hours after the onset of acute symptoms. Upon presentation to the hospital, the patient was in shock and complained of severe chest pain and dyspnea, the onset of which followed vomiting after consumption of alcohol. A diagnosis of spontaneous rupture of the esophagus was made on the basis of the history of the episode and chest X-ray and chest CT findings. After construction of a pedicled omentum created during laparotomy, left-sided thoracotomy and debridment of the mediastinum was performed, which was seen to contain necrotic tissue and purulental fluid. The site of esophageal rupture, nearly 3 cm in length, was sutured shut and reinforced with a pedicled omental covering, the postoperative course was uneventful, and oral intake was resumed 20 days following the surgery. The pedicled omental covering procedure was useful for reinforcing sutures at the site of rupture and for control of infection in this patient for whom institution of surgical therapy for spontaneous esophageal rupture was delayed following the acute onset of symptoms.
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PMID:[A case of spontaneous ruptured of the esophagus managed with pedicled omental covering]. 874 62

We assessed the Quality of Life (QOL) of 116 patients with inoperable esophageal cancer who were mainly treated with radiotherapy between 1978 and 1993. Factors including dysphagia, weight loss, side effects of radiotherapy,P.S. and psychological status were assessed retrospectively. Dysphagia was assessed using a swallowing-function scoring system. Initial improvement in dysphagia occurred in 68% of the 71 assessable patients. Radiotherapy was also effective for the other symptoms, including swallowing pain, anterior chest pain and vomiting. Improvement rates were 73%, 60% and 82%, respectively. The major side effects were pain of the pharynx, general fatigue, epigastralgia and appetite loss. But most side effects resolved within 10 days after the end of radiotherapy. Improvement of dysphagia resulted in reduced weight loss of the patients. Average weight loss was about 3 kg/month before radiotherapy. This was reduced after radiotherapy to 0.78 kg/month in patients who had improvement of dysphagia and 1.69 kg/month for those without improvement. Improvement of dysphagia also affected favorably the psychological state of the patients. There were fewer cases of patient distrust of staff and less despair in those patients with improved dysphagia. Radiotherapy appears to contribute to better QOL in patients with inoperable esophageal cancer.
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PMID:[QOL after radiotherapy for esophageal cancer]. 879 47

Boerhaave's syndrome, or the spontaneous rupture of the esophagus, appears most commonly in males between the ages of 40 and 60. Severe vomiting followed by excruciating chest pain are the classic clinical signs, often in conjunction with a history of over indulgence in food and alcohol. The authors describe a case of Boerhaave's syndrome in a child, the result of missed appendicitis.
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PMID:Boerhaave's syndrome and children: a rare and unexpected combination. 888 9

Pirarubicin (4'-O-tetrahydropyranyladriamycin), a new anthracyline derivative, was administered as a single agent into the pleural cavity of 42 patients (total 46 courses) with malignant pleural effusion at a dose of 20, 40, 60 or 80 mg/body. All 46 courses were evaluable for non-hematological toxicities. Fever and chest pain (> or = WHO grade 2) were seen in 67.4% and 13.0% of courses, respectively. Patients receiving a dose of 80 mg/body developed fever of > or = 39 degrees C in 45.5%, and chest pain lasting more than three days and requiring pentazocine more than three times in 36.4%. In contrast, patients receiving a dose of < or = 60 mg/body presented these toxicities in only 8.6% and 2.9%, respectively. Nausea-vomiting (> or = WHO grade 2) was observed in only 4.3% of the total 46 courses and alopecia was not observed. Thirty-eight courses (36 patients) were evaluable for hematological toxicities. Myelosuppression (leukocyte nadir count < or = 1900, WHO grade 3 or 4) was seen in four courses (10.5%), and thrombocytopenia (< or = 49,000, WHO grade 3 or 4) in only two (5.3%). Although the mean AUC (0-24) for pirarubicin in plasma during the four courses that produced myelosuppression was significantly higher than that during the 11 courses without myelosuppression, the difference in the mean dose was not significant. Furthermore, no significant correlation was shown between dose (mg/m2) and AUC in plasma. It is considered that myelosuppression is not a dose-related toxicity at a dose of 20-80 mg/body. The dose-limiting toxicity was fever or chest pain, although unexpected myelosuppression was also encountered. The maximum tolerated dose was 80 mg/body. With regard to clinical efficacy, the overall response rate was 73.7% in 38 evaluable courses (38 patients). The mean T(1/2) of pirarubicin concentration in pleural effusion and plasma was 22.1 h and 8.8 h, respectively. We recommend a dose of 40 or 60 mg/body pirarubicin for this pleurodesic treatment.
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PMID:Intrapleural pirarubicin (4'-O-tetrahydropyranyladriamycin) for treatment of malignant pleural effusion. 889 73

A 56-year old man was admitted to the hospital with malaise, weakness, and fatigue. He was short of breath and had bilateral foot edema. Even though he had been very active a month earlier, he could no longer climb stairs. For the last two weeks, he had had a cough producing green sputum, a "tight feeling" in his chest, polyuria, and polydipsia. He had not had radiating chest pain, palpitations, leg pain or erythema, hemoptysis, diaphoresis, flushing, fever, chills, nausea, vomiting, diarrhea, or a loud snore.
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PMID:Respiratory distress, weakness, and electrolyte abnormalities. 896 76

rHuTNF was locally applied to 26 patients with diverse advanced tumours and malignant pleural effusions following maximum possible drainage of their pleural cavities. 46 instillations (an average of 1.8 per patient) with doses between 0.10 mg and 0.50 mg were carried out. The total doses ranged from 0.15 mg to 1.01 mg per patient. 41% of the instillations resulted in flu-like symptoms, 35% fever/chill, 24% fatigue/malaise, 11% nausea/vomiting and 11% chest pain. All toxicities were fully reversible and could be treated successfully. There was no apparent relation between dose and side-effects. Of those patients treated primarily with TNF, 87% did not suffer from any recurrent effusion within 4 weeks after treatment. In patients who had already been treated employing other methods, this figure was 86%. Complete drainage of the pleural cavity was not absolutely necessary before application of TNF. Intrapleural instillation of TNF appears to be an effective method for achieving pleurodesis with relatively few side-effects and can be successful even after other methods have failed. It is a method which can also be applied to patients who have a poor general state of health.
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PMID:Recombinant tumour necrosis factor in the local therapy of malignant pleural effusion. 913 93

Spontaneous esophageal perforation, or Boerhaave syndrome, is an uncommon finding requiring prompt diagnosis and immediate surgery because of its high mortality rate. The clinical diagnosis in typical cases is based on the symptom triad of Macler: vomiting, strong sudden chest pain and subcutaneous emphysema. We report 4 cases of Boerhaave syndrome with atypical presentation studied with Computed Tomography (CT) to make the correct diagnosis with atypical clinical findings. In each patient, we assessed the clinical symptoms, classifying them as typical and atypical, the diagnostic course leading to diagnosis and CT patterns. The classic symptoms were absent in one patient, while one patient had vomiting only, one had vomiting and chest pain and one had chest pain and cough. Chest radiography was performed in three patients and permitted the diagnosis in one of them only. CT permitted the definitive diagnosis in all cases. When spontaneous esophageal rupture presents with aspecific clinical findings. CT permits its accurate and specific diagnosis. We found atypical CT signs of esophageal rupture, namely pneumopericardium, uncommunicating mediastinal and pleural effusions, and focal pleural effusion in a contralateral cavity. Finally, our finding of a periesophageal mediastinal collection moving to the parietal subpleural space is not reported in the radiological literature. The severity of these findings varies and it is probably related to the increase in intraesophageal pressure affecting the progression of abscessual and hydroaerial collections in different anatomical structures; the time when CT is performed is also important. To conclude, the CT diagnosis of spontaneous esophageal rupture is specific and CT shows lesion site correctly.
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PMID:[Spontaneous rupture of the esophagus (Boerhaave syndrome): computerized tomography diagnosis in atypical clinical presentation]. 942 52

A caucasian teenage Dutch schoolgirl with known chronic low visual acuity and albinism, presented with frank acute pulmonary oedema, died after 1 h of cardio-pulmonary resuscitation for bradyarrhythmia and cardiac arrest. Two weeks prior to presentation, during sport training, she complained of oppressive chest pain on exertion accompanied with vomiting without any other systemic symptoms. Post-mortem examination revealed supravalvular stenosis of the pulmonary trunk and ascending aorta with irregular intimal thickening associated with stenosis of the left coronary artery. Microscopic examination demonstrated cellular infiltration of the wall of the aorta and pulmonary trunk with formation of granulomas with multinucleated giant cells. These features are compatible with Takayasu's arteritis.
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PMID:Takayasu's arteritis: a rare cause of cardiac death in a Caucasian teenage female patient. 945 98

A 37-year-old Hispanic woman complained of having awakened with a tingling sensation, followed by sudden weakness, in both legs. A month earlier, she had experienced heart palpitations but had not had chest pain or dyspnea. She had lost 10 lb in the last two months despite an increased appetite and no polyuria, polydipsia, vomiting, or diarrhea.
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PMID:A woman with sudden paralysis. 952 29

Since there are few studies examining gastroesophageal reflux (GER) in healthy children beyond infancy, we report our experiences treating children older than two with this condition. GER was diagnosed by either an abnormal extended intraesophageal pH monitoring (pH study) or presence of histological esophagitis. Thirty-seven patients met the criteria, ages 3 to 19 years (mean 11) and 68% were males. Common symptoms were vomiting, abdominal or chest pain, heartburn and regurgitation. Mean duration of symptoms was 28.7 months, and six patients had severe esophagitis, and one had Barrett's esophagus. Patients with severe esophagitis were older and had strongly positive pH study parameters compared to the rest of patients (p < 0.05). All patients were treated with prokinetic and acid reducing agents for 8 to 12 weeks. Sixty-two percent responded to initial course and remained asymptomatic during the follow-up period. Nissen fundoplication was recommended to five patients (13.5% of study population) because of refractory GER. Four of these patients who required surgery had severe esophagitis. In summary, GER in normal older children is a chronic disease with potentially severe complications. All patients should be evaluated by pH study and endoscopic esophageal biopsies, and have careful follow up.
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PMID:Gastroesophageal reflux disease in children older than two years of age. 950 66


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