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)

We report the history of a 65-year-old woman, diabetic for 25 years who presented progressive alteration of consciousness with hyperthermia, right upper quadrant pain and vomiting. Bacteriological and radiographic investigations, especially computerized tomography scan of the abdomen, led to the diagnosis of emphysematous pyelonephritis caused by Escherichia coli. Despite a large spectrum antibiotic therapy and surgical drainage of the gas collection, the patient remained septic. An emergency nephrectomy was eventually performed. We review the characteristics of emphysematous pyelonephritis. Early diagnosis is essential because without early nephrectomy mortality rates reach 75%.
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PMID:[Emphysematous pyelonephritis in a diabetic patient. Literature review apropos of a case]. 164 35

Fifty children and adolescents were found to have gallstones at Children's Hospital of Buffalo (NY) during a period of 10 years. The mean (+/- SD) age was 12.2 +/- 6.2 years, with 21 boys and 29 girls. The majority of patients could be categorized into four groups: hemolytic disease (18 patients), parenteral nutrition (eight patients), adolescent pregnancy (seven patients), and idiopathic (10 patients), while seven patients had a variety of other etiologies. Right upper quadrant pain was the most common symptom (32 patients), followed by jaundice (15 patients), vomiting (13 patients), and nonspecific abdominal complaints (13 patients). Ten patients presented with jaundice and underlying hemolytic disease; seven patients were asymptomatic. Clinical presentation was found to vary with age and factors associated with the development of gallstones. Ultrasonography was the mode of diagnosis in 48 patients. Cholecystectomy was performed in 36 patients. In contrast to gallstones in adults, after exclusion of the patients with adolescent pregnancy, there was no female predominance. Pancreatitis was the most common complication, occurring in 8% of the patients; cholecystitis and cholangitis were absent.
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PMID:Gallstones in children. Characterization by age, etiology, and outcome. 173 34

Thirty-five cases of cholelithiasis diagnosed at a children's hospital over a 7.5-year period are reviewed and compared to 693 cases of pediatric gallstones reported in the literature. Symptomatology and associated medical history are more important in diagnosing cholelithiasis than are laboratory tests. Hemolytic disease is the most common associated condition in our series (46%) as well as in the literature (30%), but the frequency of the various associated conditions varies with age. Isolated gallstone disease does occur, particularly in the young infant. Jaundice is the most common symptom in children less than 1 year of age, being present in greater than 90 percent of symptomatic patients previously reported. Overall, the most common symptom in our series is vomiting (60%). Right upper quadrant pain in the absence of vomiting does not appear to be significant, as this occurred in only one patient (3%) in our series.
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PMID:Cholelithiasis. Clinical characteristics in children. Case analysis and literature review. 266 Nov 3

Differential diagnosis of viral hepatitis begins with a check for darkened urine and bile in the urine. These hallmarks of conjugated hyperbilirubinemia immediately rule out prehepatic liver disease. Next, studies are done for the elevated transaminase levels that are characteristic of hepatitis infection, and a thorough history is taken to rule out drug- and toxin-induced hepatitis that may mimic acute viral hepatitis. Elevated alkaline phosphatase is a good marker of cholestasis. Ultrasonography can clarify this diagnosis. The classic presenting symptoms of viral hepatitis are jaundice, nausea, vomiting, malaise, anorexia, and dull right upper quadrant pain. However, serologic studies are needed to detect the presence of specific viral agents.
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PMID:Viral hepatitis. The alphabet game. 305 Sep 28

Intraarterial administration of 40-microns degradable starch microspheres (DSM) in a drug solution can temporarily retard flow of the drug-blood column through the arteriolar-capillary bed and lead to increased local drug deposition. Premonitory to Phase II-III efficacy studies applying this concept to regional therapy, it was necessary to determine the DSM dose to use. Patients with hepatic cancers were treated with varying doses of DSM with mitomycin C coadministered into the hepatic artery to define a dose of DSM which produces acceptable toxicity with maximal hepatic drug deposition as determined by a reduction in systemic mitomycin C exposure. Comparison of six patients receiving 6 ml of DSM (6 X 10(6) particles/ml) with ten patients receiving 15 ml showed a lower incidence and decreased severity of acute toxicity in terms of nausea/vomiting (16% versus 50%) and right upper quadrant hepatic pain (none versus 40%) with 6 ml of DSM. Reduction in systemic mitomycin C exposure evaluated by decrements in the area under the concentration curve in peripheral blood with time due to DSM was similar in both groups. Another seven patients were treated with escalating doses of DSM concurrently with 5 mg of mitomycin C. Although all seven patients tolerated 6 ml of DSM, higher doses (9 ml, 12 ml, 15 ml) led to incremental patient drop-out due to severe, acute right upper quadrant pain with only two patients able to receive 15 ml of DSM. In these patients, 6 ml of DSM appeared nearly equivalent to higher doses in terms of systemic exposure to mitomycin C. Eleven additional patients were evaluated for tolerance to repeated 6-ml dosing of DSM. Four patients had epigastric pain correlating with flow to the stomach demonstrated by nuclide angiography. The seven patients with no pain and no flow to stomach were treated with good tolerance for three-plus courses. Thus, 6 ml of DSM appear to be appropriate for Phase II-III studies.
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PMID:Phase I study of hepatic arterial degradable starch microspheres and mitomycin. 392 57

The possible association of hepatocellular carcinoma with oral contraceptive (OC) use is supported by the case of a 33-year old black female, gravida 5, para 4. She presented in April 1978 with right upper quadrant pain, nausea, vomiting, and fatty food intolerance. The case had been taking norethindrone, 1 mg with mestranol 0.05, for 2 years. There was no history of liver disease, alcohol abuse, or exposure to chemical toxins. The preoperative diagnosis was subacute cholecystitis; however, an unresectable primary liver tumor of both lobes was detected on surgery. OC use was discontinued, and the case refused chemotherapy. On December 1, 1978, she presented with a 9-week pregnancy which was aborted. Physical examination revealed an enlarged liver and mass in the upper right quadrant. The patient was readmitted December 11 with intractable pain and discharged. She died December 28, 1978. At autopsy the liver tumor appeared as a moderate to poorly differentiated hepatoma with irregular hyperchromatic nuclei. There was no evidence of coexistent benign lesions. The rapid progression of the disease following pregnancy suggests that hepatic growth was stimulated by the high estrogen levels of pregnancy. Earlier diagnosis and improved management are required in such cases. Ultrasonography can be used to confirm the presence of a mass, and liver scan or hepatic angiogram may be useful. Liver biopsy is required for definitive diagnosis. Treatment involves discontinuation of OC use and complete excision of the tumor where possible. If tumors have progressed beyond the stage of resectability, as in this case, the prognosis is poor.
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PMID:Hepatocellular carcinoma associated with oral contraceptive use and pregnancy. 629 72

A 32-year-old woman with a contraceptive history of use of combination contraceptives (Oviston, Non-Ovlon) between 1966 and 1979 (with a 1-year interruption), followed by radical hysterectomy in 1979, complained of dull right upper quadrant pain, nausea, vomiting, and fatigue in 1980. Among various diagnostic studies performed only cholecystography and cholangiography demonstrated clear areas in the gallbladder assumed to be stones. Cholecystectomy performed in 1981 showed chronic inflammation of the gallbladder without stones. The undersurface of the liver revealed a greyish tumor (3 cm in diameter). Frozen section demonstrated mature hepatocellular adenoma. Wedge excision of the tumor and cholecystectomy were performed without complications. CAT-scan follow-up showed no residual pathology. Additional literature search reports 58 cases in western European and American journals. Diagnosis of these benign tumors is difficult because the symptoms are vague. The main complication is intraabdominal hemorrhage necessitating emergency lobectomy. Ligation of a branch of the hepatic artery is done in case of inoperability. CAT-scan and ultrasonography with selective angiography are the best procedures to ascertain the diagnosis. Needle biopsy is contraindicated because of the risk of hemorrhage.
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PMID:[Hepatocellular adenoma following long-term intake of ovulation inhibitors]. 630 51

A 69-year-old white male was admitted to the hospital for right upper quadrant pain, fever, and vomiting. Acute cholecystitis was not thought to be present because of a negative ultrasonogram and oral cholecystogram. A 99mTc-PIPIDA hepatobiliary study showed definite evidence of gallbladder perforation, with pockets of radiolabeled bile in the abdomen. Immediate surgery confirmed the scan diagnosis. In patients who are at high risk for gallbladder perforation the technetium-99m-labeled iminodiacetic acid hepatobiliary scan should be considered as a first procedure to rule out acute cholecystitis and possible gallbladder perforation.
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PMID:Perforation of the gallbladder diagnosed preoperatively. 686 82

The term biliary pseudolithiasis was coined by Schaad (1988) to describe the appearance of gallbladder sludge following treatment with ceftriaxone. After cessation of the drug the condition resolves, hence the term "pseudolithiasis." The third generation cephalosporin, cefatriaxone, is a very potent, broad spectrum antibiotic indicated in meningitis, osteomyelitis, pyelonephritis, Lyme disease and many other severe infectious diseases. Up to 46% of those receiving this antibiotic develop gallbladder sludge. Most are asymptomatic, but a small proportion may develop right upper quadrant pain, nausea, vomiting and even cholecystitis. Ultrasonography may demonstrate many, small, echogenic particles within the gallbladder, as well as larger echogenic foci casting acoustic shadows. However, it can not differentiate these pseudostones from real stones. There are reports of surgical intervention in such cases. 2 boys, aged 5 and 10 years, respectively, treated with ceftriaxone for meningitis are presented. Both developed symptoms during treatment and in both gallbladder sludge was identified by ultrasonography. In 1 intraluminal gallbladder findings were identical with the appearance of surgical stones. Follow-up ultrasonography after the drug was stopped showed no evidence of pseudostones in either case. Awareness of this phenomena might save many unnecessary operations.
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PMID:[Sonographic demonstration of pseudo-cholelithiasis after ceftriaxone]. 799 84

There are increasing challenges for the practising gastroenterologist in treating AIDS-related gastrointestinal diseases. The differential diagnoses of dysphagia and odynophagia include cytomegalovirus (CMV) and herpes simplex virus (HSV) infection, non-specific aphthous ulceration and non-AIDS oesophageal diseases, especially reflux oesophagitis. Chronic subacute abdominal pain with nausea, vomiting, early satiety and weight loss is suggestive of an obstructive lesion caused by lymphoma or Kaposi's sarcoma. Severe acute abdominal pain can indicate pancreatitis or intestinal perforation due to cytomegalovirus. Right upper quadrant pain (with or without fever, vomiting or abnormal liver function tests with a cholestatic profile) is suggestive of hepatobiliary pathology including cholecystitis, cholangitis, acalculous cholecystitis and AIDS cholangiopathy. Diarrhoea is the most common gastrointestinal symptom of AIDS, affecting 50-90% of patients. Causes of AIDS diarrhoea include protozoa (Cryptosporidium parvum, Isospora belli, Enterocytozoon bieneusi, Septata intestinalis, Cyclospora spp, Entamoeba histolytica and Giardia lamblia), bacteria (Mycobacterium avium-intracellulare, Clostridium difficile, Salmonella, Shigella and Campylobacter jejuni), and viruses (CMV, HSV and possibly HIV). Chronic diarrhoea, malnutrition and weight loss can shorten the life-span of patients with AIDS. Elemental diets, isotonic formulas, medium chain triglycerides and total parenteral nutrition have been tried with little success in AIDS patients with severe diarrhoea and wasting.
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PMID:AIDS and the gut. 805 32


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