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)

In cytostatic drug treatment, nausea and vomiting are very frequent, unpleasant and undesirable side effects that cause considerable discomfort to the patient. However, many established antiemetics (Torecan, haloperidol, Valium, Largactil etc.) have not shown significant antiemetic activity in the patients to whom cytostatics were applied. In our controlled randomized clinical trial, the antiemetic activity of methylprednisolone was investigated and compared with placebo (10 ml saline) and Torecan. All the compounds were injected before cis-platinum administration, knowing that this agent induces vomiting in almost 100% of patients. Ninety patients entered the study and have been evaluated. The results of the trial have shown that methylprednisolone in the single dose of 250 mg applied i.v. 2 h before injection of a cytostatic agent experienced pronounced antiemetic activity in 48% of the patients (15/31), as compared to Torecan 21% (6/29) and placebo 13% (4/30). This difference was statistically significant (P less than 0.01). No side effects were recorded after methylprednisolone application. The results of the study showed that methylprednisolone possesses a pronounced antiemetic activity in almost half of the patients treated with cis-platinum.
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PMID:Methylprednisolone as an antiemetic in patients on cis-platinum chemotherapy. Results of a controlled randomized study. 634 Mar

The perceptive physician can anticipate and prevent eclampsia. If possible, he should try to prolong preeclamptic pregnancies to the 37th week to avoid neonatal deaths from complications and prematurity. In some cases, preeclampsia strikes and progresses rapidly before the 30th week, however, and, in order to save the mother, the pregnancy must be terminated. If the preeclamptic woman deteriorates to the point where severe headache, epigastric pain, vomiting, and hyperreflexia exist, eclampsia is imminent. If she becomes eclamptic, clinicians must immediately begin to manage the convulsions with a sedative. Diazepam has proved successful which accounts for its widespread use in Great Britain and developing countries. Large doses given over a long period of time, however, adversely affect the newborn, e.g. respiratory depression. Another popular sedative is magnesium sulphate (in use for 50 years). Dangers of overdose can be avoided by testing the patella reflex every hour when magnesium sulphate is being administered intravenously: the reflex becomes null before serious toxic effects occur. If the systolic blood pressure exceeds 170mmHg, antihypertensives should also be given selectively to prevent cerebral hemorrhage. The preferred antihypertensive must act rapidly and predictably, with a wide margin of safety between the therapeutic and toxic dose. Hydralazine hydrochloride meets these requirements. Fluid and acid-base balances must be controlled to treat hypovolemia, oliguria, and acidosis. The longer delivery is delayed, the worse the outlook for mother and infant. Regardless of the type of delivery, clinicians must avoid hemorrhage and operative shock because eclamptics cannot tolerate blood loss. It is imperative that clinicians do not become so involved in saving the patient that they overtreat her, e.g., mixing antihypertensives.
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PMID:Eclampsia. 675 54

An efficient narco-analgesia is given by the association of two drugs: -- diazepam (Valium): a benzodiazepine with an anxiolytic and myoresolutive effect, inducing sleep and giving amnesia; -- lysine acetylsalicylate (Aspegic) giving an analgesia inferior to that of morphinomimetic drugs but not inducing respiratory depression. These two drugs are given in an intravenous catheter. Their effects last about 20 minutes - vomiting is rare. The authors report their experience of 50 cases and think that this technique is recommended in remote medical units for moderately painful and short duration operations.
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PMID:[Valium-aspegic association. Its value in a remote medical unit (author's transl)]. 678 84

Forty-one patients with advanced squamous cell lung cancer and no prior chemotherapy were entered in a prospectively randomized trial comparing dianhydrogalactitol plus Adriamycin (DA) versus DA plus cis-dichlorodiammineplatinum(II) (DAP). The DAP regimen was superior to the DA regimen in regression rate (53% versus 27%), median regression duration (255 versus 122 days), median time to tumor progression (approximately 175 versus 58 days), and median survival time (185 versus 126 days). Patients who were greater than 60 years old responded particularly well to the DAP regimen and accounted for most of the survival advantage. Nausea, vomiting, and myelosuppression were more frequent and severe with the DAP regimen. This study seems to indicate a role of cis-dichlorodiammineplatinum(II) in patients with advanced squamous cell lung cancer. The particular advantage noted for older patients needs further evaluation.
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PMID:A role of cis-dichlorodiammineplatinum(II) in squamous cell lung cancer. 699 Nov 7

Two siblings (one man, one woman), presenting with diarrhea, severe weight loss peripheral neuropathy, ophthalmoparesis, asymptomatic leukoencephalopathy were diagnosed as a new cases of Mitochondrial Neuro Gastro Intestinal Encephalomyopathy syndrome (MNGIE). Hirano (1994) defined four criteria for the diagnostic: peripheral neuropathy, ophthalmoparesis, gastro intestinal dysmotility, muscle biopsy with histologic features of mitochondrial myopathy (ragged-red fibers, muscle fibers with increased succinate deshydrogenase stain or ultra structurally abnormal mitochondria). In a review of the literature, we found 31 cases with MNGIE. With our two cases, we study this group of 33 patients. First symptoms begin about 13.5 years with a median of 10 years and extremes for 1 to 32 years. The first signs are gastro intestinal symptoms (recurrent nausea, vomiting or diarrhea with intestinal dysmotility) in 22 cases, an ophthalmoparesia in 4 cases, intestinal and ocular signs in 1 case, gait ataxia or peripheral neuropathy in 3 cases, hearing loss in 1 case, gait ataxia or peripheral neuropathy in 3 cases, hearing loss in 1 case. During the evolution, besides the cardinal signs, the following features have been observed with a variable frequency: hearing loss, short stature, facial palsy, dysphonia, dysarthria, sweating, orthostatic hypotension, bladder dysfunction, hepatomegalia, The laboratory features are: abnormal Nerve Condition Studies/EMG compatible with a sensory motor neuropathy, lactic acidosis, mitochondrial respiratory chain defect (essentially complex IV deficiency, complex I deficiency or multiple complex defect), MRI leukodystrophy, elevated CSF protein, heart block, ragged-red fibers or increased SDH stain. The prognosis is poor, due to a severe weight loss bordering on cachexia 13 patients died with a mean age of 28.5 years (median 24 years, extreme 3 years to 51 years). The prognosis seems to be worsened by a young age of onset. The 33 patients belong to 19 families with 7 cases of consanguinity. 25 patients had a brother, a sister or a cousin affected. The study of these families is compatible with an autosomic recessive transmission, suggesting a pathology of the nuclear genomi, probably impliying the control of the mitochondrial DNA replication. In fact, in 13 cases, a study of the mt DNA was realized: multiple deletions were founded in 6 cases, multiples mutations in one case, unique mutation in 1 case. In 5 cases ther was no evidence of abnormality. These precise etiology and pathophysiologic significance of the mt DNA deletions, and the heterogeneity of the modifications of the mt DNA remain unknown. However, the possibility of various phenotypes for a same genotype or inversely is known in mitochondriopathies.
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PMID:[MNGIE syndrome in 2 siblings]. 968 18

The patient who presents with a serious head injury is often very difficult to manage. The airways is of primary concern; adequate ventilation must be provided and aspiration protected against. Recent studies suggest that hyperventilation may be as beneficial as was earlier believed. As the pCO2 level decreases, vasoconstriction occurs. If the level falls too low, cerebral perfusion is restricted, and profound cerebral anoxia may ensue. Current standards call for a ventilatory rate to allow for moderate respiratory alkalosis, in theory to mildly constrict teh vessels but still provide adequate perfusion. Arterial blood gas analysis in the ED is the definitive measurement of airway management in the field. Remember that the anatomy of the meningeal layers places the arteries primarily in the epidural space and the veins in the subdural space. A bleed in the epidural space often presents with a rapid onset of signs and symptoms, as was obvious in this traumatized patient. When a bleed occurs in the subdural space, the onset is usually more insidious, and an accurate history is a key to field diagnosis. As the hemorrhage expands, compression displaces the brain within the cranial vault. This displacement causes pressure to be exerted on the medulla of the brainstem. Cushing's Traid is a result of this pressure on the medulla and is evidence by the pulse slowing while systolic blood pressure rises and respirations become ataxic. Vomiting is often associated, and as the bleed continues, herniation syndrome begins. Decorticate posturing is displayed, followed by decerebrate posturing if relief is not provided. It is important to distinguish between decorticate and decerebrate posturing. It is important to distinguish between decorticate and decerebrate posturing. An easy way to remember the differences is to picture the anatomy of the brain. The cerebral cortex lies above the cerebellum, so when a patient's arms flexed up toward the face , he is pointing to his "core" (de-cor-ticate). As the arms extend downward, he is pointing to his cerebellum(de-cere-brate). T o manage the head-injured patient, it is imperative to anticipate potential developments, as well as protect against underlying injuries that may not be fully evaluated until arrival at the ED. Cervical spine often accompany head injuries, and full spinal immobilization is a mandatory precaution in all presentations. With the expanding hematoma found on this patient's neck, vascular damage ws obvious and contributed to the suspicion of spinal injury. As the intracranial pressure rise, vomiting and seizures are common. Placement of an endotracheal tube and having suction equipment ready are the best tools to prevent against aspiration. It is possible to angle the long spine board 10-15 degrees, exercising caution to ensure the patient's spinal alignment is not manipulated during the process. Seizures are usually treated with anticonvulsants like Valium. When a seizure accompanies a head injury, it is a direct result of the increased intracranial pressure and has a generally poor response to Valium, as the underlying cause of the seizure still exists. In this case, the patient had a full neuromuscular blockade, and any seizure would not have been recognized as long as the paralytics were on board. Early notification to the ED is essential, reporting all findings and interventions. This can alert them and give them the opportunity to prepare specialized equipment, such as CT scanners, mechanical ventilators, etc. Also, consider transportation options and the length of time to definitive care, including neurosurgical evaluation. This patient needs to be seen in a trauma center capable of the most thorough evaluation and management. Evacuation by air ambulance may be the most appropriate method of transport.
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PMID:Managing head injuries. 1222 33

General anaesthesia using ketamine has been shown to be safe. It is generally used in our private hospitals where there is lack of qualified personnel and sophisticated anaesthetic machines. A retrospective review of 295 cases of laparoscopy was performed over 28 months at the fertility Unit of Life Specialist Hospital Nnewi, Anambra State, Nigeria. Ketamine general anaesthesia was used for all the patients after premedication with 0.6 mg of atropine. Seventy-six and 102 patients who had additional premedication of 10 mg diazepam and 50 mg promethazine, respectively, were compared. The duration of this procedure ranged between 7 and 18 minutes, with a mean of 12 minutes. The dose of ketamine used was 100 mg mean (range 50-180 mg); 12.6% of the patients had some form of reaction. Diazepam reduced talkativeness during recovery but increased the recovery time significantly, from an average of 45 minutes to 3 hours. Promethazine significantly reduced vomiting and restlessness and did not significantly prolong the recovery time (from an average of 45 minutes to 70 minutes). Two patients who had only atropine as premedication had an idiosyncratic reaction of breathlessness and tonic-clonic-like movements. They responded to intravenous diazepam. Ketamine produces a safe, effective and simple general anaesthesia and is recommended for use in day-case laparoscopy, where standard anaesthetic machines and trained personnel are lacking. Use of promethazine premeditation is advocated for improved outcome.
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PMID:The use of simple ketamine anaesthesia for day-case diagnostic laparoscopy. 1461 71


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