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)

A 45-year-old man who was admitted with nausea, vomiting, and abdominal pain was found to have severe metabolic alkalosis, with a PaCO2 of 11.4kPa (85.5 mm Hg), PaO2 of 5.8 kPa (43.5 mm Hg), pH of 7.61, and plasma bicarbonate concentration of 82.0 mmol/l. He was treated with oxygen, intravenous physiological saline, and phenytoin and improved within 48 hours. Radiographs showed gastric outlet obstruction secondary to peptic ulcer, which was treated by surgery. Though sever, the rise in carbon dioxide concentration in this patient was probably lifesaving. The PaCO2 was therefore allowed to fall gradually as the alkalosis was treated. The return of both PaCO2 and plasma bicarbonate values to normal in parallel suggests that hypoventilation compensated for the metabolic alkalosis and emphasises the importance of conservative treatment in cases of metabolic alkalosis.
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PMID:Severe metabolic alkalosis: a case report. 679 44

Experimentally, we produced obstruction of the intestine in dogs, and the intraluminal pressure of the small intestine was measured without inducing anesthesia and with the abdominal wall closed. The maximum active intraluminal pressure reached 44.1 +/- 3.3 milligrams of mercury three days after the obstruction was produced. The pressure rose further to 95 millimeters of mercury, or higher, after an intravenous injection of physostigmine or during vomiting. When the intraluminal pressure is artificially increased and the vascular structure is observed by the resin-casting method, impairment of the villous circulation of the mucosa is already seen when the pressure reaches 20 millimeters of mercury. When the pressure was further increased, the circulation impairment spread toward the outer layer of the intestine. Mesenteric blood flow, peripheral vascular resistance and submucosal blood flow did not show significantly lower values than did the control group, unless the intraluminal pressure was 100 millimeters of mercury, or higher, but the oxygen consumption of the intestinal tissues was significantly lower than that for the control group when the intraluminal pressure was 40 millimeters of mercury, or higher. The resin-casting method showed that, at this pressure, a finding believed to indicate an arteriovenous shunt was already present at the mucosal villous base. The aforementioned results indicate that selective mucosal ischemia may occur when the intraluminal pressure increases to a range that is clinically possible when obstruction of the intestine occurs.
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PMID:Experimental studies on the hemodynamics of the small intestine following increased intraluminal pressure. 682 51

Liz... Josiane, a 9 year old girl, was admitted with a 24 hours history of severe headache and vomiting. On admission she was conscious, irritable and complained of a severe headache. Clinical examination revealed a right hemiparesis with cyanosis of the lips and extremities and clubbing of the fingers, all consistent with chronic hypoxia. Cardiovascular examination was normal apart from a systolic murmur which could be heard posteriorly under the left scapula. There were no angiomatous or telangiectatic lesions of the skin. A blood examination revealed a raised ESR, a marked polycythaemia with a decreased arterial oxygen tension. Chest x-rays showed the presence of an irregular well delineated opacity in the posterior basal segment of the left lower lobe. This opacity was confluent with the ipsilateral hilum and was suggestive of a pulmonary arteriovenous fistula. An intracranial space occupying lesion in the left temporal region of the brain was revealed by electroencephalographic and CT scan investigations; this proved to be an abscess which was surgically removed with no subsequent complications. Further radiological investigations of the chest revealed the pulmonary lesion was an arteriovenous aneurysm occupying the whole left inferior lobe. This was removed at thoracotomy three months after the acute neurological event. The results of respiratory function and regional isotopic investigations before and after surgery will be discussed.
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PMID:[Cerebral abscess and pulmonary arteriovenous fistula. A clinical and respiratory function study]. 685 38

A case report is presented of toxic shock syndrome associated with the use of a contraceptive diaphragm and recent removal of an IUD. A 23 year old woman was admitted to St. Paul's Hospital in Vancouver, British Columbia because of frequent watery diarrhea and vomiting that had begun suddenly 2 days earlier, as well as generalized abdominal and muscular pain, fever and sweating of 1 day's duration. The patient's last menstrual period had ended 3 weeks earlier. Oral contraceptive (OC) therapy had been stopped 9 months earlier, and 2 weeks before admission an IUD had been removed because of dyspareunia. A diaphragm had been inserted 24 hours before the onset of symptoms and was in place at the time of admission. Removal of the diaphragm revealed about 10 ml of greenish yellow pus. Laboratory tests showed multiorgan involvement. The blood urea nitrogen level was 35 mg/dl and the serum creatinine level 2.9 mg/dl. The serum amylase level was 125 IU/l at the time of admission but rose to 1021 IU/l by day 6. The prothrombin time was 16 seconds. Arterial blood gas studies while the patient was breathing room air showed the following: pH 7.36, carbon dioxide tension 20 mm Hg and oxygen tension 84 mm Hg. Urinalysis showed pus and a small amount of glucose. Treatment consisted of blood volume expansion and electrolyte replacement. The patient showed improvement within 48 hours. 6 days after admission an exfoliative desquamating rash developed on the volar surfaces of the fingers and feet, and a slight scaling rash was noted on the face. These cleared spontaneously, without residual scarring. 6 criteria for the diagnosis of toxic shock syndrome have been defined: an increased body temperature; skin manifestations; shock, frequently with orthostatic hypotension and syncope; involvement of multiple organs; diarrhea; and myalgia. Clinicians need to appreciate that tampons are not the only cause of toxic shock syndrome and that the syndrome can occur at times other than during menstruation. Diaphragms may only rarely be associated, but their relation to toxic shock syndrome must be recognized. Counseling on the use of diaphragms should stress the avoidance of prolonged use.
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PMID:Toxic shock syndrome associated with a contraceptive diaphragm. 712 32

Previous man dives, in a series designed to evaluate the physiological effects of helium, nitrogen, and oxygen (trimix), investigated the comparative effects of 5% vs. 10% nitrogen with fast compression (12 h 20 min) to 460 m (1509 ft) and subsequent compression over 2.5 d to 650 m (2132 ft). In 1981 three divers were compressed twice as slowly as for these earlier dives to 650 m over a period of 6 d 8 h using 10% N2 in heliox. An extensive series of studies were made over 4 d 15 h at 650 m before further compression to 686 m (2250 ft) for a stay of 24 h with extensive tests of psychological and neurophysiological performance, pulmonary function, reflex, Doppler, and other studies. High pressure nervous syndrome (HPNS) tremors and EEG theta activity increases were effectively controlled with no nausea, vomiting, or somnolence (microsleep). Some euphoria was present. At 686 m there was a 20% to 30% impairment of concentration and attention; otherwise the physical condition of the divers was fine and they completed all tasks without difficulty. Slow compression prevented the initial large performance decrement of 40% to 50% on Day 1 as found in previous fast-compression dives. Otherwise the performance tests showed much the same decrement of 15% to 20% seen in earlier dives; deeper than 570 m (1870 ft), however, the addition test was worse, with a decrement of 35%. The results are discussed with respect to the previous two dives with faster compression, and the possible nonlinearity of nitrogen antagonism of HPNS is considered.
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PMID:Effect of compression rate on use of trimix to ameliorate HPNS in man to 686 m (2250 ft). 716 98

Ninety-six children received morphine 0.1 mg/kg (n = 47) or ketorolac 1 mg/kg (n = 49) intravenously (IV) in a prospective, randomized, double-blind fashion, after tonsillectomy. Recovery variables and complications were recorded while subjects were in the hospital and parent(s) were contacted 24 h and 14 days after surgery. There were no differences in demographics, surgical management, awakening time, oxygen requirements, or time to readiness for postanesthesia care unit (PACU) discharge or discharge home between the two groups. Ketorolac subjects had fewer emetic episodes than morphine subjects (median 1 vs 3; P = 0.006) and were less likely to have more than two episodes of emesis after PACU discharge (9/49 vs 22/47; P = 0.007). Ketorolac subjects had more major bleeding (bleeding requiring intervention; 5/49 vs 0/47, one-tailed P = 0.03) and more bleeding episodes (0.22 episodes/subject vs 0.04 episodes/subject, P < 0.05) in the first 24 h after surgery, but no greater overall incidence of bleeding than the morphine subjects. In children having tonsillectomy, ketorolac, compared to morphine, reduced the number of emetic episodes after PACU discharge, but did not hasten awakening, readiness for PACU discharge or discharge home, and increased the likelihood of major bleeding in the first 24 h after surgery.
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PMID:Recovery and complications after tonsillectomy in children: a comparison of ketorolac and morphine. 748 94

We compared the effect of a propofol-based anaesthetic to an isoflurane-based anaesthetic on the incidence of postoperative vomiting in children following tonsillectomy. Thirty-nine children were enrolled in the study and randomized to receive one of the proposed anaesthetics. All patients underwent a mask induction with halothane, nitrous oxide, and oxygen. Intravenous access was established and all children received fentanyl (2-4 micrograms.kg-1) i.v., mivacurium (0.3 mg.kg-1) i.v. and acetaminophen (10-15 mg.kg-1) p.r. Following tracheal intubation, patients received either isoflurane (0.8-1.6%) or propofol (120-180 micrograms.kg-1 min-1) i.v. with nitrous oxide 70%/oxygen 30% for maintenance of anaesthesia. Vital signs were maintained within 20% of baseline. All patients were extubated in the operating room. PACU nursing staff recorded episodes of vomiting for 4-6 h prior to discharge. A telephone interview the following day was also used for data recovery. Age, sex, and duration of the procedure were not significantly different between the two study groups. Of 19 patients who received propofol, four vomited (21%); in contrast, of the 20 patients who received isoflurane, 11 vomited (55%). This difference is significant (P = 0.048 two-tailed Fisher's Exact Test). These data suggest that using propofol for anaesthesia can diminish the incidence of vomiting following tonsillectomy.
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PMID:Propofol reduces the incidence of vomiting after tonsillectomy in children. 748 56

This study was conducted to determine whether intravenous theophylline, added to inhaled albuterol and intravenous methylprednisolone, provides a clinically significant benefit in the treatment of pediatric status asthmaticus. Patients aged 2 to 10 years were randomized to receive either intravenous theophylline or placebo. All patients received aerosolized albuterol and intravenous methylprednisolone. There was no difference between groups in the improvement of a clinical asthma score over time, in oxygen requirement, or in the number of albuterol treatments required. Theophylline group patients experienced more nausea, emesis, and insomnia. We conclude that there is no benefit in adding theophylline to treatment with methylprednisolone and albuterol for pediatric status asthmaticus. Furthermore, there are significantly more adverse effects associated with the use of theophylline.
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PMID:Intravenous theophylline in pediatric status asthmaticus. A prospective, randomized, double-blind, placebo-controlled trial. 758 20

Postoperative vomiting is induced by different mechanisms such as age, anaesthetic technique and medications, postoperative analgesia, and surgical traction on the extra-ocular muscles. The influence of anticholinergic premedication and the use of benzodiazepines as factors affecting the incidence of vomiting is controversial. In a prospective, randomised, single-blind study we examined two different treatments with regard to postoperative pain, vigilance, and vomiting in young children undergoing strabismus repair. METHODS. After institutional ethical committee approval, informed written consent was obtained from all parents. The children were randomly assigned to three groups: (1) paracetamol (P)--17 patients who received 250-500 mg paracetamol rectally (dependent on body weight) immediately after intubation of the trachea; (2) bupivacaine (B)--17 patients who received two drops 0.5% bupivacaine hydrochloride on the conjunctiva of the eye(s) being corrected following intubation of the trachea and again 10 min after intubation. After the surgeon had exposed the extra-ocular muscle and before readaptation of the conjunctiva, two drops of the same solution were applied again each time directly on the muscle; and (3) controls (C)--16 patients who received rectal paracetamol after completion of the operation but before extubation. The children were premedicated with 0.05 mg/kg flunitrazepam sublingually. After 0.25 mg atropine i.v., anaesthesia was induced with 0.1 mg/kg vecuronium, 5 mg/kg thiopentone, 1.5 vol% enflurane, and N2O/O2 50:50. When the trachea was intubated anaesthesia was maintained with enflurane as required and 70% N2O in oxygen. Extubation was performed only if the patient could touch or did not tolerate the tube. Oral diet was allowed 6 h after extubation at the earliest. EXAMINATION OF VIGILANCE AND ANALGESIA. The degrees of vigilance and pain were evaluated preoperatively and after extubation over 24 h using two different scales. Evaluation of the scales was performed during the first 3 postoperative h at 12 different time points (Figs. 1, 2) and 6, 12, and 24 h after extubation. The evaluation was conducted by nursing staff who were blinded to the treatment (single-blind study). Postoperative analgesia consisted of 250-500 mg rectal paracetamol (all patients). Parametric data were expressed as mean +/- SD, and comparisons were made with the one-way analysis of variance. Fisher's exact test was applied to ordinal data. P < 0.05 indicates a statistically significant difference. RESULTS. Two patients (P) were excluded from the study postoperatively because of refusing rectal paracetamol in spite of pain and postoperative infection of the upper airways, which had manifested on the afternoon of the operative day. No significant differences were found between the three groups in patient characteristics (Table 1). The quantity of enflurane administered, rate, postoperative consumption of rectal paracetamol, and postoperative emesis were highest in the control group (Tables 2, 3), but the incidence of postoperative vomiting ranged only between 13% and 24% (Table 3). Children with preoperative paracetamol needed more time to fulfill the criteria to "stick out the tongue" and "recognising the mother". VIGILANCE. The time to postoperative crying or screaming and restlessness was shorter in the control group. The values reached significant difference at 10 min (P) and 25 min (P and B) after extubation compared with the other groups (Fig. 1). ANALGESIE. At 5, 10, and 150 min after extubation pain was significantly higher in patients in the control group (Fig. 2). CONCLUSIONS. Intraoperative administration of rectal paracetamol or topical 0.5% bupivacaine was most effective in the treatment of postoperative pain for strabismus surgery in younger children. Sublingual flunitrazepam and i.v. atropine given as premedication probably decrease postoperative vomiting.
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PMID:[Strabismus surgery in children. The effect of paracetamol and bupivacaine]. 761 77

We evaluated the effect of transdermal scopolamine on the incidence of postoperative nausea and vertigo after outpatient ear surgery (exploratory tympanotomy, mastoidectomy, or endolymphatic sac and oval and round window surgery) in a double-blind, placebo-controlled study. A transdermal patch containing either scopolamine (n = 19) or placebo (n = 20) was placed behind the nonsurgical ear 2 h before surgery. Anesthesia was induced with thiopental (4-6 mg/kg intravenously [i.v.]), sufentanil (0.5 microgram/kg i.v.), and vecuronium (0.1 mg/kg i.v.) and maintained with isoflurane (0.2%-2%) and nitrous oxide (70%) in oxygen. Patients were observed postoperatively in the recovery room and after discharge for 72 h. There was no significant difference between groups with respect to time in recovery room, time to discharge, incidence of in-house nausea, vomiting, amount of antiemetics required, or postoperative visual analog scale (VAS) scores while in the hospital. After discharge, there were lower VAS nausea scores (by repeat measures analysis, P < 0.05) and a lower reported incidence of nausea (31% vs 62%; P < 0.05) and vertigo (6.2% vs 25%; P < 0.05) in the active patch group versus the placebo group. There was a higher incidence of dry mouth in the active patch group (44% vs 25%). Seven patients did not complete the study due to failure to keep the patch in place or failure to return the diary from home; and one patient from the placebo patch group was admitted for uncontrolled nausea and vomiting. The authors concluded that transdermal scopolamine is effective in reducing, but not eliminating, postoperative nausea and vertigo after discharge in outpatient ear surgery.
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PMID:Transdermal scopolamine for the reduction of postoperative nausea in outpatient ear surgery: a double-blind, randomized study. 763 64


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