Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An oral formulation of delta-9-tetrahydrocannabinol (THC) in sesame oil (Marinol) is at present used for the management of chemotherapy-related nausea and emesis. However, due partly to poor bioavailability, its efficacy is variable. To circumvent possible metabolism in the gut and a first-pass effect by the liver, a suppository formulation of THC hemisuccinate ester was prepared. Administration of the suppository containing 11.8 mg of the hemisuccinate ester (equivalent to 9 mg THC) to three adult females (two of whom had previously exhibited low plasma drug levels following a 10-mg dose of the oral formulation) led to a marked and sustained elevation of plasma drug levels. Areas under the curves for plasma THC were more than 30-fold higher than after oral dosing. The suppository was well tolerated. The higher and more sustained plasma drug level achieved with this new formulation should enhance its antiemetic efficacy.
 ...
PMID:Bypassing the first-pass effect for the therapeutic use of cannabinoids. 838 56

Successful bowel preparation for proctologic surgery is not schematic possible for all patients. Quality of cleansing after whole gut irrigation in women for example with chronic constipation is not always as efficient as in other patients. Two techniques for preparation of the colon were compared in a controlled trial. Fifty given the strong laxative Prepacol and fifty with whole gut irrigation. Significantly more patients suffered from vomiting and postoperative infections (translocation?) following irrigation. Prepacol preparation was well tolerated, showed a similar quality of cleansing and only a small discomfort.
 ...
PMID:[Bowel preparation for surgery of the anus, rectum and colon]. 843 49

Digestion is a process which takes place in resting conditions. Exercise is characterised by a shift in blood flow away from the gastrointestinal (GI) tract towards the active muscle and the lungs. Changes in nervous activity, in circulating hormones, peptides and metabolic end products lead to changes in GI motility, blood flow, absorption and secretion. In exhausting endurance events, 30 to 50% of participants may suffer from 1 or more GI symptoms, which have often been interpreted as being a result of maldigestion, malabsorption, changes in small intestinal transit, and improper food and fluid intake. Results of field and laboratory studies show that pre-exercise ingestion of foods rich in dietary fibre, fat and protein, as well as strongly hypertonic drinks, may cause upper GI symptoms such as stomach ache, vomiting and reflux or heartburn. There is no evidence that the ingestion of nonhypertonic drinks during exercise induces GI distress and diarrhoea. In contrast, dehydration because of insufficient fluid replacement has been shown to increase the frequency of GI symptoms. Lower GI symptoms, such as intestinal cramps, diarrhoea--sometimes bloody--and urge to defecate seem to be more related to changes in gut motility and tone, as well as a secretion. These symptoms are to a large extent induced by the degree of decrease in GI blood flow and the secretion of secretory substances such as vasoactive intestinal peptide, secretin and peptide-histidine-methionine. Intensive exercise causes considerable reflux, delays small intestinal transit, reduces absorption and tends to increase colonic transit. The latter may reduce whole gut transit time. The gut is not an athletic organ in the sense that it adapts to increased exercise-induced physiological stress. However, adequate training leads to a less dramatic decrease of GI blood flow at submaximal exercise intensities and is important in the prevention of GI symptoms.
 ...
PMID:Is the gut an athletic organ? Digestion, absorption and exercise. 846 Feb 88

The aim of the study was to clarify the effects of hypertonic solutions on jejunal motility. The study focused on differential effects of hypertonic saline and nutrients. Motility of the canine proximal jejunum was recorded with closely spaced strain-gauge transducers. During fasting, hyperosmotic solutions (up to 1520 mosmol/liter) of saline or nutrients (1 kcal/ml) were infused into the proximal jejunum (0.5-1.5 ml/min) up to 6 hr. The hyperosmotic solutions stimulated jejunal motility. With both increasing osmolarity of saline or increasing energy load of nutrients, jejunal motility linearly declined. The reduction of motility was associated with a change in motor pattern from a propulsive to a more segmenting one. Hypertonic glucose evoked a significantly smaller level of motor activity compared with both saline (at given osmolarities) and an elemental diet (at given energy loads). Motility parameters were not different between glucose and maltose, although osmolarity of maltose was less than half (760 vs 1520 mosmol/liter). In contrast, a mixture of glucose-fructose exerted a smaller inhibition of jejunal motility than glucose. The hypertonic solutions of saline or nutrients were tolerated over 2 hr; with hypertonic saline retrograde power contractions with or without vomiting occurred, whereas with hypertonic nutrients vomiting was preceded by strong inhibition of jejunal motility. Three conclusions can be derived from the present results: (1) The behavior of jejunal motility suggested that the motor activity was the result of both a local stimulation and an inhibitory feedback mechanism. (2) The different degree of inhibition between glucose and saline indicated that the nutrient itself played a major role in the inhibitory feedback regulation, whereas osmolarity was of minor importance. (3) Comparisons between different nutrients suggested a linkage between inhibitory control of motility and the absorptive capacity of the gut for the single nutrient.
 ...
PMID:Effects of enteral infusion of hypertonic saline and nutrients on canine jejunal motor patterns. 850 1

In a prospective cohort study, which was carried out at the department for abdominal surgery of the university of Mainz from June to December 1993, two methods of bowel preparation for elective colorectal surgery were compared: oral bowel preparation with Fordtran a new polyethylene glycol solution (63 patients), and whole-gut lavage with Ringer's solution (37 patients). The serum chloride levels and the bodyweight increased significantly more in the whole-gut lavage group. These patients also showed a higher frequency of vomiting during bowel preparation. Neither the bowel cleansing effect nor the postoperative complications differed significantly between the two groups. Owing to these results, the better patient acceptance, and the easier handling and lower costs of PEG solution, we recommend this method of preoperative bowel preparation for elective colorectal surgery.
 ...
PMID:[Orthograde intestinal irrigation or Fordtran solution for bowel preparation in elective colorectal surgery. Prospective outcome study]. 855 1

From a consideration of the above evidence, it is possible to hypothesize that the 5-HT3 receptors, which are located both in the gut and in the AP/NTS, may play an important and perhaps pivotal part in the mechanism(s) of action of chemotherapy and radiotherapy to induce emesis in animals and humans and represent the anti-emetic sites of action of ondansetron and related agents (see Fig. 1). The value of ondansetron and the 5-HT3 receptor antagonists has been to greatly improve the treatment of nausea and emesis in the cancer patient and to cause a renaissance in emesis research. The 5-HT3 receptor antagonists have helped to redefine the phases of chemotherapy induced emesis and establish the first clear neurotransmitter links in the emetic reflex. It has also encouraged the analysis of emetic mechanisms that will identify further points for pharmacological intervention that may ultimately provide "broad spectrum" anti-emetic agents. Such compounds would further improve the quality of life and treatment of the cancer patient, leading to increased success in the treatment of malignant tumours.
 ...
PMID:Emesis and anti-emesis. 856 88

Since the discovery of the biologically active platinum complexes 30 years ago, 2 agents have become widely established in clinical oncology practice. Both cisplatin and carboplatin are platinum(II) complexes with 2 ammonia groups in the cis- position. However, they differ in their solubility, chemical reactivity, dichloride or alicyclic oxygenated leaving groups, pharmacokinetics and toxicology. Cisplatin causes severe renal tubular damage and reduces glomerular filtration, and requires concurrent saline hydration and mannitol diuresis to eliminate potentially lethal and unacceptable damage to the kidneys. Carboplatin, at conventional doses, causes no decrease in glomerular filtration and only minor transient elevations in urinary enzymes. Cisplatin is the most emetic cancer drug in common use, while nausea and vomiting associated with carboplatin are moderately severe. Serotonin release from enterochromaffin gut mucosal cells and stimulation of serotonin 5-HT3-receptors mediates acute emesis. Selective inhibitors of the 5-HT3-receptor protect against cisplatin- and carboplatin-induced nausea and vomiting. Peripheral neurotoxicity is the most dose-limiting problem associated with cisplatin. Loss of vibration sense, paraesthesia and sensory ataxia comes on after several treatment cycles. Carboplatin, however, is relatively free from peripheral neurotoxicity. Audiometry shows cisplatin-induced ototoxicity in 75 to 100% of patients, which may be associated with tinnitus and hearing loss. Ototoxicity is rare with conventional dose carboplatin therapy. Monitoring hearing with audiograms may identify early signs before significant impairment occurs. Cisplatin causes mild haematological toxicity to all 3 blood lineages. Haematological toxicity is dose-limiting for carboplatin, with thrombocytopenia being a greater problem than leucopenia. Although carboplatin is not toxic to the kidney, renal function markedly affects the severity of carboplatin-induced thrombocytopenia. The major clearance mechanism of cisplatin is irreversible binding in plasma and tissues, while carboplatin is cleared by glomerular filtration. Metabolism of cisplatin to aqua, amino acid and protein species is extensive, whereas carboplatin exists mainly as the free unchanged form. Strong relationships between carboplatin renal clearance, glomerular filtration rate, area under the plasma concentration-time curve (AUC) of filterable platinum and severity of thrombocytopenia have prompted dose adjustment according to renal function. New analogues such as JM216 offer the potential advantages of oral administration and few nonhaematological toxicities. Analogues based on the diaminocyclohexane ligand have encountered problematic neurotoxicity.
 ...
PMID:Comparative adverse effect profiles of platinum drugs. 857 96

Real-time ultrasonography (US) of the gastric antrum after ingestion of a mixed solid-liquid meal was performed in 60 patients (median age, 8.2 years; range, 3-17) being investigated for symptoms suggesting upper intestinal dysfunction (vomiting, regurgitation, abdominal pain, early satiety, and anorexia) and in 13 controls (median age, 5 years; range, 3-15). The diagnostic work-up allowed identification of 14 patients with esophagitis (group A) and 26 with Helicobacter pylori (HP) gastritis (group B); median age in group A was 9 years (range, 3-15) and in group B was 9.5 years (range, 3-17). Group A patients had significantly more prolonged gastric-emptying times (median, 180 min; range, 110-270) than did controls (median, 150 min; range, 110-180; p < 0.01); however, group A times were not significantly longer than those of group B patients (median, 160 min; range, 90-265). In the remaining 20 patients (group C; median age, 7.1 years; range, 3-15) without a specific diagnosis, markedly delayed gastric emptying was detected (median, 237 min; range, 165-270; p < 0.01 vs. group B patients and vs. controls; p < 0.05 vs. group A patients); in this group, GI manometry revealed findings of deranged motility of the gut. Distension of the antral area (percentage of increase vs. baseline values) 60 and 90 min after feeding was higher in group C (60 min: median, 185%; range, 70-614%; 90 min: median, 175%; range, 60-400%) than in both controls (60 min: median, 80%; range 26-148%; 90 min: median 90%; range 20-253%; p < 0.01) and HP patients (60 min: median, 120%; range, 35-311%; 90 min: median, 98%; range, 23-400%; p < 0.05); there was no significant difference versus esophagitis patients. The latter differed from controls only for the 60-min postfeeding antral distension (p < 0.01), whereas HP patients did not differ from controls. In group C patients, symptomatic dyspeptic score correlated with both 60- and 90-min fed antral distension (r = 0.61 and r = 0.64, respectively; p < 0.05), but no correlation was found with gastric-emptying time. In group A patients, histologic score of esophagitis correlated with 60-min postfeeding antral distension (r = 0.56; p < 0.05), whereas poor correlation was found with 90-min postfeeding antral distension and with gastric-emptying time. However, the latter significantly correlated with 90-min fed antral distension in esophagitis patients (r = 0.70; p < 0.01). We conclude that US imaging of the antral area of the stomach reveals abnormalities of gastric motility in most children referred for dyspeptic symptoms; this technique should be included among the investigative tools in the diagnostic approach to these patients.
 ...
PMID:Real-time ultrasound reveals gastric motor abnormalities in children investigated for dyspeptic symptoms. 858 98

Enteral nutrition (EN) has several advantages over parenteral nutrition (PN) for postoperative/posttrauma patients. Modern technologies for tube-feeding have made early EN possible. Jejunal tube-feeding has advantages over gastric tube-feeding: faster metabolic recovery, less vomiting, and less risk of regurgitation and aspiration. Immediate or early EN stimulates the splanchnic and hepatic circulations, improves mucosal blood flow, prevents intramucosal acidosis and permeability disturbances, and eliminates the need for stress ulcer prophylaxis. Saliva containing important antimicrobial substances and gastric acidity are important in sepsis prevention. Chewing, saliva, and gastric acidity support gastric nitric oxide (NO) release, important for mucosal blood flow, gastrointestinal (GI) motility, mucus formation, and bacteriostasis. An oral supply of NO-donating substances and chewing of nitrate-rich food, such as lettuce or spinach, can be useful. Oral and mucosa-protective lipids are recommended. H2 blockers and saliva-inhibiting drugs are avoided. Immediate EN should be given, starting with 25 ml/hr and increasing to 100 ml/hr over 24 to 48 hours. For the immunocompromised patient special attention should be given to the purity of water. Bottled water can contain bacteria such as Pseudomonas. Food antioxidants such as glutathione, vitamin E, and beta-carotenes are important. Ingredients for the colonic mucosa are important. Approximately 10% of caloric need is satisfied by so-called colonic food (prebiotics), fermented at the level of the colonic mucosa to produce colonic mucosa nutrients and to prevent gut origin sepsis. More than 10 g of fiber per day is recommended. The fermenting flora (probiotic flora) is deranged owing to disease or antibiotic treatment, and resupply of flora is important. A new concept of ecoimmune nutrition is presented for enteral supply of mucosa-reconditioning ingredients: new surfactants, pseudomucus, fiber, amino acids such as arginine, and mucosa-adhering Lactobacillus plantarum 299.
 ...
PMID:Nutritional support to prevent and treat multiple organ failure. 866 38

Double-contrast enema is often unsuccessful in elderly patients because of their poor cooperation and colon cleaning. This work was aimed at showing that a well-done single-contrast exam with simple colon lavage can make a very good alternative to double-contrast enema in elderly patients. Thus, 66 consecutive elderly patients (age range: 70-90 years) were submitted, over a 6-month period (June-December, 1994), to single-contrast enema, after colon cleaning with oral whole-gut lavage, using an osmotically balanced electrolyte solution (Isocolan, Bracco) containing polyethylenglycol (PEG 4000). We examined, in each patient: a) the tolerance to and effectiveness of bowel cleaning, according to the liquid volume drunk by each subject, needed to obtain clear diarrhea; b) radiograph quality. Successful colon cleaning was achieved with a mean (2.5-3 liters) and a large (3.5-4 liters) amount of solution, in 80% and 20% of our patients, respectively. Tolerance was good in the whole series except for 3 patients with emesis. Moreover, radiograph quality was good in 85% of the subjects. Finally, barium enema results, compared with endoscopic results, yielded 27 true positives, 3 false negatives (small neoplastic lesions) and 1 false positive. Therefore, in our opinion, these results confirm the role of single-contrast enema, combined with gut lavage, in elderly patients.
 ...
PMID:[Single-contrast enema after colon lavage in the elderly patient]. 869 28


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>