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

A dual-cohort study was conducted to determine whether abortion induced by methotrexate alone produces fewer side effects than a misoprostol-methotrexate regimen without sacrificing efficacy. 358 consecutive Canadian abortion seekers with pregnancies of 7 weeks' gestation or less were given the choice of a regimen of 50 mg/sq. m of intramuscular methotrexate or methotrexate followed 4 days later by 800 mcg of vaginal misoprostol. 101 women chose the former and 257 opted for the latter regimen. Women tended to choose the methotrexate-only regimen to avoid misoprostol-related side effects; selection of the combination was motivated by a desire for a rapid pregnancy termination. 82 women (82.8%) in the methotrexate-only group and 228 (89.1%) in the combination group aborted successfully. The failure rate in both groups was significantly higher when the procedure was performed at 6 or more weeks of gestation. It took a mean of 23.1 days from injection to complete abortion in the methotrexate-only group compared with 11.7 days in the methotrexate-misoprostol group. More than half the women had medication-related side effects, primarily nausea, vomiting, and diarrhea, with no significant differences between groups. The mean number of days of bleeding was 9.0 in the methotrexate-only group and 10.1 in the combination group. The mean worst pain score (on an 11-point scale) was 6.4 in the former and 6.1 in the latter group. 91.8% of women in the methotrexate-only group and 90.7% of those in the misoprostol-methotrexate group who successfully aborted stated they would chose the same method again. Given the high failure rate, methotrexate alone should not be offered routinely to abortion seekers. Its use should be reserved for women with very early pregnancies who have relative contraindications for misoprostol.
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PMID:Comparing abortion induced with methotrexate and misoprostol to methotrexate alone. 1034 80

Eating disorders are serious illnesses affecting 1-2% of young women. Patients may present to any doctor, sometimes atypically (e.g. unexplained weight loss, food allergy, infertility, diarrhoea), delaying diagnosis and leading to needless investigation. The cardinal signs are weight loss, amenorrhoea, bingeing with vomiting and other compensatory behaviours, and disturbances in body image with an exaggeration of the importance of slimness. When other causes have been excluded, useful investigations are serum potassium, bone mineral density scanning and pelvic ultrasound. In emaciated patients multiple systems may fail with pancytopaenia, neuromyopathy and heart failure. Clinical assessment of muscle power is used to monitor physical risk. Treatment may involve individual, group or family sessions, using cognitive-behavioural, psychodynamic and family approaches. More severe or intractable illness is treated with day care, with in-patient care in a medical or specialist psychiatric unit reserved for the most severely ill patients. Antidepressants have a place in the treatment of bulimia nervosa unresponsive to psychological approaches, and when severe depressive symptoms develop. The children of people with eating disorders may have an increased risk of difficulties. Support for the patient and family, and effective liaison between professionals, are essential in the treatment of severe eating disorders.
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PMID:Review article: recognition and treatment of eating disorders in primary and secondary care. 1075 15

Nutritional support is essential in treating patients with gastroparesis. Initially, dietary changes should be instituted to reduce extra fat and bulk, and patients should be encouraged to eat frequent small meals with liquid supplementation. Enteral feeding should be introduced in the event of weight loss or persistent vomiting. Medical therapy is usually necessary early in treatment. Cisapride is the initial agent of choice and may be combined with an antiemetic agent, such as promethazine or chlorpromazine or, if side effects occur, ondansetron and granesitron. If cisapride is ineffective or contraindicated, metoclopramide is a reasonable option, though limited by side effects. Erythromycin is useful in the acute treatment of postoperative ileus and hospitalized gastroparetic patients, but its role is limited based on concerns about poor long-term effectiveness and antimicrobial resistance. Once domperidone becomes available in the United States, it will be useful for its promotility and antiemetic qualities. Combination therapy should be considered if monotherapy with cisapride or metoclopramide alone is ineffective. While not yet well studied, combination therapy has the potential to offer dramatic benefit for patients with refractory gastroparesis. Metoclopramide may be added to cisapride for patients with breakthrough symptoms or refractory chronic symptoms. Other combinations include metoclopramide with erythromycin, domperidone with cisapride, and domperidone with erythromycin. In the future, gastric pacing may become an effective option for patients not responding to medical therapy. Total gastrectomy should be performed only for end-stage gastroparesis when all other therapy has failed. Both procedures should be reserved for centers that specialize in severe gastric motility disorders.
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PMID:Diabetic and Nondiabetic Gastroparesis. 1109 57

An 18-month-old male Labrador retriever was referred for investigation of chronic intermittent diarrhoea and vomiting of two months duration. A diagnosis of hepatic arteriovenous fistulae was made. These are extremely rare hepatic vascular anomalies which confer arterial pressure to the portal vein. Liver atrophy, portal vein hypoplasia, portal hypertension and multiple acquired portosystemic collateral vessels are the main complications. Surgical excision is a challenge as resection of large lesions may be associated with significant blood loss. In this dog, persistence of portal vein hypoplasia and extensive collateral pathways following surgery led to a reserved prognosis.
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PMID:Hepatic arteriovenous fistulae and portal vein hypoplasia in a Labrador retriever. 1130 58

Kawasaki Disease (KD) or atypical KD (AKD) rarely presents with intestinal obstruction or pseudo-obstruction. Others have reported gastrointestinal symptoms appearing with and up to 4 weeks after the occurrence of major clinical symptoms of KD. However, we presented a 1-year-old boy with prolonged fever who was found to have pyuria and liver dysfunction on the fourth day of fever. He developed a picture of intestinal pseudo-obstruction including bilious vomiting and abdominal distention on his fifth day of fever, four days before he developed the fissured lips. Because of the emergence of four major clinical criteria of KD, coronary artery dilatation, and aseptic meningitis, AKD was initially diagnosed and prompted the use of intravenous immunoglobulin on the tenth day of fever. Hydrops of the gallbladder, leukocytosis, increased ESR, and thrombocytosis were noted during hospitalization. These atypical features rarely develop all together in one patient with KD or AKD. Nevertheless, our patient had early intestinal pseudo-obstruction with almost all of the above unusual systemic manifestations and the late occurrence of clinical features of KD. We demonstrate that intestinal pseudo-obstruction in KD may develop earlier than other major clinical features and may improve under the conservative treatment. Surgery should be reserved for those who have complete intestinal obstruction presenting with significant peritoneal signs.
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PMID:Intestinal pseudo-obstruction followed by major clinical features of Kawasaki disease: report of one case. 1135 64

Antiretroviral therapy is a form of chemotherapy, yet chemotherapy is a term generally reserved for cancer treatment. In either case, the side effects of chemotherapy (e.g., nausea, vomiting, and fatigue) are often debilitating, Chemotherapy is recognized as an option in the world of cancer, and the patient's decision is usually respected. Yet HIV patients who initiate treatment may get scant support for the complexities of personal treatment decisions. Patients are met with an onerous course of medications whose long-term effectiveness is questionable. Antiretroviral treatment needs to be individualized and offered as one option. Another option might be alternative or complementary therapies such as immunomodulators. A holistic approach to HIV is an important part of PWA self-empowerment.
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PMID:The truth about HIV therapy. 1136 18

Intussusception is the most common cause of intestinal obstruction between 3 months and 6 years of age. Recurrence after reduction of intussusception in childhood is not rare. To assess the incidence and determinants of recurrence of intussusception in childhood, we conducted a prospective observation in an emergency service of a large referral center during a four-year period. We encountered 89 cases with intussusception of whom nine cases (10.1%) had episodes of recurrent intussusception. Five patients had a single recurrence, three had double recurrence and one had triple recurrence. Age of first intussusception, sex, or concurrent adenovirus infection was not related to the recurrence. None of the 27 patients who needed operative reduction had recurrence, while 9 of 62 patients who were reduced successfully by barium enema developed recurrence (P = 0.05). Compared with the first episode, significantly less vomiting, rectal bleeding and shorter duration of abdominal pain or irritable crying were noted during recurrent episodes. All the recurrent episodes were reduced successfully by barium enema. We conclude that recurrent intussusception in childhood tends to be diagnosed earlier than previous episodes and treated successfully by hydrostatic reduction without complication. Surgical reduction of recurrent intussusception may be reserved for cases of failure of hydrostatic reduction, positive peritoneal sign or existence of pathological lead point because of favorable response to barium reduction. Recurrent intussusception seldom occurs in patients who underwent surgical reduction.
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PMID:Recurrence of intussusception in childhood. 1143 61

Gastric volvulus (GV) is a rare condition in infants. The aim of this study was to define the management strategies of infants with GV based on their clinical and radiologic features. The medical records of 13 infants with a radiologically confirmed diagnosis of GV were retrospectively reviewed. Patients were divided into two groups according to the type of treatment (surgical vs conservative). Abdominal radiographs and upper gastrointestinal contrast studies allowed an unequivocal diagnosis in both groups. Group 1 included 3 infants with acute GV and 2 with chronic, intermittent secondary GV. Three patients had associated diaphragmatic defects, 1 had an ileocolic intussusception, and 1 had hypertrophic pyloric stenosis. The main presenting symptoms were vomiting, dehydration, respiratory distress, and abdominal pain and distention in acute cases and vomiting and failure to thrive in chronic cases. A laparotomy was required in all 5 infants with no recurrence of symptoms. Group 2 included 8 infants with idiopathic chronic GV, who were managed nonoperatively with gradual improvement of symptoms over 12 months. Based on our study, we conclude that: (1) laparotomy can be reserved for patients with either acute or chronic secondary GV; (2) conservative treatment is both safe and effective in infants with chronic idiopathic GV; and (3) routine gastropexy for all patients with a radiologic diagnosis of GV appears to be overtreatment.
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PMID:Infants with radiologic diagnosis of gastric volvulus: are they over-treated? 1172 47

Severe obesity is associated with multiple comorbidities and is refractory to dietary management with or without behavioral or drug therapies. There are a number of surgical procedures for the treatment of morbid obesity, including purely gastric restrictive, a combination of malabsorption and gastric restriction or primary malabsorption. The purely gastric restrictive procedures, including vertical banded gastroplasty and laparoscopic adjustable silicone gastric banding, do not provide adequate weight loss. African-American patients do especially poorly after the banding procedure with the loss of only 11% of excess weight in one study. Gastric bypass (GBP) is associated with the loss of 66% of excess weight at 1 to 2 years after surgery, 60% at 5 years and 50% at 10 years. For unknown reasons, African-American patients lose significantly less weight than Caucasians after GBP. There is a risk of micronutrient deficiencies after GBP, including iron deficiency anemia in menstruating women, vitamin B12, and calcium deficiencies. Prophylactic supplementation of these nutrients is necessary. Recurrent vomiting after bariatric surgery may be associated with a severe polyneuropathy and must be aggressively treated with endoscopic dilatation before this complication is allowed to develop. The malabsorptive procedures include the partial biliopancreatic bypass (BPD) and BPD with duodenal switch (BPD/DS). The BPD appears to cause severe protein-calorie malnutrition in American patients; the BPD/DS may be associated with less malnutrition. Weight loss failure after GBP does not respond to tightening a dilated gastrojejunal stoma or reducing the size of the gastric pouch. These patients may require conversion to a malabsorptive distal GBP, similar to the BPD. However, because of the risk of severe protein-calorie malnutrition and calcium deficiency BPD should be reserved for patients with severe obesity comorbidity. The risk of death following bariatric surgery is between 1% and 2% in most series but is significantly higher in patients with respiratory insufficiency of obesity. In most patients, surgically induced weight loss will correct hypertension, type II diabetes mellitus, sleep apnea, obesity hypoventilation syndrome, gastroesophageal reflux, venous stasis disease, urinary incontinence, female sexual hormone dysfunction, pseudotumor cerebri, degenerative joint disease pains, as well as improved self-image and employability.
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PMID:Bariatric surgery for severe obesity. 1185 Dec 1

In Senegal, adolescents live in a socioeconomic climate that is between traditional society with its well-structured rites and customs and an extroverted modern society. They are often plunged into uncertainty and into a search of themselves. With a weak and not-yet-determined personality, sexuality erupts into their life experience. In Senegal, adolescent fertility, once encouraged by tradition, has become a social phenomenon which challenges all those interested in problems of youth. Major risks throughout the pregnancy and the puerperium confront adolescents. Complications may include grave vomiting, preeclampsia, hypertension and hemorrhaging, and more severe malaria than normal due to pregnancy. 12.9% of adolescent pregnancies end in miscarriage, 5.8% in premature births. Low birth weight and fetal death are also risk factors of adolescent pregnancy. Incomplete physical development exacerbates childbirth among adolescents, often leading to cesarean section, infection, and hemorrhaging. A combination of several risks appearing unexpectedly during pregnancy and during and after delivery can lead to a tragic death. During 1988-1989 at the gynecologic-obstetric clinic of the Aristide Le Dantac University Hospital Center of Dakar, adolescents comprised 8.1% of maternal deaths. If adolescents survive pregnancy, they may suffer after effects, e.g., genital scar tissue or psychological disorders. Infertility can also be an after effect. An unwanted pregnancy ended by illegal induced abortion can also lead to infertility. 2% of adolescents attending the clinic have common infections and/or sexually transmitted diseases (STDs). These infections almost always are a result of poor hygiene of the genital region. Family life education should prepare adolescents for sexuality and contraceptive use. Barrier methods can best prevent STDs and AIDS. Other contraceptive methods require compliance with strict rules. Emergency contraception should be reserved for cases of rape or incest. Prevention of unwanted pregnancies is the best means to prevent infanticide which is relatively common among youth leaving rural areas.
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PMID:[The adolescent manages fertility badly. Uncertainty and pursuit of self in a society in transition]. 1234 47


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