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Se presenta el caso de una mujer en la quinta década de la vida que ingresa al servicio de urgencias con manifestaciones gastrointestinales consistentes en vómito e hipo. Después de múltiples estudios e intervenciones por especialistas, se piensa en el origen central de los síntomas. Se realiza una resonancia magnética nuclear (RMN) cerebral que permite el enfoque del caso y posterior confirmación del diagnóstico de una enfermedad dentro del espectro de la neuromielitis óptica, positiva para anticuerpos anti-acuaporinas-4. El tratamiento con esteroide y anticuerpo monoclonal (Rituximab) llevan a un control adecuado de la enfermedad.
We present a case report of a woman in her 50s admitted to the emergency room with gastrointestinal manifestations consisting of vomiting and hiccups. After a series of studies and interventions by specialists, a brain magnetic resonance imaging (MRI) is performed in order to find the central origin of the symptoms. This allows the approach of the case and subsequent confirmation of the diagnosis of Neuromyelitis optica, positive for anti-acuaporin-4 antibodies. Finally, it seems that treatment with steroids and monoclonal antibodies leads to proper control of the disease.
Se apresenta o caso de uma mulher na quinta década de vida que ingressa ao serviço de urgências com manifestações gastrointestinais consistentes em vômito e soluço. Depois de múltiplos estudos e intervenções por especialistas, se pensa na origemcentral dos sintomas. Se realiza uma ressonância magnética nuclear (RMN) cerebral que permite o enfoque do caso e posterior confirmação do diagnóstico de uma doença dentro do espectro da neuromielite óptica, positiva para anticorpos anti-acuaporinas-4. O tratamento com esteroide e anticorpo monoclonal (Rituximab) levam a um controle adequado da doença.
Subject(s)
Humans , Neuromyelitis Optica , Vomiting , Brain , Magnetic Resonance Imaging , Aquaporins , Hiccup , AntibodiesABSTRACT
Resumen: Los antieméticos son usados frecuentemente por diversas áreas de la medicina, aunque existe una tendencia a subestimar sus efectos adversos neurológicos. El objetivo del presente estudio de revisión fue revisar la literatura sobre la fisiología, farmacología, factores predisponentes, clínica y manejo del extrapiramidalismo por antieméticos. Se realizó una búsqueda en la literatura de artículos de revistas científicas, libros y trabajos de grado. Se utilizaron los buscadores Medline, LILACS, PubMed, EMBASE, Current contents y Google Scholar con las siguientes palabras claves: deshidratación, gastroenteritis, vómitos, antieméticos, distonía, dopamina, hipertermia, citocromo, meto-clopramida y domperidona. Se obtuvieron 252 artículos, de los cuales 50 fueron considerados aptos para la revisión. A partir del análisis, se concluyó que el uso de antieméticos es de uso frecuente por medicina general y especialidades como anestesiología y pediatría, por lo cual un conocimiento sobre los efectos extrapiramidales permitirá un diagnóstico y manejo temprano.
Abstract: Antiemetics are frequently used by various areas of medicine, although there is a tendency to underestimate their neurological adverse effects. This paper aims to review the literature on the physiology, pharmacology, predisposing factors, clinical picture, and management of the extrapyramidal side effects of antiemetics. Scientific journal articles, books, and dissertations were searched. The search engines Medline, LILACS, PubMed, EMBASE, Current Contents, and Google Scholar were used with the following keywords: dehydration, gastroenteritis, vomit, antiemetics, dystonia, dopamine, hyperthermia, cytochrome, metoclopramide, and domperidone. Two hundred and fifty-two articles were obtained, 50 of which were considered suitable for review. From the analysis, it was concluded that antiemetics are often used by general medicine and specialties such as anesthesiology and pediatrics; therefore, knowledge of the extrapyramidal effects will allow early diagnosis and treatment.
Resumo: Os antieméticos são frequentemente usados por diversas áreas da medicina, embora possamos constatar uma tendência a subestimar seus efeitos adversos neurológicos. O objetivo do presente estudo é revisar a literatura sobre a fisiologia, a farmacologia, os fatores predisponentes, a clínica e o tratamento de reações extrapiramidais causadas por antieméticos. Foi realizada uma busca na literatura por artigos de revistas científicas, livros e monografias. Os mecanismos de busca Medline, LILACS, PubMed, EMBASE, Current contents e Google Scholar foram utilizados com as seguintes palavras-chave: desidratação, gastroenterite, vómito, antieméticos, distonia, dopamina, hipertermia, citocromo, metoclopramida e domperidona. Foram encontrados 252 artigos, dos quais 50 foram considerados aptos para a revisão. A partir da análise, concluiu-se que os antieméticos são frequentemente utilizados pela medicina geral e especialidades, como anestesiologia e pediatria, portanto, o conhecimento dos efeitos extrapiramidais possibilitará um diagnóstico e tratamento precoces.
Subject(s)
Humans , Child , Basal Ganglia Diseases , Pediatrics , Pharmacology , Gastroenteritis , AntiemeticsABSTRACT
Objective: To observe the changes of urine metabolic profile of Wuzhuyu Decoction in rats with deficiency cold and vomit, and explore its possible mechanism of treatment of deficiency cold and vomit syndrome. Methods: A rat model of deficiency cold and vomit was prepared by a composite method (rhucax + cisplatin). Rats were randomly divided into control group, model group, and Wuzhuyu Decoction group. UPLC-MS/MS combined with principal component analysis and partial least squares analysis were used to analyze urine data and identify potential biomarkers. Diversified ROC curves were used to validate differential metabolites; Pathway Analysis database was used for topological analysis of differential metabolites; R and Cytoscape were used for correlation analysis and modular analysis of metabolites. Results: The urine metabolic spectrum of control group and model group were completely separated. Wuzhuyu Decoction group was close to the control group, indicating that the model was successfully replicated; And Wuzhuyu Decoction can interfere with the symptoms of deficiency cold and vomit in rats, suggesting that the rat body had a tendency to return to normal state. Through modular analysis of 34 urine differential metabolites, the deficiency cold and vomit treatment was revealed to affect biosynthesis of valine, leucine and isoleucine, phenylalanine, tyrosine and tryptophan biosynthesis, arginine and proline metabolism, tryptophan metabolism, tyrosine metabolism, arachidonic acid metabolism, citric acid cycle (TCA cycle) pathways. Modularity analysis revealed that there was close relationship between 10 modules; Alanine, leucine, tyrosine, tryptophan, isoleucine, succinic acid, alanine, fumaric acid, malic acid, isocitrate, and other biological targets can thus be used as markers of deficiency cold and vomit. Conclusion: Wuzhuyu Decoction can improve the physiological characteristics of the model of deficiency cold and vomit. The mechanism may be related to the regulation of amino acid metabolism, energy metabolism and lipid metabolism in rats.
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Resumen La inclusión de opioides durante la preanestesia y anestesia, potencialmente puede incrementar la presentación de vómito y náuseas posoperatorias, acrecentando el riesgo de presentación de sangrado, dehiscencias, neumonía por aspiración o esofagitis. En éste estudio se evaluó la presentación de vómito, salivación excesiva y anorexia durante 24 horas del periodo posanestésico en 100 perros ASA I y II. El grupo A (n: 40) fue premedicado con una mezcla de acepromacina a 0.08 mg/kg i.v. y fentanilo a 5 μg/kg i.v. y el grupo X (n: 60) con xilacina a 0.3 mg/kg i.v. más fentanilo a 5 μg/kg i.v. La inducción anestésica para ambos grupos se realizó con propofol a 4 mg/kg y el mantenimiento con isoflurano a 1,5-3%. La presentación general de vómito post-anestesia fue del 12%. Entre ambos grupos no se encontraron diferencias significativas en la incidencia de vómito a las 2 (p= 0,837), a las 6 (p= 0,439) y a las 24 horas (p= 0,639). No hubo diferencias significativas entre grupos para la presentación de salivación excesiva o anorexia. Se encontró una asociación entre vómito post-anestésico y cirugía del aparato reproductivo en hembras (p= 0,02). Se concluye que un único bolo de fentanilo a 5 μg/kg con acepromacina a 0,08 mg/kg o xilacina 0,3 mg/kg durante la premedicación anestésica, no incrementa la presentación de vómito en las primeras 24 horas del postquirúrgico en perros.
Abstract Opioid inclusion in pre-anesthesia and anesthesia may increase postperative vomiting and nausea, increasing the risk of bleeding, dehiscence, aspiration pneumonia or esophagitis. Therefore, the purpose of this study was to monitor vomiting, excessive salivation and anorexia during 24 hours of the post-surgical period on 100 dogs ASA I and II. Group A (n: 40) was pre-medicated with acepromazine at 0.08 mg/kg with fentanyl at 5 μg/kg i.v; group X (n: 60) with xylazine at 0.3 mg/kg i.v. with fentanyl at 5 μg/kg i.v. Anesthesia induction was made with propofol at 4 mg/kg and maintained with isofluorane at 1.5-3% for both groups. The overall vomiting produced was 12% and there were no significant differences in vomiting manifestation at 2 (p=0.837), 6 (p=0.439) and 24 hours (p= 0.639) between the groups. In the same way, there were no major differences neither for excessive salivation nor anorexia. There was a significant association between postanesthesia vomiting and reproductive surgery in female dogs (p=0.02). As a conclusion, a single bolus of fentanyl at 5 μg/kg with acepromazine at 0.08 mg/kg or xylazine 0.3 mg/kg in pre-anesthesia does not increase post-surgery vomiting in dogs in the first 24 hours.
Resumo A inclusão de opioides durante a pré-anestesia e anestesia, potencialmente podem incrementar a apresentação de vomito e náuseas pós-operatórias, acrescentando o risco de apresentação de sangrado, deiscências, pneumonia por aspiração e esofagites. Neste estudo se avalio a apresentação de vomito, salivação excessiva e anorexia durante 24 horas do período pós-anestésico em 100 cães ASA I e II. O grupo A (n: 40) foi medicado com uma mistura de acepromazina 0.08 mg/kg IV e fentanilo 5 μg/kg IV e no grupo X (n: 60), xilacina 0.3 mg/kg IV e fentanilo 5 μg/kg IV. A indução anestésica para ambos grupos se realizou com propofol 4 mg/kg e manutenção com isoflurano 1,5-3%. A apresentação geral de vomito pós-anestésico foi do 12%. Entre ambos grupos não se encontraram diferencias significativas na incidência de vomito nas 2 (p= 0,837), 6 (p= 0,439) e 24 horas (p= 0,639). Não teve diferenças significativas entre grupos na apresentação de salivação excessiva ou anorexia. Se achou uma associação entre vomito pós-anestésico e cirurgia do trato reprodutivo em fêmeas (p= 0,02). Como conclusão uma única doses de fentanilo 5 μg/kg com acepromacina 0,08 mg/kg ou xilacina 0,3 mg/kg durante a pré-medicação anestésica, não incrementa a apresentação de vomito nas primeiras 24 horas do pós-cirúrgico em cães.
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Objective Through analyzing the literatures about acupuncture-moxibustion in releasing chemotherapyinduced nausea and vomit,to understand its current situation and progress,preparing for further studies in the future.Method Four databanks were retrieved.Two researchers independently skimmed the titles and abstracts for filtering the collected data,and then carefully read through the full texts for further selection.Snowball retrieval of the references in each recruited article completed the whole literature search.Result A total of 407 manuscripts were collected by retrieving databanks,but 80 were excluded due to ineligible designs or intervention protocols.Finally,76 articles were included.Conclusion Acupuncture-moxibustion is effective in preventing and treating nausea and vomit induced by chemotherapy.Future studies should rigorously follow the randomized controlled trials design and adopt precise efficacy evaluations,to provide foundation for subsequent evidence-based studies.
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Midazolam is one of the most commonly used drugs for sedation in Emergency Department (ED). This was a retrospective study conducted on 380 patients from December 2012 to May 2014 in ED of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The objective was to elicit the frequency of side effects and correlation to various factors i.e. socio-demography, co-morbidities, age groups and underlying illnesses. Out of 380 patients, 35 patients experienced side effects (20 patients with midazolam alone, 15 patients with combination of drugs). The average age was 42 years and the average dose of midazolam was 3.5mg. The most common other drug combined was fentanyl. The overall complication rate for midazolam was 5.3%. The most common side effect recorded was excessive somnolence (1.6%). Other side effects included local skin reactions (1.1%), vomiting (0.8%), headache (0.8%) and hypotension (0.5%). There was no significant association between the socio-demographic factors and drugs combination with the side effects of midazolam on patients. It was concluded that midazolam was a safe drug due to absence of any life-threatening side effects. There are possibilities that most side effects recorded could be caused by other comfounding factors e.g. underlying injuries or disease and combination with other drugs.
Subject(s)
MidazolamABSTRACT
El artículo expone el caso de un gato macho doméstico, pelicorto, castrado, de tres años y medio de edad, con un plan sanitario vigente, que presenta pérdida de peso y signología digestiva. Luego de hacérsele las pruebas diagnósticas necesarias, se encontró que presentaba una masa intestinal y era positivo a leucemia viral felina; después del diagnóstico, y por petición de los propietarios, se le aplicó la eutanasia. Posterior a la necropsia y del resultado de histopatología, se encontró que la masa intestinal se trataba de un linfoma linfocítico difuso, presumiblemente de células B con metástasis en linfonódulos mesentéricos y en el hígado.
The case of a domestic, shorthaired male cat, neutered, of three and a half years of age, with a current health plan that is presenting weight loss and digestive signology is presented. After performing the necessary diagnostic tests, an intestinal mass was found and it tested positive for viral feline leukemia; after the diagnosis, and following the request of the owners, the cat was euthanized. Following the necropsy and the histopathology results, it was found that the intestinal mass was a diffuse lymphocytic lymphoma, presumably of B cells with metastases in mesenteric lymph nodes and the liver.
Expõe-se o caso de um gato macho doméstico, e pelagem curta, castrado, de três anos e meio de idade, com um plano sanitário vigente, que apresenta perda de peso e sintomas digestiva. Depois de realizar as provas diagnósticas necessárias, se encontrou que apresentava uma massa intestinal com resultado positivo à leucemia viral felina; depois do diagnóstico, e por petição dos proprietários, foi submetido à eutanásia. Posterior à necropsia e do resultado de histopatologia, se observou que a massa intestinal se tratava de um linfoma linfocítico difuso, presumivelmente de células B com metástase em linfonodos mesentéricos e no fígado.
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La membrana duodenal congénita se presenta con mayor frecuencia en la región ampular, y se expresa clínicamente como obstrucción intestinal durante el periodo neonatal. En algunos escenarios el diagnóstico de esta condición clínica pasa inadvertida cuando dicha membrana es incompleta, como en los casos de membrana duodenal fenestrada. En consecuencia, se modifica la forma de presentación y se dificulta su diagnóstico temprano. Se cuenta con distintos accesos terapéuticos para esta enfermedad, desde los abiertos, hasta los endoscópicos y laparoscópicos. Se presenta el caso de una lactante con diagnóstico tardío de membrana duodenal fenestrada, que se trató quirúrgicamente mediante acceso laparoscópico.
Congenital duodenal membrane is more frequently seen in the ampullary region and is clinically expressed as intestinal obstruction in the neonatal period. In some settings, the diagnosis of this clinical condition is glossed over when the membrane is incomplete as it happens in fenestrated duodenal membrane. Consequently, its way of presentation changes and thus the early diagnosis becomes difficult. There are different therapeutic accesses to this disease, from open to endoscopic and laparoscopic ones. This is a nursling who was lately diagnosed as fenestrated duodenal membrane case and was surgically treated through the laparoscopic access.
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Objective To study the effect of rice oil on secretory immunoglobulin A (sIgA) content in feces and disease outcome in children with acute diarrhea.Methods We selected 180 children with acute diarrhea hospitalized in Tianjin Children's Hospital during the period from January 2013 to October 2014.They were randomly divided with a random number table into rice oil group,montmorillonite powder group and control group (all n =60).The effect of treatment,duration before subsiding of diarrhea and vomit,length of hospital stay and sIgA content in feces before and after treatment were analyzed.Results The total effective rates in the rice oil group and the montmorillonite powder group (93.3％,96.7％) were significantly higher than that in the control group (76.7％,P =0.011,P =0.001).Length of hospital stay,duration before subsiding of diarrhea and vomit in the rice oil group and the montmorillonite powder group were significantly shorter than those in the control group[(5.6±1.4) d,(5.7±1.6) d vs.(6.9±1.8) d;(3.7±0.9) d,(3.5±0.9) d vs.(5.4±1.2) d;(2.8 ± 0.6) d,(3.2 ± 0.8) d vs.(5.1 ± 0.8) d;all P =0.000].The total effective rates,length of hospital stay,duration before subsiding of diarrhea showed no statistically significant differences between the rice oil group and the montmorillonite powder group (P =0.402,0.716,0.226),but the duration before subsiding of vomit in the rice oil group was significantly shorter than that in the montmorillonite powder group (P =0.016).Before treatment,the sIgA contents in feces in the control group,the montmorillonite powder group,the rice oil group were 0.527 ± 0.133,0.487 ± 0.109,0.534 ± 0.150,with no significant difference (P ＞ 0.05).Two days after treatment,sIgA contents in the rice oil group and the montmorillonite powder group (0.669 ±0.176,0.612 ± 0.161) were significantly higher than in the control group (0.541 ±0.149,P =0.000,0.014).There was no significant difference between the montmorillonite powder group and the rice oil group (P =0.067).Four days after treatment,sIgA content in the montmorillonite powder group (1.981 ±0.462) was significantly higher than in the control group (1.762 ±0.378,P =0.005),while sIgA content in the rice oil group (2.331 ± 0.494) was significantly higher than in the other 2 groups (P =0.000).Compared with the levels before treatment,sIgA content 2 days after treatment was not significantly changed in the control group (P =0.295),but was significantly elevated in the montmorillonite powder group and the rice oil group (both P =0.000).sIgA contents of all the three groups 4 days after treatment were significantly higher than the contents 2 days after treatment (all P =0.000).Conclusion The effect of rice oil on acute diarrhea in children is as same as that of montmorillonite powder,and may be better in mitigating vomit and promoting the secretion of intestinal sIgA.
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Objective To observe the curative effect of acupoint injection combined with miscarriage prevention and anti -vomit recipe on hyperemesis gravidarum.Methods 88 patients with hyperemesis gravidarum in our hospital from February 2013 to February 2014 were selected and randomly divided into the control group and treatment group with 44 cases in each.The control group was given conventional western medicine therapy;and the treatment group was given acupoint injection combined with miscarriage pre-vention and anti-vomit recipe additionally.The two groups were compared in terms of the time of vomit stopping, treatment duration of hyperemesis gravidarum, number of people with normal dieting after treatment, number of people with normal electrolyte level, fre-quency of daily vomiting, curative effect of hyperemesis gravidarum, ketone levels before and after treatment and carbon dioxide com-bining power indicators of the two groups.Results The time of vomiting stopping and treatment duration of hyperemesis gravidarum of the treatment group were significantly shorter than those of the control group; the ketone values before and after treatment of the treatment group improved significantly compared with the control group; the number of people with normal dieting after treatment and normal electrolyte level of the treatment group was significantly larger than that of the control group .The average frequency of vomit of the treatment group was significantly smaller than that of the control group; and the curative effect of hyperemesis gravidarum of the treatment group was significantly better than the control group (p<0.05).Conclusion Acupoint injection combined with miscar-riage prevention and anti-vomit recipe in the treatment of patients with hyperemesis gravidarum is clinically effective and is worthy of clinical application and promotion.
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Objectives To evaluate the effect and safety of Xiao Er Fu Xie Tie in children with acute diarrhea. Methods A multicenter, randomized, open-label, active-controlled clinical trial was carried out in three hospitals from March 2011 to December 2012. Children with acute diarrhea were enrolled and divided randomly into two groups, the observation group (treated with Xiao Er Fu Xie Tie) and the control group (treated with smectite powder). Boths groups received oral rehydration salts treatment. Symptoms and signs were recorded before and after therapy. The therapeutic effect was evaluated at 3 and 5 days after therapy. All of the adverse drug reactions were recorded during the study. Results In 197 children who completed the study, 100 children received Xiao Er Fu Xie Tie and 97 received smectite powder. Both groups were similar in age and gender distribution, weight, duration and frequency of diarrhea, times of vomiting, degree of dehydration and so on (P>0.05). After therapy, effective rates of the observation group at 3 days (97%) and 5 days (100%) were similar to those of control group (P>0.05). The effective rate for relieving vomiting in the observation group was higher than that in control group (P<0.05). No obvious adverse drug reactions were found during the study. Conclusions Xiao Er Fu Xie Tie has the same effect as smectite powder for treatment of acute diarrhea in children and is more effective in vomiting. Furthermore, no obvious adverse drug re-actions were found.
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INTRODUÇÃO: A emetofobia ou fobia de vômitos - que inclui o medo excessivo de vomitar ou de ver outras pessoas vomitando e pode ser desencadeado por estímulos internos e externos - é um transtorno mental complexo e pouco conhecido. OBJETIVO: Este estudo teve como objetivo levantar os conhecimentos disponíveis sobre diversos aspectos do quadro. MÉTODO: Revisão convencional da literatura dos últimos 30 anos utilizando como estratégia de busca as seguintes palavras-chave: "emetofobia", "emetofóbico", "medo de vomitar", "fobia de vomitar" e"fobia de vômito". Foram incluídos artigos sobre epidemiologia, fenomenologia, diagnóstico diferencial e tratamento da emetofobia, assim como artigos referidos nestes. RESULTADOS: Não há dados de prevalência na população geral e pouco se sabe sobre a etiologia da emetofobia. A maioria dos estudos aponta predominância no sexo feminino, início precoce e curso crônico. Os comportamentos de esquiva podem impactar negativamente a vida ocupacional, social e familiar. Os principais diagnósticos diferenciais são: transtorno de pânico com agorafobia, fobia social, anorexia nervosa e transtorno obsessivo-compulsivo. Estudos de tratamento se resumem a relatos de casos e não há ensaios clínicos controlados, mas intervenções cognitivo-comportamentais parecem ser promissoras. CONCLUSÃO: Mais estudos são necessários para melhor compreensão sobre a epidemiologia, o quadro clínico, a etiologia, a classificação e o tratamento da emetofobia.
INTRODUCTION: Emetophobia or fear of vomit - which includes an excessive fear of vomiting or seeing other people vomiting and can be triggered by internal and external stimuli -is a complex and fairly unknown disorder. OBJECTIVE: This study aimed at reviewing the current knowledge about this condition. METHOD: A conventional literature review of the previous 30 years, using as search strategy the following keywords: "emetophobia", "emetophobic", "fear of vomiting", "vomiting phobia", and "phobia of vomit". All articles about the epidemiology, phenomenology, differential diagnosis and treatment of emetophobia were included, as well as articles cited in these ones. RESULTS: There are no available data on the prevalence in the general population and little is known about the etiology of emetophobia. Most studies describe predominance in females, early onset and chronic course. The avoidant behaviors can have a significant impact on occupational, social and family lives. The most important differential diagnoses are: panic disorder with agoraphobia, social phobia, anorexia nervosa and obsessive-compulsive disorder. Treatment studies are mostly case reports and no controlled clinical trials have been published. Cognitive-behavioral interventions, however, seem to be promising. CONCLUSION: More studies are needed for a better understanding of the epidemiology, clinical picture, etiology, classification and treatment of emetophobia.
Subject(s)
Humans , Female , Adolescent , Adult , Agoraphobia/etiology , Gagging , Fear/psychology , Phobic Disorders/diagnosis , Phobic Disorders/etiology , Vomiting , Diagnosis, Differential , Social Behavior , Anxiety Disorders/therapyABSTRACT
There are many causes of chronic and/or recurrent vomiting. The differential diagnosis is sometimes difficult because the clinical manifestations are often similar with each other. In this review, common causes of chronic and/or recurrent vomiting, and a general approach to children with vomiting are described. The involuntary passage of ingested material from the stomach into the esophagus, gastroesophageal reflux (GER), is a common event in infants. GER-disease can arise when the refluxed material causes esophagitis, resulting in pain, impaired esophageal function, poor growth or some respiratory symptoms. Esophageal impedance-pH meter will be the golden standard test in these cases. Parental reassurance and dietary management are expected to be the important components of managing mild GER-disease. Eosinophilic esophagitis is a clinicopathological disease characterized by (1) Feeding intolerance and GER-disease symptoms in children; (2) >15 eosinophils/HPF; (3) Exclusion of other disorders associated with similar clinical, histological, or endoscopic features, especially GERD. Appropriate treatments include dietary approaches based upon eliminating exposure to food allergens, or topical corticosteroids. Cyclic vomiting syndrome (CVS), a paroxysmal, especially severe, recurrent vomiting disorder, may be second to GER-disease as a cause of recurrent vomiting in children. It is highly incapacitating brain-gut disorder. The different diagnosis of CVS cuts a broad swath across neurologic, gastrointestinal, renal, metabolic, and endocrinologic disorders. Treatment is divided between acute intervention, when a patient is actively and severe vomiting, and prophylactic treatment in their interictal phase, the goal of which is reducing frequency and intensity of subsequent episodes.
Subject(s)
Child , Humans , Infant , Adrenal Cortex Hormones , Allergens , Diagnosis, Differential , Eosinophilic Esophagitis , Esophagitis , Esophagus , Gastroesophageal Reflux , Parents , Stomach , VomitingABSTRACT
@#ObjectiveTo compare the effects of patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) on postoperative nausea and vomit (PONV) in gynecologic and obstetric patients. Methods56 gynecologic or obstetric patients (ASA Ⅰ～Ⅱ) scheduled for lower abdominal surgeries were randomly allocated to receive either 1 mg/ml morphine plus 0.1 mg/ml droperidol intravenously (group PCIA) or 0.1 mg/ml morphine plus 0.125% bupivacaine (group PCEA-Ⅰ) or 0.1 mg/ml morphine plus 0.1 mg/ml droperidol plus 0.125% bupivacaine (group PCEA-Ⅱ) epidurally. 4, 24, and 48 h after operation, pain scores with visual analogus scale (VAS), sedation scores with Ramesay and the incidences of nausea, vomiting, pruritus, respiratory depression were assessed. ResultsVAS scores in the two PCEA groups were much lower than that of PCIA (P<0.01). The incidences of nausea and vomiting in PCEA-Ⅱ group were significantly lower than those in PCIA group (P<0.05), incidences of other side-effects such as pruritus, respiratory depression etc. were similar between the three groups (P>0.05). ConclusionThe regimen morphine/droperidol/bupivacaine by PCEA shows superiorities in relieving pain and reducing postoperative nausea and vomiting in gynecologic and obstetric patients.
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@#ObjectiveTo compare the effects of patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) on postoperative nausea and vomit (PONV) in gynecologic and obstetric patients. Methods56 gynecologic or obstetric patients (ASA Ⅰ～Ⅱ) scheduled for lower abdominal surgeries were randomly allocated to receive either 1 mg/ml morphine plus 0.1 mg/ml droperidol intravenously (group PCIA) or 0.1 mg/ml morphine plus 0.125% bupivacaine (group PCEA-Ⅰ) or 0.1 mg/ml morphine plus 0.1 mg/ml droperidol plus 0.125% bupivacaine (group PCEA-Ⅱ) epidurally. 4, 24, and 48 h after operation, pain scores with visual analogus scale (VAS), sedation scores with Ramesay and the incidences of nausea, vomiting, pruritus, respiratory depression were assessed. ResultsVAS scores in the two PCEA groups were much lower than that of PCIA (P<0.01). The incidences of nausea and vomiting in PCEA-Ⅱ group were significantly lower than those in PCIA group (P<0.05), incidences of other side-effects such as pruritus, respiratory depression etc. were similar between the three groups (P>0.05). ConclusionThe regimen morphine/droperidol/bupivacaine by PCEA shows superiorities in relieving pain and reducing postoperative nausea and vomiting in gynecologic and obstetric patients.
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Objective To disuss the clinic characteristics,the etiologies and the misdiagnosis cause of hyperthyroidism featuring in vomit mainly.Methods The clinic data of 35 hyperthyroids featuring in vomit mainly were reviewed and analyzed.Results The hyperthyroids in this group were middle-aged female mainly whose symptoms showd that they vomit frequently with abdominal distention,thin,inappetence,chest congestion,palpitation;tachycardia;hypohepatia and electrolyte disturbance.Furthermore,their thyroid gland function assay is in concordance with the hyperthyroidism diagnosis.Treatment for antihyperthyroidism can get remarkable effects.Conclusion The patient showing vomit of unknown origin may be taken into account as hyperthyroid.The key points to prevent misdiagnosis are to detect thyroid gland function in time and to improve the understanding for un-typical hyperthyroidism.
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[Objective] To confirm the effects of Neiguan massaged to prevent ache nausea and vomit after laparoscopic cholecystectomy(LC).[Methods] 400 patients were randomly divide into 2 groups;the group 1 were treated by Neiguan massage during the LC,the group 2 nothing during the operation.[Results]Group 1 suffered the same ache in the 1st hour as group 2,but less in the last 24h,and less nausea and vomit too.[Conclusions ]Neiguan massage could obviously prevent ache nausea and vomit after LC.
ABSTRACT
El Diprivan por sus características farmacológicas es uno de los logros en el campo de la anestesiología. Sus propiedades antieméticas dadas por actividad antidopaminérgica y efecto depresor sobre la zona quimiorreceptora de disparo emético bulbar son útiles en la cirugía ambulatoria. Realizamos un estudio prospectivo y longitudinal en 60 pacientes amigdalectomizados, en el Hospital Pediátrico "Pepe Portilla" entre marzo de 2002 a enero del 2004, con el objetivo de comparar la incidencia postoperatoria de vómitos al utilizar Diprivan o Halotane como anestésico base en las amigdalectomias. 60 niños del perímetro urbano fueron enrolados en el estudio y elegidos al azar para recibir una de las propuestas anestésicas. Un acceso intravenoso fue establecido y todos los niños recibieron Fentanyl (2 µcgr. Kg. ev ) y Lidocaína 2% (1mg.kg.ev). A 30 niños se le administró Diprivan 2mg.kg como agente inductor y al resto inducción con máscara con Halotane (3-4%), O2 100%. La intubación endotraqueal fue facilitada con Atracurio (0.25mg.kg.ev). Seguidamente a la misma recibieron Diprivan (120-180µcgr .Kg. min. ev) o Halotane (0.8-1.6%) indistintamente con O2 100% para el mantenimiento de la anestesia. Los episodios de vómitos fueron recogidos en las 6 horas siguientes antes del acta y una entrevista telefónica fue realizada al siguiente día. De un total de 29 pacientes que presentaron vómitos el 89.7% correspondió al grupo del Halotane y solo un 10.3 % al del Diprivan. p< 0.01. Estos datos sugieren que utilizando Diprivan como anestésico podemos disminuir la incidencia de vómitos siguiendo a una amigdalectomía.
The Propofol for its pharmacological characteristics is one of the achievements in the field of the anesthesiology. Their properties antiemetics given by activity antidopaminergics and effect depressor on the quimiorreceptora area of shot emetic bulbar are useful in the ambulatory surgery. We carry out a prospective and longitudinal study in 60 patient amigdalectomized, in the Pediatric Hospital "Pepe Portilla" among March of the 2002 to January of the 2004, with the objective of comparing the postoperative incidence of vomits when using Diprivan or Halotane like anesthetic bases on the amigdalectomy. 60 children of the urban perimeter were signed up in the study and chosen at random to receive one of the anesthetic proposals. An intravenous access was established and all the children received Fentanyl (2 µcgr. Kg. ev) and Lidocaína 2% (1mg.kg.ev). To 30 children´s was administered Diprivan 2mg.kg as agent inductor and to the rest induction with mask with Halotane (3-4%), O2 100%. The endotraqueal intubation was facilitated with Atracurio (0.25mg.kg.ev). Subsequently to the same one Diprivan received (120-180µcgr. Kg. min. ev) or Halotane (0.8-1.6%) indistinctly with O2 100% for the maintenance of the anesthesia. The episodes of vomits were picked up in the 6 following hours before the records and a phone interview was carried out to the following day. Of a total of 29 patients that presented vomits 89.7% it corresponded to the group of the Halotane and alone 10.3% to that of the Diprivan. p<0.01. These data suggest that using Diprivan like anesthetic can diminish the incidence of vomits continuing to an amigdalectomy.