Subject(s)
Aortic Diseases/complications , Chest Pain/etiology , Hematoma/complications , Plaque, Atherosclerotic/complications , Ulcer/complications , Acute Disease , Aged , Aortic Diseases/diagnosis , Female , Hematoma/diagnosis , Humans , Plaque, Atherosclerotic/diagnosis , Syndrome , Tomography, X-Ray Computed , Tunica Intima/diagnostic imaging , Tunica Media/diagnostic imaging , Ulcer/diagnosisSubject(s)
Abdominal Pain/etiology , Aortic Aneurysm, Abdominal/complications , Aortic Diseases/diagnosis , Intestinal Fistula/diagnosis , Multiple Organ Failure/etiology , Postoperative Complications/surgery , Vascular Fistula/diagnosis , Aged , Anastomosis, Surgical , Aortic Aneurysm, Abdominal/surgery , Aortic Diseases/surgery , Fatal Outcome , Humans , Intestinal Fistula/surgery , Male , Vascular Fistula/surgeryABSTRACT
Cannabis is the most widely used illicit drug in the world. The medicinal value of cannabis as an antiemetic is well known by the medical fraternity. A less well-recognised entity is the potential for certain chronic users to develop hyperemesis. We describe the case of a young man who presented to us with features of cannabinoid hyperemesis syndrome. We review the current literature on this condition, its pathogenesis and management.
Subject(s)
Antiemetics , Cannabinoids/adverse effects , Cannabis/chemistry , Disease Management , Marijuana Abuse/complications , Nausea/etiology , Vomiting/etiology , Adult , Antiemetics/adverse effects , Antiemetics/therapeutic use , Cannabis/adverse effects , Dronabinol/adverse effects , Humans , Male , Metoclopramide/therapeutic use , Nausea/metabolism , Nausea/therapy , Receptors, Cannabinoid/metabolism , Syndrome , Vomiting/metabolism , Vomiting/therapy , Young AdultABSTRACT
INTRODUCTION: Chronic nausea and vomiting have a detrimental impact on quality of life. When standard diagnostic investigations fail to provide a definitive diagnosis, patients are often attributed as having a functional gastrointestinal disorder such as cyclic vomiting syndrome. Cannabinoid hyperemesis syndrome (CHS) is a relatively recently described entity presenting with symptoms similar to cyclic vomiting syndrome. METHODS: We carried out a retrospective cohort study of all patients attending a tertiary neurogastroenterology and secondary care gastroenterology clinic from 2013 to 2015. Data were obtained by review of clinical notes, letters and electronic patient records. RESULTS: We identified 10 cases of CHS (five men, mean age 27 years, range 19-51), who hitherto had been labelled with a variety of alternative diagnoses. All patients had symptoms that were episodic and refractory to medical therapy. Patients had experienced symptoms for a mean of 19.3±11.09 months before diagnosis. The median length of cannabinoid use was 42 months (interquartile range: 15-81.8). Eight patients (80%) had a history of compulsive hot water bathing (hydrophilia). The patients had a median follow-up of 9.5 months (range 1-20), during which symptoms recurred in three patients who returned to regular cannabis use. CONCLUSION: CHS is an underappreciated cause of recurrent nausea and vomiting and is frequently misdiagnosed. Healthcare providers should have a low index of suspicion for diagnosing CHS and the clinical history in such patients should routinely include direct questioning on cannabis use. The prognosis is very good upon cessation of cannabis intake.
Subject(s)
Marijuana Abuse/complications , Marijuana Abuse/diagnosis , Vomiting/etiology , Adult , Chronic Disease , Diagnosis, Differential , Female , Follow-Up Studies , Gastrointestinal Diseases/diagnosis , Humans , Male , Middle Aged , Prognosis , Recurrence , Retrospective Studies , Syndrome , Young AdultABSTRACT
BACKGROUND: The deleterious effects of climate change mean that environmental sustainability is increasingly becoming a moral and economic necessity. Consequently, clinicians will increasingly be called upon to manage the effects of health care on climate change, and they must therefore do as much as is practically possible to limit the negative effects of their practice on the environment. As medical educators we have the opportunity not only to reduce the environmental impact of our own clinical practice, but also that of those who we teach, through innovation. Such novelty can be explored during student-selected components (SSCs). Clinicians will increasingly be called upon to manage effects of health care on climate change CONTEXT: The project, entitled 'Can we introduce sustainability to clinical skills teaching?' was led by two third-year medical students during their SSC periods. New ways to make existing skills more sustainable were explored by surveying existing practice in the workplace, analysing selected skills in a lab-based setting and through discussions with sustainability champions. INNOVATION: Cannulation and intravenous (IV) antibiotic preparation were chosen by the students as prototype skills. These skills were observed by the students in the workplace and adapted by them to appease the 'triple bottom line' of sustainability: environmental, social and economic factors were addressed. The revised skills were taught by the students to their peers in a sustainably conscious fashion. IMPLICATIONS: Provided that such innovations in sustainable skills teaching are deemed appropriate by clinical skills directors, such methods could be adopted across medical schools and expanded to cover a wider range of skills.
