Quilotórax secundario a linfoma no Hodgkin: una presentación poco habitual / Chylothorax secondary to non-Hodgkin Lymphoma: an unusual presentation

El quilotórax es una patología infrecuente que se produce por la efusión linfática de quilo al espacio pleural procedente del conducto torácico. Está causado por la obstrucción o perforación del mismo. Las causas del quilotórax son traumáticas, neoplasias, misceláneas e idiopáticas. Su diagnóstico debe sospecharse ante la apariencia lechosa y opalescente del líquido pleural, y se confirmará con la detección de triglicéridos o quilomicrones en el líquido. Clásicamente, su tratamiento se basa en medidas de soporte nutricional y drenaje del derrame. El pronóstico dependerá de la causa subyacente. Presentamos el caso de una paciente de 43 años estudiada por aumento de edemas en miembros inferiores y disnea de una semana de evolución, sin síndrome constitucional ni síntomas B asociados. En la exploración física se palpaban adenopatías a nivel de las regiones cervical, submandibular y supraclavicular izquierdas, junto con hipofonesis en base y campo medio izquierdos. La radiografía de tórax mostraba extenso derrame pleural izquierdo, realizándose toracocentesis diagnóstica, con líquido pleural de apariencia lechosa y opalescente e inmunofenotipo compatible con linfoma de célula grande. La tomografía computarizada y la biopsia quirúrgica de las adenopatías supraclaviculares, confirmaron el diagnóstico de linfoma no Hodgkin folicular

Chylothorax is an infrequent disease due to the lymphatic effusion of chyle into the pleural space from the thoracic duct. The causes of chylothorax are traumatic, tumors, miscellaneous and idiopathic. The diagnosis is suspected by the milky and opalescent appearance of the pleural fluid, and it will be confirmed by the detection of triglycerides or chylomicrons in the fluid. The treatment will be based on measures of nutritional support and drainage of the pleural effusion. The prognosis will depend on the underlying cause. We present a 43-years-old patient with 1-week history of increase edema of the lower limbs and dyspnea, without constitutional syndrome or B symptoms associated. On physical examination, adenopathies were palpable at left cervical, submandibular and supraclavicular regions. Chest radiography showed extensive left pleural effusion. We did a diagnostic thoracocentesis and we got a milky and opalescent pleural fluid. The immunophenotype was compatible with large cell lymphoma. Computed tomography and surgical biopsy of the adenopathies confirmed the diagnosis of follicular non-Hodgkin Lymphoma

Insuficiencia cardiaca izquierda como causa de hemoptisis / Left heart failure as a cause of hemoptysis

La hemoptisis puede ser la primera manifestación de un gran número de enfermedades cuyo pronóstico y tratamiento son muy diversos. Por ello, en la práctica clínica es muy importante plantear un buen diagnóstico diferencial y realizar un correcto diagnóstico etiológico. Presentamos el caso de un varón de 26 años con hemoptisis secundaria a insuficiencia cardiaca izquierda

Hemoptysis may be the first manifestation of a large number of diseases whose prognosis and treatment are very diverse. Therefore, in clinical practice it is very important to propose a good differential diagnosis and make a correct etiological diagnosis. We present the case of a 26-year-old man with hemoptysis secondary to left heart failure

Desarrollo de embolismo pulmonar por cemento tras vertebroplastia / Pulmonary embolism after percutaneous vertebroplasty

En los últimos años se ha extendido el uso de la vertebroplastia percutánea con cemento de polimetilmetacrilato como técnica alternativa al tratamiento convencional de las fracturas vertebrales por osteoporosis. Presentamos el caso de una paciente sometida a vertebroplastia con polimetilmetacrilato que desarrolló embolismo pulmonar secundario a dicho material

In recent years the use of percutaneous vertebroplasty with polymethylmethacrylate cement as treatment of osteoporotic vertebral fractures has increased, gradually replacing the conventional treatment. A 51-year-old female’s case, who developed pulmonary embolism due to a precutaneous vertebroplasy, is presented in this article

Paciente con fiebre y hemoptisis / No disponible

La vasculitis necrosante sistémica afecta al pulmón, sobre todo en el contexto de los síndromes de vasculitis granulomatosa o los síndromes pulmonares-renales. La complicación más grave, consecuencia del daño en la microcirculación, es la hemorragia pulmonar. Clínicamente se define como un síndrome caracterizado por hemoptisis, anemia, insuficiencia respiratoria aguda e infiltrados alveolares pulmonares de aparición brusca, junto con otros síntomas inespecíficos. Es potencialmente mortal y con una evolución clínica impredecible. Presentamos un caso de un paciente de 42 años que debutó con hemorragia alveolar difusa e insuficiencia respiratoria grave, infiltrados alveolares bilaterales y títulos altos de anticuerpos anticitoplasma de neutrófilo (c-ANCA), siendo diagnosticado finalmente de granulomatosis con poliangeítis o enfermedad de Wegener

Systemic necrotizing vasculitis affects the lung, especially in the context of granulomatous vasculitis syndromes or pulmonary-renal syndromes. The most serious complication, resulting from damage to the microcirculation, is pulmonary hemorrhage. It is clinically defined as a syndrome characterized by hemoptysis, anemia, acute respiratory failure, and sudden onset pulmonary alveolar infiltrates, along with other nonspecific symptoms. It is potentially fatal and has an unpredictable clinical course. We present the case of a 42 years old patient with diffuse alveolar hemorrhage and severe respiratory insufficiency, bilateral alveolar infiltrates and high titers of anti-neutrophil cytoplasmic antibodies (c-ANCA), finally being diagnosed as having granulomatosis with polyangeitis or Wegener's

Aspergiloma pulmonar / No disponible

Aspergillus spp es un género de hongos, ubicuo, que puede encontrarse libre en el aire, siendo un contaminante frecuente en los laboratorios de microbiología. En cuanto a la afectación pulmonar, se adquiere mediante la inhalación de esporas. Produce distintas patologías pulmonares en pacientes predispuestos, fundamentalmente en inmunodeprimidos, al ser un hongo oportunista. El aspergiloma es la forma más frecuente. Se trata de una masa de hongos filamentosos que asienta sobre una cavidad pulmonar preformada. Clínicamente los pacientes suelen estar asintomáticos, siendo la hemoptisis el único síntoma claramente atribuible. El diagnóstico se basa principalmente en la combinación clínica y radiológica. El tratamiento no está bien definido, siendo quirúrgico en primera instancia. Presentamos el caso de un paciente de 69 años con antecedentes de enfermedad pulmonar obstructiva crónica y enfisema de predominio en lóbulos superiores, que a lo largo de un ingreso prolongado desarrolló un aspergiloma pulmonar que se trató con voriconazol

Aspergillus spp is an ubiquitous fungus which can be found floating in the air, being a frequent pollutant in microbiology laboratories. Lung involvement is produced by the inhalation of spores. As an opportunistic fungus it produces various pulmonary pathologies in immunocompromised hosts. Among them, the aspergilloma is the most common and recognizable one. It is a ball made up of fungal hyphae which grows in preformed lung cavities. Clinically, patients are often asymptomatic and the hemoptysis is the only symptom clearly due to the disease. The diagnosis is based on clinical findings and in the radiography. The treatment is not well defined, being surgical in the first instance. We present a 69-years-old male patient with chronic obstructive pulmonary disease and emphysema predominating in the upper lobes. The patient developed a pulmonary aspergilloma which was treated with voriconazole

Carcinoma anaplásico de tiroides con invasión traqueal / No disponible

El carcinoma anaplásico de tiroides es uno de los tumores sólidos más agresivos y constituye una forma rara pero muy letal de cáncer. Está formado por tejido indiferenciado del epitelio folicular del tiroides. Suelen ser asintomáticos, por tanto en la mayoría de las ocasiones el diagnóstico es tardío. En fases avanzadas, clínicamente se caracteriza por una masa en la región anterior del cuello de rápido crecimiento que puede acompañarse de síntomas de compresión o invasión de las vías digestiva y aérea superior. Presentamos un caso de una paciente de 81 años estudiada por hemoptisis y síndrome constitucional de tres meses de evolución con carcinoma anaplásico de tiroides. En la exploración física se palpaba una masa de consistencia dura y adherida a planos profundos en lóbulo tiroideo derecho y se oía estridor inspiratorio. La radiografía de tórax mostraba la tráquea desplazada lateralmente. La tomografía computarizada y fibrobroncoscopia aportaron el diagnóstico

Anaplastic thyroid cancer is one of the most aggressive types of solid tumors and it is a rare form of cancer with a high mortality rate. It is formed by undifferentiated tissue from the follicular epithelium of the thyroid. This cancer is usually asymptomatic, so in most cases the diagnosis is delayed. In advanced stages of the disease, it is clinically characterized by a fast growing central neck mass which, can show up as symptoms of compression or invasion of the digestive tract and upper respiratory airways. We present a 81-years-old patient with 3-month history of hemoptisis and constitutional syndrome. She was diagnosed with anaplastic thyroid cancer. On general physical examination a cervical mass of hard consistency was palpated. We could hear inspiratory stridor. Chest radiograph showed the tracheal laterally displaced. Computed tomography and fibrobronchoscopy with biopsy allowed the final diagnosis

Absceso pulmonar por Pseudomonas aeruginosa en paciente / No disponible

En los pacientes inmunodeprimidos, entre las causa más frecuentes de absceso pulmonar se encuentra la Pseudomonas aeruginosa. Para el diagnóstico etiológico de absceso pulmonar necesitamos que la radiografía de tórax muestre un infiltrado con cavitación superior a 2 cm y que exista documentación microbiológica que determinará la elección del tratamiento antibiótico adecuado. En el caso de que el absceso sea por P. aeruginosa, resultará más complicado porque los antibióticos empíricamente indicados no suelen ir dirigidos específicamente a esta bacteria. Presentamos un caso de una paciente de 78 años con esclerosis sistémica y neumopatía intersticial no específica en tratamiento inmunosupresor que presentó un absceso pulmonar por P. aeruginosa de instauración brusca y de evolución tórpida

In the inmunocompromised patients, among the most common cause of lung abscess stand out Pseudomonas aeruginosa. For a etiologic diagnosis of lung abscess we need the thorax radiograph to show a pulmonary infiltrate with a cavitatiom with a depth of at least 2 cm and microbiological documentation, which will define which is the best antibiotic therapy. If the lung abscess is caused by the bacteria P. aeruginosa, its treatment will be more difficult because empirically recommended antibiotics barely target this bacteria. We present a 78-years-old female patient with systemic sclerosis and nonspecific interstitial pneumonia, who is receiveing an immunosuppressive treatment. She was diagnosed with a P. aeruginosa lung abscess which had a sudden onset and a bad evolution

First Report of Foliar Infection of Cabbage by Phytophthora drechsleri in Argentina.

Cabbage (Brassica oleracea var. capitata L.) is a popular crop grown along the northeast horticultural belt of Buenos Aires Province, Argentina. In the summer of 2010, fields in this region remained flooded for long periods due to frequent and intense precipitation (560 mm from January to March). Commercial cabbage crops in the cities of Luján and General Rodríguez developed patches of diseased plants that were stunted and wilted. Affected plants had necrotic areas in the crowns and roots. Symptoms expanded to the upper stems, leaving vascular tissues exposed. During April 2010, samples from 2 fields were brought to the laboratory where the stems were washed thoroughly and disinfected with a 1% bleach solution for 2 minutes. Small pieces (5 mm in diameter) were removed from the lesion edge, plated on V8 agar (V8A) plates, and incubated at 24°C in the dark for 5 days. Four isolates were transferred to V8A using hyphal tips. Morphological studies were performed on the V8A cultures as well as plates flooded with tap water. Sporangia were obpyriform, nonpapillate, persistent, and variable in size, averaging 44 × 28 µm. Each isolate belonged to the A1 mating type when paired with P. capsici tester isolates, CBS 370.72 and CBS 111.334 (Fungal Biodiversity Centre, CBS, Utrecht, the Netherlands). The isolates produced amphigynous antheridia, and chlamydospores were present but scarce. Maximum temperatures for growth (37°C) were also performed. Edited sequences of the internal transcribed spacer (ITS) region of the rDNA (GenBank Accession Nos. JQ653300, JQ653301, JQ653302, and JQ653303) were compared with Phytophthora sequences available in GenBank using the BLASTN search utility (1) and aligned to the data set of Cooke et al. (2). Sequences of the four isolates (strains 2: R-cai-cuello-col-3, 3: R-cai-cuello-col-18, 4: R-AN-col-1A and 5: R-AN-col-1B) matched 100% with GenBank sequences of P. drechsleri (100% coverage, 100% identity and no gaps). Based on these results, the four Argentinian cabbage isolates were identified as P. drechsleri (3). Pathogenicity tests were completed using three detached heads of mature cabbage plants (B. oleracea var. capitata) for each isolate. A 5-mm colonized mycelial plug of the appropriate isolate was placed on the main vein of the outermost leaves. For the control treatments, three heads were inoculated with non-colonized V8A plugs. The inoculated and control heads of cabbage were incubated in plastic boxes wrapped in black nylon bags at 24°C for 4 days. Broccoli (B. oleracea var. italica) and cauliflower (B. oleracea var. botrytis) were also tested following the same procedure. All heads of cabbage, broccoli, and cauliflower developed necrotic lesions 2 to 4 cm in diameter and a dark grey color. Control heads of each plant remained green. P. dreschleri was consistently reisolated as described above from the inoculated heads, but not from the control heads. To our knowledge, this is the first report of cabbage as a host for P. dreschleri in Argentina. Frezzi (4) reported this species as a pathogen of Chrysanthemum cinerariefolium, Celosia plumosa, Schinus molle, and Solanum lycopersicum in Argentina in 1950. References: (1) S. S. Altschul et al. Nucleic Acids Res. 25:3389, 1997. (2) D. E. L. Cooke et al. Fungal Gen. Biol. 30:17, 2000. (3) D. C. Erwin and O. K. Ribeiro. Phytophthora Diseases Worldwide. The American Phytopathological Society Press, St. Paul, MN, 1996. (4) M. J. Frezzi. Rev. Invest. Agric. Buenos Aires 4:49, 1950.

Validation and psychometric properties of the State Impulsivity Scale (SIS).

INTRODUCTION: Impulsivity is a complex phenomenon that can be evaluated from a trait or state perspective. Impulsive trait is a predisposition relatively stable over time, but not always perceptible by behavior. However, the impulsivity state covers transient variations on impulsivity levels that are dependent on environmental or biologic conditions. OBJECTIVE: This study has aimed to validate a scale to assess impulsivity as a state in a Spanish sample. METHOD: State Impulsivity Scale (SIS) was designed based on three experimental models: Reward, Automatism and Attentional. All the items in the SIS explore the presence and frequency of impulsive behaviors. Statistical analyses of reliability and validity were done. Convergent validity was examined by means of correlations among SIS and Barratt Impulsiveness Scale (BIS-11), Sensitivity to the punishment and sensitivity to the reward questionnaire (SPSRQ) and Sensations Seeking Scale type V (SSS). RESULTS: We used a Spanish sample of 70 patients who had at least one diagnosis of Impulse Control Disorder (IP), 73 psychiatric patients without impulsive disorders (NIP) and 150 control subjects (CS). The values obtained reveal the high reliability of the SIS (Cronbach's alpha coefficients 0.884), factor analysis confirmed the theoretical three-dimensional structure and convergent validity was excellent. SIS also demonstrated its capacity for discrimination among IP group and NIP and CS groups. CONCLUSIONS: SIS is a new impulsive behavior assessment instrument validated in Spanish population. The results obtained indicate adequate psychometric properties for its use in the clinical and research fields. Key Words: State Impulsivity, Trait, Evaluation, Scale.

Linfadenopatía axilar por rotura de prótesis mamaria de silicona / No disponible

Las prótesis de silicona han sido usadas durante muchotiempo como implantes para el aumento mamario o para lareconstrucción tras cirugía oncológica. La rotura de unaprótesis es una complicación reconocida de esta cirugía. Suincidencia se desconoce, aunque sabemos que se incrementaal aumentar la edad de la prótesis.Si la silicona alcanza un ganglio linfático axilar puede provocardolor local o aumento del mismo, si bien, el procesosuele ser asintomático y verse como hallazgo incidental al realizaruna mastectomía en pacientes con antecedentes de mamoplastia.Presentamos un caso de linfadenopatía axilar por siliconatras rotura de prótesis mamaria, y realizamos una revisión delas complicaciones más habituales del uso de este material, enfatizandoen la linfadenopatía a propósito del caso(AU)

Silicone breast prostheses have been widely used for a longtime for breast augmentation or for reconstruction after cancersurgery. Rupture of prostheses is a known complication of thistype of surgery. Its incidence is unknown, even though it is knownthat there is an increase of rupture as the prostheses ages.If the silicone reaches an axilary lymph node, it can causelocal pain or enlargement in size. Even though, the processnormally does not result in these issues. It is frequently detectedas an incidental finding after performing a mastectomy aftermammaplasty.We present a clinical case of axillary lymphadenopathy associatedwith the rupture of a mammary silicone prostheses,and we review the most common and usual complicationswhen using this material, especially when dealing with a caseof lymphadenopathy(AU)

[Preoperative diagnostic imaging in stump appendicitis]. / Diagnóstico preoperatorio por métodos de imagen de una apendicitis del muñón.

Stump appendicitis is a rare condition in which the diagnosis is often delayed and is eventually reached during exploratory surgery. Knowledge of stump appendicitis makes it possible to reach the diagnosis using imaging techniques and thereby reduce the morbidity of this condition. We present the case of a patient with appendicitis of the appendicular stump that was diagnosed prior to surgery using plain-film radiography and abdominal CT.

Diagnóstico preoperatorio por métodos de imagen de una apendicitis del muñón / Preoperative diagnostic imaging in stump appendicitis

La apendicitis del muñón es una entidad rara en la que a menudo el diagnóstico se retrasa y se lleva a cabo en el quirófano. El conocimiento de esta entidad hace que sea posible su diagnóstico preoperatorio por métodos de imagen, disminuyendo la morbilidad de la misma. Presentamos a una paciente con una apendicitis del muñón apendicular diagnosticada preoperatoriamente por medio de radiografía simple y tomografía computarizada abdominal

Stump appendicitis is a rare condition in which the diagnosis is often delayed and is eventually reached during exploratory surgery. Knowledge of stump appendicitis makes it possible to reach the diagnosis using imaging techniques and thereby reduce the morbidity of this condition. We present the case of a patient with appendicitis of the appendicular stump that was diagnosed prior to surgery using plain-film radiography and abdominal CT

[Heart transplant]. / Trasplante cardíaco.

A heart transplant is at present considered the treatment of choice in cases of terminal cardiac insufficiency refractory to medical or surgical treatment. Due to factors such as the greater life expectancy of the population and the more efficient management of acute coronary syndromes, there is an increasing number of people who suffer from heart failure. It is estimated that the prevalence of the disease in developed countries is around 1%; of this figure, some 10% are in an advanced stage and are thus potential receptors of a heart transplant. The problem is that it is still not possible to offer this therapeutic form to all of the patients that require it. Consequently, it is necessary to optimise the results of the heart transplant through the selection of patients, selection and management of donors, perioperative management and control of the disease due to graft rejection. Since the first transplant carried out in 1967, numerous advances and changes have taken place, which has made it possible to increase survival and quality of life of those who have received a new heart. In this article we review the most relevant aspects of the heart transplant and the challenges that are currently faced.

Cost analysis of neuromuscular blocking agents in the operating room: cisatracurium, atracurium, vecuronium and rocuronium.

Cisatracurium (C), Atracurium (A), Rocuronium (R) and Vecuronium (V) are four neuromuscular blockers (NMB) used in the operating room with similar efficacy, defined as adequate muscle relaxation, but different pharmacokinetics. C and A have organ-independent elimination, A is associated with histamine release and R has a shorter onset time. The objective of this study was to economically compare these four NMB from the hospital point of view in order to facilitate drug selection. A cost analysis was performed. Only direct costs were considered and data were collected through a retrospective chart review. A total of 151 patient charts were randomly selected. Differences between patients receiving one of the four NMB were evaluated by ANOVA or Kruskal-Wallis tests. Then a multiple linear regression analysis was conducted. In the chart review, no significant difference was observed between the four groups of patients in age, weight or surgery duration (p > 0.05). Multiple regression analysis revealed that atracurium was on average PTA 237 (1 Euro = PTA 166) cheaper per surgery than any other NMB after adjusting for other factors (p < 0.01) and there is no significant difference in cost between the other three NMBs (p > 0.1). We recommend the use of rocuronium when a quick onset is needed and the patient does not have hepatic failure, cisatracurium when a haemodynamic instability is possible and atracurium in the remaining cases. If just one NMB can be included in the drug formulary we would select cisatracurium due to its pharmacological advantages over atracurium with a small increment in cost.

A comparative study with oral nifedipine, intravenous nimodipine, and magnesium sulfate in postoperative analgesia.

UNLABELLED: We tested the ability of two L-type calcium channel blockers (nifedipine and nimodipine) and the N-methyl D-aspartate natural antagonist magnesium to decrease morphine requirements and pain in the postoperative period in 92 patients undergoing elective colorectal surgery. In a randomized, double-blinded study, patients were assigned to one of four groups. The control group received placebo. The nifedipine group received 60 mg of oral nifedipine. The magnesium group received an initial dose of 30 mg/kg followed by 10 mg x kg(-1) x h(-1) of magnesium sulfate over 20 h. The nimodipine group received 30 microg x kg(-1) x h(-1) of nimodipine over 20 h. Postoperative morphine consumption was assessed for 48 h. Pain at rest and pain on movement were assessed up to the fifth day postsurgery. There were no differences among groups in postoperative morphine consumption at 12 and 24 h. The nifedipine group consumed more morphine than the control and nimodipine groups during 24-48 h. Pain at rest scores were higher at 16 and 24 h in the nifedipine group than in the other three groups. Pain on movement scores were lower at 72 h in the nimodipine group than in the control and nifedipine groups. In conclusion, the perioperative application of oral nifedipine, IV nimodipine, or IV magnesium sulfate failed to decrease postoperative morphine requirements after colorectal surgery. IMPLICATIONS: The increase of intracellular calcium plays a key role in spinal transmission of pain and in the establishment of central sensitization. We examined the effects of nifedipine, nimodipine, and magnesium sulfate in postoperative analgesia after colorectal surgery. We found no differences in morphine consumption with the administration of each drug alone.

Collateral biliary circulation in portal hypertension syndrome.

OBJECTIVE: to describe collateral circulation in the gallbladder wall in relation with portal hypertension syndrome, and to determine whether this syndrome is frequently associated portal vein thrombosis. METHODS: images were retrospectively reviewed for 9 patients with previously diagnosed portal hypertension syndrome, in whom ultrasound results suggested the presence of varices of the cystic vein. RESULTS: four patients showed signs suggesting portal vein thrombosis. The gallbladder wall showed diffuse hypoechoic thickening in all patients, 7 of whom had intramural dilation of tubular, tortuous appearance. Ultrasound findings, however, were not very specific, and differential diagnosis with a large number of other entities is required to rule out other possible causes of focal and diffuse thickening of the gallbladder wall. The use of Doppler sonographic techniques made it possible to determine the cause of the varices, and to confirm suspicions of portal thrombosis. This method was found to be just as sensitive as ultrasound imaging, and much more specific. Angiograms obtained in 3 patients for different reasons confirmed the ultrasonographic findings in all cases. CONCLUSIONS: this study confirms the association between thromboses and varices, and analyzes the physiopathological hypotheses invoked to explain this association. We emphasize the need for correct diagnosis, given the frequency of surgical iatrogenic bleeding or misdiagnosis resulting from confusion with other possible causes of gallbladder wall thickening. Doppler ultrasound is considered the ideal diagnostic method as it is harmless, sensitive and specific.

Repeated transient neurological symptoms after spinal anaesthesia with hyperbaric 5% lidocaine.

We report a case of repeated delayed pain after cystoscopy under spinal lidocaine anaesthesia, which may be caused by transient radicular irritation. The possible aetiology of the symptoms is discussed.

Combination of ondansetron and droperidol in the prophylaxis of postoperative nausea and vomiting.

The aim of this study was to compare the efficacy and safety of ondansetron plus droperidol with each drug alone or placebo in the prevention of postoperative nausea and vomiting (PONV). One hundred females, aged 18-65 yr, ASA physical status I-II, undergoing general anesthesia for elective abdominal surgery were included in a prospective, double-blind, placebo-controlled, randomized study. A standardized anesthetic technique and postoperative analgesia (ketorolac plus patient-controlled analgesia [PCA] with morphine) were used in all patients. Patients were randomly assigned to receive placebo (Group 1, n = 25), droperidol 2.5 mg with induction of anesthesia and 1.25 mg 12 h later (Group 2, n = 25), ondansetron 4 mg with induction (Group 3, n = 25), and ondansetron plus droperidol at the same doses as Groups 3 and 2, respectively (Group 4, n = 25). A complete response, defined as no PONV in 48 h, occurred in 28% of patients in Group 1, 60% in Group 2 (P < 0.05 vs Group 1), 56% in Group 3 (P < 0.05 vs Group 1), and 92% in Group 4 (P < 0.01 vs Groups 1, 2, and 3). Sedation was significantly greater with droperidol (Groups 2 and 4) for 12 h postoperatively. In conclusion, the combination of ondansetron plus droperidol was more effective than each antiemetic alone or placebo in the prevention of PONV in women undergoing elective abdominal surgery.