Search

A case study of a 76-Year-Old Woman with Nausea, Diarrhea, and Acute Kidney Failure is presented. Topics include the patient was admitted to this hospital with respiratory failure due to an exacerbation of heart failure and pneumonia; and treated with intravenous ceftriaxone and oral doxycycline for 5 days, and diuretic agents were adjusted during a 3-week hospitalization.

Background: No approved therapies exist for inoperable plexiform neurofibromas in patients with neurofibromatosis type 1.Methods: We conducted an open-label, phase 2 trial of selumetinib to determine the objective response rate among patients with plexiform neurofibromas and to assess clinical benefit. Children with neurofibromatosis type 1 and symptomatic inoperable plexiform neurofibromas received oral selumetinib twice daily at a dose of 25 mg per square meter of body-surface area on a continuous dosing schedule (28-day cycles). Volumetric magnetic resonance imaging and clinical outcome assessments (pain, quality of life, disfigurement, and function) were performed at least every four cycles. Children rated tumor pain intensity on a scale from 0 (no pain) to 10 (worst pain imaginable).Results: A total of 50 children (median age, 10.2 years; range, 3.5 to 17.4) were enrolled from August 2015 through August 2016. The most frequent neurofibroma-related symptoms were disfigurement (44 patients), motor dysfunction (33), and pain (26). A total of 35 patients (70%) had a confirmed partial response as of March 29, 2019, and 28 of these patients had a durable response (lasting ≥1 year). After 1 year of treatment, the mean decrease in child-reported tumor pain-intensity scores was 2 points, considered a clinically meaningful improvement. In addition, clinically meaningful improvements were seen in child-reported and parent-reported interference of pain in daily functioning (38% and 50%, respectively) and overall health-related quality of life (48% and 58%, respectively) as well as in functional outcomes of strength (56% of patients) and range of motion (38% of patients). Five patients discontinued treatment because of toxic effects possibly related to selumetinib, and 6 patients had disease progression. The most frequent toxic effects were nausea, vomiting, or diarrhea; an asymptomatic increase in the creatine phosphokinase level; acneiform rash; and paronychia.Conclusions: In this phase 2 trial, most children with neurofibromatosis type 1 and inoperable plexiform neurofibromas had durable tumor shrinkage and clinical benefit from selumetinib. (Funded by the Intramural Research Program of the National Institutes of Health and others; ClinicalTrials.gov number, NCT01362803.). [ABSTRACT FROM AUTHOR]

A 64-year-old man presented to the emergency department in the summer with intermittent fevers that began 7 weeks after he underwent heart transplantation at that hospital. The patient had a history o f ischemic cardiomyopathy for which he had received a HeartMate II left ventricular assist device (LVAD) that remained implanted for 2 years. An infection with coagulase-negative staphylococcus had developed in the drive-line o f the device, a finding that led to the patient’s name being placed higher on the waiting list for transplantation; before transplantation, he had received long-term treatment with doxycycline for suppression. His initial postoperative course was uneventful. After receiving induction therapy with basiliximab, the patient was treated with mycophenolate mofetil, tacrolimus, and prednisone to prevent allograft rejection. He received trimethoprim-sulfamethoxazole and valganciclovir for prophylaxis against pneumocystis and cytomegalovirus (CMV) infections (the patient and donor were both CMV-seropositive). Four weeks after heart transplantation, an endomyocardial biopsy showed grade 2 acute cellular rejection, which prompted administration o f pulse therapy with methylprednisolone for 3 days and increased maintenance doses o f immunosuppressive therapy. His treatment with tacrolimus was changed to cyclosporine because o f tremors. Seven weeks after transplantation, he began to have intermittent high fevers with temperatures o f up to 40°C, along with chills, nausea, and headaches. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 29-year-old female patient who was evaluated at a primary care clinic affiliated with this hospital because of nausea, vomiting, and diarrhea. Other information about the patient, who had been in her usual condition of good health until the day before presentation because of nausea, vomiting, diarrhea, fever, muscle aches, and a mild nonproductive cough, is presented.

The article presents a case study of an 83-year-old woman who was admitted due to confusion, diarrhea, vomiting and nausea. The patient reported abdominal pain, shortness of breath, chest pain and changes in vision in the emergency department. She had a history of heart failure, atrial fibrillation, and rheumatic heart disease with regurgitation and mitral-valve stenosis.

A 23-year-old woman presents with five episodes of headache during the past 2 months. Each episode began with yawning, sensitivity to light, and a depressed mood that was followed by the gradual onset of neck pain that spread to the occipital region and eventually to the retro-orbital region on the right side. The pain became incapacitating over a period of 1 to 2 hours and was associated with nausea and sensitivity to light and sound. With two of the episodes, she had jagged lines in her vision for 15 minutes as the neck pain was beginning; with all the episodes, she had severe fatigue and difficulty concentrating and finding words. The headache lasted approximately 24 hours, and, after resolution, she had several hours of residual neck soreness, fatigue, and depressed mood. How would you evaluate and treat this patient? [ABSTRACT FROM AUTHOR]

The article presents a case study of a 34-year-old man who was taken in hospital due to nephropathy or kidney disease. Topics mentioned include the nausea, decreased appetite, and fatigue experienced by the patient, the urinalysis conducted to him, and the treatment for kidney disease. Also mentioned are the classification of kidney disease and the effects of nonsteroidal antiinflammatory drugs (NSAIDs) to kidney.

Background: Patients with advanced midgut neuroendocrine tumors who have had disease progression during first-line somatostatin analogue therapy have limited therapeutic options. This randomized, controlled trial evaluated the efficacy and safety of lutetium-177 (177Lu)-Dotatate in patients with advanced, progressive, somatostatin-receptor-positive midgut neuroendocrine tumors.Methods: We randomly assigned 229 patients who had well-differentiated, metastatic midgut neuroendocrine tumors to receive either 177Lu-Dotatate (116 patients) at a dose of 7.4 GBq every 8 weeks (four intravenous infusions, plus best supportive care including octreotide long-acting repeatable [LAR] administered intramuscularly at a dose of 30 mg) (177Lu-Dotatate group) or octreotide LAR alone (113 patients) administered intramuscularly at a dose of 60 mg every 4 weeks (control group). The primary end point was progression-free survival. Secondary end points included the objective response rate, overall survival, safety, and the side-effect profile. The final analysis of overall survival will be conducted in the future as specified in the protocol; a prespecified interim analysis of overall survival was conducted and is reported here.Results: At the data-cutoff date for the primary analysis, the estimated rate of progression-free survival at month 20 was 65.2% (95% confidence interval [CI], 50.0 to 76.8) in the 177Lu-Dotatate group and 10.8% (95% CI, 3.5 to 23.0) in the control group. The response rate was 18% in the 177Lu-Dotatate group versus 3% in the control group (P<0.001). In the planned interim analysis of overall survival, 14 deaths occurred in the 177Lu-Dotatate group and 26 in the control group (P=0.004). Grade 3 or 4 neutropenia, thrombocytopenia, and lymphopenia occurred in 1%, 2%, and 9%, respectively, of patients in the 177Lu-Dotatate group as compared with no patients in the control group, with no evidence of renal toxic effects during the observed time frame.Conclusions: Treatment with 177Lu-Dotatate resulted in markedly longer progression-free survival and a significantly higher response rate than high-dose octreotide LAR among patients with advanced midgut neuroendocrine tumors. Preliminary evidence of an overall survival benefit was seen in an interim analysis; confirmation will be required in the planned final analysis. Clinically significant myelosuppression occurred in less than 10% of patients in the 177Lu-Dotatate group. (Funded by Advanced Accelerator Applications; NETTER-1 ClinicalTrials.gov number, NCT01578239 ; EudraCT number 2011-005049-11 .). [ABSTRACT FROM AUTHOR]

Background: We examined the efficacy of olanzapine for the prevention of nausea and vomiting in patients receiving highly emetogenic chemotherapy.Methods: In a randomized, double-blind, phase 3 trial, we compared olanzapine with placebo, in combination with dexamethasone, aprepitant or fosaprepitant, and a 5-hydroxytryptamine type 3-receptor antagonist, in patients with no previous chemotherapy who were receiving cisplatin (≥70 mg per square meter of body-surface area) or cyclophosphamide-doxorubicin. The doses of the three concomitant drugs administered before and after chemotherapy were similar in the two groups. The two groups received either 10 mg of olanzapine orally or matching placebo daily on days 1 through 4. Nausea prevention was the primary end point; a complete response (no emesis and no use of rescue medication) was a secondary end point.Results: In the analysis, we included 380 patients who could be evaluated (192 assigned to olanzapine, and 188 to placebo). The proportion of patients with no chemotherapy-induced nausea was significantly greater with olanzapine than with placebo in the first 24 hours after chemotherapy (74% vs. 45%, P=0.002), the period from 25 to 120 hours after chemotherapy (42% vs. 25%, P=0.002), and the overall 120-hour period (37% vs. 22%, P=0.002). The complete-response rate was also significantly increased with olanzapine during the three periods: 86% versus 65% (P<0.001), 67% versus 52% (P=0.007), and 64% versus 41% (P<0.001), respectively. Although there were no grade 5 toxic effects, some patients receiving olanzapine had increased sedation (severe in 5%) on day 2.Conclusions: Olanzapine, as compared with placebo, significantly improved nausea prevention, as well as the complete-response rate, among previously untreated patients who were receiving highly emetogenic chemotherapy. (Funded by the National Cancer Institute; ClinicalTrials.gov number, NCT02116530.). [ABSTRACT FROM AUTHOR]

The article presents a study that conducted randomized trial of perioperative subcutaneous pasireotide in patients undergoing either pancreaticoduodenectomy or distal pancreatectomy. The study reveals the association between decreased rate of clinically significant postoperative pancreatic fistula, leak or abscess perioperative treatment with paseireotide, and hyperglycemia and dose-limiting nausea as the two most common adverse events associated with pasireotide.

The article describes the case of a male patient who presented to the emergency department with chest pain. The patient experienced nausea, emesis, bloating and epigastric pain. The patient later developed heaviness of the chest developed on exertion and progressed to pain at rest accompanied by diaphoresis and dyspnea.

The article presents a case study of a 40-year old woman who was seen in the emergency department because of nausea, abndominal pain, nausea, and anorexia. The patient also manifests pain in the epigastrium and decrease energy as well as concentration. The article discusses the case of severe complications of cancer.

The article presents a case study of a 52-year-old man with chest pain and ST-segment elevations on electrocardiography (ECG). It says that the patient has taken 325 milligram (mg) aspirin daily and had developed nausea and vomiting. It mentions that the patient's case has highlighted issues on the management of myocardial infarction with ST-segment elevation (STEMI) and ventricular fibrillation.

The article presents a case study of a 35-year-old man who was taken to the emergency room because of syncope while playing soccer. He regained consciousness after some time and had no nausea, diaphoresis and even don't have any history of fainting or light-headedness. After one year during sexual intercourse, the patient had an episode of monomorphic ventricular tachycardia and was found diagnostic to Chagas disease.

The article focuses on a study which described the outcomes of in-flight medical emergencies on commercial airlines. Records of in-flight medical emergency calls during the period of January 1, 2008 to October 31, 2010 were analyzed. Results of the study showed that syncope, respiratory symptoms and nausea were the most common problems. The study also found that majority of the medical assistance were provided by physician passengers.

The article presents the case of a 44-year-old male who was rushed to the emergency department with chest pain that has awakened him from sleep and is accompanied by nausea and nonbilious, nonbloody vomiting. He has no family history of premature coronary artery disease. He was diagnosed to be suffering from primary myelofibrosis.

The article describes the case of a 54-year-old HIV-positive woman who was admitted to a hospital because of dyspnea and chest pain. The woman reported substernal chest pain during sexual intercourse, associated with dyspnea, nausea and diaphoresis. She had initially been treated with zidovudine and lamivudine. She underwent electrocardiography to understand her condition.

The article discusses a case of a 34-year-old man diagnosed with antimony poisoning due to ingestion of antimony potassium tartrate or tartar emetic. The patients experienced nausea and had over 50 episodes of vomiting, as well as diarrhea. The poison control center recommended continuous cardiac monitoring and serial ECGS, serial measurement of potassium levels, administration of activated charcoal and chelatin therapy with dimercaprol.

The article describes the case of a 19-year-old woman who was admitted to a hospital because of jaundice, nausea and pruritus. The patient's medical history is given. Results of some tests such as for acute Epstein-Barr virus (EBV) infection, complete blood count and renal-function are provided. A differential diagnosis showed acute hepatitis which is caused by one of several hepatotropic viruses. Pathological tests showed panlobular hepatitis with inflammation, necrotic hepatocytes and disarray of the hepatic plates.

The article describes the case of a teenage girl who presented an enlarging neck mass in a pediatric endocrinology clinic. Aside from the physical symptom of neck swelling, the patient also complained of occasional nausea and neck tightness. Details about her clinical background are discussed, noting that her family has a history of hypothyroidism. Surgical treatment has been recommended following the detection of a papillary thyroid carcinoma within the right isthmus of the thyroid of the patient.

The article offers clinical information on a 61-year-old man who was admitted with a week-long history of nausea, vomiting, nocturia, and polyuria and presents the comments on a clinician on the patient's condition. The clinician discusses the possible causes of the man's fatigue and weight loss, his orthostatic hypotension due to intravascular volume depletion and serum parathyroid hormone (PTH) concentration. Others examined are his hypercalcemia, serum calcium level and his multiple calcified lesions in the lungs, liver, spleen and hilar lymph nodes.

The authors comment on the clinical case of a 62-year-old woman who presented to a community hospital with nausea, vomiting, diarrhea and fever, all in one week's duration, consistent with acute diarrhea. According to the authors, bacteremia was likely at first intermittent given the possibility of opportunistic pathogens. They believe that lupus was a less likely cause of her cardiac disease since antiphospholipid antibodies were absent and that the autoantibodies observed in the patient probably resulted from the anti-tumor necrosis factor (TNF) therapy.

The article discusses the case of a 52-year-old man who was taken to the emergency department because of abdominal discomfort. The discomfort started to develop in the epigastric region and worsened after eating. The pain, which was associated with bloating and nausea, was eventually felt in the periumbilical area. The patient had other diseases such as angioedema-urticaria and hypothyroidism. Several tests were performed on the patient including physical examination, cardiac examination, and computed tomography.

The article presents an overview of the current understanding of chemotherapy induced nausea and vomiting and the status of pharmacologic interventions for their prevention and treatment. A discussion of the factors that can lead to an increased risk of chemotherapy induced nausea and vomiting is presented. An overview of the vomit reflex in humans is offered. Antiemetic agents, including selective 5-HT3-receptor antagonists, which are available for the prevention of chemotherapy induced nausea and vomiting, are discussed.