Search

Our patient is a 60-year-old woman of Indian ethnicity with background of diabetes mellitus for 10 years. She presented with persistent vomiting, giddiness and significant weight loss for 1 month. Of note, she had recent hypoglycaemia necessitating gradual reduction in doses of glucose-lowering

Here, we report a case of a 42-year-old female patient with left lobular breast cancer-gastric metastasis (initially misdiagnosed five years ago as an invasive ductal carcinoma) presenting with dyspepsia, weight loss, and persistent vomiting lasting for four weeks. Upper GI endoscopy revealed evidence of linitis plastica, and histological and immunocytochemical analyses of the biopsy confirmed gastric metastasis secondary to invasive lobular breast carcinoma.

Introduction Transpyloric tube (TPT) feeding is used in a multitude of conditions including gastroesophageal reflux disease. We here describe a new simple method to insert TPTs. Methods 6 French feeding tube is premeasured nose to xiphisternum, and then another 7 cm of length is added and 3-5 silk (4-0) ties are applied to the end of the tube spaced 0.5–1 cm apart. The knots are placed in different radial directions, and multiple throws are placed on each knot so as to add bulkiness. The tube is then inserted transnasally to the premeasured length and secured. The child is given a single dose of metoclopramide and placed on his right side for 4 h. A plain abdominal x-ray is then performed to confirm adequate TP placement. Following correct placement the patient is tube fed with small volumes every 15–20 min. Descriptive data was prospectively collected. Results 34 patients were recruited, median age 3.5 months. All presented with vomiting, and 26 had failure to thrive. 24 had successful TP tube placement from the first attempt, 6 from the second attempt, 2 on third attempt, and in 2 placement was unsuccessful. In 28 patients vomiting almost stopped completely. 9 patients had fundoplication, and 1 had gastrostomy placement. 3 patients died during the study because of unknown reasons. Conclusion The silk tie technique is a safe and simple way to treat persistent vomiting and may prove useful in low resourced environments. Level of evidence IV

With increase in incidence rate of persistent vomiting (PV) in the post-legalization period it is important to understand adverse effects of cannabis use and its relationship with PV.We investigated the relationship between cannabis use disorder (CUD) and PV-related hospitalization.A Nationwide Inpatient Sample was analyzed from 2010 to 2014 for patients (aged 15-54 y) with a primary diagnosis of PV (N = 55,549), and a comparison was made between patients with the International Classification of Diseases, Ninth Edition classification of CUD versus non-CUD cohorts. We used logistic regression to study the odds ratio between CUD and PV.The number of PV-related hospitalizations with CUD had a significantly increased trend (P0.001), with a 286% increase over 5 years. A higher proportion of these patients with CUD were younger (15-24 y), female, and African American/Hispanic. In regression analysis, cannabis was associated with a seven-fold higher odds (95% confidence interval: 6.931-7.260) of PV-related hospitalization.This study found that CUD was independently associated with a 609% increased likelihood of PV-related hospitalization, and this association persisted even after adjusting for known risk factors and other substances.

A 3-month-old male infant was referred for persistent vomiting, feeding difficulty, and dehydration.

Submitted by Biblioteca SESARAM (repositorio@sesaram.pt) on 2021-09-29T08:15:41Z No. of bitstreams: 1 Wernicke encephalopathy in children 2020.pdf: 6901314 bytes, checksum: 0099f44fc7fc690b9b653eb76803161c (MD5) Made available in DSpace on 2021-09-29T08:15:41Z (GMT). No. of bitstreams: 1 Wernicke encephalopathy in children 2020.pdf: 6901314 bytes, checksum: 0099f44fc7fc690b9b653eb76803161c (MD5) Previous issue date: 2020-09-23 info:eu-repo/semantics/acceptedVersion

Von Recklinghausen disease (neurofibromatosis type 1—NFT1) is a genetic disorder with autosomal dominant inheritance pattern, caused by mutation of a tumour suppressor gene. Its main features include multiple cutaneous café-au-lait spots and neurofibromas. It is associated with an increased risk of developing neuroendocrine tumours, for instance, in the duodenum. The authors present a case of a 23-year-old male patient admitted to the emergency department due to persistent vomiting. Imaging and biopsy studies revealed an obstructive and large duodenal neuroendocrine tumour; hence the patient underwent a pancreaticoduodenectomy.

A 40-year-old female presented with history of persistent vomitings since 6 months. History of constipation and increased frequency of urination present. History of significant weight loss is present (lost 15kgs in 6 months). Work up for polyuria confirmed diabetes insipidus. Work up for diabetes insipidus revealed hypercalcemia secondary to primary hyperparathyroidism, resulting due to right parathyroid adenoma. Right parathyroid adenectomy was done and postoperatively patient developed hungry bone syndrome, which was treated by supplementing high dose of calcium and vitamin D supplementation.

The case cited by the author concerns a patient who, for 3 months every day, in the morning on an empty stomach, had vomiting, preceded by severe pain in the epigast., Radiating to the back and shoulders.

Objective To study the serum level of ondansetron after oral administration of intravenous ondansetron, and test the palatability of the drug after being flavored. Method This is a single-center prospective study enrolling children aged 3-8 years with gastroenteritis treated for persistent vomiting; patients received single dose of flavored intravenous ondansetron orally. The primary outcome was ondansetron serum level at 4 hours. Secondary outcome was palatability of the drug. Results Forty previously healthy patients presenting with acute gastroenteritis were enrolled. The mean age was 4.86±1.37 years. Serum level at 4 h had a median of 26.23 ng/ml, range (8.3-52 ng/ml). Palatability of the drug had a mean of 3.23 (of 5) ± 0.80, based on score from visual analog scale. Conclusions Flavored intravenous ondansetron administered orally is a safe and an effective option and can be considered in the absence of the oral forms of the drug.

Bezoars are an undigested mass causing an intraluminal obstruction in children. Pharmacobezoars are formed from medicines or their vehicle, considered as a less frequent type observed in children. Our objective is to report a relatively rare entity as a potential cause of intestinal obstruction in children. Here we report a case of 13-year-old girl with a history of herbal medicine intake who presented with persistent vomiting and abdominal distension. She was diagnosed with acute intestinal obstruction and managed conservatively without any complications. The patient became stable within two days so was discharged home. We found that ineffective history could lead to a delay in diagnosis and management. Clinicians should have a high index of suspicion for pica and psychiatric disorders, especially in adolescent children.

Brain tumors, the second common cancer following hematological malignancies account for up to 21% of all malignancies below 14 years of age. Medulloblastoma is a common form of Primitive neuro ectodermal tumor and likely arise from either the external granular layer (e.g., desmoplastic variant) or the subependymal matrix cells of the fourth ventricle (e.g., classic variant), or both. The clinical course of the disease is aggressive in children than in adults. The tumor can invade the CSF through the ventricles or even cause metastases to bones and lymph node. With the emergence of advanced technologies and treatment facilities, the morbidity and mortality of the disease is greatly improved with a five-year survival of up to 75%. However, the presence of disease in children

Domperidone is a dopamine-2 receptor (D2) antagonist. It is used as an antiemetic and has an excellent safety profile. We present a case of acute dystonia secondary to domperidone use in an 11-year-old girl. She was admitted with the diagnosis of viral gastroenteritis and received domperidone for persistent vomiting along with other supportive measures. The vomiting subsided with treatment, but she developed acute dystonia. Domperidone discontinued, and her condition improved in the next 24 hours. The patient discharged, and on a follow-up visit, she was asymptotic. A review of the literature suggests a possible association of acute dystonia with domperidone in children.

Background and Aim: Persistent vomiting is mentioned as a symptom of a large variety of systemic disorders. It is commonly used interchangeably with chronic, recurrent, or intractable vomiting and widely used as a warning sign of severe illness in dengue infection. However, it has been poorly defined in the medical literature. Therefore, we aimed to systematically review a definition of persistent vomiting in the medical literature. Methods: A systematic search was done through; PubMed, Google Scholar, Web of Science, Scopus, VHL, WHO-GHL, Grey Literature Report, POPLINE, and SIGLE for the last 10 years. Consensus on the definition was considered to be reached if at least 50% of studies described the same definition using the Delphi consensus technique. Result: Of 2362 abstracts reviewed, 15 studies were selected based on the inclusion criteria. Three studies used the same definition. Another 2 studies defined it as vomiting of all foods and fluid in 24 hours. Three studies defined persistent vomiting in the units of days or weeks. Four studies used the number of episodes: ≥2 episodes 15 minutes apart, >3 episodes in 12 hours, and >3 episodes within 24 hours. Conclusion: No consensus for the definition was found among authors. This is a point of concern that needs to be addressed by further studies.

A 3-month-old boy was admitted from his pediatrician’s office for failure to thrive and vomiting. On admission, he weighed barely more than his birth weight and was cachectic with muscle wasting. His abdomen was grossly distended but soft and nontender. A trial of nasogastric feeds resulted in a worsening of his clinical status. He was transferred to the ICU, and diagnostic imaging was concerning for a distal bowel obstruction. Surgical pathology revealed a surprising diagnosis, which is described in detail in the following case.

L2-hydroxyglutaric aciduria (L2-HGA) is a rare neurometabolic disease characterized by accumulation of L2-hydroxyglutarate (L2-HG), a potential oncometabolite resulting in significant lifetime risk for cerebral tumors. Herein, we present a case of intraventricular glioblastoma multiforme (GBM) in a 16-year-old child with L2-HGA who presented with rapid functional decline and persistent vomiting. The tumor was completely resected, and the patient remained well at 2-year follow-up. Clinicians should be aware of the usual insidious nature of the disease. Rapid deterioration is unusual and should raise the suspicion of tumor development. This case also illustrates the importance of surveillance neuroimaging in patients with L2-HGA. To the best of our knowledge, only 1 case of GBM has been reported and it was sited in the temporal lobe, unlike the unusual intraventricular location in our case.

You are called to evaluate a 4-year-old healthy child who is in the postanesthesia care unit (PACU) and in severe pain after orthopedic surgery. You will need to answer questions as to how to evaluate a patient in pain in the PACU and the options available to control such pain. Regional analgesia vs. systemic analgesics are discussed. Issues concerning cardiopulmonary stability are reviewed in additional questions. Other issues confronting you are nausea and persistent vomiting in an adolescent female.

Empty azygos fissure implies dislocation of the azygos vein to the mediastinal side of the right upper lobe from azygos fissure, which is usually secondary to pneumothorax, pleural effusion, parenchymal fibrosis, vertebral collapse or persistent vomiting. We are presenting here a case where a separated azygos vein in CT and radiography images was noted. Moreover, in the follow-up images, it appeared that the complete reexpansion of the right lung resulted in reentrance of the azygos vein into azygos fissure in its native position., NA

Introduction: Iatrogenic or physician-induced hypervitaminosis D is a rare cause of persistent vomiting. To the best of our knowledge, this is the first case report on iatrogenic hypervitaminosis D presenting with persistent vomiting in Pakistan. Case Report: We report a rare case of continual vomiting for 15 days in a 48-year-old woman of Pakistani descent. She was a known case of diabetes mellitus for 8 years, which was well controlled at the time of presentation. Conclusions: The correct diagnosis of our patient was based on clinical suspicion, appropriate lab tests, and deliberation of the differential diagnosis. It is important to consider hypervitaminosis D as a cause of persistent vomiting if no other obvious is apparent.

Dengue infection can have spectrum of manifestations, often with an unpredictable clinical progression and outcome. There have been increasing reports of atypical manifestations. Abdominal pain or tenderness and persistent vomiting (warning signs) are present in the majority of cases with severe dengue prior to clinical deterioration. We report a 10-year-old child who presented with fever, persistent vomiting, and abdominal pain. A diagnosis of acute pancreatitis was made. This is a very infrequently reported complication of dengue hemorrhagic fever.

Vomiting is a frequently reported symptom in children and can be a presenting feature in both gastro-intestinal and non gastro-intestinal disease. Careful evaluation of all children with vomiting is essential in order to identify causes which require urgent management. Important aspects of the history include onset, frequency, duration and colour of the vomitus as well as associated gastro-intestinal, respiratory and neurological symptoms. Bilious vomiting at any age should always be taken seriously and any history of recurrent bouts of vomiting is important. A thorough examination is necessary to assess hydration status of the child and elicit other associated features such as congenital abnormalities, failure to thrive or neurological deficit. Definitive management will depend on the underlying cause and may include medical and surgical therapies. In all cases good supportive care is vital with adequate fluid and electrolyte replacement being paramount. ‘Red flag' symptoms including early morning headache, signs of peritonism, lethargy, bulging fontanelle in infants, and persistent vomiting with poor growth or abnormal development, should point the clinician to the possibility of more sinister causes of vomiting.

To compare the efficacy and safety of ondansetron versus less expensive metoclopramide in the treatment of children with persistent vomiting with acute gastroenteritis.A double-blind trial including consecutive consented patients ages 1 to 14 years was conducted in an urban infirmary setting from June 2008 through December 2008. Children were randomized to receive a single dose of intravenous ondansetron or metoclopramide. The primary efficacy outcome was the proportion of patients with cessation of vomiting shortly after completion of the study medication infusion in each group. Observed adverse effects and diarrhea frequency during admission and in follow-up were recorded to assess safety.One hundred sixty-seven previously healthy children (median age 3 years) diagnosed as having acute gastroenteritis with persistent vomiting completed treatment and observation. Cessation of vomiting was achieved in 68/84 patients (81%) of the ondansetron and 60/83 (72%) of the metoclopramide groups, P = 0.14. Mean time to complete cessation of vomiting was 39 minutes (SD 111) for ondansetron, and 61 minutes (SD 110) for metoclopramide, P = 0.2. The mean length of infirmary stay was 550 minutes (SD 427) for ondansetron and 575 minutes (SD 449) for metoclopramide, P = 0.71. Revisit rate, readmissions rate, and frequency of diarrhea after discharge were similar in the 2 treatment groups. No adverse reaction or other safety concerns were identified.In the sample size tested, intravenous metoclopramide therapy did not differ from ondansetron in the treatment of persistent vomiting for children with gastroenteritis admitted for intravenous fluid hydration.

A 24-year-old woman presented with a history of persistent vomiting for at least 3 months. This resulted in severe dehydration with risk of acute kidney injury. In addition to volume depletion, loss of gastric fluid resulted in a specific metabolic derangement—hypokalaemic, hypochloraemic normal anion gap metabolic alkalosis with a reduced ionised calcium concentration and paradoxical aciduria. These metabolic changes were reflected in her ECG. Investigation demonstrated acquired gastric outflow tract obstruction secondary to a pyloric peptic ulcer. The patient was resuscitated with intravenous crystalloid and electrolyte supplements. The acquired pyloric stenosis was treated medically with a proton pump inhibitor and Helicobacter pylori eradication therapy with excellent recovery.

SUMMARY Neurological findings in the newborn period are presented from a series of 94 infants who were selected from 760 asphyxiated newborn infants on the basis of seven criteria—feeding difficulties, apnoeic and cyanotic attacks, apathy, convulsions, hypothermia, persistent vomiting and a high-pitched cerebral cry. These criteria were prognostic for subsequent handicap. The 94 infants were further categorised on the basis of the state of muscle tone, which was found to be one of hypotonia, extensor hypertonus, or normal flexor tone, or in transition from hypotonia to extensor hypertonus. Other neurological findings were correlated with muscle tone. Of the 94 nfants, 93 were subsequently followed to a mean age of 21 months. There were 20 deaths and 24 infants had a functionally significant handicap. The sever ty of the handicap was related to the earlier categorisation according to the muscle tone. It was found that infants with hypotonia or with hypotonia progressing to extensor hypertonus had a very bad prognosis, while infants with normal flexor tone had a very good prognosis. It is suggested that abnormal behaviour after an asphyxial birth can be used in the neonatal period to detect potentially brain-damaged infants, and that an assessment of muscle tone and a neurological examination can extend and refine this ability to make an accurate prognosis of long-term mental and neurological handicaps. RESUME Les signes neurologiques de la periode neo-natale sont presentes pour une serie de 94 enfants choisis parmi 760 nouveaux-nes ayant presente une asphyxie en se basant sur plusieurs criteres: difficultes d'a imentation, crises d'apnee et de cyanose, apathie, convulsions, hypothermie, vomissements persistants et cri cerebral de haute tonalite. Ces criteres constituaient des elements de pronostic pour le handicap ulterieur. Les 94 nourrissons furent par la suite classes a partir du tonus musculaire, hypotonic, hypertonie en extension ou tonus normal en flexion ou encore transition d'une hypotonic a une hypertonie en extension. Les autres symptomes neurologiques etaient correles avec le tonus musculaire. 93 des 94 nourrissons ont ete suivis par la suite jusqu'a un âge moyen de 21 mois. Il y eut 20 deces, et 24 enfants presenterent un handicap fonctionnel significatif. La severite du handicap a pu etre reliee a la categorisation anterieureeflectuee a partir du tonus musculaire. Il a ete note que les enfants avec hypotonic ou hypotinie ayant evolue vers une hypertonic en extension avaient un tres mauvais pronostic tandis que les enfants avec un tonus normal en flexion avaient un tres bon pronostic. Il est suggere que pendant la periode neo-natale, un comportement anormal apres une asphyxie a la naissance peut etre utilise pour deceler une lesion cerebrale et que l'appreciation du tonus musculaire et l'examen neurologique peuvent etendre et preciser cette possibilite d'etablir un pronostic precis concernant les handicaps mentaux et neurologiques a long terme. ZUSAMMENFASSUNG Es werden die neurologischen Befunde in der Neugeborenenperiode von 94 Kindern dargestellt, die auf der Basis verschiedener Kriterien aus einer Gruppe von 760 Kindern mit Geburtsasphyxie ausgewahlt wurden: Futterschwierigkeiten, Apnoen und Zyanoseanfalle, Apathie, Krampfe, Hypothermic, persistierendes Erbrechen und hohes schrilles zerebrales Schreien. Diese Kriterien liesen nachfolgende Beeintrachtigungen erwarten. Diese 94 Kinder wurden weiterhin eingeteilt auf der Basis des Status des Muskeltonus; dieser wurde klassifiziert als Hypotonic, Extensorhypertonus oder normaler Flexortonus oder als Ubergang von Hypotonic zu Extensorhypertonus. Andere neurologische Befunde wurden mit dem Muskeltonus korreliert. Bei 93 dieser 94 Kinder wurde der Verlauf bis zu einem Altersdurchschmitt von 21 Monaten verfolgt. Bis dahin waren zwanzig gestorben und 24 zeigten deutliche Funktionsbehinderungen. Die Schwere der Behinderung wurde zur fruher gegebenen Einteilung des Muskeltonus in Beziehung gesetzt. Man fand, das die Kinder mit Hypotonic oder mit Hypotonic mit Ubergang zu Extensorhypertonus eine sehr schlechte Prognose hatten, wahrend die Kinder mit normalem Flexortonus eine sehr gute Prognose zeigten. Es wird vermutet, das in der Neonatalperiode ein abnormes Verhalten nach einer Geburtsasphyxie benutzt werden kann, urn moglich hirngeschadigte Kinder herauszufinden. Die Beurteilung des Muskeltonus und eine neurologische Untersuchung konnen auf langdauernde geistige und neurologische Ausfalle hinweisen.

Primary Carcinoma of the Jejunum is very rare and very difficult to diagnose before surgery. No definite investigations are available to come into a pre-operative diagnosis though barium meal studies and capsule endoscopy may help in some cases to arrive at a proper diagnosis. It is characterized by hidden and non-specific symptomatology. Our patient presented with sub- acute intestinal obstruction with dyselectrolytemia due to persistent vomiting. The patient was subjected to a battery of tests and most of them were inconclusive. Ultimately an exploratory laparotomy with resection of diseased segment of jejunum and histopathological examination confirmed the diagnosis of primary carcinoma of jejunum.

Background and Aim:Persistent vomiting is mentioned as a symptom of a large variety of systemic disorders. It is commonly used interchangeably with chronic, recurrent, or intractable vomiting and widely used as a warning sign of severe illness in dengue infection. However, it has been poorly

Fragestellung: Erst seit Anfang der 1920er liegen Angaben zur Häufigkeit der Hyperemesis gravidarum (H.g.) vor. (David 2008) Ätiologie und Therapiemaßnahmen waren und sind Gegenstand einer seit Jahrzehnten geführten Debatte, wobei unterschiedliche Ursachen dieser Schwangerschaftsstörung favorisiert werden. Heute vermutet man, dass es sich um ein multifaktorielles Geschehen handelt. Neben der Beteiligung des Endokrinen Systems werden vor allem psychosomatische Ursachen als Auslöser für das schwere Erbrechen in der Frühschwangerschaft angesehen. Aufgrund der nach wie vor ungeklärten Ätiologie erfolgt die Therapie symptomabhängig. Die Entwicklung der verschiedenen Theorien zur Ätiologie und Therapie des unstillbaren Erbrechens während der Schwangerschaft in dem Zeitraum von 1870 – 1970 ist Gegenstand der vorliegenden Arbeit, wobei der Fokus auf die Entwicklung der psychisch/psychosomatischen Ursachentheorie gelegt wurde. Dabei wird besonders der Frage nach gegangen, unter welchen Einflussfaktoren sich die Theorie einer Mitbeteiligung von psychisch/psychosomatischen Komponenten an der Entstehung der H. g. entwickelt hat. Methodik: Für die vorliegende Untersuchung wurden die in allen Heften aller Jahrgänge der vier Fachzeitschriften „Zentralblatt für Gynäkologie“, „Zeitschrift für Geburtshülfe und Gynäkologie“, „Monatsschrift …“ und „Archiv für Gynäkologie“ publizierten Artikel zum Thema H. g. der Jahre 1870 - 1970 mit dem Fokus Ätiologievorstellungen analysiert und die Entwicklung der psychosomatischen Ursachentheorie in den Gesamtkontext medizinhistorischer und gesellschaftlicher Ereignisse eingeordnet. Ergebnisse: Am Beginn der Ätiologievorstellungen standen die Hysterie-Theorie, die Intoxikationstheorie sowie unterschiedliche Stoffwechselstörungstheorien. Psychosomatische Aspekte spielten Ende des 19. Jahrhunderts auch schon eine Rolle. Auch in dem Zeitraum als somatisch – toxische Ätiologievorstellungen dominierten, wurde der Einfluss der Psyche als möglicher Faktor in der Entstehung des unstillbaren Erbrechens während der Schwangerschaft nicht aus den Augen verloren. Die psychische Komponente wird heute, als ein wichtiger ursächlicher Faktor bei der Entstehung der H. g. angesehen. Es konnten Zusammenhänge sowohl zwischen medizinhistorischen als auch politisch/gesellschaftlichen Entwicklungen und den Ätiologie- und Therapievorstellungen zur H. g. nachgewiesen werden. Schlussfolgerung: Die Ätiologie und Therapie des unstillbaren Erbrechens während der Schwangerschaft ist heute weitgehend ungeklärt. Für ein multifaktorielles Geschehen spricht vor allem die Tatsache, dass sich bis zum heutigen Zeitpunkt keine der zahlreichen in der Vergangenheit publizierten Ätiologievorstellungen bezüglich der H. g. durchsetzten konnte. Um einen Zusammenhang zwischen psychischen/psychosozialen Aspekten und dem Auftreten der H. g. zu verifizieren ist die Durchführung von weiteren Studien nötig, welche natürlich den evidence based Kriterien standhalten müssen und sich auch den kulturell – regionalen Faktoren widmen sollten., Research question: It has been only since the beginning of the 1920ies that data about the frequency of Hyperemesis gravidarum (H.g.) exists. Etiology and therapy of H.g. were and are still part of an ongoing debate, during which different causes of this pregnancy-related complication were favored. Nowadays it is assumed that the causes are multifactorial. Next to the involvement of the endocrine system, most of all psychosomatic causes are seen as a trigger for the emesis during precocious pregnancy. Due to the still unresolved etiology, the therapy must be realized on the basis of the symptoms. The development of the various theories on the etiology and treatment of insatiable vomiting during pregnancy in the period 1870 - 1970 is the subject of the present study, the focus was on the development of psychological/psychosomatic cause theory. Particullary the issue is gone, under the influence factors, the theory of involvement of psychological/psychosomatic component in the development of H. g. developed. Methods: To answer the research question, every single article about the topic H. g. with focus on etiology in the following four trade journals, including all issues of all volumes between 1870 and 1970, has been analyzed: Central Journal of Gynecology, Journal of Obsterics and Gynecology, Monthly Journal of Obsterics and Gynecology, Archives of Gynecology. Further, the development of the psychosomatic causal theory will be placed into the context of medical history and social events. Results: At the beginning of etiology the theory of hysteria, the theory of intoxication and different theories of metabolism were common. At the end of the 19th century psychosomatic aspects did also play a role. Even during the period in which somatic-toxic ideas of etiology were predominant, the influences of the psyche as a possible trigger for the unsatiable emesis during pregnancy has not been completely displaced. Today, the psychological component is seen as an important causal factor of the development of H. g. There has been proof of the correlation between medical history, political and social developments, on the one hand, and the ideas of aetiology and therapy of H. g, on the other hand. Conclusion: Today, the etiology and the therapy of H .g. during pregnancy are still mostly unresolved. Up to now, none of the numerously published ideas of etiology regarding H. g. could be established. This, in return, indicates that the causes of H. g. are multifactorial. To verify a correlation between psychological/psycho-social aspects and and H.g. further research is necessary. Those studies have to withstand the evidence based criteria and should further address cultural-regional factors.

HISTORY OF PRESENT ILLNESS This infant presented with a 2-week history of vomiting. Initially, the episodes of vomiting were infrequent and appeared to the parents to be possibly self-induced. They were often associated with tantrums. After 1 week, the episodes of emesis gradually became more frequent and copious. At the time of the initial evaluation, the vomiting was occurring about 4 to 5 times a day. There was no particular time of day or activity in which the vomiting occurred more frequently. There was no relationship with meals. The parents noted a gradual failure to gain weight over the previous 5 months. There was no associated history of fever, diarrhea, or constipation. His activity level was unchanged and he was developmentally appropriate for his age. There was no history of travel or exposure to any pets. He was on no medications.

A 40 year old woman presented with four weeks of persistent vomiting and reduced urination in the absence of abdominal pain. Examination identified …

Cystic dystrophy of the duodenal wall (CDDW) is a complication of heterotopic pancreatic tissue located in the wall of the gastrointestinal tract, characterized by the presence of multiple small cysts, usually found in the wall of the second part of the duodenum. Gastrointestinal hemorrhage due to CDDW is a rare complication. We report the case of a 50-year-old man who was admitted to our hospital for persistent vomiting. The imaging tests confirmed the diagnosis of CDDW. During his stay in hospital, the patient had a gastrointestinal hemorrhage secondary to this disorder, which made it necessary to perform a Roux-en-Y gastrojejunostomy (Billroth III).

Postoperative herniation of the stomach into potential spaces is a rare but serious complication of Nissen fundoplication. We report a 55-year-old female who presented with persistent vomiting shortly following laparoscopic Nissen fundoplication. At laparotomy, the anterior wall of the stomach was noted to be herniating into a congenital space behind the diaphragm. Anterior gastropexy was performed following the reduction of the herniating gastric segment. A high index of suspicion followed by aggressive and timely intervention is necessary to diagnose and manage postoperative gastric herniation and reduce the subsequent morbidity and mortality.

Neuroborreliosis usually presents with facial palsy and meningitis, but unspecific symptoms may also occur and can result in delayed diagnosis. We report on 3 children in whom persistent vomiting was the key clinical finding of neuroborreliosis.

A 13-year-old boy with a 10-day history of vomiting after swallowing any substance was successfully treated via shaping and contingency management. Points, which were exchanged for activities and phone privileges, were used to reward increasing vomiting latencies from baseline levels of 10 seconds to the point of no vomiting. Volume and consistency of swallowed substances also were gradually increased. Vomiting was totally eliminated after 12 days of treatment. Vomiting had not recurred at one year follow-up.