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PubMed1990

Characteristic behavior of the respiratory muscles, esophagus, and external anal and urethral sphincters during straining, retching, and vomiting in the decerebrate dog.

To ascertain differences in the brainstem pattern generators for straining and retching, discharges of 230 respiratory single motor units from the intercostal nerves and discharges of the nerves to accessory respiratory muscles, the esophagus, and external anal and urethral sphincters were observed during straining, retching, and vomiting (fictive expulsion) in decerebrate and paralyzed dogs. Straining and retching were identified with coactivation of the phrenic nerve and the nerve to the rectus abdominis, which was elicited by distension of the rectum and stomach, respectively. Synchronous discharges with each retch and straining were always exhibited by the phrenic nerve, the nerves innervating the abdominal part of the rectus abdominis and the external anal and urethral sphincters. In contrast, different behaviours were constantly observed in four nerves. 1) The nerves to the serratus dorsalis cranialis was inhibited during straining, but activated synchronously with each retch and vomiting. 2) Vagal pharyngeal branches innervating the upper esophagus and branches of the recurrent nerve innervating the lower part of the cervical esophagus fired synchronously with straining. The esophageal nerves, on the other hand, did not fire with each retch, but did fire strongly between retches. 3) The nerve to the sacrocaudalis dorsalis lateralis discharged concomitantly with straining but did not with retches. Straining and retching behaviors exhibited by the nerves innervating other thoracic accessory inspiratory muscles (the intercartilagineus, rectus thoracis, scalenus) varied from dog to dog. The nerves innervating the thoracic parts of the rectus abdominis and obliquus externus abdominis always discharged synchronously with straining, and discharged with retches in the majority of dogs, but did not in a minority of dogs. The expiratory units from the internal intercostal nerves showed intense discharges synchronously with coactivation in straining (96%), retching (65%), and vomiting (100%). In contrast, none of the inspiratory units from the external intercostal nerves exhibited such intense discharges with straining and retching. These results suggest that the functional difference in straining and retching mainly depends on the differences in the behavior of the serratus dorsalis cranialis and esophagus. The forms of this dependence were discussed.

Anal Canal↗

PubMedDate not supplied

Bulimic vomiting alters pain tolerance and mood.

Bulimia, a disorder of episodic binging and purging, remains without a known etiology. A case report is presented of a patient who attributed bulimic episodes to efforts at inducing euphoria. Experimental pain tolerance was increased by bulimic vomiting, blocked by naloxone, but not by saline. Vomiting was also associated with falls in depression and anxiety. Plasma ACTH and cortisol, putative markers for beta-endorphin, also rose following vomiting. It is hypothesized that in some bulimics, the disorder arises by virtue of an addiction to one's own internally released endogenous opioid peptides.

Adrenocorticotropic Hormone↗

PubMed1991

Effect of fusaric acid on brain regional neurochemistry and vomiting behavior in swine.

Fusaric (5-butylpicolinic) acid is a phytotoxin produced especially by Fusarium moniliforme, a mold commonly found in Canadian-grown corn. Experiments were conducted to determine the effects of acute doses of fusaric acid on brain neurochemistry and behavior in swine. A total of 40 crossbred barrows (initial weight 10 kg) were orally dosed with 0 or 200 mg of fusaric acid/kg of BW and five animals from each treatment were killed 4.5, 9, 18, or 36 h after dosing. All brains were dissected, and concentrations of indoleamine and catecholamine neurotransmitters and metabolites were determined. Animals in the group killed 36 h after dosing were observed for behavioral changes. Vomiting was noted in 60% of the pigs dosed with fusaric acid. These pigs also seemed more lethargic than controls and appeared sedated. The major neurochemical changes due to exposure to fusaric acid were seen in the hypothalamus 18 h after dosing. Brain tryptophan, serotonin, and 5-hydroxyindoleacetic acid all tended to be elevated by the action of fusaric acid. Brain catecholamine concentrations were largely refractory to treatment. It was concluded that exposure to acute doses of fusaric acid can cause vomiting and neurochemical changes in swine. Fusaric acid may, therefore, be acting synergistically with trichothecene mycotoxins to cause vomiting and feed refusal in pigs consuming trichothecene-contaminated feedstuffs.

Administration, Oral↗

PubMed1995

Study on vomiting related to the vestibulo-autonomic reflex.

The purpose of this study was to investigate the neural pathway from the vestibular labyrinth to the medullary vomiting center in the cat, using electrophysiological techniques. During electrical stimulation of the canal nerve, we found conflicting results: the pressure in the stomach sometimes increased, and sometimes decreased. There might be several neural structures between the semicircular canal nerve and the vomiting center in the dorsolateral portion of the reticular formation of medulla oblongata. Retching or vomiting-like behavior during both respiration and movement of the stomach was recorded during stimulation at several sites in the lateral medullary reticular formation. However, the evoked unit activities were not always induced by stimulation of the canal nerve.

Animals↗

PubMed1992

Ondansetron and tropisetron with dexamethasone in the prophylaxis of acute vomiting induced by non-cisplatin-containing chemotherapy.

Forty-seven patients receiving non-cisplatin-containing chemotherapy were entered in a prospective study in which the efficacy of ondansetron plus dexamethasone and tropisetron plus dexamethasone in the prophylaxis of acute vomiting was evaluated. Thirty-nine patients were evaluable for cross-over analysis. During the 24 hours following the start of chemotherapy, 97% of patients on ondansetron plus dexamethasone reported total control of vomiting compared with 82% of those on tropisetron plus dexamethasone (p = 0.026). Thus, both 5-HT3- receptor antagonists combined with dexamethasone were highly effective in controlling acute vomiting induced by non-cisplatin-containing chemotherapy. The observed difference between the treatments may be caused by different dose schedules of ondansetron and tropisetron. A double-blind design with equal number of placebo-controlled administrations is needed to ascertain whether there is a significant pharmacological difference between ondansetron and tropisetron.

Acute Disease↗

PubMed2000

Gastric Ollulanus tricuspis infection identified in captive cheetahs (Acinonyx jubatus) with chronic vomiting.

Gastritis, vomition and weight loss are common in captive cheetahs (Acinonyx jubatus). Gastric spiral bacteria (Helicobacter spp.) and the very small, viviparous nematode Ollulanus tricuspis, a stomach worm of cats, are believed to be important causes. Three sibling cheetahs at Wellington Zoo, New Zealand, developed chronic vomiting, diarrhoea and debility. Their parents were both South African-born. Response to antibacterial treatment was poor. Endoscopic examinations revealed chronic lymphoplasmacytic gastritis and Ollulanus infection. Treatment with oxfendazole and pyrantel embonate resulted in clinical improvement; however, 1 cheetah, which died 7 months later as a result of a ruptured liver due to hepatic amyloidosis, still had Ollulanus worms present in her stomach. Ollulanus tricuspis is a significant cause of gastritis and vomiting in captive cheetahs, lions and tigers, as well as wild cougars and tigers. The parasite has not yet been found in sub-Saharan Africa. Because of the unusual characteristics of this parasite, the literature on its life history and techniques for diagnosis is reviewed.

Acinonyx↗

PubMed1996

An open multicentre study of tropisetron for cisplatin-induced nausea and vomiting.

OBJECTIVES: (i) To assess the efficacy and tolerability of tropisetron when used for acute and delayed cisplatin-induced emesis. (ii) To investigate whether dexamethasone added to tropisetron improves the control of emesis for patients who do not achieve a complete response to tropisetron alone. (iii) To assess sex of the patient and alcohol intake as prognostic factors for nausea and vomiting. DESIGN: A prospective open label phase II trial over one or two cycles of chemotherapy. Data collection was based on observed response and patients' self-reporting. SETTING: Twenty Australian tertiary care hospitals in 1994. PATIENTS: 102 male and female patients from 18 to 75 years with histologically confirmed malignancy receiving their first chemotherapy containing > or = 50 mg/m2 cisplatin. INTERVENTION: In Cycle 1 tropisetron 5 mg was given intravenously before chemotherapy on Day 1, then 5 mg orally before breakfast on Days 2 to 6. In Cycle 2, dexamethasone 20 mg intravenously on Day 1, then 8 mg orally on Days 2 to 6 could be added to tropisetron if a complete antiemetic response had not been achieved in Cycle 1. MAIN OUTCOME MEASURES: Number of vomiting episodes and severity of nausea for 6 days after chemotherapy; severity of side effects; patient satisfaction with chemotherapy treatment; oestradiol levels in women; and past alcohol consumption in men and women. RESULTS: (i) The complete response rate (CR) for acute emesis in Cycle 1 was 64% (95% confidence interval [CI], 54%-72%), with 84% (95% CI, 76%-90%) having < or = 2 vomits. The CR for delayed emesis was 24% (95% CI, 17%-32%). The CR for acute nausea was 56% (95% CI, 47%-66%), with 97% (95% CI, 91%-99%) having < or = 2 nausea episodes. The CR for delayed nausea was 21% (95% CI, 14%-30%). Seventy-one patients received Cycle 2. The main side effects were headache (20 patients) and constipation (16 patients). The control of acute emesis was rated as "good" or "very good" by 68% of investigators; 85% rated the tolerability of treatment as "good" or "very good". Treatment was rated as "very satisfactory" or "satisfactory" by 52% of patients. (ii) The CR for acute emesis with dexamethasone added was 78% (95% CI, 64%-88%). (iii) Women with lower oestradiol levels had better control of emesis, although this difference was not statistically significant. Chronic alcohol intake and binge drinking were strongly associated with a complete acute antiemetic response. CONCLUSIONS: Tropisetron was effective for acute cisplatin-induced emesis; adding dexamethasone enhanced this response. Both single and combined therapy had less effect on delayed emesis. The impact of alcohol on control of emesis is a chronic rather than acute phenomenon which requires prospective testing.

Adolescent↗

PubMed1981

Gastric and small intestinal myoelectric dysrhythmia associated with chronic intractable nausea and vomiting.

We describe a patient with symptoms of severe nausea, vomiting, epigastric bloating and pain, and marked weight loss due to a gastrointestinal motility disturbance. Motility abnormalities were characterized by uncoordinated high pressure (as high as 300 mm Hg) contractions and uncoordinated interdigestive motor complexes in the duodenum and small intestine, and tachygastria often associated with tachyarrhythmia in the gastric myoelectric activity recordings. Uncoordinated interdigestive myoelectric complexes again were found in the duodenum and small intestine. These abnormal myoelectric activities observed in the in-vivo study were confirmed in the in-vitro study. After distal hemigastrectomy and gastrojejunostomy, the symptoms of nausea, vomiting, and epigastric pain decreased considerably. Thus, the motility abnormality found in the study appears to be responsible for the symptoms described. This is probably a new clinical entity. The importance of manometric and myoelectric study of a gastrointestinal motility for unexplained nausea and vomiting is emphasized.

Adult↗

PubMed1976

"Dieters" and "vomiters and purgers" in anorexia nervosa.

Thirty-one females with primary anorexia nervosa were studied by means of a retrospective analysis of hospital notes. The patients were divided into 2 groups. The first group consisted of subjects who had become emaciated solely because of dieting, food refusal and excessive exercising ("dieters"); the second of those who had used additional means to bring about weight loss such, as habitual vomiting and the abuse of purgatives ("vomiters and purgers"). Most "dieters" were intense, introverted, socially withdrawan individuals whose anorexia behaviour had started in response to psychological stress. They had become completely preoccupied with thoughts of food, eating and losing weight. Several did well in treatment, and recovered fully from their anorexic symptoms. "Vomiters and purgers", on the other hand, were more outgoing in respect to personality. Most had previously been obese and, as they had been unable to keep themselves thin by simply abstaining from food, they had learnt to use other means to control their weight. These latter patients did less well in treatment. They continued to experience difficulty in controlling their weight, and the majority persisted with their abnormal behaviour.

Adolescent↗

PubMed1998

Oral granisetron as prophylaxis for nausea and vomiting during fluorescein angiography. A multicentre, double-blind, randomised, parallel group, placebo-controlled study.

BACKGROUND: Prophylaxis with oral Granisetron was assessed in patients undergoing fluorescein angiography (FAG) in order to evaluate its efficacy in reducing patients' discomfort due to nausea and vomiting (4% > 20%) and to ensure completion of the investigation. EXPERIMENTAL PLAN: Multicentre, randomised, double-blind, placebo-controlled study, with a follow-up visit performed 24 hrs after FAG. ENVIRONMENT: Five Anaesthesia/Resuscitation and Ophthalmology operational units participated in the study. PATIENTS: 120 patients (24 from each Centre) of both sexes and aged > 18 years, suffering from retinal disorders, were enrolled after informed consent. Pregnancy, lactation, anti-neoplastic treatment, ASA status IV/V were main exclusion criteria. All recruired patients completed the study. INTERVENTIONS: Ophthalmological evaluation was performed 30 days before and the same day as FAG. Anaesthesiological assessment on the same day as FAG, recording, BP, HR, ASA status, allergic diathesis, allergy to medications and contrast media, concomitant treatments. Oral Granisetrom 1 mg or placebo was given on an empty stomach 1 hr before the injection of 5 ml 20% fluorescein in 3 sec. A follow-up examination was done 24 hrs after FAG. SURVEY: In both groups nausea, retching and vomiting were seen after fluorescein injection. RESULTS: The study demonstrated that Granisetron is more active than placebo in controlling nausea (3 cases vs 4), and retching (2 vs 6). It was significantly more effective than placebo in the prevention of vomiting (0 vs 3). Efficacy was evaluated with chi 2, p < or = 0.05). CONCLUSIONS: The results suggest that Granisetron may be indicated as prophylaxis in patients undergoing FAG in order to prevent or control emesis, improve patients' comfort and ensure successful outcome of the investigation.

Administration, Oral↗

PubMed1999

[Effects of intravenous and oral administration of ondansetron hydrochloride on chemotherapy-induced nausea and vomiting in patients with esophageal cancer].

The effects of ondansetron hydrochloride (OND) were studied through 11 courses of chemotherapy, including 70 mg/m2 of cisplatin, in 9 patients with advanced esophageal cancer. During the observation period of 5 days, 4 mg of OND was given intravenously on the day of cisplatin infusion and orally for consecutive 4 days, and nausea was controlled by over 70%. Vomiting was controlled by over 80%. The inhibitory effect of OND on nausea and vomiting was found in 72.7% on the day of cisplatin injection and 88.9% overall. No other side effects of OND except slight increases in total bilirubin and LDH were found in any patient. These findings suggest that intravenous and oral administration of OND may inhibit chemotherapy-induced nausea and vomiting in patients with advanced esophageal cancer.

Administration, Oral↗

PubMed1999

[The effects of propofol anesthesia with or without the use of nitrous oxide on the intraoperative involuntary movement, the postoperative awareness and vomiting].

The authors investigated the effect of anesthesia with nitrous oxide and propofol on intraoperative involuntary movement, muscle relaxant usage, postoperative nausea and vomiting, the total amount of propofol used, and recovery time from anesthesia. Eighty-eight patients for gynecological surgery were randomly divided into group PE: propofol/epidural (n = 44), and group PEG: propofol/epidural/nitrous oxide (n = 44). The frequency of postoperative nausea and vomiting were assessed at 24-h postoperatively by blinded observers. There were significant decreases of the mean amounts of propofol and muscle relaxant used between group PEG and group PE. The authors found no correlation between the use of nitrous oxide and intraoperative involuntary movement, subsequent development of postoperative quality of awareness, recovery time, nausea and vomiting. We recommend PEG method for gynecological surgery rather than PE from an economical viewpoint because it is associated with the reduction of mean propofol and muscle relaxant used.

Adult↗

PubMed2000

Cyclic vomiting syndrome: evolution in our understanding of a brain-gut disorder.

Cyclic vomiting syndrome (CVS) remains a mysterious disorder despite our increasing knowledge since its classic description by Gee in 1882. Its hallmark feature of recurrent, explosive bouts of vomiting punctuating periods of normal health causes substantial medical morbidity (50% of patients require intravenous therapy), as well as significant time lost from school (20 school absences per year) and work. Limited epidemiologic data indicate that CVS may occur more commonly than previously thought, affecting as many as 1.9% of school-aged children. Besides the relentless vomiting, the child usually has pallor (87%), lethargy (91%), anorexia (74%), nausea (72%), and abdominal pain (80%). There is evidence of clinical and physiologic overlap among CVS, abdominal migraine, and migraine headaches. We propose revised criteria for abdominal migraine that include pain as the predominant and consistent symptom, lack of abnormal screening tests, and in retrospect, either subsequent development of migraines or positive response to antimigraine medication. Besides migraines, other etiologic possibilities include mitochondrial DNA mutations, ion channelopathies, excessive hypothalamic-pituitary-adrenal axis activation, and heightened autonomic reactivity. The differential diagnosis includes idiopathic CVS (88%); gastrointestinal disorders (7%), including serious surgical disorders (e.g., malrotation); and extraintestinal disorders (5%), including serious surgical (brain stem neoplasm) and metabolic disorders (e.g., fatty acid oxidation disorder). Within the idiopathic group, there may be migraine, Sato's neuroendocrine, mitochondrial, and other subgroups. Treatment includes avoidance of triggers, prophylactic medication, supportive care, abortive medication, and family support. In the future, investigation into mitochondrial DNA mutations, ion channel defects, corticotropin-releasing factor, and serotonin and tachykinin receptor physiology and pharmacology may help discover the etiology and pathogenesis of this disorder.

Antiemetics↗

PubMed2000

[Comparison of propofol and isoflurane anesthesia on postoperative nausea, vomiting and pruritus induced by epidural morphine].

We compared propofol-nitrous oxide anesthesia (Group P) with isoflurane-nitrous oxide anesthesia (Group I) on the incidence of postoperative nausea, vomiting and pruritus induced by epidural morphine. Twenty-eight patients for thoracotomy for lung surgeries were randomly assigned either to Group P or Group I. All patients were administrated epidural morphine (4-7 mg.day-1) during and after the operation. The incidence of nausea, vomiting and pruritus was evaluated at the postoperative early (< 9 hour) and late (> 9 hour) periods. In the late postoperative period, in Group P the incidence of nausea and vomiting tended to be low compared with Group I, but the difference was not statistically significant. The incidence of pruritus was not different between the two groups in both early and late periods.

Aged↗

PubMed2000

Randomised, prospective, controlled trial comparing tropisetron with metoclopramide and placebo in controlling postoperative nausea and vomiting.

OBJECTIVE: To compare the results of Tropisetron, Metoclopramide and placebo on postoperative nausea and vomiting in patients undergoing minilaparotomy cholecystectomy. SETTING: Patients operated for minilaparotomy cholecystectomy in two private hospitals in Karachi. SUBJECTS: Fifty consecutive patients of all ages and both sex who had simple cholelithiasis and underwent minilaparotomy cholecystectomy by a single surgeon. MAIN OUTCOME MEASURES: Postoperative nausea and vomiting (PONV) at 2 hours and within 24 hours and requirement of rescue antiemetic. RESULTS: Tropisetron was better than Metoclopramide and placebo in controlling postoperative nausea and vomiting. CONCLUSION: Tropisetron when given at induction at a dose of 2 mg. intravenously prevents PONV better than Metoclopramide and placebo in 2 hours and 24 hours. It also reduces the need for rescue antiemetic significantly.

Adult↗

PubMed2000

[Etiology and precipitating factors of cyclic vomiting].

The aim of the study was to determine the nature, severity, precipitants and associated features of attacks and the incidence of potential aetiological factors of cyclic vomiting syndrome (CVS). Ten patients (6 boys and 4 girls aged 2-12 years) with CVS, defined as recurrent episodes of vomiting with symptom-free intervals occurring two or more times per year, with episodes having a similar pattern and for which no other cause could be found, ten patients (7 boys and 3 girls aged 7-14 years) with migraine, defined as recurrent headache with symptom-free intervals and at least three of the following symptoms or associated findings: abdominal pain, nausea or vomiting, throbbing headache, unilateral location, associated aura (visual, sensory, motor), relief after sleeping and ten controls (6 boys and 4 girls aged 4-13 years) were studied. The mean age at onset of symptoms in patients with CVS was 3.9 years and the mean number of attacks per year was 4, the average duration of episodes was 20.5 hours and the mean number of school missed days were 6 per year. The mean age at onset of symptoms in patients with migraine was 7.6 years and the mean number of attacks per year was 9.9, the average duration of episodes was 8 hours and the mean number of school missed days were 6.4 per year. A family history of migraine was significantly higher in both groups of patients, compared with controls (p = 0.009). A personal history of headache and/or migraine and associated sign or symptoms like recurrent abdominal pains, limb pain and kinetosis was significantly higher in both patients compared with controls (p < 0.001). CVS is a chronic, disabling condition and is a migraine variant, with attacks usually precipitated by stress and intercurrent infections.

Child↗

PubMed1993

Effect of nitrous oxide on post-operative nausea and vomiting during propofol anaesthesia for short surgical operations.

One hundred patients of ASA status I or II, undergoing gynaecological or urological surgery were studied. Opioids were omitted from premedication and anaesthesia. Patients were allocated randomly to one of two equal groups and were anaesthetized using a computer controlled infusion system, programmed to achieve theoretically any target blood propofol concentration. One group received 60% nitrous oxide in oxygen while the other group received 100% oxygen. Six patients in the nitrous oxide group had nausea and three of these patients vomited. Two patients in the oxygen group had nausea but no patient vomited. The frequency of nausea and vomiting in the two groups was not statistically different (P > 0.05). Theoretical blood propofol concentration shown to produce surgical anaesthesia was maintained in all patients. However 12% of the patients that received nitrous oxide and 40% of the patients that did not, responded to the surgical stimulus by limb movement. Patients in the oxygen group required higher rates of propofol infusion to maintain surgical anaesthesia.

Adolescent↗

PubMedDate not supplied

Efficacy of a single-dose ondansetron for preventing post-operative nausea and vomiting after laparoscopic cholecystectomy with sevoflurane and remifentanil infusion anaesthesia.

In this randomized study we compared the efficacy of ondansetron 4 mg with ondansetron 8 mg for the prevention of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy with sevoflurane and remifentanil infusion anaesthesia. Sixty patients were randomized to receive ondansetron 8 mg (30 pts) or ondansetron 4 mg (30 pts) before the induction of anaesthesia with thiopental and remifentanil. Anaesthesia was maintained with sevoflurane (0.5 MAC), oxygen and remifentanil infusion (0.25, 0.35, 0.5 microg/kg/min). Postoperative analgesia was provided by intravenous ketorolac 60 mg. The incidence of PONV, the pain score, and the analgesic requirement were recorded for 24 hours. There was no difference among groups in patient characteristics, risk factors for PONV, or side effects. During the first 6 h postoperatively, the incidence of PONV after ondansetron 4 mg and 8 mg were similar (p < 0.001). After 6 h the incidence of PONV increased significantly in patients who had received ondansetron 4 mg (p = 0.01) and was greater than that in patients who had received ondansetron 8 mg (p = 0.001). We conclude that single-dose ondansetron 8 mg is more effective than ondansetron 4 mg in the prevention of PONV after laparoscopic cholecystectomy. This surgery is associated with a high incidence of postoperative nausea and vomiting. A single dose of IV ondansetron 8 mg is well tolerated and decrease the number of nausea and vomiting episodes after surgery.

Adult↗