Existen estudios que encontraron mayor prevalencia de anticuerpos contra Helicobacter pylori (Hp) en gestantes con hiperémesis gravídica, en comparación con mujeres embarazadas asintomáticas. Objetivos. Determinar la relación entre la seropositividad a Hp y la presencia de náusea y vómitos durante las primeras 20 semanas del embarazo en gestantes de una red hospitalaria, entre marzo y diciembre de 2015. Material y métodos. Estudio de casos y controles no pareado en gestantes hasta las 20 semanas de embarazo. El índice de Rhodes para náusea y vómitos clasificó a las gestantes en casos (9-40 puntos) y en controles (8 puntos). La seropositividad a Hp fue definida como IgG ≥ 1,1 U/mL. La asociación entre Hp y náusea y vómitos del embarazo se determinó con el análisis de regresión logística, controlando por edad, paridad, edad gestacional y nivel socioeconómico. Resultados. Un total de 108 pacientes fueron incluidas, 21 controles y 87 casos. No hubo diferencias significativas en edad (p = 0,916), paridad (p = 0,18) y nivel socioeconómico (p = 0,36). La seropositividad a Hp en los casos fue 78,2% (68/87) y en los controles 61,9% (13/21). En el análisis de regresión logística, los casos presentaron mayor riesgo de seropositividad a Hp que los controles (OR = 3,05; IC 95%: 0,92-10,1; p = 0,068), pero no fue significativa. Conclusiones. Las pacientes con náusea y vómitos en las primeras 20 semanas de gestación tuvieron un mayor riesgo de haber estado expuestas a Hp, aunque esta relación no fue significativa debido al pequeño tamaño de muestra. / There are studies that found a higher prevalence of antibodies against Helicobacter pylori (Hp) in patients with hyperemesis gravidarum, compared to asymptomatic pregnant women. Objective. To determine the relationship between seropositivity to Hp and the presence of nausea and vomiting during the first 20 weeks of gestation in pregnant women of a hospital network, from March to December 2015. Material and methods. Unmatched case-control studies in pregnant women until 20 weeks of gestation. The Rhodes’ index for nausea and vomiting classified pregnant women in cases (9-40 points) and controls (8 points). Hp seropositivity was defined as IgG ≥ 1.1 U/mL. The association between Hp and nausea and vomiting of pregnancy was determined by logistic regression analysis controlling for age, parity, gestational age and socioeconomic status. Results. A total of 108 patients were included, 21 controls and 87 cases. There were no significant differences in age (p = 0.916), parity (p = 0.18) and socioeconomic status (p = 0.36). Hp seropositivity in cases was 78.2% (68/87) and controls 61.9% (13/21). In the logistic regression analysis, cases had higher risk of Hp seropositivity than controls (OR = 3.05; 95% CI: 0.92-10.1; p = 0.068), but was not significant. Conclusions. Patients with nausea and vomiting in the first 20 weeks of gestation had a higher risk of having been exposed to Hp, although this relationship was not significant due to the small sample size.

During the nineteenth century, as today, nausea and vomiting were common signs and symptoms of illness, the interpretation of which contributed to doctors' diagnostic, prognostic and therapeutic choices. At the core of this thesis lies the research question: how did medical understandings and management of nausea and vomiting change in the period 1800-1900? In addition to being signs of bodily disorder, nausea and vomiting constituted an individual, typically non-medicalised experience of sickness. As such, a secondary thesis question is: how were nausea and vomiting experienced, interpreted and responded to by sufferers? These questions are pursued through four key themes: physiology, vomit analysis, morning sickness and sea-sickness. Medical textbooks, journals, hospital case reports, newspapers, letters and diaries are the principal source base. Throughout the nineteenth century physiological explanations for nausea and vomiting followed a generally reductionist path. In the 1830s Marshall Hall's reflex theory encouraged new perceptions of the nervous mechanisms involved in nausea and vomiting, and helped stimulate their redefinition into local, central and peripheral causes. Changing physiological explanations for nausea and vomiting were also contemporaneous to the growth of microscopy. This thesis draws attention to the interest nineteenth-century practitioners showed in using vomited matters as pathological fluids. This is explored primarily through a case study of sarcina ventriculi, a vegetable microorganism discovered in fermenting vomit. Responses to this discovery showed that laboratory techniques were largely inapplicable to everyday occurrences of nausea and vomiting. Consequently, neither the increasing localisation of the causes of vomiting, nor interest in vomited matters as pathological fluids, contributed to specificity in diagnoses or treatments. This research thereby demonstrates the cumulative and overlapping nature of nineteenth-century medical cosmologies - 'bedside', 'hospital' and 'laboratory' - and the continuation of the 'clinical art'. The histories of morning sickness and sea-sickness contextualise medical understandings of nausea and vomiting in relation to these transient conditions. They bring to the fore perceptions of health and sickness and show that medical theory was often secondary to cultural beliefs and practices. Specifically, this thesis questions the medicalisation of pregnancy during the nineteenth century and uses experiences of sea-sickness to reveal new features of Victorian understandings of the mind-body relationship. This thesis shows that 'feeling sick' (nausea) was arguably as significant to contemporaries as actually 'being sick' (vomiting). It also confirms the complexity and fluidity of taken-for-granted terms such as: 'patient', 'sufferer', 'disease', 'illness' 'sign' and 'symptom', and, of course, 'sick'. Furthermore, it demonstrates the importance to historians of studying everyday, self-limiting illnesses and morbidity.

An evaluation of a series of interventions was conducted for an individual who engaged in life-threatening rumination and emesis. There is substantial research indicating that the delivery of peanut butter (Barton & Barton, 1985; Greene, Johnston, Rossi, Racal, Winston, & Barron, 1991) and/or chopped bread following meals (Thibadeau, Blew, Reedy, & Luiselli, 1999), chewing gum (Rhine & Tarbox, 2009), and satiation procedures (Dudley, Johnston, & Barnes, 2002; Lyons, Rue, Luiselli, & DiGennario, 2007; Rast, Johnston, Drum, & Conrin, 1981) can be effective treatments for rumination. In the current case, each of these interventions was found to be either ineffective or contraindicated based on the participant's fragile health status. Previous literature has shown that liquid delivery can affect rates of rumination in some clients (Barton & Barton, 1985,; Heering, Wilder, & Ladd, 2003). We examined how liquid affected the rate of rumination during and after meals. Based on the individual's medical condition, oral nutrition and fluids were discontinued indefinitely and a gastronomy-jejunostomy tube was used for nutrition. All rumination ceased when fluids and nutrition were delivered via the jejunostomy tube. Finally, a fluid analysis procedure was implemented in which the participant received small amounts of fluid while NPO. Color and flavor were manipulated systematically, and results suggested that flavor impacted the rate of rumination.

Published in Supportive Care in Cancer 2014;22(8):2161-6. DOI:10.1007/s00520-014-2182-7 / 京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第18548号 / 社医博第59号 / 新制||社医||8(附属図書館) / 31448 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 武藤 学, 教授 佐藤 俊哉, 教授 千葉 勉 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

No / The aim of the present study was to investigate an opioid receptor involvement in the adaptation response to motion sickness in Suncus murinus. Different groups of animals were treated intraperitoneally with either saline, morphine (0.1 and 1.0 mg/kg), naloxone (1.0, 10.0 and 5.0 mg/kg) or a combination of naloxone plus morphine in the absence or 30 min prior to a horizontal motion stimulus of I Hz and 40 mm amplitude. For the study of adaptation, different groups received saline on the first trial, and in subsequent trials (every 2 days) they received either saline, naloxone (1.0 and 10.0 mg/kg, ip) or morphine (0.1 mg/kg, ip) 30 min prior to the motion stimulus. Pretreatment with morphine caused a dose-related reduction in emesis induced by a single challenge to a motion stimulus. Pretreatment with naloxone alone did not induce emesis in its own right nor did it modify emesis induced by a single challenge to a motion stimulus. However, pretreatment with naloxone (5.0 mg/kg, ip) revealed an emetic response to morphine (P<.001) (1.0 mg/kg, ip) and antagonised the reduction of motion sickness induced by morphine. In animals that received saline or naloxone (1.0 mg/kg), a motion stimulus inducing emesis decreased the responsiveness of animals to a second and subsequent motion stimulus challenge when applied every 2 days for 11 trials. However, the animals receiving naloxone 10.0 mg/kg prior to the second and subsequent challenges showed no significant reduction in the intensity of emesis compared to the first trial. The data are revealing of an emetic potential of morphine when administered in the presence of a naloxone pretreatment. The administration of naloxone is also revealing of an additional inhibitory opioid system whose activation by endogenous opioid(s) may play a role in the adaptation to motion sickness on repeated challenge in S. murinus.

No description available.

<p>Antiemetska terapija u hemioterapijom izazvanoj mučnini i povraćanju se bazira na znanju o etiologiji, fiziologiji, kliničkoj slici, posledicama i uticaju povraćanja na kvalitet života. Za izbor antiemetske terapije presudno je poznavanje emetogenog potencijala antineoplastika, mehanizma delovanja, indikacija, puta primene, doziranja, neželjenih delovanja, farmakokinetike, interakcija i kontraindikacija tri najznačajnije grupe lekova koje se primenjuju kao antiemetici prema međunarodnim preporukama. Značajno je i poznavanje bolesnika, odnosno njegovih individualnih karakteristika i to: starost, pol, istorija kinetoze, istorija konzumiranja alkohola, istorija jutarnjih mučnina u trudnoći, pridružene bolesti i dr. Cilj doktorske teze je analiza efikasnosti kombinacije antiemetika ondansetron, deksametazon, aprepitant u drugom ciklusu hemioterapije po protokolu fluorouracil, doksorubicin, ciklofosfamid u odnosu na ondansetron, deksametazon u bolesnica sa dijagnozom karcinoma dojke, efikasnosti kombinacije antiemetika ondansetron, deksametazon, aprepitant u drugom ciklusu hemioterapije po protokolu fluorouracil, doksorubicin, ciklofosfamid u odnosu na palonosetron, deksametazon u bolesnica sa dijagnozom karcinoma dojke i da se ispita kvalitet života bolesnica nakon prvog i drugog ciklusa. Materijal i metode: uzorak su bolesnice sa dijagnostikovanim karcinomom dojke lečene hemioterapijom po protokolu fluorouracil, doksorubicin, ciklofosfamid. Bolesnice koje su nakon prvog ciklusa hemioterapije uz antiemetsku terapiju ondansetron, deksametazon iskusile mučninu i povraćanje podeljene su u grupe koje su primale dve različite kombinacije antiemetika uz drugi ciklus hemioterapije i to: ondansetron, deksametazon i aprepitant ili palonosetron i deksametazon. Bolesnice su praćene pet dana tokom kojih su se izja&scaron;njavale o mučnini i povraćanju, kao i o kvalitetu života. Mučnina je praćena pomoću numeričke skale, povraćanje kao broj epizoda povraćanja tokom 5 dana i kvalitet života je praćen popunjavanjem upitnika o kvalitetu života. Rezultati: Analiza rezultata ukazala je na postojanje statistički značajne razlike u efikasnosti između tri primenjene kombinacije antiemetika. Trojna kombinacija ondansetron, deksametazon i aprepitant značajno sprečava mučninu i povraćanje u odnosu na kombinaciju ondansetron, deksametazon, ali značajnost nije toliko izražena u odnosu na kombinaciju palonosetron, deksametazon zbog inicijalne razlike između početne grupe ispitanika. Slični rezultati su uočeni u ispitivanju svih aspekata kvaliteta života. Zaključak: Zaključak proizilazi iz rezultata kliničkog ispitivanja kojima se potvrđuju postavljene hipoteze. Trojna kombinacija ondansetron, deksametazon i aprepitant je efikasnija u sprečavanju mučnine i povraćanja izazvanih hemioterapijom u odnosu na kombinaciju palonosetron, deksametazon, kao i kombinaciju ondansetron, deksametazon. Ista razlika pri primeni antiemetika dobijena je i pri proučavanju kvaliteta života. Zaključci izvedeni ovim ispitivanjem potvrda su drugih radova na ovom polju.</p> / <p>Antiemetic therapy options in chemotherapy induced nausea and vomiting (CINV) is based on knowledge on ethiology, physiology, clinical signes and simptoms, and influence on quality of life (QoL). Also it is needed to understand emetogenic potential of antineoplastics, mechanism of action, indication, uses, dosage, side effects, pharmacokinetics, interaction, and contraindication of three most important groups of drugs which are used in CINV according to international recommendation. The goal were to analyze efficacy of the combination antiemetics ondansetron, dexamethasone, aprepitant and ondansetron, dexamethasone in second line chemotherapy based on fluorouracil, adriamycin, cyclophosphamide in patient with diagnosed carcinoma of the breast, efficacy of the combination antiemetics ondansetron, dexamethasone, aprepitant and palonosetron, dexamethasone and quality of life. Material and methods: the sample consist of patients with diagnosed carcinoma of the breast, on chemotherapy fluorouracil, adriamycin, cyclophosphamide. Patients wich was on antiemetic drugs ondansetron, dexamethasone with chemotherapy induced nausea or vomiting after first cycle of chemotherapy were split in two groups randomly. First group was on antiemetic therapy palonosetron, dexamethasone and second one on ondansetron, dexamethasone and aprepitant. Nausea and vomiting was measured for 5 days, by numeric scale for nausea and counting number of emetic episodes, and it was questionnaire about quality of life. Results: It was statistical important differences between three used combination of antiemetics. The highest efficacy was in combination of ondansetron, dexamethasone and aprepitant than palonosetron, dexamethasone, and the last was ondansetron, dexamethasone. Results were similar for all aspects of quality of life. Conclusion: The combination ondansetron, dexamethasone and aprepitant had the highest efficacy in stopping chemotherapy induced nausea and vomiting. Similar was for quality of life. Conclusion was in accordance with literature data.</p>

<p>Postoperative nausea and vomiting (PONV) is still a clinical problem and its incidence is unacceptably high. After the introduction of propofol as an agent for induction and maintenance of anesthesia, it was reported that the incidence of PONV was lower. It was also proposed that propofol possesses antiemetic effects. Dopamine, serotonin and opioids may contribute to PONV. Therefore the purpose of these investigations was to evaluate if propofol has dopamine, serotonin or opioid antagonistic effects and if a subhypnotic infusion of propofol decreases the incidence of PONV. </p><p>Nausea and vomiting were induced in volunteers by a dopamine agonist, apomorphine, and by ipecacuanha which releases serotonin from the enterochromaffin cells in the gut. The effects of propofol on gastric emptying and orocecal transit time were evaluated in volunteers with the paracetamol method and by measuring the endtidal hydrogen concentration after ingestion of the trisaccharide raffinose. The effects of morphine on gastric emptying and gastric tone were studied in patients before surgery with the paracetamol method and with an electronic barostat, respectively. The effects of low dose propofol for prophylaxis of PONV were studied in 172 patients undergoing breast and abdominal surgery. Propofol prophylaxis was compared with a multidrug regimen consisting of dexamethasone and three antiemetic drugs, ondansetron, droperidol and metoclopramide. </p><p>Propofol did not abolish apomorphine-induced vomiting but reduced the number of retchings induced by ipecacuanha. Propofol sedation did not influence gastric emptying of liquids but it slightly prolonged orocecal transit time. Gastric relaxation induced by morphine was abolished by propofol but propofol did not abolish morphine-induced delay of gastric emptying. Propofol in a low dose infusion reduced the incidence of PONV but nausea and especially vomiting increased significantly after termination of the infusion. Pro- phylaxis with the multidrug regimen was very effective in preventing PONV. </p><p>These studies have shown that propofol does not have any dopamine antagonistic effect but may have a weak serotonin antagonistic effect. Propofol cannot abolish morphine-induced delay of gastric emptying. Low dose propofol infusion was effective in preventing PONV as long as the infusion was ongoing but after termination of the infusion nausea and especially vomiting substantially increased. The multidrug regimen (dexamethasone, ondansetron, droperidol, metoclopramide) was very effective in preventing PONV and can be recommended as prophylaxis in patient groups with a known high risk for PONV. </p>

Postoperative nausea and vomiting (PONV) is still a clinical problem and its incidence is unacceptably high. After the introduction of propofol as an agent for induction and maintenance of anesthesia, it was reported that the incidence of PONV was lower. It was also proposed that propofol possesses antiemetic effects. Dopamine, serotonin and opioids may contribute to PONV. Therefore the purpose of these investigations was to evaluate if propofol has dopamine, serotonin or opioid antagonistic effects and if a subhypnotic infusion of propofol decreases the incidence of PONV. Nausea and vomiting were induced in volunteers by a dopamine agonist, apomorphine, and by ipecacuanha which releases serotonin from the enterochromaffin cells in the gut. The effects of propofol on gastric emptying and orocecal transit time were evaluated in volunteers with the paracetamol method and by measuring the endtidal hydrogen concentration after ingestion of the trisaccharide raffinose. The effects of morphine on gastric emptying and gastric tone were studied in patients before surgery with the paracetamol method and with an electronic barostat, respectively. The effects of low dose propofol for prophylaxis of PONV were studied in 172 patients undergoing breast and abdominal surgery. Propofol prophylaxis was compared with a multidrug regimen consisting of dexamethasone and three antiemetic drugs, ondansetron, droperidol and metoclopramide. Propofol did not abolish apomorphine-induced vomiting but reduced the number of retchings induced by ipecacuanha. Propofol sedation did not influence gastric emptying of liquids but it slightly prolonged orocecal transit time. Gastric relaxation induced by morphine was abolished by propofol but propofol did not abolish morphine-induced delay of gastric emptying. Propofol in a low dose infusion reduced the incidence of PONV but nausea and especially vomiting increased significantly after termination of the infusion. Pro- phylaxis with the multidrug regimen was very effective in preventing PONV. These studies have shown that propofol does not have any dopamine antagonistic effect but may have a weak serotonin antagonistic effect. Propofol cannot abolish morphine-induced delay of gastric emptying. Low dose propofol infusion was effective in preventing PONV as long as the infusion was ongoing but after termination of the infusion nausea and especially vomiting substantially increased. The multidrug regimen (dexamethasone, ondansetron, droperidol, metoclopramide) was very effective in preventing PONV and can be recommended as prophylaxis in patient groups with a known high risk for PONV.

Bakgrund: Postoperativt illamående och kräkningar (PONV, Post Operative Nausea and Vomiting) är ett vanligt problem efter anestesi. Även om många riktlinjer och riskbedömningsverktyg har utvecklats för PONV, så är implementeringen ofta svår. Attityder och kunskap kring ämnet har visat sig påverka implementeringen av riktlinjer. Syfte: Syftet med denna studie var att undersöka anestesipersonals kunskap och attityder kring PONV och kliniska riktlinjer för att förebygga PONV. Metod: Studien är utformad som en kvantitativ, deskriptiv enkätstudie. En totalundersökning genomfördes på en anestesiklinik på ett större sjukhus i Mellansverige. Enkäten innehöll frågor angående anestesipersonals attityder och kunskaper kring riktlinjer och PONV. Resultat: Anestesipersonalens kunskap om PONV var god och stämde överens med skattningen av de egna kunskaperna. Av respondenterna angav 45,5 % att PONV är ett vanligt problem inom anestesi medan 36,3 % såg det som ett stort problem på kliniken. Riktlinjer för PONV ansågs förbättra patientvården och vara av stort värde för att identifiera riskpatienter, men samtidigt framkom att endast 48,5 % uppgav att de använder riktlinjer för PONV dagligen. Större delen av respondenterna ansåg att det föreligger ett delat ansvar för att riktlinjer följs, men det rådde delade meningar om vilka som delade detta ansvar. Slutsats Orsakerna till den diskrepans som förelåg mellan respondenternas positiva attityder och användandet av riktlinjer kan inte till fullo utläsas i huvudresultat. Det kan dock med stöd av tidigare studier argumenteras att externa faktorer på kliniken spelar in. För att klargöra problemet vidare och hur riktlinjer bättre ska kunna implementeras i den kliniska verksamheten så krävs ytterligare studier i ämnet. / Background: Postoperative nausea and vomiting (PONV) is a common problem after anesthesia. Even though many guidelines and risk assessment tools for PONV have been developed, implementation often is difficult. Attitudes and knowledge regarding the subject have been shown to influence the implementation. Aim: The aim of this study was to investigate anesthesia staffs knowledge and attitudes regarding PONV and guidelines. Method: The study is designed as a quantitative, descriptive questionnaire study. A census of an anesthesia clinic of a larger Swedish hospital was executed. The questionnaire contained questions concerning anesthesia staffs attitudes and knowledge about guidelines and PONV. Results: The anesthesia staffs knowledge of PONV was good and correlated with their self-assessment. Of the respondents 45,5 % stated that PONV was a common problem in anesthesia, while 36,3 % regarded it as a big problem in their clinic. Guidelines for PONV were seen as improving patient care and to be of great value for identifying risk patients, while only 48,5 % stated that they use PONV guidelines daily. The major part of the respondents deemed the responsibility for following guidelines as collective, however the opinion on exactly who shared this responsibility differed. Conclusion: The reason for the discrepancy that occurred between the respondents’ positive attitudes and the use of guidelines cannot be fully deduced from the main results. However, with the support of earlier studies it can be argued that external factors in the clinic contribute. Further studies of the subject is needed to clarify the problem.