Small cell variant of medullary thyroid carcinoma is an extremely rare histologic entity with a paucity of data. As such, there is a lack of literature and clinical experience regarding this disease. In this report, we examine a case of small cell variant of medullary thyroid carcinoma that presented with intractable nausea, vomiting and diarrhea. While these symptoms were essentially refractory to the standard symptomatic treatment, further laboratory analysis revealed dramatically elevated calcitonin levels and mildly raised thyroid-stimulating hormone levels. Interestingly, repletion of thyroid hormone and treatment with lanreotide resulted in an abatement of our patient's symptoms. This temporal clinical improvement highly suggests a potential role involving thyroid-stimulating hormone and calcitonin levels in the pathogenesis of this disease, and consequently suggests a role for thyroxine in treating the associated gastrointestinal symptoms.

No description available.

Syftet med denna litteraturstudie var att beskriva de icke-farmakologiska åtgärder som kan göra att incidensen av postoperativt illamående och kräkningar minskar. Studien baseras på tio vetenskapliga artiklar som har noggrant valts ut och kvalitetsgranskats. Resultaten visar att de icke-farmakologiska åtgärder som sjuksköterskan kan utföra och som visar sig hjälpa mot postoperativt illamående och/eller kräkningar är baserade på den österländska läran om människan. Med stimuleringar av vissa bestämda punkter på kroppen kan incidensen av postoperativt illamående och kräkningar minskas. Det finns flera sätt på vilka de stimuleringarna kan göras, samt olika punkter som kan stimuleras. I den kinesiska akupunkturen är det punkt P6 på handleden och i den koreanska handaku-punkturen är det punkter K-K9 och K-D2 som har visat effekt i prevention och behandling av illamående och kräkningar. De åtgärderna har visat sig fungera själva, men också som komplement till de farmakologiska behandlingarna. De icke-farmakologiska åtgärderna ger inte biverkningar samtidigt som de är mindre kostsamma än de farmakologiska. Fler studier behövs dock för att evidensen kan konstateras, samt andra icke-farmakologsika åtgärder visas. / The aim of this literature overview was to describe nonpharmacologic treatments which can decrease incidence of Postoperative Nausea and Vomiting (PONV). This literature overview is based on ten scientific articles which have been systematically searched and critically appraised. Our findings show that the non-pharmacologic treatments which have decreased PONV and which a nurse can achieve are based on Asian traditional medicine like acupressure and acupuncture. By stimulating specific points on the body the incidence of PONV decreases. There are many ways that the stimulation can be achieved. In the Chinese acu-pressure it is the P6 acupoint on the wrist and the K-K9 and K-D2 points in the Korean Hand Acupuncture, that have shown efficacy in preventing and treating PONV. The treatments appeared to have an effect if lonly applied or as a complement to pharmacologic treatments. The nonpharmacologic treatments have no side effects and they are less expensive than pharmacologic treatments. However further studies are required to determine the scientific evidence of our findings and to bring light on some others nonpharmacologic treatments.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

Introdução: Náuseas e vômitos (NV) são ainda um desafio problemático no período pós operatório (PO). Modelos preditores, como o critério de Apfel, auxiliam para estratificação do risco dos pacientes e direcionar profilaxias antieméticas. Identificar fatores de risco que possam adicionar informações ao critério de Apfel no paciente oncológico é de extrema importância pela vulnerabilidade à Náusea e Vômito Pós-operatório (NVPO) nesta população. Métodos: foi realizado um estudo retrospectivo de 1500 pacientes oncológicos consecutivos submetidos a cirurgias oncológicas de médio a grande porte entre abril e julho de 2011. NVPO foi avaliada nas primeiras 24 horas de pós-operatório durante a avaliação pós-anestésica pela equipe do Centro Multidisciplinar de Tratamento de Dor (CMTD) do ICESP. Foi preenchido um prontuário eletrônico com todas as variáveis estudadas. A análise de regressão logística múltipla foi realizada para avaliar se qualquer das variáveis poderia adicionar alguma capacidade de previsão para o modelo preditor de Apfel e foram modeladas curvas CCO (curvas características do operadora). As áreas abaixo da curva (AAC) foram utilizados para comparar a capacidade discriminante do modelo para prever os pacientes que vomitaram daqueles que não o fizeram. Resultados: A incidência global de NVPO foi de 26%. Regressões logísticas múltiplas identificaram dois preditores independentes (razão de chances, IC 95%): pontuação do Apfel (1,78; 1,23-2,63) e náuseas e vômitos anteriores induzidos pela quimioterapia (3,15; 1,71-5,9), p de Hosmer -Lemeshow < 0,0001. Náusea e Vômito Pós Quimioterapia (NVPQ) anterior é o indicador mais importante para ser adicionado ao modelo preditor de Apfel nesta população. Conclusão: história de NVPQ deve ser considerada como um forte preditor para NVPO e deve ser adicionado como um fator de risco para NVPO no período pré-operatório de pacientes oncológicos / Background: Postoperative nausea and vomiting (PONV) is still a troublesome problem in the postoperative period. Predictive models as Apfel score help to stratify risk of patients and orientate antiemetic prophylaxis. Identifying risk factors that may add information to Apfel score in oncological patient is of extreme importance due to the vulnerability to PNV in this population. Methods: We conducted a retrospective study of 1500 consecutive patients undergoing intermediate or major cancer surgery between April and July 2011. PONV was assessed in the first 24 hours by Pain Management Team. Electronic medical record with all the studied variables was filled. Multiple logistic regression analysis were performed to assess if any of the variable could add some predictive ability to Apfel\'s tallying heuristic and a receiver operating characteristic (ROC) curves were modeled. The areas under the curve (AUC) were used to compare the model\'s discriminating ability for predicting patients who vomited from those who did not. Results: The overall incidence of PONV was 26%. Multiple logistic regressions identified two independent predictors (odds ratio; 95% CI): Apfel\'s score (1.78; 1.23-2.63) and previous chemotherapy-induced nausea and vomiting (3.15; 1.71-5.9), Hosmer-Lemeshow\'s p < 0.0001. Previous CINV is the most significant predictor to be added to Apfel\'s heuristic in this population. Conclusions: History of previous CINV should be considered as a strong predictor for PONV and should be added as an additive risk factor for PONV in the preoperative period of oncological surgery

Introdução: Náuseas e vômitos pós-operatórios são queixas importantes no período pós-operatório e seu controle adequado em pacientes oncológicos ainda é um desafio. Na avaliação de fatores de risco relacionados à NVPO é importante melhorar a estratificação dos pacientes a serem submetidos à anestesia e cirurgia, de maneira a propor intervenções que diminuam a NVPO. Neste estudo avaliou-se as variáveis náuseas e vômitos induzidos por quimioterapia (NVIQ), o uso crônico de opioides prévio à cirurgia, a história detalhada de tabagismo e o processo de cessação do tabagismo no período anterior à cirurgia em pacientes oncológicos. Métodos: Foi realizado um estudo observacional, prospectivo de 1829 pacientes oncológicos submetidos à cirurgia oncológicas de médio e grande porte entre maio de 2014 e novembro de 2015 no Instituto do Câncer do Estado de São Paulo (ICESP), Brasil. NVPO foram avaliados nas primeiras 24 horas de pós-operatório. Os dados foram obtidos por meio de entrevistas e de consulta aos prontuários. Foi realizada análise bivariada para estudar os potenciais fatores associados à NVPO. A análise de regressão logística múltipla identificou um novo modelo para previsão de NVPO através do estado de tabagismo detalhado. Resultados: A incidência global de NVPO foi de 30,8%. Houve correlação entre NVPO e as variáveis sexo feminino, idade, não tabagismo, NVIQ e história de cinetose. O risco de NVPO em fumantes foi de 14,1%, de 18,1% naqueles que pararam de fumar até um mês, 24,7% naqueles que pararam de fumar entre um mês e seis meses, 29,4% naqueles que pararam de fumar há mais de seis meses e 33,9% naqueles que nunca fumaram. Esta correlação gerou um novo modelo preditor para previsão de NVPO incluindo o histórico de tabagismo detalhado ao invés da variável dicotômica usada pelo modelo de Apfel, curva ROC com modelo de Apfel - AUC: 63,7% e novo modelo: 67,9%. Não foi encontrada relação entre o tipo de cirurgia e uso opioide crônico com NVPO. Conclusão: As variáveis sexo feminino, idade, não tabagismo, NVIQ, história prévia de cinetose foram confirmadas como fatores de risco para NVPO e um novo modelo preditor foi identificado pela associação entre NVPO e a história tabágica na população oncológica / Introduction: Nausea and vomiting are the main sources of discomfort in the postoperative period and their adequate control in oncological patients is still defiant. During the evaluation of PONV risk factor it is important to better stratify the patients to be submitted to anesthesia and surgery, in order to propose interventions that lead to the decrease in PONV. In this study, we evaluated chemotherapy induced nausea and vomiting (CINV), chronic use of opioid prior to surgery and the detailed history of smoking and of smoking quitting in oncological patients. Methods: This was an observational prospective study of 1829 oncological patients submitted to surgery from May 2014 and November 2015 in the Institute of Cancer of the State of São Paulo (ICESP), Brazil. PONV was evaluated in the first 24 hours after surgery. The data was obtained by interviews and medical records consultation. Bivariate analysis was performed to study potential factors associated to PONV. Multiple logistics analysis identified a new prediction model to PONV adding detailed smoking status. Results: Incidence of PONV was of 30.8%. There was correlation among PONV and female sex, age, non-smoking, CINV and previous motion sickness. Risk of PONV was of 14.1% in smokers, 18.1% in individuals that quit smoking in less than a month, 24.7% in individuals that quit smoking between one and six months, 29.4% in those who quit smoking more than six months and 33.9% in individuals that never smoked. This correlation generated a new PONV prediction model, including detailed smoking status rather than the Apfel dichotomous variable of smoking (yes/no), ROC curve using Apfel´s model - AUC - 63.7% and new model - 67.9%. There was no correlation between type of surgery, chronic opioid use and PONV. Conclusion: Female sex, age, non-smoking, CINV, previous motion sickness was confirmed as risk factors for PONV and a new PONV prediction model was identified through the association between PONV and the detailed history of smoking and smoking quitting in the oncological population

Introdução: Náuseas e vômitos (NV) são ainda um desafio problemático no período pós operatório (PO). Modelos preditores, como o critério de Apfel, auxiliam para estratificação do risco dos pacientes e direcionar profilaxias antieméticas. Identificar fatores de risco que possam adicionar informações ao critério de Apfel no paciente oncológico é de extrema importância pela vulnerabilidade à Náusea e Vômito Pós-operatório (NVPO) nesta população. Métodos: foi realizado um estudo retrospectivo de 1500 pacientes oncológicos consecutivos submetidos a cirurgias oncológicas de médio a grande porte entre abril e julho de 2011. NVPO foi avaliada nas primeiras 24 horas de pós-operatório durante a avaliação pós-anestésica pela equipe do Centro Multidisciplinar de Tratamento de Dor (CMTD) do ICESP. Foi preenchido um prontuário eletrônico com todas as variáveis estudadas. A análise de regressão logística múltipla foi realizada para avaliar se qualquer das variáveis poderia adicionar alguma capacidade de previsão para o modelo preditor de Apfel e foram modeladas curvas CCO (curvas características do operadora). As áreas abaixo da curva (AAC) foram utilizados para comparar a capacidade discriminante do modelo para prever os pacientes que vomitaram daqueles que não o fizeram. Resultados: A incidência global de NVPO foi de 26%. Regressões logísticas múltiplas identificaram dois preditores independentes (razão de chances, IC 95%): pontuação do Apfel (1,78; 1,23-2,63) e náuseas e vômitos anteriores induzidos pela quimioterapia (3,15; 1,71-5,9), p de Hosmer -Lemeshow < 0,0001. Náusea e Vômito Pós Quimioterapia (NVPQ) anterior é o indicador mais importante para ser adicionado ao modelo preditor de Apfel nesta população. Conclusão: história de NVPQ deve ser considerada como um forte preditor para NVPO e deve ser adicionado como um fator de risco para NVPO no período pré-operatório de pacientes oncológicos / Background: Postoperative nausea and vomiting (PONV) is still a troublesome problem in the postoperative period. Predictive models as Apfel score help to stratify risk of patients and orientate antiemetic prophylaxis. Identifying risk factors that may add information to Apfel score in oncological patient is of extreme importance due to the vulnerability to PNV in this population. Methods: We conducted a retrospective study of 1500 consecutive patients undergoing intermediate or major cancer surgery between April and July 2011. PONV was assessed in the first 24 hours by Pain Management Team. Electronic medical record with all the studied variables was filled. Multiple logistic regression analysis were performed to assess if any of the variable could add some predictive ability to Apfel\'s tallying heuristic and a receiver operating characteristic (ROC) curves were modeled. The areas under the curve (AUC) were used to compare the model\'s discriminating ability for predicting patients who vomited from those who did not. Results: The overall incidence of PONV was 26%. Multiple logistic regressions identified two independent predictors (odds ratio; 95% CI): Apfel\'s score (1.78; 1.23-2.63) and previous chemotherapy-induced nausea and vomiting (3.15; 1.71-5.9), Hosmer-Lemeshow\'s p < 0.0001. Previous CINV is the most significant predictor to be added to Apfel\'s heuristic in this population. Conclusions: History of previous CINV should be considered as a strong predictor for PONV and should be added as an additive risk factor for PONV in the preoperative period of oncological surgery

<p>Булимија је у великом броју случајева праћена учесталим повраћањем, које у дужем временском периоду може резултирати иреверзибилним губитком зубних ткива и хиперсензитивношћу, као и квантитативним и квалитативним променама нестимулисане и стимулисане пљувачке. Циљ истраживања је био да се утврди присуство, локализација и степен денталних ерозија употребом BЕWЕ (Basic Erosive Wear Examination) индексног система, као и утврђивање вредности индекса меких наслага и гингивалног индекса папиларног крварења код пацијената са булимијом праћеном повраћањем и здравих испитаника. Циљ лабораторијских испитивања је био да се утврди количина и pH вредност нестимулисане и стимулисане пљувачке, као и концентрације јона калцијума, фосфата, бикарбоната и урее код пацијената са булимијом праћеном повраћањем и здравих испитаника. У истраживању је учествовало 30 испитаника оболелих од булимије праћене повраћањем и 30 здравих испитаника, а коришћене су анкетне методе (упитник), клиничко и лабораторијско испитивање. Клинички преглед обухватио је ектраоралну и интраоралну инспекцију, уз бележење статуса зуба и примену BЕWЕ индекса, индекса меких наслага и индекса гингивалног крварења. Лабораторијске методе подразумевале су обраду узорковане пљувачке уз утврђивање количине пљувачке, pH вредности и концентрације електролита. На основу резултата спроведеног истраживања утврђено је да пацијенти оболели од булимије праћене повраћањем значајно чешће имају денталне ерозије у односу на контролне испитанике, да су еродоване лезије тежег степена у булимичној групи што је праћено интензивнијим болним сензацијама на надражај, као и да су оне значајно чешће локализоване на оралним површинама зуба у оболелој групи. Утврђено је и да булимични испитаници имају више вредности гингивалног индекса папиларног крварења у односу на контролну групу, док су анализе пљувачке указале да булимични испитаници имају значајно мању количину нестимулисане пљувачке, значајно ниже pH вредности у обе фракције пљувачке, више концентрације калцијума у нестимулисаној пљувачки, ниже концентрације фосфата у обе фракције, ниже концентрације бикарбоната у нестимулисаној фракцији и ниже вредности урее у обе фракције пљувачке.</p> / <p>Bulimija je u velikom broju slučajeva praćena učestalim povraćanjem, koje u dužem vremenskom periodu može rezultirati ireverzibilnim gubitkom zubnih tkiva i hipersenzitivnošću, kao i kvantitativnim i kvalitativnim promenama nestimulisane i stimulisane pljuvačke. Cilj istraživanja je bio da se utvrdi prisustvo, lokalizacija i stepen dentalnih erozija upotrebom BEWE (Basic Erosive Wear Examination) indeksnog sistema, kao i utvrđivanje vrednosti indeksa mekih naslaga i gingivalnog indeksa papilarnog krvarenja kod pacijenata sa bulimijom praćenom povraćanjem i zdravih ispitanika. Cilj laboratorijskih ispitivanja je bio da se utvrdi količina i pH vrednost nestimulisane i stimulisane pljuvačke, kao i koncentracije jona kalcijuma, fosfata, bikarbonata i uree kod pacijenata sa bulimijom praćenom povraćanjem i zdravih ispitanika. U istraživanju je učestvovalo 30 ispitanika obolelih od bulimije praćene povraćanjem i 30 zdravih ispitanika, a korišćene su anketne metode (upitnik), kliničko i laboratorijsko ispitivanje. Klinički pregled obuhvatio je ektraoralnu i intraoralnu inspekciju, uz beleženje statusa zuba i primenu BEWE indeksa, indeksa mekih naslaga i indeksa gingivalnog krvarenja. Laboratorijske metode podrazumevale su obradu uzorkovane pljuvačke uz utvrđivanje količine pljuvačke, pH vrednosti i koncentracije elektrolita. Na osnovu rezultata sprovedenog istraživanja utvrđeno je da pacijenti oboleli od bulimije praćene povraćanjem značajno češće imaju dentalne erozije u odnosu na kontrolne ispitanike, da su erodovane lezije težeg stepena u bulimičnoj grupi što je praćeno intenzivnijim bolnim senzacijama na nadražaj, kao i da su one značajno češće lokalizovane na oralnim površinama zuba u oboleloj grupi. Utvrđeno je i da bulimični ispitanici imaju više vrednosti gingivalnog indeksa papilarnog krvarenja u odnosu na kontrolnu grupu, dok su analize pljuvačke ukazale da bulimični ispitanici imaju značajno manju količinu nestimulisane pljuvačke, značajno niže pH vrednosti u obe frakcije pljuvačke, više koncentracije kalcijuma u nestimulisanoj pljuvački, niže koncentracije fosfata u obe frakcije, niže koncentracije bikarbonata u nestimulisanoj frakciji i niže vrednosti uree u obe frakcije pljuvačke.</p> / <p>Bulimia is in many cases followed by frequent vomiting, which in long term can result in irreversible loss of dental tissue and hypersensitivity, as well as quantitative and qualitative changes of unstimulated and stimulated saliva. The aim of the research was to determine the presence, localization and degree of dental erosion using BEWE (Basic Erosive Wear Examination) index system, as well as to determine the values of soft debris index and papilla bleeding index in patients with purging bulimia and healthy subjects. The aim of laboratory research was to determine the amount and pH value of unstimulated and stimulated saliva, as well as the concentration of calcium, phosphate, bicarbonate and urea in patients with purging bulimia and healthy subjects. The study involved 30 bulimic patients and 30 healthy subjects. Used methods were survey (questionnaire), clinical and laboratory testing. The clinical examination included extraoral and intraoral inspection, assessment of dental status and application of BEWE index, soft debris index and papilla bleeding index. Laboratory methods involved the processing of sampled saliva and determination of saliva quantity, pH value and electrolyte concentrations. On the bases of conducted research, it has been found that purging bulimic patients have significantly more dental erosion than control subjects, that eroded lesions are more severe in the bulimic group, followed by more intense pain sensations on the stimulants, and that erosions are significantly more often located on oral surfaces of the teeth in the diseased group. It has been found that bulimic patients have higher values of papilla bleeding index then control subjects, while analyzes of saliva indicated that bulimic subjects had a significantly lower amount of unstimulated saliva, a significantly lower pH value in both salivary fractions, higher calcium levels in nonstimulated saliva, lower concentrations of phosphate in both fractions, lower bicarbonate concentrations in the unstimulated fraction and lower urea values in both salivary fractions.</p>

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

Bakgrund: Postoperativt illamående och kräkningar (PONV) är en vanlig komplikation i samband med anestesi och drabbar cirka 30% av alla patienter. Kvinnor som genomgår gynekologiska laparoskopiska operationer är en särskilt utsatt grupp. Många individer som drabbas upplever ett onödigt lidande. Anestesisjuksköterskan har ett centralt ansvar i att arbeta preventivt och på så sätt lindra samt förebygga komplikationer. Genom att studera och jämföra olika enheter kan problemet med PONV uppmärksammas och eventuellt reduceras. Syfte: Syftet med studien är att undersöka skillnader i förekomst av postoperativt illamående och kräkningar hos kvinnor som genomgår laparoskopiska gynekologiska steriliseringar på två olika operationsenheter i södra Sverige. Metod: Kvantitativ retrospektiv jämförande studie med journalgranskning av 95 patienter som genomgått gynekologisk laparoskopisk sterilisering på ett länssjukhus i södra Sverige. Förekomsten av PONV och skillnader samt korrelation mellan enheterna har jämförts avseende profylaktiska interventioner i förhållande till riskfaktorer. Resultat: Utfallet av PONV blev 13% kontra 8% på respektive enhet. Ingen statistisk signifikant skillnad påvisades mellan enheterna. Korrelationen mellan antal riskfaktorer och antal profylaktiska interventioner visade på en svag icke signifikant korrelation på bägge enheter. Slutsats: Endast en liten del av de kvinnor som genomgår laparoskopiska steriliseringar drabbas av PONV. Bättre dokumentation skulle underlätta kartläggningen av olika faktorer som bidrar till PONV. Individernas riskfaktorer beaktas inte och patientperspektivet är inte i fokus. Gemensamma rutiner skulle kunna leda till bättre förutsättningar för god vård och minskat lidande hos fler individer. Förslag på framtida forskning är en prospektiv studie där utfallet av PONV studeras över längre tid. / Background: Postoperative nausea and vomiting (PONV) is a common complication associated with anesthesia and affects an average 30% of all patients. Women who go through gynecological laparoscopic surgery are a particularly vulnerable group. Many individuals experience an unnecessary suffering due to PONV. The nurse anesthetist has a central responsibility in working preventively, thus alleviating and reducing complications. By studying and comparing different units, the problem can be noted and possibly reduced. Aim: The aim of this study is to examine differences in postoperative nausea and vomiting in women undergoing gynecological laparoscopic sterilization at two different operating units in southern Sweden. Method: Quantitative retrospective comparative study with journal review of 95 patients undergoing gynecological laparoscopic sterilization at a county hospital in southern Sweden. The outcome of PONV with differences and correlation between the units has been compared with regard to prophylactic interventions in relation to risk factors. Results: The outcome of PONV was 13% versus 8% on the respective unit. No statistically significant difference was detected between the units. The correlation between the number of risk factors and the number of prophylactic interventions showed a weak, non-significant correlation on both units. Conclusion: Only a small proportion of women undergoing laparoscopic sterilization suffer from PONV. Better documentation would favor the mapping of various factors contributing to PONV. Risk factors are not considered for each individual and therefore the patient perspective is not in focus. Common routines could lead to better conditions for good care in more individuals, thereby reducing suffering. A proposal for future research is a prospective study where the outcome of PONV is studied over a longer period of time.