1/8. Investigation into the usefulness and adverse events of CDDP, 5-fU and dl-leucovorin (PFL-therapy) for advanced colorectal cancer.Biochemical modulation of 5-fluorouracil (5-FU) has been verified the evidence of significant improvement of survival and quality of life in patients with advanced colorectal carcinoma. We investigated the therapeutic and adverse drug reaction of intensive chemotherapy using cisplatin (CDDP), 5-FU and dl-leucovorin (LV) (PFL-therapy), which may be producing dual biochemical modulation effect of 5-FU for advanced colorectal carcinoma. Administration schedule was 13 mg/m2 of CDDP, 300 mg/m2 of 5-FU, and 30 mg/body of dl-LV for 5 consecutive days. This regimen was repeated at 3-week intervals in hospital. Sixteen patients were enrolled in this study, most of whom had a history of previous chemotherapy as adjuvant treatment, and the response rate was 25%, with four patients having "partial response" and eight "no change". In respect to performance status, 46% of patients who completed the protocol were markedly improved in spite of their poor performance status before treatment. Moreover, when patients were classified into two groups based on changes of the serum level of CEA, "responder in CEA level" showed better prognosis than "non-responder in CEA level". Major toxicities were nausea, hyperglycemia and neutropenia. Three patients experienced Grade 4 hematological side effect, but these complications resolved quickly in all patients except for one patient. PFL-therapy is effective for advanced colorectal cancer with large tumor burden and showed the same prognostic result as the American and European trials in spite of smaller number of treatment cycles and a history of previous chemotherapy. We will be able to demonstrate the usefulness of this regimen for Japanese patients with advanced colorectal cancers after adding new cases to the present report.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
2/8. Self-regulation treatment to reduce the aversiveness of cancer chemotherapy.In an A-B design, the effectiveness of a multicomponent intervention for reducing chemotherapy-associated nausea and emesis in an 11-year-old cancer patient was evaluated. A highly structured, time-limited, self-regulation treatment was implemented that consisted of patient and parent instruction in self-hypnotic methods, cue-controlled relaxation, and guided imagery. Practice of the self-regulation methods at home and in vivo (clinic setting) in the absence of chemotherapy infusion were emphasized to promote skill acquisition and cross-setting generalization. Dependent variables included self-reported nausea intensity and parental report of duration of the patient's sleep and vomiting frequency. Data were obtained before, during, and following chemotherapy for baseline and self-regulation treatment phases across five cycles of chemotherapy that occurred over a 5-month period. During the intervention phase, a marked and clinically significant reduction in self-reported nausea and parent-observed vomiting were noted as well as a concurrent increase in sleep duration. The integrity of patient self-report and parental observations were supported by clinic staff anecdotal data. Treatment limitations and cost-effectiveness are discussed as well as the use of this intervention with adolescent patients.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
3/8. Chronic vomiting in a case of citrullinaemia detected after treatment by total parenteral nutrition.We report a case of a 56 year old woman who presented with a long history of chronic attacks of vomiting. On admission to hospital she was cachectic, and attempted parenteral nutrition induced coma. The illness was found to be due to citrullinaemia, a metabolic disorder of the urea cycle. Our patient is the oldest with this disorder so far described in the literature. The main points of the case and its investigation are outlined: hyperammonaemia, amino acid chromatogram, measurement of enzyme activity in skin and liver biopsy material. The therapeutic measures which led to cure are of particular interest.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
4/8. Psychophysiologic treatment of cyclic vomiting.Cyclic vomiting (CV) presents a crisis not only to the identified patient but also to the entire family, who often feel like helpless victims of the effects of the vomiting cycles. This often creates despair, depression, and anger about the vomiting continuing indefinitely. If the child can be given effective medication and the family can be helped with the emotional burden surrounding the illness, the frequency and severity of CV tends to diminish. This article explores ways of lessening the psychologic and social effects of the cyclical vomiting through a multidisciplinary treatment plan for the family that involves the pediatrician, school, psychotherapist, and family as effective therapeutic agents. The child needs to be helped to express feelings which he or she cannot put into words. The article describes dramatic play involving symbolization of the illness, creation of metaphors in stories and drawings for the dilemmas surrounding CV and family therapy in which unnamed stresses are given consideration. Through this treatment, health and hope are promoted within each family member.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
5/8. Cyclic vomiting: association with multiple homeostatic abnormalities and response to ketorolac.Cyclic vomiting is a rare syndrome that over the years has variously been ascribed to psychogenic causes, sensory seizures, abdominal migraine, and more recently, to mechanical or electrical disturbances in gastric physiology. We describe the case of a 65-year-old white diabetic female with a 10-yr history of recurrent episodes of nausea and vomiting, occurring every 10-12 days and lasting approximately 1-3 days at a time. These episodes were accompanied by edema, mild temperature elevations, and remarkable elevations in blood pressure. In between these episodes, the patient remained asymptomatic. Initial screening tests were also negative except for moderate gastroparesis. However, antral motility was found to be normal, as was an electrogastrogram. Detailed neurological and psychiatric evaluations were negative. Trials of erythromycin, metoclopramide, naloxone, ondansetron, and amitryptiline were unsuccessful. Serial endocrinological testing revealed that an episode of vomiting was always preceded by an abnormal elevation in at least one of the following: serum adrenocorticotropic hormone, serum cortisol, or urinary cortisol. In the midst of an episode, all three values were exceedingly high (e.g., > 10-fold increases in 24-hr urinary cortisol levels). Fluctuations of a milder degree, though still abnormally high, were also noted in between cycles at times when the patient was completely asymptomatic. High-dose dexamethasone suppressed these hormonal surges completely but not the clinical symptoms, which continued undisturbed. The patient was finally given a trial of intramuscular ketorolac during one of her episodes, which produced prompt and sustained relief. During the next few weeks, she was given this drug each time her symptoms commenced, and each time it appeared that her cycle had been aborted. She has since been able to terminate her episodes promptly and completely by self-administration of ketorolac. We speculate that her syndrome is caused by a poorly characterized disorder of endogenous prostaglandin release, resulting not only in derangements in the hypothalamic pituitary system but also in nausea and vomiting.- - - - - - - - - - ranking = 2keywords = cycle (Clic here for more details about this article) |
6/8. vomiting, ataxia, and altered mental status in an adolescent: late-onset ornithine transcarbamylase deficiency.A case of a 13-year-old boy with protracted vomiting, ataxia, and altered mental status, ultimately diagnosed with late-onset ornithine transcarbamylase (OTC) deficiency, is presented. OTC deficiency is the most common urea cycle defect and typically is diagnosed in male infants with irritability, poor feeding, vomiting, lethargy, and often death caused by the effects of hyperammonemia. Late-onset OTC deficiency has been described in patients of all ages. The presenting symptoms in these patients vary but the most common are vomiting and lethargy. The pathophysiology, clinical features, differential diagnosis, and treatment of this disorder are discussed. Because of the risks of serious consequences, early detection and treatment of OTC deficiency and hyperammonemic episodes are mandatory. Emergency physicians caring for children and adults need to be aware of the spectrum of clinical presentations of OTC deficiency, including late-onset disease.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
7/8. Median arcuate ligament syndrome: a possible cause of idiopathic gastroparesis.The median arcuate ligament syndrome (MALS) is characterized by abdominal pain, nausea, and vomiting attributed to compression of the celiac axis by a fibrous band (the median arcuate ligament) connecting the diaphragmatic crura. The pathophysiologic origin of these symptoms is not clearly understood. Theories invoking either a neurogenic or vascular origin for the clinical features associated with MALS have been proposed, but objective evidence to support these theories is lacking. We describe the clinical course and gastric myoelectrical features of a patient with postprandial epigastric pain, weight loss, gastroparesis, and gastric dysrhythmias in whom a diagnosis of MALS was established. Surgical decompression of the celiac axis in our patient resulted in resolution of abdominal pain, return to a full diet within 4 weeks without nausea or vomiting, improvement in radionuclide gastric emptying, and restoration of the gastric electrical rhythm to a normal 3 cycle/min conduction rate. This is the first demonstration of altered gastric myoelectrical activity in a patient with MALS. The regularization of the gastric electrical rhythm in our patient after surgical decompression of the celiac axis would support a neurogenic basis for the symptoms associated with MALS. MALS should be excluded in patients with idiopathic gastroparesis and unexplained epigastric pain.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
8/8. Argininemia: a treatable genetic cause of progressive spastic diplegia simulating cerebral palsy: case reports and literature review.Argininemia, a rare autosomal recessive urea cycle disorder, is caused by a deficiency of arginase, with resulting elevated plasma arginine and ammonia levels. Reports to date have focused little on the neurology of this disorder or the efficacy of treatments. A medline search revealed 25 previously reported cases, to which we have added two brothers who presented with late onset progressive spastic diplegia. Though their degree of enzyme deficiency was comparable, the severity of their phenotypic abnormalities differed substantially. With dietary therapy, both showed improved cognitive and motor function. Late metabolic crises occurred in both, resulting in death of the less severely affected brother. Based on analysis of our clinical database, we report on the full spectrum of neurologic abnormalities seen in argininemia with particular focus on the accompanying progressive spastic diplegia and its response to treatment; progressive decline in head growth; distinctive neuroradiologic findings; and life-threatening later complications. Current and potential future therapies and long-term outcome are summarized.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |