"Fatigue on rest" and associated symptoms (headache, vertigo, blurred vision, nausea, tension and irritability) due to locally asymptomatic, unerupted, impacted teeth.

"Fatigue on Rest", headache, vertigo and the feeling of loss of balance, blurred vision, nausea, tension and irritability, were found to be prevalent amongst patients who had locally asymptomatic, unerupted impacted teeth. A comparative pressure sign was developed, which, when positive, confirmed the relationship between the impacted teeth and the medical symptoms. Removal of the impactions resulted in the alleviation of the symptoms. Stress and psychogenic factors are considered as trigger mechanisms, rather than as basic causes of the symptoms.     

Optimum dose of epidural morphine for postsurgical analgesia

To determine the optimum dose of epidural morphine for postoperative pain control, 0.5–4.0mg of morphine was administered to 198 patients who had undergone operations on lower abdomen or lower extremities under continuous epidural anesthesia. Analgesic effect of morphine and incidence of nausea or vomiting were studied using linear discriminant analysis. As explanatory variables, age and dose of morphine were statistically significant in discriminating analgesic effect of morphine. Among indices for physique of patients, height was the most useful for predicting the analgesic effect. The dose which made the discriminant function zero corresponded to the minimum effective dose (MED) of morphine and it was expressed as follows; MED (mg·meter^–1) = –0.0107 × age + 1.85. Predicting the incidence of nausea or vomiting in relation to the dose of morphine did not reach a level of statistical significance.(Ochi G, Yamane C, Arai T: Optimum dose of epidural morphine for postsurgical analgesia. J Anesth 4: 35–39, 1990)     

国产四类新药盐酸格拉司琼注射液与恩丹西酮预防化疗引起的恶心和呕吐的疗效比较

目的 验证国产盐酸格拉司琼注射预防恶性肿瘤患者化疗所致恶心与呕吐的有效性和安全性。方法 对６９例接受以顺铂为主化疗和４０例接受以蒽环类抗肿瘤药为主化疗的恶性肿瘤患者,采用前瞻性多中心随机对照试验,比较国产格拉司琼和国产上市恩丹西酮预防化疗所致恶心与呕吐的疗效和不良反应。结果 格拉司琼和恩丹西酮对预防强致吐和中度致叶化疗药物所致的急性和迟发性恶心与呕吐的疗效基本相同;不良反应变基本相似,以便秘、疲倦     

国产盐酸托烷司琼治疗顺铂化疗所致恶心、呕吐的疗效与安全性评价

目的:比较国产与进口盐酸托烷司琼在治疗顺铂化疗所致恶心、呕吐的疗效和安全性。方法:采用多中心、双盲、随机对照方法,128例接受顺铂化疗的恶性肿瘤患者随机分为进口盐酸托烷司琼组和国产盐酸托烷司琼组,于化疗前1d应用盐酸托烷司琼,5mg/次,1次/d,连用6d,观察并记录用药1wk内患者食欲减退、恶心、呕吐及其他不良反应。结果:128例患者按研究要求完成观察,2组在治疗恶心、呕吐方面及发生其他不良反应方面均无显著性差异(P>0.05)。结论:国产盐酸托烷司琼在治疗顺铂化疗所致恶心、呕吐的疗效和安全性与进口盐酸托烷司琼相当。     

Rapid improvement in post-infectious gastroparesis symptoms with mirtazapine

We report the case of a 34-year-old woman with severe post-infectious gastroparesis who was transferred from an outside medical facility for a second opinion regarding management.This patient had no prior history of gastrointestinal symptoms.However,in the aftermath of a viral illness,she developed two months of intractable nausea,vomiting,and oral intake intolerance that resulted in numerous hospitalizations for dehydration and electrolyte disturbances.A solid-phase gastric emptying scan had confirmed delayed emptying,confirming gastroparesis.Unfortunately,conventional pro-kinetic agents and numerous anti-emetic drugs provided little or no relief of the patient’s symptoms.At our institution,the patient experienced a cessation of vomiting,reported a significant reduction in nausea,and toler-ated oral intake shortly after taking mirtazapine.Based on mirtazapine’s primary action as a serotonin(5-HT)1a receptor agonist,we infer that this receptor system mediated the clinical improvement through a combination of peripheral and central neural mechanisms.This report highlights the potential utility of 5-HT1a agonists in the management of nausea and vomiting.We conclude that mirtazapine may be effective in treating symptoms associated with non-diabetic gastroparesis that are refractory to conventional therapies.     

Emesis in patients receiving acupuncture,sham acupuncture or standard care during chemo-radiation: A randomized controlled study

ObjectiveTo study nausea, vomiting and need for rescue antiemetics in patients receiving antiemetic acupuncture, sham acupuncture or standard care during concomitant chemotherapy during pelvic radiotherapy.MethodsIn total, 68 patients participated (75% women, mean age 56 years, 53% had gynecological, 43% colorectal, and 4% other cancer types). Fifty-seven of them were blinded randomized to verum (n = 28) or sham (n = 29) acupuncture, median 10 sessions. During the study period of four weeks, the patients daily registered their nausea, vomiting and consumption of antiemetics. They were compared to a reference group (n = 11) receiving standard care only, who delivered these data once (after receiving mean 27 Gy radiotherapy dose).ResultsMore patients in the sham acupuncture group (17 of 20; 85%, p = 0.019, RR 1.81, CI 1.06–3.09) consumed antiemetics, compared to the verum acupuncture group (8 of 17; 47%). In the standard care group, 7 of 11 (63%) consumed antiemetics. The verum acupuncture treated patients experienced lower intensity of nausea than the other patients (p = 0.049). There was a non-significant tendency that more patients receiving either sham acupuncture or standard care experienced nausea (21 of 31; 68%) than patients receiving verum acupuncture (9 of 17; 53%: p = 0.074, RR 1.58, CI 0.91–2.74).ConclusionPatients treated with verum acupuncture needed less antiemetics and experienced milder nausea than other patients. Our study was small and many analyses lacked statistical power to detect differences; we welcome further sham-controlled efficacy studies and studies regarding the role of non-specific treatment components for experiencing antiemetic effects of acupuncture.     

The nurse's role in day surgery: a literature review

AIM: This paper reports a literature review to synthesize the evidence on day surgery, demonstrating its usefulness for innovative nurses. BACKGROUND: Day surgery growth has developed rapidly in recent years. Such a rapid growth has triggered a shift in nursing roles and interventions. Nursing roles are taking shape within modern day surgical units but have not been widely reviewed in developing countries. METHODS: The RCN library, BNI, CINAHL and Medline databases were searched using the terms 'day surgery and technological advantages', 'financial/economic benefits', 'patient experiences/satisfaction', 'day surgery/international comparisons', 'day surgery and developing countries'. Only papers in the English language from 1990 to 2005 were reviewed, with a predominantly adult focus. The papers examined mainly used research techniques and some opinion papers, policy documents and textbooks were examined for additional information. FINDINGS: The key strengths of day surgery are cost-effectiveness, increased patient satisfaction and low infection rates. Patients indicated that effective information provision and psychological preparation helped them cope with the experience. The use of music, story telling and distraction reduced pre-operative anxiety. Contrastingly, the deficits included poor information giving and psychological preparation resulting in high anxiety levels. Many patients encountered variable pain and nausea management and education strategies. CONCLUSION: This review highlights the importance of adequate preparation and continuous psychological support for patients undergoing day surgery. The challenges faced by practitioners involved with innovation are also emphasized.