Vomiting post tonsillectomy with or without other upper airway and/or aural procedures

OBJECTIVE: The incidence of vomiting post tonsillectomy has been quoted to be 30-73 percent. Vomitting can cause considerable patient suffering. Our aim was to assess the incidence at this institution and to determine its effects and casual factors in our patient population. METHODS: This study was conducted both retro- and prospectively over the period January 1, 2000 to December 31, 2000. The medical records of all patients who underwent tonsillectomy with or without upper airway or aural procedure/s were reviewed. Data collected included: age, gender, body weight, diagnosis, premedication, type of induction of anaesthesia, blood loss, duration of anaesthesia and recovery room stay, peri-operative analgesia, antibiotic, steroid, atropine and anti-emetic administration. Approval from the institutional ethics committee was obtained. RESULTS: A total of 76 patients underwent tonsillectomy during the study period. The medical records of 75 of these patients were reviewed. The age range for the study sample was 10 months to 38 years. The majority, 66 of the patients, were children (<13 years) and hence they accounted for 88 percent of the study sample. Most were in the 0-5 year-age group and accounted for 57 percent of the study sample. Thirteen patients (17 percent of the study sample) vomited. Most of the vomiters (nine) were in the 0-5-year-age group, three in the 6-12-year-age group, and one in the adult group. Overall, there were equal numbers of male and female vomiters. CONCLUSION: Opioid analgesia (pethidine) was a significant risk factor for vomiting, while trimeprazine tartrate (a premedicant) and steroid were significant preventive factors. Studies have shown that one dose of dexamethasone (administered pre- or intra-operatively) decreases vomiting as well as the need for analgesia (especially opioid) post-operatively. There is therefore the need for a follow-up study to assess the effect of dexamethasone in this patient population. (AU)

A clinico-pathological study of Cushing's syndrome at the University Hospital of the West Indies and a review of literature

Cushing's syndrome is an uncommon but important disease. Twenty-one confirmed cases of spontaneous Cuching's syndrome were documented at the University Hospital of the West Indies over a 21-year period. They were predominantly young females (F:M ratio of 17:4; mean age 25 years and three months). The commonest presenting symptoms were amenorrhoea (41 percent) and obesity (19 percent). Common clinical features were cushingnoid features (95 percent), hypertension (76 percent) and hirsutism (82 percent). Twenty-nine per cent had frank hyperglycaemia. Cushing's syndrome was due to Cushing's disease in 10 cases, adrenal adenoma in 3 and adrenal carcinoma in 2 cases. In 4 cases with presumed adrenal hyperplasia, the histology was either unavailable or was not consistent with the diagnosis. Two cases appear now to have had ectopic ACTH syndrome. Adrenalectomy was the commonest treatment offered. There were no intra-operative or post-operative deaths but recurrence was common after subtotal adrenalectomy in Cushing's disease. Twenty-seven per cent of the patients developed Nelson's syndrome, which was fatal in 50 per cent. Long-term hormone replacement therapy was unnecessary after surgery for adrenal adenomas. Treatment of Cushing's syndrome was well tolerated by the patients. (AU)

The ectopic ACTH Syndrome and superior vena cava obstruction due to a malignant carcinoid tumour of the thymus

We report the case of a 28-year-old African Caribbean woman with Cushing's syndrome and superior vena cava obstruction secondary to an ACTH-secreting carcinoid tumour of the thymus. The case highlights the problems which may be encountered in performing the 2-day high dose dexamethasone suppression test but clinicians are reminded that this test or any other dynamic test is absolutely essential for elucidating the cause of ACTH-dependent Cushing's Syndrome (AU)

High dosage cyclophosphamide and dexamethasone treatment of paraquat poisoning with 75 percent survival

The mortality from paraquat poisoning is usually very high, and even in the best centres it exceeds 60 percent. In this paper, we report a treatment regimen with the surival of fifteen of twenty patients (75 percent) who had ingested 15 ml to 250ml of 20 percent and 24 percent paraquat. They were treated for 2 weeks with high doses of cyclophosphamide amd dexamethasone, forced diuresis with intravenous frusemide, triamterine and hydrochlorothiazide and liberal potassium supplements in addition to the routine measures for the elimination of paraquat from the gut with Fuller's Earth, activated charcoal and magnesium sulphate. The regimen is based on our hypothesis that the damage to the pulmonary alveolar capillary membrane is caused by superoxide produced by paraquat, and that this process triggers off further immunological changes with the activation of neutrophils and production of toxic oxygen metabolites by the immune complexes, and that the immunological mechanisms causing activation of the neutrophils are suppressed by cyclophosphamide and dexamethasone (AU)

Unusual chorioretinal degeneration in sickle cell disease. Possible sequelae of posterior ciliary vessel occlusion

The vascular occlusive process characteristic of sickle cell disease may affect the retinal circulation and the resulting pathological changes, from peripheral vessel obstructions to a proliferative retinpathy, are well recognized. In the present report, three cases of sickle cell disease are described with an unusual chorioretinopathy. It is suggested that these change may have resulted from the vascular occlusive process affecting the posterior ciliary vessels. (Summary)

Adrenocortical function in children with severe protein-calorie malnutrition

Adrenocortical function was investigated in malnourished Jamaican children and comparisons made with children who had recovered from malnutrition. Malnourished children had high levels of plasma cortisol which fell with recovery. The normal diurnal rhythm of plasma cortisol was poorly marked or abolished. Dexamthasone produced partial supression of the high plasma cortisol in three children in whom it was tested. The malnourished children responded to adrenal stimulation by Synacthen (á1-24 corticotrophin) with higher levels of plasma cortisol but the absolute rise was the same in both groups. There was also a marked prolongation of the half-life of exogenous cortisol levels. There was a significant negative correlation between blood glucose and plasma cortisol levels. The absolute cortisol production rates tended to rise with recovery, but when related to body weight, there was no difference between the two groups of children. It is concluded that in the malnourished child there are two major phenomena; first there is impairment of cortisol catabolism; secondly malnutrition engenders stresses which override the normal control mechanisms, since production rates remained relatively high in the presence of high levels of plasma. Several of the metabolic disturbances of infantile malnutrition may be related to high circulating levels of plasma cortisol.(Summary)