Compulsive showering and marijuana use - the cannabis hyperemisis syndrome.

PATIENT: Male, 26 FINAL DIAGNOSIS: Marihuana addiction Symptoms: Compulsive showering • nausea • vomiting MEDICATION: - Clinical Procedure: - Specialty: Toxicology. OBJECTIVE: Unexpected drug reaction. BACKGROUND: The use or misuse of Cannabis is well recognized in the Caribbean region. Recently, the cannabinoid hyperemesis syndrome has been described. The triad is characterized by chronic marijuana use, cyclical vomiting, and compulsive bathing. With the extensive use to marijuana as a recreational drug and also the increased use as prescription medication, a patient presenting with this symptomatology needs to be assessed appropriately and this syndrome needs to be one of the differential diagnoses. CASE REPORT: To our knowledge, we report the first such case in the Caribbean region. Here, we report on the case of a 26-year-old Caucasian male with a 3-week history of nausea and week of epigastric pain and vomiting. The patient was known to use marijuana daily for 2 years and had similar complaints for the last 6 months. CONCLUSIONS: Because this popular recreational drug is now being used with increased frequency as a prescribed medication, it is crucial that clinicians be aware of this condition, which can present as a diagnostic dilemma.

Length of stay following primary total hip replacement.

INTRODUCTION: Much of the cost of primary total hip arthroplasty (THA) comprises the length of stay in hospital. Given the increasing drive for cost-effective surgery in today's National Health Service, the aim of this investigation was to determine the patient and surgical factors that most influence the length of stay following surgery. PATIENTS AND METHODS: A large, population-based study of 675 consecutive patients in a regional orthopaedic centre in the South West of Britain. RESULTS: The median length of stay was 8 days. The majority of patients (81.5%) left hospital within 2 weeks, 13.6% within 2-4 weeks and 4.9% after 4 weeks. On multivariate analysis, age above 70 years, ASA grades 3 and 4, prolonged operations and long incisions were highly significantly associated with hospital stay of over 2 weeks. CONCLUSIONS: Prolonged stay after THA is largely predetermined by case mix and this should be taken into account when units are compared for performance and in the remuneration they receive for providing this service. Slick surgery through limited incisions may reduce the length of stay.