Ondansetron with propofol reduces the incidence of emesis in children following tonsillectomy.

PURPOSE: This study tested the hypothesis that the antiemetic effects of a combination of ondansetron and propofol were superior to propofol alone in children undergoing tonsillectomy surgery. METHODS: A prospective, randomized, double-blind, placebo-controlled study design was employed. Young children underwent mask induction with halothane, nitrous oxide and oxygen and then had i.v. access established: older children had i.v. induction with propofol. All patients received 0.3 mg x kg(-1) mivacurium and 2-4 microg x kg(-1) fentanyl i.v. and 30 mg x kg(-1) acetaminophen pr to a maximum dose of 650 mg. Following induction, patients received either 100 microg x kg(-1) ondansetron or placebo. Anaesthesia was maintained with 120-140 microg x kg(-1) x min(-1) propofol, nitrous oxide and oxygen to maintain vital signs within 20% of baseline. After surgery, in all patients the tracheas were extubated in the operating room without use of neuromuscular reversing agents. Episodes of emesis were recorded by PACU nurses for four to six hours. A telephone interview on the following day was also used for data recovery. Groups were compared in relation to age using the Mann-Whitney test, and with respect to sex and number of episodes of vomiting using the Fisher Exact Test. RESULTS: Three of the 45 patients who received ondansetron vomited (6.7%), whereas 10 of the 45 patients who received placebo vomited (22.2%). (P = 0.035) CONCLUSION: Ondansetron in a dose of 100 microg x kg(-1), when combined with propofol for children undergoing tonsillectomy reduced the incidence of postoperative vomiting to very low levels.

Rapidly progressive cutaneous vasculitis in a patient with chronic myelomonocytic leukemia.

This case report reviews the unique development of a vasculitic syndrome involving medium-sized arteries in a man with chronic myelomonocytic leukemia (CMMoL). This case has many features in common with cutaneous polyarteritis nodosa (CPAN), and this may represent the first instance in which CPAN developed in the setting of CMMoL.

A primer on coding and reimbursement for gastrointestinal endoscopy.

The days when a physician could rely solely on "the front office" to deal with coding, billing, and reimbursement have passed. Only the practitioner knows specifically what service or procedure has been performed, and for which diagnosis. There is no substitute for remaining up-to-date on the rules and regulations for coding and payment. The safest approach to reporting services and procedures is to keep abreast of changes and heed the axiom "do what you say and say what you do."

Diffuse hemorrhagic gastroenteropathy: report of a new entity.

An apparently novel entity, diffuse hemorrhagic gastroenteropathy (DHG), in a 70-year-old female who had an unremitting course of chronic gastrointestinal blood loss for 3 years requiring transfusion of more than 200 units of packed red blood cells over this period is reported here. Endoscopy showed diffusely hemorrhagic mucosa in the stomach, duodenum, and small bowel. Full-thickness biopsy of the stomach and small intestine revealed luminal narrowing of capillaries and post-capillary venules within the lamina propria due to swelling and some proliferation of the endothelial cells with margination and emigration by neutrophils as well as partial occlusion of some vessels by fibrin thrombi. DHG may represent a new entity characterized by mucosal hemorrhage due to local mucosal ischemia of the gastrointestinal tract secondary to a small vessel "vasculopathy" apparently restricted to this site.

Lower GI bleeding: updated diagnosis and management.

Lower GI bleeding in the elderly can be attributed to diverticula or vascular ectasias in most cases. Usually, a diagnosis is established by colonoscopy, but often this test must be supplemented by radiographic and additional endoscopic techniques, especially in the evaluation of obscure GI bleeding. Responsible lesions are frequently remediable by non-operative therapy. However, if surgical intervention is called for, it should not be delayed solely because of the patient's advanced age.

Upper GI bleeding in the elderly: diagnosis and management.

Because the rates of morbidity and mortality from gastrointestinal (GI) bleeding in the elderly are substantially higher than those seen in younger patients, practitioners caring for the elderly should be familiar with aspects of GI bleeding that are unique to this population. A discussion of the differential diagnosis of upper GI tract bleeding is followed by a review of approaches for diagnosis and treatment.