The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficiency of whole bowel irrigation with and without metoclopramide pretreatment.
Whole bowel irrigation (WBI) with a polyethylene glycol electrolyte lavage solution (PEG-ELS) is a gastrointestinal (GI) decontamination procedure used after selected ingestions of toxic substances. The purpose of this study was to evaluate the ability of WBI, with and without metoclopramide pretreatment, to clear the GI tract of foreign bodies using previously established WBI end points, ie, the presence of a clear effluent or the administration of 2 L/h PEG-ELS for 5 hours. Eleven healthy, adult, male volunteers participated in this controlled, two-phase, blinded, crossover study. ⋯ For the placebo group, the mean number of beans passed was equal to 3.5 (+/- 1.9 SD; 2 to 7 R), and the mean number at clear effluent was equal to 2.3. In conclusion, the presence of a clear effluent or the administration of 10 L of PEG-ELS are not valid markers for the termination of WBI if complete elimination of a foreign body is required. Pretreatment with 10 mg of oral metoclopramide does not enhance the efficiency of WBI.
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Review Case Reports
Aortic dissection presenting as superior vena cava syndrome.
Aortic dissection usually presents with chest pain, abnormal pulses, and a widened mediastinum on chest radiograph. It is rarely associated with the superior vena cava syndrome (SVCS), which more commonly occurs in the setting of malignant disease. A patient who had SVCS as a result of a painless aortic dissection is presented and compared with other previously reported cases of simultaneous SVCS and aortic dissection.
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Although patient comfort is a frequent rationale for antipyretic therapy, there have been few systematic studies of relationships between temperature and comfort. In this study, adult outpatients with febrile illnesses were asked to complete a symptom diary at multiple time points at which temperature was recorded. Temperature readings showed modest correlation (0.316) with scores of "feeling better or worse" and moderate correlation (0.586) with aggregate symptom scores. ⋯ Direction of temperature change was not significantly associated with overall subjective score of "feeling better or worse" although aggregate symptom scores were slightly higher with rising than falling temperature. These findings suggest that temperature is a partial determinant of morbidity in minor febrile illnesses but contribution of temperature change to well being may be small. Further study is needed to determine the appropriate priority of temperature reduction in symptomatic therapy.