RESUMEN
Introduction: Cyclic vomiting syndrome (CVS) is an under recognized entity causing significant impact on patient's lifestyle. CVS is characterized by recurrent episodes of abdominal pain, nausea, and vomiting leading to many emergency department presentations prior to diagnosis. Patients often have lengthy delays in starting appropriate therapy leading to significant physical and financial hardship. Most cases of cyclic vomiting syndrome are reversible by managing risk factors and starting on appropriate treatment.Areas covered: This review covers the diagnostic criteria, pathophysiology, risk factors, and treatment for CVS and provides a valuable resource for clinicians to review and help with managing this challenging syndrome. The latest literature regarding the diagnosis and management of CVS is summarized.Expert Opinion: The direction for future research in CVS and insights to managing CVS are summarized. The role of pain that can be frequently controlled by tricyclic antidepressants and lorazepam suggests a central nervous system (CNS) origin. A standardized treatment regimen for CVS must be implemented as patients do respond to current therapies but there is often a significant delay in initiation of treatment. Reviewed recent data looking at MRI brain changes in patients with CVS that may lead to a better understanding of the pathophysiology of this disease.
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Motilidad Gastrointestinal , Tracto Gastrointestinal/fisiopatología , Periodicidad , Vómitos/terapia , Diagnóstico Diferencial , Humanos , Valor Predictivo de las Pruebas , Pronóstico , Factores de Riesgo , Factores de Tiempo , Vómitos/diagnóstico , Vómitos/fisiopatologíaRESUMEN
OBJECTIVES: Treatment with ipilimumab, a cytotoxic T lymphocyte antigen-4 approved for metastatic melanoma can result in clinically significant immune-mediated drug injury in the form of colitis. Timely diagnosis and response are essential for optimal management. The aims of our study were to determine the percentage of our patients with ipilimumab-associated colitis in which the colitis could be diagnosed by flexible sigmoidoscopy only and to describe the variations in endoscopic and histologic findings as well as the patients' clinical courses. METHODS: We retrospectively reviewed 244 patients with metastatic melanoma, treated them with ipilimumab, and characterized the endoscopic and histologic features for those who developed colitis. RESULTS: Of the 68 patients who presented with diarrhea, 33 were diagnosed as having ipilimumab-associated colitis. Endoscopically, all of them had involvement of the left side of the colon; none of the patients were noted to have isolated right colon involvement. CONCLUSIONS: Ipilimumab-associated colitis can be diagnosed with a flexible sigmoidoscopy alone, obviating the need for full colonoscopy.
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Antineoplásicos Inmunológicos/efectos adversos , Colitis/diagnóstico , Colon Sigmoide/patología , Ipilimumab/efectos adversos , Melanoma/tratamiento farmacológico , Sigmoidoscopía/métodos , Colitis/inducido químicamente , Colitis/patología , Colonoscopía/métodos , Diarrea/inducido químicamente , Femenino , Humanos , Masculino , Melanoma/secundario , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
The experience of foraging under natural conditions increases the volume of mushroom body neuropil in worker honey bees. A comparable increase in neuropil volume results from treatment of worker honey bees with pilocarpine, an agonist for muscarinic-type cholinergic receptors. A component of the neuropil growth induced by foraging experience is growth of dendrites in the collar region of the calyces. We show here, via analysis of Golgi-impregnated collar Kenyon cells with wedge arborizations, that significant increases in standard measures of dendritic complexity were also found in worker honey bees treated with pilocarpine. This result suggests that signaling via muscarinic-type receptors promotes the increase in Kenyon cell dendritic complexity associated with foraging. Treatment of worker honey bees with scopolamine, a muscarinic inhibitor, inhibited some aspects of dendritic growth. Spine density on the Kenyon cell dendrites varied with sampling location, with the distal portion of the dendritic field having greater total spine density than either the proximal or medial section. This observation may be functionally significant because of the stratified organization of projections from visual centers to the dendritic arborizations of the collar Kenyon cells. Pilocarpine treatment had no effect on the distribution of spines on dendrites of the collar Kenyon cells.