Paraneoplastic rhombencephalitis and cerebellitis preceded by isolated intractable vomiting

Paraneoplastic cerebellar and brainstem disorders

Paraneoplastic cerebellar and brainstem disorders are a heterogeneous group that requires prompt recognition and treatment to help prevent irreversible neurologic injury. Paraneoplastic cerebellar degeneration is best characterized by Yo antibodies in patients with breast or ovarian cancer. Tr (DNER) antibodies in patients with Hodgkin lymphoma can also present with a pure cerebellar syndrome and is one of the few paraneoplastic syndromes found with hematological malignancy. Opsoclonus-myoclonus-ataxia syndrome presents in both pediatric and adult patients with characteristic clinical findings. Other paraneoplastic brainstem syndromes are associated with Ma2 and Hu antibodies, which can cause widespread neurologic dysfunction. The differential for these disorders is broad and also includes pharmacological side effects, infection or postinfectious processes, and neurodegenerative diseases. Although these immune-mediated disorders have been known for many years, mechanisms of pathogenesis are still unclear, and optimal treatment has not been established.

Construction and effectiveness of vomit-free ward

Objective

To build a vomit-free ward of scientific and standardized management mode, and to evaluate its clinical effects on preventing nausea and vomiting in patients undergoing chemotherapy.

Methods

A total of 200 patients suffering from nausea and vomiting were randomly selected from the registration system, from which 120 cases were enrolled according to the inclusion and exclusion criteria. These subjects were divided into control group and observation group (60 patients in each). Both of the two groups received routine nursing care, while the treatment group subjects lived in the vomit-free wards where extra nursing interventions were applied to prevent chemotherapy-induced nausea and vomiting (CINV), with constant observation of the frequency and severity of nausea and vomiting. The outcomes of the subjects from both the groups as well as nurses’ cognition level of CINV were compared after four chemotherapy cycles.

Results

The difference in the scoring for the frequency and severity of nausea and vomiting in two groups was statistically significant (P < 0.05). The scores of nurses’ cognition level of CINV were compared between before and after the interventions, and the difference had statistical significance (P < 0.05).

Conclusion

The management mode aiming to build vomit-free wards could decrease the incidence of CINV in patients during chemotherapy, and at the same time increased the cognitive level of nursing staff toward CINV, which is of great value in clinical practice and is worthy of further application.