Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0012833 (dizziness)
 9,689 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The study objective was to evaluate the safety and efficacy of a single 16, 16-dimethyl prostaglandin E2 (PGE2) vaginal suppository for achieving nonmechanical dilation when administered 12 hours prior to a 1st trimester suction curettage. 20 women between 7 and 12 weeks gestation who wanted an abortion volunteered to be the study subjects. 4 women were primigravidas and 16 were multiparous. All the women had normal medical histories and clinical examinations. Cervical dilatation, if any, was measured with Hegar dilators and recorded in millimeters. The serum concentration of prostaglandin reached its highest levels 4 hours following the insertion of the vaginal suppository. A higher level between 2 and 4 hours cannot be ruled out. Serum progesterone levels showed a slight decrease in 3 patients and no significant change in the other 4 patients. Cramping was noted in 17 of 20 patients. Its onset occurred between 1 hour and 8 hours post insertion. Vaginal bleeding occurred in 19 patients 1-12.5 hours. All patients were found to have a significant degree of cervical softening and cervical dilation when examined at 12 hours following the insertion of the suppository. 16 patients (80%) did not require any further medical dilation. The additional amount of cervical dilation for the 4 remaining patients ranged from 1 mm to 3 mm and was greatly facilitated by a softened cervix. 2 of these 4 women were primigravidas. 10 patients passed "tissue" per vagina during the observation period, prior to the termination procedure. Chorionic villi was confirmed by histologic examination in only 3 instances. The systemic absorption of the paracervical anesthetic was apparently increased since the initial group of patients complained of dizziness, numbness of tongue, and/or bitter taste in mouth. Study results indicate that a single 16, 16-dimethyl PGE2 vaginal suppository can "prime" the cervix so the further mechanical dilation was easily accomplished and in most cases (80%) was completely eliminated.
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PMID:Intravaginal administration of 9-deoxo-9-methylene-16,16-dimethyl PGE2 for cervical dilation prior to suction curettage. 612 34

Progesterone is the natural progestagen produced by the corpus luteum during the luteal phase. It is absorbed when administered orally, but is greater than 90% metabolized during the first hepatic pass. This greatly limits the efficacy of once-daily administration and also results in unphysiologically high levels of progesterone metabolites, particularly those reduced at the 5-a position. These metabolites can cause dizziness and drowsiness to the point of preventing the operation of a motor vehicle. Synthetic progestins, such as medroxyprogesterone acetate and norethindrone acetate (NETA), have been specifically designed to resist enzymatic degradation and remain active after oral administration. However, these compounds exert undesirable effects on the liver and often cause severe psychological side effects. The permeability of the skin does not allow for administration of progesterone in the quantities normally produced by the corpus luteum, i.e., up to 25 mg/day during the mid-luteal phase. To avoid this problem, synthetic progestins such as NETA have been administered transdermally. These compounds, though, just like synthetic estrogens administered non-orally, retain undesirable hepatic effects even when administered transdermally. Transvaginal administration of progesterone is a practical non-oral route available for administering progesterone. Early experience was gained with vaginal suppositories, which lack manufacturing controls. Recently, a new progesterone gel formulation has been designed for vaginal use. The clinical acceptability of this product has been enhanced by the bioadhesive characteristics of its polycarbophil-based gel, which conveys controlled and sustained-released properties. Investigations have shown that because of local direct vagina-to-uterus transport, which results in a preferential uterine uptake of progesterone, this formulation given in conjunction with physiological amounts of estradiol produces endometrial changes similar to those seen in the luteal phase, despite plasma progesterone levels that remain subphysiologic. Studies in infertility show that vaginal progesterone in this form allows secretory transformation of the endometrium and the development of pregnancy despite providing low systemic progesterone concentrations. Fewer side effects occur when used for hormone replacement than typically encountered with progestins and oral progesterone. Uses in patients with infertility and hypoestrogenism and secondary amenorrhea are reviewed.
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PMID:Uses of progesterone in clinical practice. 1033 67