Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intra-amniotic pressures were measured following 1 mg gemeprost for cervical preparation before first trimester vacuum aspiration (n = 10) and following 2 mg gemeprost before second trimester dilatation and evacuation (n = 15). Twenty-five women, matched for gestational age and parity, who did not receive gemeprost served as controls. Compared to control values (2-8 mmHg), basal intra-amniotic pressure (IAP) was significantly increased after 1 mg and 2 mg of gemeprost (median 20.0, range 4-45 mmHg, median 20.0, range 8-60 mmHg, respectively). Uterine contractions were recorded in 8 of 10 subjects after 1 mg (median delta IAP 28.0, 95% CI 10.0-42.6 mmHg) and 14 of 15 subjects after 2 mg (median delta IAP 52.5, 95% CI 26.7-60.3 mmHg). Gemeprost produces an increase in uterine contractility which may be additional to cervical softening properties and which may be responsible for the adverse effects of pain and bleeding experienced by some women prior to termination.
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PMID:Intra-amniotic pressures following vaginal gemeprost prior to first and second trimester termination of pregnancy. 142 6

The development of the antiprogestin RU-486, and its current use in France and the UK, potential other application, politics in the US, and future are presented. Ru-486, as commonly known by its company code name, rather than its generic name mifepristone, is an analogue of a progestin used in oral contraceptives, with an added chemical group that allows it to link up with the progesterone receptor, but prevents progesterone's effects. It was approved in France in 1988, and has been used for early abortion up to 7 weeks LMP on 80,000 women. French women, after an initial diagnostic appointment, take 3 200 mg tablets of RU-486, then 36-48 hr later return for a Sulprostone (prostaglandin) injection, and are checked up 4-6 weeks later. About 96% abort completely. Some have nausea, vomiting, or pain. Bleeding averages 9 days, and 1% require treatment for bleeding. 2 cardiovascular events and 1 heart attack have been associated with the prostaglandin, now contraindicated in smokers or women 35. In England, RU-486 abortions began in late 1991, for pregnancies up to 9 weeks, using a gentler prostaglandin, Gemeprost, in a vaginal suppository. Only company-trained doctors may order the drug. Research continues on lower doses of RU-486, other prostaglandins, and effects on the fetus if abortion fails. While there is no known basis for a teratogenic effect of the antiprogestin, strong uterine contractions brought on by prostaglandins, such as misoprostol, as abused for illegal abortion in Latin America, may cause birth defects. RU-486 is expected to be useful for inducing labor, dilating the cervix, emergency contraception, pre-surgical management of Cushing's syndrome, brain cancers with profesterone receptors, among other conditions. Several of the 400 or so antiprogestins known are being tested clinically, notably HRP 2000 by WHO. Political controversy is so intense in the US that Roussel, the maker of RU-486, has no intention of marketing it, and even research supplies are unreliable. Meanwhile, pro-choice groups are innovating ways to test and market antiprogestins legally, perhaps inside state lines. It is expected that a suitable prostaglandin, misoprostol, licensed for peptic ulcer, will be available soon, and even RU-486 will become generic by 1998 when its patent expires.
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PMID:Antiprogestins and the abortion controversy: a progress report. 178 9

A randomized clinical trial has been performed to evaluate the efficacy of intravaginal 1 mg Gemeprost for pre-operative cervical dilatation prior to vacuum aspiration and curettage for endometrial biopsy. Eighty-nine patients were evaluated, 51 treated with Gemeprost and 38 with placebo: in the first group biopsy was possible in 94% of cases vs 86% in the second group. Pain was significantly reduced with Gemeprost improving the success rate and the patient compliance.
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PMID:[The Gemeprost test in the screening of endometrial pathology]. 185 16

Gemeprost vaginal suppositories (16,16-dimethyl-PGE1 methyl ester) were compared with intraamniotic Pgf2alpha in 20% saline after Dilapan tents for termination of 14-16 week pregnancies in 58 women. After randomization there were 44% multigravidae in the Gemeprost group and 58% in the Pgf2alpha-saline-Dilapan group; the Gemeprost group averaged 23.4 years, the Pgf2alpha group 26.2%. Gemeprost 1 mg vaginal pessaries were inserted at 3 hr intervals for a maximum of 5 doses. Pgf2alpha 20 mg in 40 ml 20% NaCl was injected intraamniotically under ultrasonic control immediately after Dilapan was inserted in the cervix. If abortion had not occurred within 24 hours, management by iv oxytocin, iv Pgf2alpha, intraamniotic Pgf2alpha or saline or both was at the physician's discretion, as was post-abortion treatment with oxytocin, ergometric or surgical evacuation of the placenta if not delivered within 2 hours. Successful abortion, defined as induction abortion intervals of 24 hours, occurred in 58% of the Gemeprost group and 90% of the PG-saline group, for mean induction-abortion intervals of 12.6 and 11.7 hours. 6 more Gemeprost patients aborted within 27.8 hours without additional treatment, while the last 2 patients to deliver took 42 and 50 hours, compared to a 32-hour maximum interval for PG-saline patients. Much of the difference in intervals was accounted for by primigravidas, who took 15.84 hours on average with Gemeprost, compared to 13.7 hours with PG-saline. Gastrointestinal side effects were more common in the Gemeprost group: diarrhea in 58% and vomiting in 62%, compared to 7% with diarrhea and 34% with vomiting in the PG-saline group. Retained placenta, hemorrhage 300 ml and pain requiring narcotics were similar in both series. The outcomes in terms of induction-abortion intervals were not significantly different. Gemeprost was considered the agent of choice, since it is not invasive, and avoids the risk of sudden collapse or death, intrauterine infection, saline intoxication or clotting disorders, which occur on rare occasions in Pgf2alpha- or saline-induced midtrimester abortions.
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PMID:Second-trimester termination with 16,16 dimethyl-PGE1-methyl ester (gemeprost), compared with a regimen that included intra-amniotic PGF2 alpha and hypertonic saline. 207 46

This double-blind study is concerned with the efficacy and safety of a new prostaglandin E1-analogue (16,16'-dimethyl-trans-delta 2PGE1-methylester) (Gemeprost) (ONO-802), which was administered as a single 1 mg vaginal pessary three hours prior to legal abortion. The efficacy of the prostaglandin was assessed by the largest size of the dilator meeting no resistance when inserted in the cervical channel. Furthermore, the quality of the cervix and the effort needed for further dilatation was evaluated. The average size of the cervix prior to dilatation was found to be 10 mm, in comparison to only 7 mm in the placebo-group (p less than 0.001). 80% of the patients of the Gemeprost group did not need any further dilatation, i.e. the dilatation procedure of the cervix was easier than in the group without treatment (19%). The incidence of uterine pain was more frequent in the Gemeprost group (40%) than in the Placebo group (7%). Analgesics were not required. The frequency of gastrointestinal side effects was rare in the Gemeprost group (13%) and in the Placebo group (11%) compared with other prostaglandins. By the preoperative application of a new prostaglandin E1-analogue (1 mg) prior to vacuum aspiration in the first trimenon of pregnancy sufficient softening of the cervix and a dilatation of the cervix was achieved. It significantly reduces the need for further mechanical dilatation of the cervix as well as the force needed to perform this dilatation. These effects reduce the trauma associated with mechanical dilatation and therefore diminish the risk of subsequent complications.
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PMID:[Use of a new vaginal suppository: prostaglandin E1 analog Gemeprost for cervix maturation prior to abortion in the 1st trimester]. 389 47

In a double-blind placebo-controlled comparative study, 180 female patients were randomly assigned to groups and treated approximately 3 h before dilatation and curettage with either a single 1 mg vaginal suppository of Gemeprost or a matching placebo. The patient population included premenopausal non-pregnant or postmenopausal patients presenting at four participating centers in West Germany. Patients were monitored from the time of drug administration to approximately 24 h after the operation. A marked response to treatment with Gemeprost was noted at the general cervical assessment performed immediately prior to dilatation. A significant increase in diameter of the cervical canal was observed and subsequent mechanical dilatation was found to be significantly easier as a result of Gemeprost treatment. No differences between the response to treatment in premenopausal and postmenopausal patients were found in our interim analysis of 113 patients. The incidence of preoperative uterine pain increased with time as a result of Gemeprost treatment but it was predominantly mild and no analgesics were required. Gastrointestinal side-effects were rare and well tolerated in both treatment groups. This study indicates that Gemeprost is an effective, well tolerated preoperative cervical dilator/softener in non-pregnant patients.
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PMID:Study of 16,16'-dimethyl-trans-delta 2 prostaglandin E1 methyl ester vaginal suppository for cervical dilatation in premenopausal and postmenopausal women. 391 41

In a prospective, randomised study, 40 primi- and plurigravida were treated either intracervically with 50 micrograms Sulprostone gel or vaginally with a pessary containing 1 mg Gemeprost in order to soften the cervix prior to first trimester termination of pregnancy. Curettage was performed on average 6.0 and 3.2 hours, respectively, after prostaglandin administration. For objective demonstration of the priming effect, the force required for dilatation of the cervical canal was measured in Newton by a special tonometer before prostaglandin treatment and before operation. The free passability of the cervical canal, the maximal dilatability with a force of 10 N and the increase in dilatability after local prostaglandin application were measured. A modified visual analogue scale was used to evaluate the subjective pain experience. During the time between administration and curettage, no abortion occurred in any of the patients. There were no statistically significant differences between both groups regarding the free passability and the maximal dilatability, however, the increase in dilatability was significantly greater in the Gemeprost group. The visual analogue scale allows the patient to quantify, at least to some extent, her experience of pain, but there were no differences in the rate of uterine cramps between both groups; gastrointestinal symptoms did not occur. Both methods were found to be equally efficient; the advantages of Gemeprost are the ease of administration and the short application-curettage interval; however, the cost for one Gemeprost application is nearly 6-fold higher than that of one Sulprostone gel application.
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PMID:[Gemeprost vaginal suppositories versus intracervical sulprostone gel administration for cervic priming in the 1st trimester. A tonometric controlled comparative study]. 818 18