Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

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

Medical methods of 2nd trimester abortion are reviewed from recent large studies comparing intramuscular and vaginal application of synthetic prostaglandins (PGs) with natural PGE2 and PGF2alpha, and standard hypertonic saline. The available synthetic PGs for abortion are Sulprostone (Schering) and Carboprost (Upjohn), both PGF analogs for intramuscular injection and Gemeprost (May & Baker, Dagenham, UK) a PGE analog for intravaginal use. Beside these 9-deoxo-16, 16-dimethyl-9-methylene PGE2 and 15(S)-15-methyl-PGF2alpha methyl ester have been evaluated in clinical trials. Best results were obtained in women receiving intramuscular PG analogs by priming the cervix the laminaria tents. All 3 commercially available PGs are more effective than their parent PGs and saline in terms of success rates, 95% or more vs. 85 and 80%. While the abortion interval was 18-20 hours with intraamniotic PGF2alpha, it was about 23 hours with the intramuscular PG analogs, but only 19.3 hours with vaginal Gemeprost. Side effects of vomiting and diarrhea tended to be lower with the PGE analog Gemeprost. Gemeprost was highly acceptable for patients and staff because of the simplicity of administration of the vaginal gel, and also because it caused much less cramping, judging by half as many analgesic injections. The PGE analog in gel form also permits a much lower dose and allows administration by non-physicians, and reduces risk of complications resulting from invasive administration routes. A preliminary study suggests that pretreatment with RU-486 in early 2nd trimester facilitates termination by intraamniotic PGE2.
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PMID:Non-invasive methods for termination of second trimester pregnancy. 222 4

Blood levels of the placental protein PP12, a protein secreted in response to progesterone, were determined in 10 women having 1st trimester abortions by RU-38486 and prostaglandin. The women were all 9 weeks pregnant, and received 600 mg RU-38486 orally at 10.30 hr, followed 48 hours later by a vaginal suppository containing 1 mg 16,16- dimethyl-trans-2-PGE1 (Gemeprost, May and Baker). They were followed by ultrasound and blood was sampled hourly after RU-38486, and 2-hourly after PG. The protein PP12, assayed by radioimmunoassay, fell significantly over 4 hours after RU-38486 (p0.05), they rose to levels higher than seen initially, and fell somewhat over the 4 hours after PG administration (n.s.). All women aborted completely 2-4 hours after PG. They experienced various side effects such as moderate vaginal bleeding (2), nausea (8), vomiting (3), cramping (10) requiring analgesia (5). This study confirms that PP12 is dependent on progesterone, shows that RU-38486 directly affects the decidua, and constitutes the 1st demonstration of an anti-progesterone effect in women.
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PMID:Circulating levels of placental protein 12 and chorionic gonadotrophin following RU 38486 and gemeprost for termination of first trimester pregnancy. 271 11

Gemeprost (16,16-dimethyl-trans-delta2 Prostaglandin E1-methyl ester) is a synthetic analogue of Prostaglandin E. It is used to induce midtrimester abortion. 40 women, with diagnoses of fetal abnormality or fetal death in utero, were given a 1 mg Gemeprost pessary in the posterior vaginal fornix. After resting for 30 minutes, the patients were free to move around. The treatment was repeated every 3 hours, until either the products of conception were expelled or 5 pessaries had been inserted. If delivery did not occur within 12 hours, oxytocin infusion was commenced. 42% of the patients delivered with Gemeprost alone, and only 17.5% required surgery. Side effects were few and included incomplete abortion, fever, vomiting, diarrhea, and bleeding. Gemeprost is considered safer and simpler than its alternative, extraamniotic infusion of Prostaglandin F2 alpha.
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PMID:Vaginally administered 16,16-dimethyl-PGE1-methyl ester (Gemeprost) to induce termination of pregnancy after the first trimester. 323 78

The results of the cervical priming with a Dinoprost-containing gel and a Gemeprost-containing vaginal suppository were compared in 68 patients, who required termination of pregnancy beyond 14 weeks because of a severe maternal disease or a fetal abnormality. The priming consisted of either an intracervical application of Dinoprost (500 micrograms) in a tylose-gel in 6-8 hour intervals or a retrocervical application of Gemeprost (1 mg) as a vaginal suppository in 12 hour intervals. Although no significant parameter variances were found in the selected patient groups, abortion was induced in 75% of cases within 24 hours, in 89% within 36 hours using Gemeprost. Mean induction time for Gemeprost was 19.5 hours. Using Dinoprost only 19% of patients had an abortion within 24 hours (44% within 36 hours, respectively), mean induction time was significantly longer (38.8 hours, p < 0.005). These differences remained unchanged, when patients who had a prior caesarean section were not evaluated. Using Gemeprost the additional systemic administration of Sulprost was necessary in 21% of cases, using Dinoprost, in 50% of cases. Severe complications did not occur and minor side effects such as nausea or vomiting were observed in single cases. These results demonstrate that Gemeprost can be used in cervical priming even after 14 weeks of pregnancy and that the longer application interval of 12 hours results in a reduction of side effects without a decrease in efficacy.
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PMID:[Comparison of dinoprostone gel and gemeprost suppositories for induction of abortion in the second and third trimester]. 779 69

Gemeprost (Cervagem), a synthetic PGE1 prostaglandin analogue was used to induce labour in 20 patients with second trimester intra uterine fetal death. The mean induction abortion interval was 13.8 hours; 17 of the 20 patients delivered within 24 hours. In 17 cases the placenta was retained and the uterus was evacuated under general anaesthesia. Nausea was noted in five (25%) patients, vomiting in two (10%) and diarrhoea in three (15%). No serious side-effects were encountered.
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PMID:Gemeprost in the management of second trimester intrauterine fetal death. 819 55

Vaginal pessaries, up to a maximum of 5, each containing 1 mg of 16,16-dimethyl-trans-delta squared-prostaglandin E1, ester (Gemeprost) were inserted as high as possible into the posterior fornix of the vagina at 3 hourly intervals in 459 women with abnormal intrauterine pregnancies presenting for termination of the pregnancy. There were 145 missed abortions (31.6%), 207 intrauterine fetal deaths (45.1%), 86 molar pregnancies (18.7%), 5 anencephalics (1.1%), and 16 others (3.5%). The study was conducted from July 1981-March 1982. 402 women (87.6%) underwent abortion within the 30 hour observation period, including 139 women (30.3%) who required additional procedures to complete evacuation of the uterus. Expulsion of the uterine contents failed to occur within 30 hours in 57 women (12.4%) and alternative procedures were employed. These failures consisted of 37 missed abortions, 17 intrauterine fetal deaths, 2 molar pregnancies, and 1 pregnancy with an IUD in situ. Side effects caused by the drug were basically tolerable. 234 women (51.0%) had 1 or more side effects, gastrointestinal tract disturbances (nausea, vomiting, and diarrhea) being the most frequently observed, and moderate fever the next most frequent. There was 1 ruptured uterus.
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PMID:Evaluation of gemeprost vaginal pessaries in the termination of abnormal intra-uterine pregnancies at twelve teaching hospitals in Indonesia. 1234 11