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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

Literature data on current methods of induced abortion during the 2nd trimester are reviewed with special emphasis on the use of intraamniotic administration of hypertonic saline solution. A 20% saline is injected during amniocentesis either intra-abdominally or through the vagina; the optimum time period for pregnancy termination is 21-23 weeks of gestation. In the majority of patients, miscarriage occurs within 24-36 hours. The incidence of complications after administration of 20% saline ranges from 1.7-2.18%. Complications include hypernatremia, hemolysis, anuria, coma, seizures, incomplete abortion, hemorrhage, and inflammatory pelvic disease. Contraindications for pregnancy termination using hypertonic saline include cardiovascular diseases, central nervous system diseases, kidney diseases, late pregnancy toxemias, presence of postoperative cicatrix on the uterus, and placenta previa. The mechanism of abortifacient action of hypertonic saline may be associated with stimulation of the synthesis of endogenous prostaglandins (PG). The findings that PG can stimulate uterine contractions prompted clinical trials of PG as abortifacient agents. Longterm iv administration of PGF2 alpha and PGE during 2nd trimester was found to be associated with serious complications (nausea, vomiting, diarrhea, phlebitis at the site of vein puncture). For this reason, the method of iv administration of PG was abandoned. Intra-amniotic administration of PGF2 alpha (40-50 mg) was shown to induce abortion in 82-91% of the patients within 48 hours after injection. The incidence of hemorrhage and rupture of the cervix uteri after PG administration was significantly greater than that after saline injection. The intramuscular and vaginal administration of synthetic PG alone or in combination with Laminaria was shown to provide the most effective and safe method of induced abortion during the 2nd trimester.
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PMID:[Artificial termination of pregnancy in late periods]. 332 84

Synthetic analogues of prostaglandins (PGs) E and F are now being used widely to induce abortion at any point in pregnancy without surgical intervention. This study compared the abortifacient effect of PGE and PGF given intramuscularly, intravaginally, and with and without laminaria dilatation in 72 1st-trimester abortion patients. Pregnancy was terminated in 40 women through use of a single suppository containing 3 mg of 15-me-PGF2 beta: complete abortion occurred in 18 of the 20 pregnancies at 6-7 weeks gestation but in only 5 of the 20 pregnancies 10-12 weeks gestation. An additional 32 pregnancies at 6-7 weeks gestation were aborted through vaginal suppositories containing 1 mg of 16.16 dimethyltrans-delta 2-PGE1 methyl ether (ONO-802); complete abortion occurred in 24 of these women, within an average of 5-10 hours. Although suppositories containing 15-me-PGF2 beta were more effective than those with ONO-802, the number of side effects experienced was considerably lower with PGE2. Abortion, whether complete or incomplete, was associated in both groups with full cervical dilatation--a factor of significance in the prevention of future is thmicocervical insufficiency. Pregnancy was also terminated in 47 2nd-trimester patients given either intramuscular PGE2 methyl sulfonylamide or intramuscular 15-m3-PGF2 alpha. The abortion time was an average of 14.3 hours with PGE2 and 4.3 hours with PGF2 alpha; patients in both groups experienced severe low back pain of 25-30 seconds' duration. Complete abortion occurred in 3/4 of the PGF2 alpha women and 1/2 of the women receiving PGE2. Complete abortion was twice as likely in parous women than in primigravidae. The use of PGF2 was associated with no side effects, while PGE2 caused vomiting and diarrhea.
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PMID:Use of different prostaglandin analogues for terminating pregnancy at different terms. 358 56

The termination of early pregnancy (less than 56 days amenorrhoea) has been investigated using 16,16-dimethyl-trans-delta 2-PGE, methyl ester in a controlled release preparation. The onset of crampy abdominal pain was seen after 270 +/- 39 minutes and bleeding occurred after 603 +/- 95 minutes. Two (15%) patients required no pain relief during treatment, however 5 (38%) requested oral analgesia, and in 6 (46%) individuals the pain was severe enough to warrant parenteral opiates. The overall success rate for complete abortion was 85%. No serious adverse effects were seen, but vomiting occurred in 2 (15%) women, and diarrhoea in 3 (23%). Although the use of this prostaglandin analogue in slow release form provides an effective treatment method for early abortion using a reduced total dose of prostaglandin, the acceptability of the drug as an agent for menstrual induction continues to be limited by the occurrence of troublesome gastro-intestinal side effects.
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PMID:A controlled release form of 16,16-dimethyl-trans-delta 2-PGE, methyl ester for early abortion. 369 93

1. The effect of prostaglandin E(1) (PGE(1)) on gastric secretion was studied in dogs equipped with gastric fundic pouches, either innervated (Pavlov) or denervated (Heidenhain).2. PGE(1) inhibited gastric secretion (volume, acid concentration, acid output, pepsin output) when given either by constant intravenous infusion or by single intravenous injection. The degree of inhibition was dose dependent.3. The antisecretory effect of PGE(1) was demonstrated against gastric stimulants which operate through different mechanisms. Thus, PGE(1) counteracted the secretogogue effect of:(a) histamine dihydrochloride; the ED(50) was 0.5-1.0 mug/kg. min for a submaximal dose, and 1.0-1.5 mug/kg. min for a maximal dose;(b) pentagastrin; the ED(50) was around 0.25 mug/kg. min;(c) food; the ED(50) was 0.5 to 0.75 mug/kg. min;(d) 2-deoxyglucose; the ED(50) was less than 0.1 mug/kg. min.4. Although in some experiments, nausea and vomiting were observed during administration of PGE(1), the antisecretory property of the substance is not related to a vomiting reflex, since(a) an antiemetic, such as atropine, prevented vomiting without interfering with the effect of PGE(1), and(b) profuse vomiting elicited by apomorphine did not reduce gastric secretion stimulated by either histamine or pentagastrin.5. The mechanism by which PGE(1) inhibits gastric secretion is unknown. Studies by others have shown that the compound reduces gastric mucosal blood flow, inhibits acid formation from gastric mucosa when applied in vitro and may change the rate of formation of gastric cyclic AMP. It is likely that PGE(1) interferes with biochemical processes, within parietal and chief cells, which lead to elaboration of gastric juice.6. Unlike most gastric inhibitors, PGE(1) appears to act as a protective shield against most, if not all, gastric stimulants. Since prostaglandins of the E series are naturally occurring substances and are normally present in the stomach, they may play a role in the regulation of gastric secretion.
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PMID:Inhibition by prostaglandin E 1 of gastric secretion in the dog. 439 9

PGE2 (prostaglandin E2) had been successfully used in initiating labor in term pregnancies (Karim and Sharma, 1971). This study evaluates the safety and efficacy of prostaglandin for induction of labor in 23 patients (gestational length, 38-41 weeks; mean age, 27; age range, 17 to 40; parity 0 to 6). 20 received an oral PGE2 0.5 mg tablet hourly while 3 received an initial dose of 0.5 mg with 0.5 mg incremental increase hourly. 20 patients delivered vaginally liveborn infants without neonatal depression according to Apgar score and subsequent behavior in the nursery. 2 patients delivered by C-section and 1 was excluded from the study because of inadequate duration of treatment. Mean time to delivery was 5 hours, 47 minutes; mean drug dose, 2.53 mg. Mild transient emesis and diarrhea occurred in 2 patients, and emesis only in 1. Bishop induction score did not correlate with total dose of PGE2 used. Parity correlated negatively with dose necessary to achieve delivery (p0.05). The findings confirm the efficacy and safety of oral PGE, which provides an alternate drug and route for induction of labor. Oxytocin induction is briefly compared with prostaglandin induction.
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PMID:Oral prostaglandin E2 for induction of labor. 482 94

The use of prostaglandins E(2) and F(2)alpha, administered by extra-amniotic instillation, for the induction of abortion was studied in 94 patients in the first and second trimesters of pregnancy. Abortion was successfully induced in 87% of patients within 36 hours and in 94% within 48 hours. The mean abortion time was 22.4 hours. In 60% of patients abortion was complete.Though the differences were not statistically significant, on average multigravid patients aborted more quickly than primigravidae, while the mean abortion time in PGE(2)-treated patients was less than in those receiving PGF(2)alpha.No serious complications occurred. Some side effects were observed. Occasional vomiting was the commonest symptom but the incidence of side effects was lower than with alternative routes of administration. A leucocytosis was often noted but there were no significant instances of infection.The method has proved a safe and effective means of terminating pregnancies in the second trimester.
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PMID:Induction of abortion by extra-amniotic administration of prostaglandins E2 and F2-alpha. 503 77

This in vitro study examines the possibility that the E prostaglandins (PGEs) supplement the action of syntocinon on human muscle strips. 11 strips of upper segment myometrium removed from 10 pregnant patients (17-40 weeks gestation) for various reasons were analyzed. The human myometrium at term responded to a minimum concentration of 0.01-0.05 mcg syntocinon and 1-5 ng PGE1 or PGE2 in the 5 ml bath, while the midtrimester myometrium responded to 0.2-1 mcg syntocinon and 2-20 ng PGE1 or PGE2. These results show a 20 times increase in myometrial sensitivity to syntocinon and a 2-4 fold increase in sensitively to PGE1 or PGE2 at term as compared to the midtrimester. A syntocinon dose given immediately following a dose of PGE exhibited a response greater than that elicited by the same dose of syntocinon prior to the PG; this sensitizing effect of PG was observed in both term and midtrimester myometrium. The enhancement effect was observed in the increased duration of syntocinon response or as an increase in amplitude of response or a combination of these, the effect lasting for as long as 90 minutes after the PGE dose had been washed out of the bath. These findings led to the hypothesis that during the parturition process, endogenous PGs act as mediators which sensitize the uterine muscle to circulating oxytocin. The physiological implication of this enhancement effect is that undesirable side effects (vomiting, diarrhea) associated with PG infusion may be reduced or even eliminated when the PG-syntocinon method is used.
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PMID:Interaction of E prostaglandins and syntocinon on the pregnant human myometrium. 555 14

A multicentre, randomized, comparative clinical trial of 200 mg RU486 (Mifepristone) followed 48 h later by either 5 mg 9-methylene PGE(2) vaginal gel (meteneprost) or 600 microg oral PGE(1) (misoprostol) for termination of pregnancy within 28 days of the missed period, was carried out through the Indian Council of Medical Research's (ICMR) network of Human Reproduction Research Centres (HRRCs). A total of 893 subjects were assessed regarding their therapeutic responses to the two different treatment groups. The results indicated a success rate of 84.6% among 453 women treated with RU486 followed by 9 methylene PGE(2) vaginal gel, that was not significantly different from the success rate of 87.7% observed in 440 women treated with RU486 followed by oral PGE(1). The majority of study subjects (90%) started bleeding within 72 h. About 26% of the subjects had started bleeding before the administration of any prostaglandin. The average duration of bleeding in all the subjects was about 7 days. No life threatening side effects were observed among the subjects in two treatment groups. Gastro-intestinal complaints were reported more often by women treated with oral PGE(1) as compared to those treated with 9-methylene vaginal PGE(2) gel; nausea occurred in 25.7% and 19.2%, vomiting in 6.8% and 4.6%, and diarrhoea in 4.8% and 0.9% of the subjects in the 2 treatment groups, respectively. Fever higher than 38 degrees C and severe abdominal pain were reported by 4.2% and 5.0% of all subjects treated, respectively. Intravenous infusion of glucose and saline was required by 6 subjects in each treatment of the prostaglandin treated groups. Blood transfusion was required in 2 subjects, one in each treatment group, for profuse bleeding.
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PMID:A multicentre randomized comparative clinical trial of 200 mg RU486 (mifepristone) single dose followed by either 5 mg 9-methylene PGE(2) gel (meteneprost) or 600 microg oral PGE(1) (misoprostol) for termination of early pregnancy within 28 days of missed menstrual period. ICMR Task Force Study. Indian Council of Medical Research. 1112 59

A neonate presenting to the emergency department can present a challenge to even the most experienced clinician. This article has focused on four deceiving and potentially devastating neonatal diseases. 1. Neonatal herpes is a potentially devastating illness without pathognomonic signs or symptoms. Early recognition and therapy can reduce mortality markedly. Although no specific sign or symptom is diagnostic,the diagnosis should be strongly considered in the presence of HSV risk factors, atypical sepsis, unexplained acute hepatitis, or focal seizure activity. Acyclovir therapy should be initiated before viral dissemination or significant CNS replication occurs. 2. Pertussis is a disease in which infants are at greatest risk of death or severe complication. Neonatal pertussis often presents in an atypical manner, lacking the classic signs and symptoms such as the "whoop."More common signs and symptoms include cough, feeding difficulty,low-grade fever, emesis, increasing respiratory distress, apnea, cyanosis,and seizures. Management should include hospitalization, supportive care, and antibiotics. 3. Congenital heart defects, particularly ductal-dependent lesions, may have an initial asymptomatic period that culminates in a rapidly progressive and fatal course. A neonate with CHD presents with shock refractory to volume resuscitation or pressor support. Resuscitative efforts are ineffective unless PGE, is administered. 4. Inborn errors of metabolism often are unsuspected because of their protean and heterogeneous nature. Signs and symptoms are subtle,are nonspecific, and often mimic other, more common diseases.An elevated index of suspicion, along with application and correct interpretation of a select few laboratory tests, is the key to making a diagnosis. Therapy is relatively straightforward and focused on resuscitation followed by prevention of catabolism and correction of specifically identified abnormalities. Although these disorders are relatively uncommon, prompt diagnosis and therapy can lead to a decrease in morbidity and mortality. The key is to maintain a high index of suspicion.
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PMID:Unsuspected neonatal killers in emergency medicine. 1547 77


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