IUD appendicitis

A case of uterine perforation by an IUD with acute and chronic irritation of the appendix is presented. The patient, a 30-year old gravida 4, para 4, was admitted to the hospital with severe abdominal pain, fever, and diarrhea. A Lippes loop IUD had been inserted 3 years previously. The device could not be visualized at laparoscopy. At laparotomy the IUD was palpable within a large inflammatory mass in the right lower abdomen . Dissection of the adhesions revealed the IUD twisted around the appendix, and appendectomy was performed. This is the 1st reported case of a perforated, nonmedicated IUD causing appendicitis. The 2 cases of IUD appendicitis previously described in the literature involved Copper-7 devices, which have been shown to cause considerable tissue response when placed in the peritoneal cavity. Abdominal signs and symptoms associated with a missing IUD string should alert physicians to the possibility of IUD appendicitis.     

Mifepristone and misoprostol versus Dilapan and sulprostone for second trimester termination of pregnancy

Objective. To compare two methods for second trimester termination of pregnancy: mifepristone and misoprostol versus Dilapan® and sulprostone.

Methods. This was a randomized study involving 16 patients with a singleton live fetus with congenital malformations or genetic disorders. Eight patients were treated with 200 mg mifepristone orally followed by 200 μg misoprostol vaginally 3 hourly and eight patients received a sulprostone infusion after cervical dilatation with Dilapan.

Results. Mifepristone and misoprostol had a mean induction interval of 17.8 hours and sulprostone and Dilapan 20.9 hours. The mean induction interval did not differ significantly. Mean hospital stay was shorter in the patients treated with misoprostol: 2.1 vs. 3.3 days (p = 0.02) with a 95% confidence interval of ?2.1 to 0.3.

Conclusion. Mifepristone and misoprostol did not reduce the induction interval significantly compared to the sulprostone and Dilapan treatment for second trimester pregnancy termination. Hospital admission was significantly shorter in patients treated with mifepristone and misoprostol.     

Prostaglandins inhibit secretion of histamine and pancreastatin from isolated rat stomach ECL cells

1. The present study examines the effect of naturally occurring prostanoids and prostaglandin (PG) congeners on gastrin- and pituitary adenylate cyclase-activating peptide (PACAP)-evoked histamine and pancreastatin secretion from isolated rat stomach ECL cells.
2. ECL cells (75–85% purity) were isolated from rat stomach using pronase digestion followed by repeated counter-flow elutriation and cultured for 48 h before secretion experiments. The release of histamine and pancreastatin was determined by radioimmunoassay.
3. None of the PGs tested stimulated the release of either histamine or pancreastatin.
4. PGE₁ and PGE₂ inhibited both gastrin- and PACAP-evoked histamine and pancreastatin secretion (IC₅₀=1–2×10⁻¹⁰ M). Most other naturally occuring prostanoids and PG congeners had no or little inhibitory effect. The PGE analogues misoprostol and sulprostone were more potent (IC₅₀=0.9×10⁻¹¹ M and 2×10⁻¹¹ M respectively) than PGE₁ and PGE₂. The rank order of potency was misoprostol>sulprostone>PGE₁=PGE₂, suggesting the involvement of the so-called EP₃ receptor.
5. The effects of PGs on the stomach ECL cells may be direct or indirect, for instance through the stimulated release of somatostatin from contaminating D cells (2–3%). However, the amount of somatostatin in the cell culture after 48 h was below the limit of detection, and somatostatin immunoneutralization did not prevent misoprostol from inhibiting secretion from the ECL cells.
6. The misoprostol-induced inhibition was reversed by pertussis toxin suggesting the involvement of G-protein subunits Gα₀ and/or Gα_i.
7. In view of the potency by which PGE₁, PGE₂, misoprostol and sulprostone inhibited the stimulated release of histamine and pancreastatin, we suggest that the ECL cells represent a primary target for prostaglandins acting via an EP₃ receptor in the oxyntic mucosa.
8. The results suggest that the clinically useful effect of misoprostol as an anti-ulcer drug reflects its ability to inhibit stomach ECL-cell histamine secretion.

     

硫前列酮治疗产后宫缩乏力出血

本文应用硫前列酮治疗产后宫缩乏力性出血20例,出血总量600-2060 mL不等,经按摩子宫,压迫止血及应用缩宫素40-70U后仍不能制止出血时采用本药。用药量0.5-mg不等。根据评价标准结果:优良6例,好7例,中等7例。20例全部有效,均免除切除子宫,保留了生育功能。     

Assessment of the predictive value of X-ray pelvimetry and biparietal diameter in cephalopelvic disproportion

13 ,14 -Dihydro-15-keto-PGF2 alpha (PGFM) serum levels were determined by radioimmunoassay in 101 postpartum women who were treated with 200 micrograms methergin, 5 I.U. oxytocin and 500 micrograms sulprostone, respectively, 30 min after expulsion of placenta. All patients had normal deliveries. The present radioimmunoassay system did not show cross-reactivity with sulprostone. In addition, radioimmunoassayable sulprostone serum levels were monitored. Covariance analysis of area under PGFM serum levels between time zero and 180 min after application of oxytocics was performed. A higher but statistically not significantly PGFM serum level was maintained in subjects treated with sulprostone. Sulprostone serum levels are rapidly attained after application. Decrease of radioimmunoassayable sulprostone indicates a half-life of 75 min. These data corroborate clinical findings of an accompanying paper and combine to suggest that sulprostone may be a useful alternative therapy in high-risk patients with severe postpartum atony and hemorrhage in whom prior preventive measures have failed.     

Stimulation of PGE receptors EP2 and EP4 protects cultured neurons against oxidative stress and cell death following beta-amyloid exposure

Alzheimer's disease (AD) is associated with gliosis, neuroinflammation and higher levels of prostaglandins. Conflicting roles for cyclooxygenases and prostaglandins in the etiopathology of AD have been reported. We hypothesized that PGE2 signaling through EP2 and EP4 G-protein-coupled receptors could protect against amyloid beta-peptide (Abeta) neurotoxicity by increasing the cAMP signaling cascade. Using primary neuronal cultures, we investigated the presence of EP receptors (EP1-4) and the action of PGE2 and EP receptor agonists on neuronal susceptibility to Abeta1-42 toxicity. Low concentrations (1 microm) of PGE2, butaprost (EP2 agonist), and 1-hydroxy-PGE1 (EP4/EP3 agonist) were neuroprotective against Abeta1-42 toxicity, while sulprostone (EP3/EP1 agonist) at similar doses had no detectable effects. EP2 and EP4 receptor-mediated neuroprotection would involve changes in cAMP levels, as both EP2 and EP4 agonists increased intracellular cAMP concentration by approximately doubling basal levels, and both exhibited neuroprotective actions against Abeta-induced toxicity. The protein kinase A (PKA) inhibitor RpcAMPS significantly attenuated the neuroprotection by butaprost, but not that by 1-hydroxy-PGE1, implying differences between EP2 and EP4 receptor protective mechanisms. Additionally, the increase in reactive oxygen species generated following exposure to Abeta was reduced by stimulation of both EP2 and EP4 receptors. Together, these results indicate that PGE2 can protect neurons against Abeta toxicity by acting on given receptors and stimulating a cascade of intracellular events, including the cAMP-PKA pathway. We propose that development and testing of specific PGE2 receptor agonists downstream of cyclooxygenase could lead to therapeutic applications.     

PROSTANOID ACTION ON THE HUMAN PULMONARY VASCULAR SYSTEM

1. Four types of prostanoid receptor are present on pulmonary arterial vessels of man. Thromboxane (TP) receptors mediate constriction and are blocked by antagonists such as BAY u-3405, GR 32191 and EP169. Prostaglandin (PG) EP₃ receptors also mediate constriction, the agonist potency ranking being SC 46275 > sulprostone > misoprostol≥PGE₂; this action needs to be borne in mind when PGE analogues are used therapeutically. 2. Prostaglandi. E₂ causes relaxation in a few pulmonary artery preparations: an EP₂ receptor may be involved. Prostacyclin, acting through IP receptors, consistently produces relaxation and studies are in progress to determine the contribution made by K⁺-channel opening. Agonist potencies of stable prostacyclin analogues and non-prostanoid prostacyclin mimetics, such as BMY 45778 and the novel diphenylindole CU 23, on human pulmonary artery and platelets are well correlated. Interestingly, the non-prostanoid mimetics show persistent relaxant effects in vitro, which may be related to their high lipophilicities. 3. Prostacyclin and iloprost are being used to treat severe pulmonary hypertension; further study of the pharmacodynamic and pharmacokinetic properties of other IP receptor agonists could produce improve. therapy.     

磺前列酮的药效学研究

证明磺前列酮能有效地终止小鼠、大鼠及田鼠的早期妊娠,并对大鼠离体子宫有明显收缩作用;其抗早孕效率明显高于同类物PGE_2的终止妊娠作用。在一定剂量下磺前列酮对大鼠的行为及狗的呼吸、血压、心率和心电图无明显作用,但大剂量对心血管系统有一定影响。     

RU486合并前列腺素终止早孕的效果及对性激素影响的研究

4O例早孕妇女,停经49天以内,给予RU 486合并前列腺素(Sulprostone)终止早孕。对象随机分为两组(每组20例)。组Ⅰ,口服RU 486 25mg2次/日×4天,在第四天上午肌注Sulprostone 0.25mg;组Ⅱ,RU 486 25mg2次/日×3天,在第三天上午肌注Sulprostone 0.25mg。对象必须从服药的第一天起连续四天(组Ⅱ三天)上午来门诊,此外第8、15及43天亦须来门诊,接受访视及取血,用以测定B-hCG、E_2、P、PRL及Cortisol等。检测结果,血清B-hCG及E_2水平在服药期间继续上升,但流产后迅即下降;PRL及Cortisol在服药期间及服药后,血清水平上下波动不大;P在服药期间水平未见上升,但流产后迅即下降。40例对象,不论服药三天或四天,均发生完全流产,无一例需要刮宫或输血。     

Termination of early human pregnancy with RU 486 (mifepristone) and the prostaglandin analogue sulprostone: a multi-centre, randomized comparison between two treatment regimens

A multi-centre, randomized trial was conducted to compare theefficacy and side-effects of two combination regimens of theantiprogestin RU 486 and the intramuscular PGE2 analogue sulprostonefor termination of early pregnancy (amenorrhoea up to 49 days).Women in the 3-day group (n = 125) received 25 mg RU 486 twicedaily for 3 days plus a single injection of 0.25 mg sulprostonein the morning of the third day of antiprogestin treatment.In the 4-day group (n = 126), RU 486 was given for 4 days andthe sulprostone injection in the morning of the fourth day.Treatment outcome in the two groups was similar. Overall, 88.8%had a complete abortion, 6.8% an incomplete abortion and 2.4%were treatment failures; in the remaining 2% treatment outcomecould not be determined. Only three of the six women with treatmentfailure still had detectable fetal heart activity when the pregnancywas terminated by vacuum aspiration two weeks after the startof treatment. Five of the 17 interventions for incomplete abortionwere carried out as emergency procedures because of heavy bleeding;two of these five women were given a blood transfusion. Themajority of the curettages (10/17) were performed in one centre.If the data from this centre and the women with undeterminedtreatment outcome were excluded, the rates for complete abortion,incomplete abortion and treatment failure in the remaining sixcentres were 93.6, 3.7 and 2.7%, respectively. Neither of thetwo treatment regimens caused any significant side-effects exceptfor lower abdominal pain which was reported by 88.5% of thewomen following sulprostone injection and led to the use ofnarcotic analgesics in 7.6% of the subjects. Use of analgesiavaried markedly between centres, however. Treatment was morelikely to fail in subjects who were heavier and in those witha larger amniotic sac or higher levels of /3-HCG and progesteroneprior to therapy.