Prostaglandins Health Dictionary

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Prostaglandins: From 1 Different Sources

Those natural substances, so-called because they were ?rst discovered in the SEMEN and thought to arise in the PROSTATE GLAND, are a group of fatty-acid substances with a wide range of activity. The richest known source is semen, but they are also present in many other parts of the body. Their precise mode of action is not yet clear, but they are potent stimulators of muscle contraction and they are also potent VASODILATORS. They cause contraction of the UTERUS and have been used to induce labour (see PREGNANCY AND LABOUR); they are also being used as a means of inducing therapeutic abortions (see ABORTION).

Prostaglandins play an important part in the production of PAIN, and it is now known that ASPIRIN relieves pain by virtue of the fact that it prevents, or antagonises, the formation of certain prostaglandins. In addition, they play some, although as yet incompletely de?ned, part in producing in?ammatory changes. (See INFLAMMATION; NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS).)

Thus prostaglandins have potent biological effects, but their instability and rapid metabolism make them short-acting. They are produced but not stored by most living cells and act locally. The two most important prostaglandins are prostacycline and thromboxane: prostacycline is a vasodilator and an inhibitor of platelet aggregation; thromboxanes have the opposite effects and cause vasoconstriction and platelet aggregation. The NSAIDs act by blocking an ENZYME called cyclo-oxygenase which converts arachidonic acid to the precursors of the various prostaglandins. Despite their potent pharmacological properties, the role of prostaglandins in current therapeutics is limited and controversial. They have been used most successfully as an inhibitor of platelet aggregation in extra-corporeal haemoperfusion systems. The problems with the prostacyclines is that they have to be given intravenously as they are inactive by mouth, and continuous infusion is required because the drug is rapidly eliminated with a half-life of minutes. Side-effects tend to be severe because the drug is usually given at the highest dose the patient can tolerate. The hope for the future lies in the exploitation of the compound to generate, synthetically, stable orally active prostacycline analogues which will inhibit platelet aggregation and hence thrombotic events, and yet have minimal effects on the heart and blood vessels.

Health Source: Medical Dictionary
Author: Health Dictionary

Prostaglandin

One of a group of fatty acids that is made naturally in the body and acts in a similar way to hormones. Prostaglandins cause pain and inflammation in damaged tissue, protect the lining of the stomach and duodenum against ulceration, lower blood pressure, and stimulate contractions in labour.

(See also prostaglandin drugs.)... prostaglandin

Dysmenorrhoea

Painful menstruation – two types – (1) primary or spasmodic (2) secondary – secondary to pelvic disease. Herbal treatment is the same for both types.

The womb goes into spasm with pains as in labour; teenager screams aloud. Causes may be glandular inadequacy, prolapse of the womb, inflammation and congestion of the lining, scars on the cervix, psychological disorders. The most likely cause is hormonal imbalance. Where due to a chill, a hot bath and herbal teas (Agnus Castus, Pennyroyal, or Raspberry leaves) are indicated. Where accompanied by emotional excitability, the addition of Skullcap or Motherwort is beneficial.

Cause of the pain is mostly a high concentration of prostaglandins – chemical hormone-like substances that have an astringent effect upon walls of the womb thus arresting blood supply. Herbal vaso-dilators or relaxants have an anti-prostaglandin effect.

Treatment. The first concern of the practitioner is to administer a uterine vaso-dilator to increase the capacity of the blood vessels to transport blood. This effect can be obtained by employing antispasmodics, and nerve relaxants. Those having a specific effect upon the womb are: Agnus Castus, Black Cohosh, Black Haw, Blue Cohosh, Butterbur, Caraway, Cramp bark, Helonias, Jamaica Dogwood, Goldenseal, Lovage, Motherwort, Mugwort, Peppermint, Pulsatilla, St John’s Wort, Skullcap, Squaw Vine, Valerian, Wild Thyme, Wild Yam.

Teas. Lovage, Motherwort, Mugwort, Peppermint, Skullcap, Chamomile, Wild Thyme, Agnus Castus, Raspberry leaves. Add a pinch of Ginger.

Decoctions. Black Cohosh, Black Haw, Blue Cohosh, Butterbur, Cramp bark, False Unicorn root, Jamaica Dogwood, Squaw Vine, Valerian, Wild Yam. A pinch of Ginger enhances action.

Formula. Skullcap 2; Black Cohosh 1; Cramp bark 1. Dosage. Powders: 500mg or one-third teaspoon. Liquid extracts: half-1 teaspoon. Tinctures: 1-2 teaspoons. In honey, water or fruit juice thrice daily, before meals.

In the absence of the above, the following are also reliable: Black Haw, Helonias, Squaw Vine. Jamaica Dogwood combines well with Black Haw.

Antispasmodic drops.

Supplements. B-complex, B6, Calcium, Magnesium.

Supportives: Heat to the feet. Hot water bottle and electric blanket. Bedrest helps relax pelvic tissues. ... dysmenorrhoea

Abortion

Abortion is de?ned as the expulsion of a FETUS before it is normally viable, usually before 24 weeks of pregnancy. (There are exceptional cases nowadays in which fetuses as young as 22 weeks’ gestation have survived.) (See also PREGNANCY AND LABOUR.)

Spontaneous abortion Often called miscarriage, this may occur at any time before 28 weeks; 85 per cent occur in the ?rst 12 weeks of pregnancy. Of all diagnosed pregnancies, 25 per cent end in spontaneous abortion.

Spontaneous abortions occurring in early pregnancy are almost always associated with chromosomal abnormalities of the fetus. Other causes are uterine shape, maternal disorders such as DIABETES MELLITUS, diseases of the thyroid gland (see under ENDOCRINE GLANDS), and problems with the immune system (see IMMUNITY). Recurrent spontaneous abortion (that is, three or more) seems to be a particular problem in women who have an abnormal response of their immune system to pregnancy. Other factors include being older, having had a lot of babies previously, cigarette smoking and spontaneous (but not therapeutic) abortions in the past.

Early ULTRASOUND scans have altered the management of spontaneous abortions. These make it possible to distinguish between threatened abortion, where a woman has had some vaginal bleeding but the fetus is alive; inevitable abortion, where the neck of the uterus has started to open up; incomplete abortion, where part of the fetus or placenta is lost but some remains inside the uterus; and complete abortion. There is no evidence that bed rest is e?ective in stopping a threatened abortion becoming inevitable.

Inevitable or incomplete abortion will usually require a gynaecologist to empty (evacuate) the uterus. (Complete miscarriage requires no treatment.) Evacuation of the uterus is carried out using local or general anaesthetic, usually gentle dilatation of the neck of the uterus (cervix), and curetting-out the remaining products of the pregnancy.

A few late abortions are associated with the cervix opening too early, abnormal structural abnormalities of the uterus, and possibly infection in the mother.

Drugs are often used to suppress uterine contractions, but evidence-based studies show that these do not generally improve fetal salvage. In proven cases of cervical incompetence, the cervix can be closed with a suture which is removed at 37 weeks’ gestation. The evidence for the value of this procedure is uncertain.

Therapeutic abortion In the UK, before an abortion procedure is legally permitted, two doctors must agree and sign a form de?ned under the 1967 Abortion Act that the continuation of the pregnancy would involve risk – greater than if the pregnancy were terminated – of injury to the physical and/or mental health of the mother or any existing child(ren).

Legislation in 1990 modi?ed the Act, which had previously stated that, at the time of the abortion, the pregnancy should not have exceeded the 24th week. Now, an abortion may legally be performed if continuing the pregnancy would risk the woman’s life, or the mental health of the woman or her existing child(ren) is at risk, or if there is a substantial risk of serious handicap to the baby. In 95 per cent of therapeutic terminations in the UK the reason is ‘risk of injury to the physical or mental health of the woman’.

There is no time limit on therapeutic abortion where the termination is done to save the mother’s life, there is substantial risk of serious fetal handicap, or of grave permanent injury to the health of the mother.

About 190,000 terminations are carried out in the UK each year and only 1–1.5 per cent are over 20 weeks’ gestation, with the vast majority of these late abortions being for severe, late-diagnosed, fetal abnormality.

The maternal mortality from therapeutic abortion is less than 1 per 100,000 women and, provided that the procedure is performed skilfully by experienced doctors before 12 weeks of pregnancy, it is very safe. There is no evidence that therapeutic abortion is associated with any reduction in future fertility, increased rates of spontaneous abortion or preterm birth in subsequent pregnancies.

Methods of abortion All abortions must be carried out in premises licensed for doing so or in NHS hospitals. The method used is either surgical or medical, with the latter being used more and the former less as time goes on. Proper consent must be obtained, signed for and witnessed. Women under 16 years of age can consent to termination provided that the doctors obtaining the consent are sure she clearly understands the procedure and its implications. Parental consent in the under-16s is not legally required, but counselling doctors have a duty to record that they have advised young people to inform their parents. However, many youngsters do not do so. The woman’s partner has no legal say in the decision to terminate her pregnancy.

MEDICAL METHODS A combination of two drugs, mifepristone and a prostaglandin (or a prostaglandin-like drug, misoprostol – see PROSTAGLANDINS), may be used to terminate a pregnancy up to 63 days’ gestation. A similar regime can be used between nine and 12 weeks but at this gestation there is a 5 per cent risk of post-treatment HAEMORRHAGE.

An ultrasound scan is ?rst done to con?rm pregnancy and gestation. The sac containing the developing placenta and fetus must be in the uterus; the woman must be under 35 years of age if she is a moderate smoker, but can be over 35 if she is a non-smoker. Reasons for not using this method include women with diseases of the ADRENAL GLANDS, on long-term CORTICOSTEROIDS, and those who have a haemorrhagic disorder or who are on ANTICOAGULANTS. The drugs cannot be used in women with severe liver or kidney disease, and caution is required in those with CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), disease of the cardiovascular system, or prosthetic heart valves (see PROSTHESIS), as well as with those who have had a CAESAREAN SECTION or an ECTOPIC PREGNANCY in the past or who are being treated for HYPERTENSION.

Some clinics use this drug combination for pregnancies older than 12 weeks. In pregnancies approaching viability (20 weeks), pretreatment fetocide (killing of the fetus) with intrauterine drug therapy may be required.

SURGICAL METHODS Vacuum curettage is a method used up to 14–15 weeks. Some very experienced gynaecologists will perform abortions surgically by dilating the cervix and evacuating the uterine contents up to 22 weeks’ gestation. The greater the size of the pregnancy, the higher the risk of haemorrhage and perforation of the uterus. In the UK, illegal abortion is rare but in other countries this is not the case. Where illegal abortions are done, the risks of infection and perforation are high and death a de?nite risk. Legal abortions are generally safe. In the USA, partial-birth abortions are spoken of but, in fact, there is no such procedure recorded in the UK medical journals.... abortion

Bismuth

Various bismuth chelates and complexes, such as sucralfate, e?ective in healing gastric and duodenal ulcers are available. They may act by a direct toxic e?ect on gastric HELICOBACTER PYLORI, or by stimulating mucosal prostaglandin (see PROSTAGLANDINS) or bicarbonate secretion. Healing tends to be longer than with H2-RECEPTOR ANTAGONISTS and relapse still occurs. New regimens are being developed involving co-administration with antibiotics. ENCEPHALOPATHY, described with older high-dose bismuth preparations, has not been reported.... bismuth

Analgesics

Drugs which relieve or abolish PAIN. Unlike local anaesthetics, they are usually given systemically – affecting the whole body – and produce no SENSORY or MOTOR blockade stopping the activity in the sensory or motor nerves respectively that supply a part of the body. The many di?erent types of analgesics have varying modes of action. The choice of drug and method of administration will depend upon the type and severity of pain being treated.

Non-opioid analgesics include ASPIRIN, PARACETAMOL and NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS), which are used to treat mild or moderate pain such as headache (see also MIGRAINE), DYSMENORRHOEA, and transient musculoskeletal pain. Some analgesics – for example, aspirin and paracetamol – also reduce PYREXIA. A strong non-opioid analgesic is NEFOPAM HYDROCHLORIDE, which can be used for persistent pain or pain that fails to respond to other non-opioid analgesics, but does have troublesome side-effects. These non-opioid analgesics can be obtained without a doctor’s prescription – over the counter (OTC) – but the sale of some has to be supervised by a quali?ed pharmacist. A wide range of compound analgesic preparations is available, combining, say, aspirin or paracetamol and CODEINE, while the weak stimulant CAFFEINE is sometimes included in the preparations. Most of these are OTC drugs. NSAIDs are especially e?ective in treating patients with chronic diseases accompanied by pain and in?ammation. They, too, are sometimes combined with other analgesics.

Paracetamol acts within the central nervous system by inhibition of PROSTAGLANDINS. It is often combined with other analgesics – for example, aspirin or codeine; in proprietary compounds and in therapeutic doses it has few side-effects. Overdosage, however, can cause damage to the liver or kidneys (20–30 tablets are su?cient to do this). Paracetamol is often used by individuals attempting suicide. Even if there are no immediate symptoms, individuals suspected of having taken an overdose should be sent to hospital urgently for treatment.

The NSAIDs (including aspirin) inhibit prostaglandin synthesis. Prostaglandins are released by tissues that are in?amed, and may cause pain at peripheral pain sensors or sensitise nerve endings to painful stimuli: by inhibiting their production, pain and in?ammation are reduced. NSAIDs are particularly e?ective for pain produced by in?ammation – for example, ARTHRITIS. Side-effects include gastrointestinal bleeding (caused by mucosal erosions particularly in the stomach), inhibition of platelet aggregation (see PLATELETS), and potential for renal (kidney) damage.

Severe pain is often treated with opioid drugs. The original drugs were naturally occurring plant ALKALOIDS (e.g. MORPHINE), whilst newer drugs are man-made. They mimic the action of naturally occurring compounds (ENDORPHINS and ENCEPHALIN) which are found within the brain and spinal cord, and act on receptors to reduce the transmission of painful stimuli within the central nervous system (and possibly peripherally). They tend to produce side-effects of euphoria, respiratory depression, vomiting, constipation and itching. Chronic use or abuse of these drugs may give rise to addiction.... analgesics

Laser

Laser stands for Light Ampli?cation by Stimulated Emission of Radiation. The light produced by a laser is of a single wavelength and all the waves are in phase with each other, allowing a very high level of energy to be projected as a parallel beam or focused on to a small spot.

Various gases, liquids and solids will emit light when they are suitably stimulated. A gassed laser is pumped by the ionising e?ect of a high-voltage current. This is the same process as that used in a ?uorescent tube. Each type of laser has a di?erent e?ect on biological tissues and this is related to the wavelength of the light produced. The wavelength determines the degree of energy absorption by di?erent tissues, and because of this, di?erent lasers are needed for di?erent tasks. The argon laser produces light in the visible green wavelength which is selectively absorbed by HAEMOGLOBIN. It heats and coagulates (see COAGULATION) tissues so can be used to seal bleeding blood vessels and to selectively destroy pigmented lesions. The carbon-dioxide laser is the standard laser for cutting tissue: the infra-red beam it produces is strongly absorbed by water and so vaporises cells. Thus, by moving a ?nely focused beam across the tissue, it is possible to make an incision.

The two main uses of laser in surgery are the endoscopic (see ENDOSCOPE) photocoagulation of bleeding vessels, and the incision of tissue. Lasers have important applications in OPHTHALMOLOGY in the treatment of such disorders as detachment of the retina and the diabetic complications of proliferative retinopathy and of the cornea (see EYE, DISORDERS OF). The destruction of abnormal cells – a sign of pre-malignancy – in the CERVIX UTERI is done using lasers. The beams may also be used to remove scar tissue from the FALLOPIAN TUBES resulting from infection, thus unblocking the tubes and improving the chances of CONCEPTION. Lasers also have several important applications in DERMATOLOGY. They are used in the treatment of pigmented lesions such as LENTIGO, in the obliteration of port-wine stains, in the removal of small, benign tumours such as verrucas, and ?nally in the removal of tattoos.

Low-intensity laser beams promote tissue healing and reduce in?ammation, pain and swelling. Their e?ect is achieved by stimulating blood and lymph ?ow and by cutting the production of PROSTAGLANDINS, which provoke in?ammation and pain. The beams are used to treat ligament sprains, muscle tears and in?amed joints and tendons.

The three great advantages of lasers are their potency, their speed of action, and the ability to focus on an extremely small area. For these reasons they are widely used, and have allowed great advances to be made in microsurgery, and particularly in FIBREOPTIC ENDOSCOPY.... laser

Latanoprost

An analogue of prostaglandin (see PROSTAGLANDINS), used to treat open-angled GLAUCOMA and raised intra-ocular pressure in the EYE. Delivered as an eye drop, the drug is used in patients who cannot tolerate, or who fail to respond to, other treatments.... latanoprost

Leukotrienes

A group of naturally occurring, slow-reacting substances (SRSS) which have powerful smooth-muscle stimulating properties, particularly on bronchial smooth muscle. Leukotrienes are a metabolic derivative of PROSTAGLANDINS. Leukotriene receptor antagonists, such as montelukast and za?rlukast, are drugs useful in asthma.... leukotrienes

Menstruation

A periodic change occurring in (female) human beings and the higher apes, consisting chie?y in a ?ow of blood from the cavity of the womb (UTERUS) and associated with various slight constitutional disturbances. It begins between the ages of 12 and 15, as a rule – although its onset may be delayed until as late as 20, or it may begin as early as ten or 11. Along with its ?rst appearance, the body develops the secondary sex characteristics: for example, enlargement of the BREASTS, and characteristic hair distribution. The duration of each menstrual period varies in di?erent persons from 2– 8 days. It recurs in the great majority of cases with regularity, most commonly at intervals of 28 or 30 days, less often with intervals of 21 or 27 days, and ceasing only during pregnancy and lactation, until the age of 45 or 50 arrives, when it stops altogether – as a rule ceasing early if it has begun early, and vice versa. The ?nal stoppage is known as the MENOPAUSE or the CLIMACTERIC.

Menstruation depends upon a functioning ovary (see OVARIES) and this upon a healthy PITUITARY GLAND. The regular rhythm may depend upon a centre in the HYPOTHALAMUS, which is in close connection with the pituitary. After menstruation, the denuded uterine ENDOMETRIUM is regenerated under the in?uence of the follicular hormone, oestradiol. The epithelium of the endometrium proliferates, and about a fortnight after the beginning of menstruation great development of the endometrial glands takes place under the in?uence of progesterone, the hormone secreted by the CORPUS LUTEUM. These changes are made for the reception of the fertilised OVUM. In the absence of fertilisation the uterine endometrium breaks down in the subsequent menstrual discharge.

Disorders of menstruation In most healthy women, menstruation proceeds regularly for 30 years or more, with the exceptions connected with childbirth. In many women, however, menstruation may be absent, excessive or painful. The term amenorrhoea is applied to the condition of absent menstruation; the terms menorrhagia and metrorrhagia describe excessive menstrual loss – the former if the excess occurs at the regular periods, and the latter if it is irregular. Dysmenorrhoea is the name given to painful menstruation. AMENORRHOEA If menstruation has never occurred, the amenorrhoea is termed primary; if it ceases after having once become established it is known as secondary amenorrhoea. The only value of these terms is that some patients with either chromosomal abnormalities (see CHROMOSOMES) or malformations of the genital tract fall into the primary category. Otherwise, the age of onset of symptoms is more important.

The causes of amenorrhoea are numerous and treatment requires dealing with the primary cause. The commonest cause is pregnancy; psychological stress or eating disorders can cause amenorrhoea, as can poor nutrition or loss of weight by dieting, and any serious underlying disease such as TUBERCULOSIS or MALARIA. The excess secretion of PROLACTIN, whether this is the result of a micro-adenoma of the pituitary gland or whether it is drug induced, will cause amenorrhoea and possibly GALACTORRHOEA as well. Malfunction of the pituitary gland will result in a failure to produce the gonadotrophic hormones (see GONADOTROPHINS) with consequent amenorrhoea. Excessive production of cortisol, as in CUSHING’S SYNDROME, or of androgens (see ANDROGEN) – as in the adreno-genital syndrome or the polycystic ovary syndrome – will result in amenorrhoea. Amenorrhoea occasionally follows use of the oral contraceptive pill and may be associated with both hypothyroidism (see under THYROID GLAND, DISEASES OF) and OBESITY.

Patients should be reassured that amenorrhoea can often be successfully treated and does not necessarily affect their ability to have normal sexual relations and to conceive. When weight loss is the cause of amenorrhoea, restoration of body weight alone can result in spontaneous menstruation (see also EATING DISORDERS – Anorexia nervosa). Patients with raised concentration of serum gonadotrophin hormones have primary ovarian failure, and this is not amenable to treatment. Cyclical oestrogen/progestogen therapy will usually establish withdrawal bleeding. If the amenorrhoea is due to mild pituitary failure, menstruation may return after treatment with clomiphene, a nonsteroidal agent which competes for oestrogen receptors in the hypothalamus. The patients who are most likely to respond to clomiphene are those who have some evidence of endogenous oestrogen and gonadotrophin production. IRREGULAR MENSTRUATION This is a change from the normal monthly cycle of menstruation, the duration of bleeding or the amount of blood lost (see menorrhagia, below). Such changes may be the result of an upset in the balance of oestrogen and progesterone hormones which between them control the cycle. Cycles may be irregular after the MENARCHE and before the menopause. Unsuspected pregnancy may manifest itself as an ‘irregularity’, as can an early miscarriage (see ABORTION). Disorders of the uterus, ovaries or organs in the pelvic cavity can also cause irregular menstruation. Women with the condition should seek medical advice. MENORRHAGIA Abnormal bleeding from the uterus during menstruation. A woman loses on average about 60 ml of blood during her period; in menorrhagia this can rise to 100 ml. Some women have this problem occasionally, some quite frequently and others never. One cause is an imbalance of progesterone and oestrogen hormones which between them control menstruation: the result is an abnormal increase in the lining (endometrium) of the uterus, which increases the amount of ‘bleeding’ tissue. Other causes include ?broids, polyps, pelvic infection or an intrauterine contraceptive device (IUD – see under CONTRACEPTION). Sometimes no physical reason for menorrhagia can be identi?ed.

Treatment of the disorder will depend on how severe the loss of blood is (some women will become anaemic – see ANAEMIA – and require iron-replacement therapy); the woman’s age; the cause of heavy bleeding; and whether or not she wants children. An increase in menstrual bleeding may occur in the months before the menopause, in which case time may produce a cure. Medical or surgical treatments are available. Non-steroidal anti-in?ammatory drugs may help, as may tranexamic acid, which prevents the breakdown of blood clots in the circulation (FIBRINOLYSIS): this drug can be helpful if an IUD is causing bleeding. Hormones such as dydrogesterone (by mouth) may cure the condition, as may an IUD that releases small quantities of a PROGESTOGEN into the lining of the womb.

Traditionally, surgical intervention was either dilatation and curettage of the womb lining (D & C) or removal of the whole uterus (HYSTERECTOMY). Most surgery is now done using minimally invasive techniques. These do not require the abdomen to be cut open, as an ENDOSCOPE is passed via the vagina into the uterus. Using DIATHERMY or a laser, the surgeon then removes the whole lining of the womb. DYSMENORRHOEA This varies from discomfort to serious pain, and sometimes includes vomiting and general malaise. Anaemia is sometimes a cause of painful menstruation as well as of stoppage of this function.

In?ammation of the uterus, ovaries or FALLOPIAN TUBES is a common cause of dysmenorrhoea which comes on for the ?rst time late in life, especially when the trouble follows the birth of a child. In this case the pain exists more or less at all times, but is aggravated at the periods. Treatment with analgesics and remedying the underlying cause is called for.

Many cases of dysmenorrhoea appear with the beginning of menstrual life, and accompany every period. It has been estimated that 5–10 per cent of girls in their late teens or early 20s are severely incapacitated by dysmenorrhoea for several hours each month. Various causes have been suggested for the pain, one being an excessive production of PROSTAGLANDINS. There may be a psychological factor in some sufferers and, whether this is the result of inadequate sex instruction, fear, family, school or work problems, it is important to o?er advice and support, which in itself may resolve the dysmenorrhoea. Symptomatic relief is of value.... menstruation

Pge

Short for Prostaglandin E, presumably the fifth subtype discovered, and usually separated into PGE1 and PGE2. These two, if made by the kidneys, slow sodium reabsorption; if within in the uterus, induce a stronger response to less stimulus; if made in the stomach lining inhibit gastric secretion; if secreted by macrophages, target tissues become more accessible to infiltration...and inflammation. These are the two prostaglandins whose levels are meant to be stabilized by gamma-linolenic acid (GLA) supplements. See PROSTAGLANDIN... pge

Cherries

Nutritional Profile Energy value (calories per serving): Low Protein: Moderate Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: Moderate Sodium: Low Major vitamin contribution: Vitamin A (sour cherries), vitamin C Major mineral contribution: Potassium

About the Nutrients in This Food Cherries have moderate amounts of fiber, insoluble cellulose and lignin in the skin and soluble pectins in the flesh, plus vitamin C. One cup fresh red sweet cherries (two ounces, without pits) has 3.2 g dietary fiber, 64 IU vitamin A (.2 percent of the R DA) and 10.8 mg vitamin C (14 percent of the R DA for a woman, 12 percent of the R DA for a man). One-half cup canned water-packed sour/tart cherries has 0.5 g dietary fiber and 1.5 mg vitamin C, and 377 IU vitamin A (16 percent of the R DA for a woman, 13 percent of the R DA for a man). Like apple seeds and apricot, peach, or plum pits, cherry pits contain amygdalin, a naturally occurring cyanide/sugar compound that breaks down into hydrogen cyanide in the stomach. While accidentally swallow- ing a cherry pit once in a while is not a serious hazard, cases of human poisoning after eating apple seeds have been reported (see apples). NOTE : Some wild cherries are poisonous.

The Most Nutritious Way to Serve This Food Sweet cherries can be eaten raw to protect their vitamin C; sour (“cook- ing”) cherries are more palatable when cooked. * Except for maraschino cherries, which are high in sodium.

Diets That May Restrict or Exclude This Food Low-sodium diet (maraschino cherries)

Buying This Food Look for: Plump, firm, brightly colored cherries with glossy skin whose color may range from pale golden yellow to deep red to almost black, depending on the variety. The stems should be green and fresh, bending easily and snapping back when released. Avoid: Sticky cherries (they’ve been damaged and are leaking), red cherries with very pale skin (they’re not fully ripe), and bruised cherries whose flesh will be discolored under the bruise.

Storing This Food Store cherries in the refrigerator to keep them cold and humid, conserving their nutrient and flavor. Cherries are highly perishable; use them as quickly as possible.

Preparing This Food Handle cherries with care. When you bruise, peel, or slice a cherry you tear its cell walls, releasing polyphenoloxidase—an enzyme that converts phenols in the cherry into brown compounds that darken the fruit. You can slow this reaction (but not stop it completely) by dipping raw sliced or peeled cherries into an acid solution (lemon juice and water or vinegar and water) or by mixing them with citrus fruits in a fruit salad. Polyphenoloxidase also works more slowly in the cold, but storing sliced or peeled cherries in the refrigerator is much less effective than bathing them in an acid solution.

What Happens When You Cook This Food Depending on the variety, cherries get their color from either red anthocyanin pigments or yellow to orange to red carotenoids. The anthocyanins dissolve in water, turn redder in acids and bluish in bases (alkalis). The carotenoids are not affected by heat and do not dissolve in water, which is why cherries do not lose vitamin A when you cook them. Vitamin C, how- ever, is vulnerable to heat.

How Other Kinds of Processing Affect This Food Canning and freezing. Canned and frozen cherries contain less vitamin C and vitamin A than fresh cherries. Sweetened canned or frozen cherries contain more sugar than fresh cherries. Candying. Candied cherries are much higher in calories and sugar than fresh cherries. Maraschino cherries contain about twice as many calories per serving as fresh cherries and are high in sodium.

Medical Uses and/or Benefits Anti-inflammatory effects. In a series of laboratory studies conducted from 1998 through 2001, researchers at the Bioactive Natural Products Laboratory in the Department of Horti- culture and National Food Safety and Toxicology Center at Michigan State University dis- covered that the anthocyanins (red pigments) in tart cherries effectively block the activity of two enzymes, COX-1 and COX-2, essential for the production of prostaglandins, which are natural chemicals involved in the inflammatory response (which includes redness, heat, swelling, and pain). In other words, the anthocyanins appeared to behave like aspirin and other traditional nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen. In 2004, scientists at the USDA Human Nutrition Research Center in Davis, California, released data from a study showing that women who ate 45 bing (sweet) cherries at breakfast each morning had markedly lower blood levels of uric acid, a by-product of protein metabolism linked to pain and inflammation, during an acute episode of gout (a form of arthritis). The women in the study also had lower blood levels of C-reactive protein and nitric acid, two other chemicals linked to inflammation. These effects are yet to be proven in larger studies with a more diverse group of subjects.... cherries

Essential Fatty Acids

Three acids – arachidonic, linolenic and tinoleic – which are essential for life, but which the body cannot produce. They are found in natural vegetable and ?sh oils and their functions are varied. EFAs have a vital function in fat metabolism and transfer and they are also precursors of PROSTAGLANDINS.... essential fatty acids

Gemeprost

One of the PROSTAGLANDINS administered vaginally as pessaries for the medical induction of late therapeutic ABORTION. Gemeprost also softens the cervix before surgical abortion, being particularly useful for women in their ?rst pregnancy. Prostaglandins induce contractions of the UTERUS while keeping blood loss to a minimum.... gemeprost

Prostacyclin

A prostaglandin (see PROSTAGLANDINS) produced by the endothelial lining of the blood vessels. It inhibits the aggregation of PLATELETS, and thereby reduces the likelihood of the blood clotting. It is also a strong vasodilator (see VASODILATORS).... prostacyclin

Stomach, Diseases Of

Gastritis is the description for several unrelated diseases of the gastric mucosa.

Acute gastritis is an in?ammatory reaction of the gastric mucosa to various precipitating factors, ranging from physical and chemical injury to infections. Acute gastritis (especially of the antral mucosas) may well represent a reaction to infection by a bacterium called Helicobacter pylori. The in?ammatory changes usually go after appropriate antibiotic treatment for the H. pylori infection. Acute and chronic in?ammation occurs in response to chemical damage of the gastric mucosa. For example, REFLUX of duodenal contents may predispose to in?ammatory acute and chronic gastritis. Similarly, multiple small erosions or single or multiple ulcers have resulted from consumption of chemicals, especialy aspirin and antirheumatic NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS).

Acute gastritis may cause anorexia, nausea, upper abdominal pain and, if erosive, haemorrhage. Treatment involves removal of the o?ending cause.

Chronic gastritis Accumulation of cells called round cells in the gastric mucosal characterises chronic gastritis. Most patients with chronic gastritis have no symptoms, and treatment of H. pylori infection usually cures the condition.

Atrophic gastritis A few patients with chronic gastritis may develop atrophic gastritis. With or without in?ammatory change, this disorder is common in western countries. The incidence increases with age, and more than 50 per cent of people over 50 may have it. A more complete and uniform type of ATROPHY, called ‘gastric atrophy’, characterises a familial disease called PERNICIOUS ANAEMIA. The cause of the latter disease is not known but it may be an autoimmune disorder.

Since atrophy of the corpus mucosa results in loss of acid- and pepsin-secreting cells, gastric secretion is reduced or absent. Patients with pernicious anaemia or severe atrophic gastritis of the corpus mucosa may secrete too little intrinsic factor for absorption of vitamin B12 and so can develop severe neurological disease (subacute combined degeneration of the spinal cord).

Patients with atrophic gastritis often have bacterial colonisation of the upper alimentary tract, with increased concentration of nitrite and carcinogenic N-nitroso compounds. These, coupled with excess growth of mucosal cells, may be linked to cancer. In chronic corpus gastritis, the risk of gastric cancer is about 3–4 times that of the general population.

Postgastrectomy mucosa The mucosa of the gastric remnant after surgical removal of the distal part of the stomach is usually in?amed and atrophic, and is also premalignant, with the risk of gastric cancer being very much greater than for patients with duodenal ulcer who have not had surgery.

Stress gastritis Acute stress gastritis develops, sometimes within hours, in individuals who have undergone severe physical trauma, BURNS (Curling ulcers), severe SEPSIS or major diseases such as heart attacks, strokes, intracranial trauma or operations (Cushing’s ulcers). The disorder presents with multiple super?cial erosions or ulcers of the gastric mucosa, with HAEMATEMESIS and MELAENA and sometimes with perforation when the acute ulcers erode through the stomach wall. Treatment involves inhibition of gastric secretion with intravenous infusion of an H2-receptorantagonist drug such as RANITIDINE or FAMOTIDINE, so that the gastric contents remain at a near neutral pH. Despite treatment, a few patients continue to bleed and may then require radical gastric surgery.

Gastric ulcer Gastric ulcers were common in young women during the 19th century, markedly fell in frequency in many western countries during the ?rst half of the 20th century, but remained common in coastal northern Norway, Japan, in young Australian women, and in some Andean populations. During the latter half of this century, gastric ulcers have again become more frequent in the West, with a peak incidence between 55 and 65 years.

The cause is not known. The two factors most strongly associated with the development of duodenal ulcers – gastric-acid production and gastric infection with H. pylori bacteria – are not nearly as strongly associated with gastric ulcers. The latter occur with increased frequency in individuals who take aspirin or NSAIDs. In healthy individuals who take NSAIDs, as many as 6 per cent develop a gastric ulcer during the ?rst week of treatment, while in patients with rheumatoid arthritis who are being treated long term with drugs, gastric ulcers occur in 20–40 per cent. The cause is inhibition of the enzyme cyclo-oxygenase, which in turn inhibits the production of repair-promoting PROSTAGLANDINS.

Gastric ulcers occur especially on the lesser curve of the stomach. The ulcers may erode through the whole thickness of the gastric wall, perforating into the peritoneal cavity or penetrating into liver, pancreas or colon.

Gastric ulcers usually present with a history of epigastric pain of less than one year. The pain tends to be associated with anorexia and may be aggravated by food, although patients with ‘prepyloric’ ulcers may obtain relief from eating or taking antacid preparations. Patients with gastric ulcers also complain of nausea and vomiting, and lose weight.

The principal complications of gastric ulcer are haemorrhage from arterial erosion, or perforation into the peritoneal cavity resulting in PERITONITIS, abscess or ?stula.

Aproximately one in two gastric ulcers heal ‘spontaneously’ in 2–3 months; however, up to 80 per cent of the patients relapse within 12 months. Repeated recurrence and rehealing results in scar tissue around the ulcer; this may cause a circumferential narrowing – a condition called ‘hour-glass stomach’.

The diagnosis of gastric ulcer is con?rmed by ENDOSCOPY. All patients with gastric ulcers should have multiple biopsies (see BIOPSY) to exclude the presence of malignant cells. Even after healing, gastric ulcers should be endoscopically monitored for a year.

Treatment of gastric ulcers is relatively simple: a course of one of the H2 RECEPTOR ANTAGONISTS heals gastric ulcers in 3 months. In patients who relapse, long-term inde?nite treatment with an H2 receptor antagonist such as ranitidine may be necessary since the ulcers tend to recur. Recently it has been claimed that gastric ulcers can be healed with a combination of a bismuth salt or a gastric secretory inhibitor

for example, one of the PROTON PUMP INHIBITORS such as omeprazole or lansoprazole

together with two antibiotics such as AMOXYCILLIN and METRONIDAZOLE. The long-term outcome of such treatment is not known. Partial gastrectomy, which used to be a regular treatment for gastric ulcers, is now much more rarely done unless the ulcer(s) contain precancerous cells.

Cancer of the stomach Cancer of the stomach is common and dangerous and, worldwide, accounts for approximately one in six of all deaths from cancer. There are marked geographical di?erences in frequency, with a very high incidence in Japan and low incidence in the USA. In the United Kingdom around 33 cases per 100,000 population are diagnosed annually. Studies have shown that environmental factors, rather than hereditary ones, are mainly responsible for the development of gastric cancer. Diet, including highly salted, pickled and smoked foods, and high concentrations of nitrate in food and drinking water, may well be responsible for the environmental effects.

Most gastric ulcers arise in abnormal gastric mucosa. The three mucosal disorders which especially predispose to gastric cancer include pernicious anaemia, postgastrectomy mucosa, and atrophic gastritis (see above). Around 90 per cent of gastric cancers have the microscopic appearance of abnormal mucosal cells (and are called ‘adenocarcinomas’). Most of the remainder look like endocrine cells of lymphoid tissue, although tumours with mixed microscopic appearance are common.

Early gastric cancer may be symptomless and, in countries like Japan with a high frequency of the disease, is often diagnosed during routine screening of the population. In more advanced cancers, upper abdominal pain, loss of appetite and loss of weight occur. Many present with obstructive symptoms, such as vomiting (when the pylorus is obstructed) or di?culty with swallowing. METASTASIS is obvious in up to two-thirds of patients and its presence contraindicates surgical cure. The diagnosis is made by endoscopic examination of the stomach and biopsy of abnormal-looking areas of mucosa. Treatment is surgical, often with additional chemotherapy and radiotherapy.... stomach, diseases of

Uterus, Diseases Of

Absence or defects of the uterus

Rarely, the UTERUS may be completely absent as a result of abnormal development. In such patients secondary sexual development is normal but MENSTRUATION is absent (primary amennorhoea). The chromosomal make-up of the patient must be checked (see CHROMOSOMES; GENES): in a few cases the genotype is male (testicular feminisation syndrome). No treatment is available, although the woman should be counselled.

The uterus develops as two halves which fuse together. If the fusion is incomplete, a uterine SEPTUM results. Such patients with a double uterus (uterus didelphys) may have fertility problems which can be corrected by surgical removal of the uterine septum. Very rarely there may be two uteri with a double vagina.

The uterus of most women points forwards (anteversion) and bends forwards (ante?exion). However, about 25 per cent of women have a uterus which is pointed backwards (retroversion) and bent backwards (retro?exion). This is a normal variant and very rarely gives rise to any problems. If it does, the attitude of the uterus can be corrected by an operation called a ventrosuspension.

Endometritis The lining of the uterine cavity is called the ENDOMETRIUM. It is this layer that is partially shed cyclically in women of reproductive age giving rise to menstruation. Infection of the endometrium is called endometritis and usually occurs after a pregnancy or in association with the use of an intrauterine contraceptive device (IUCD – see CONTRACEPTION). The symptoms are usually of pain, bleeding and a fever. Treatment is with antibiotics. Unless the FALLOPIAN TUBES are involved and damaged, subsequent fertility is unaffected. Very rarely, the infection is caused by TUBERCULOSIS. Tuberculous endometritis may destroy the endometrium causing permanent amenorrhoea and sterility.

Menstrual disorders are common. Heavy periods (menorrhagia) are often caused by ?broids (see below) or adenomyosis (see below) or by anovulatory cycles. Anovulatory cycles result in the endometrium being subjected to unopposed oestrogen stimulation and occasionally undergoing hyperplasia. Treatment is with cyclical progestogens (see PROGESTOGEN) initially. If this form of treatment fails, endoscopic surgery to remove the endometrium may be successful. The endometrium may be removed using LASER (endometrial laser ablation) or electrocautery (transcervical resection of endometrium). Hysterectomy (see below) will cure the problem if endoscopic surgery fails. Adenomyosis is a condition in which endometrial tissue is found in the muscle layer (myometrium) of the uterus. It usually presents as heavy and painful periods, and occasionally pain during intercourse. Hysterectomy is usually required.

Oligomenorhoea (scanty or infrequent periods) may be caused by a variety of conditions including thyroid disease (see THYROID GLAND, DISEASES OF). It is most commonly associated with usage of the combined oral contraceptive pill. Once serious causes have been eliminated, the patient should be reassured. No treatment is necessary unless conception is desired, in which case the patient may require induction of ovulation.

Primary amenorrhoea means that the patient has never had a period. She should be investigated, although usually it is only due to an inexplicable delay in the onset of periods (delayed menarche) and not to any serious condition. Secondary amenorrhoea is the cessation of periods after menstruation has started. The most common cause is pregnancy. It may be also caused by endocrinological or hormonal problems, tuberculous endometritis, emotional problems and severe weight loss. The treatment of amenorrhoea depends on the cause.

Dysmenorrhoea, or painful periods, is the most common disorder; in most cases the cause is unknown, although the disorder may be due to excessive production of PROSTAGLANDINS.

Irregular menstruation (variations from the woman’s normal menstrual pattern or changes in the duration of bleeding or the amount) can be the result of a disturbance in the balance of OESTROGENS and PROGESTERONE hormone which between them regulate the cycle. For some time after the MENARCHE or before the MENOPAUSE, menstruation may be irregular. If irregularity occurs in a woman whose periods are normally regular, it may be due to unsuspected pregnancy, early miscarriage or to disorders in the uterus, OVARIES or pelvic cavity. The woman should seek medical advice.

Fibroids (leiomyomata) are benign tumours arising from the smooth muscle layer (myometrium) of the uterus. They are found in 80 per cent of women but only a small percentage give rise to any problems and may then require treatment. They may cause heavy periods and occasionally pain. Sometimes they present as a mass arising from the pelvis with pressure symptoms from the bladder or rectum. Although they can be shrunk medically using gonadorelin analogues, which raise the plasma concentrations of LUTEINISING HORMONE and FOLLICLE-STIMULATING HORMONE, this is not a long-term solution. In any case, ?broids only require treatment if they are large or enlarging, or if they cause symptoms. Treatment is either myomectomy (surgical removal) if fertility is to be retained, or a hysterectomy.

Uterine cancers tend to present after the age of 40 with abnormal bleeding (intermenstrual or postmenopausal bleeding). They are usually endometrial carcinomas. Eighty per cent present with early (Stage I) disease. Patients with operable cancers should be treated with total abdominal hysterectomy and bilateral excision of the ovaries and Fallopian tubes. Post-operative RADIOTHERAPY is usually given to those patients with adverse prognostic factors. Pre-operative radiotherapy is still given by some centres, although this practice is now regarded as outdated. PROGESTOGEN treatment may be extremely e?ective in cases of recurrence, but its value remains unproven when used as adjuvant treatment. In 2003 in England and Wales, more than 2,353 women died of uterine cancer.

Disorders of the cervix The cervix (neck of the womb) may produce an excessive discharge due to the presence of a cervical ectopy or ectropion. In both instances columnar epithelium – the layer of secreting cells – which usually lines the cervical canal is exposed on its surface. Asymptomatic patients do not require treatment. If treatment is required, cryocautery – local freezing of tissue – is usually e?ective.

Cervical smears are taken and examined in the laboratory to detect abnormal cells shed from the cervix. Its main purpose is to detect cervical intraepithelial neoplasia (CIN) – the presence of malignant cells in the surface tissue lining the cervix – since up to 40 per cent of women with this condition will develop cervical cancer if the CIN is left untreated. Women with abnormal smears should undergo colposcopy, a painless investigation using a low-powered microscope to inspect the cervix. If CIN is found, treatment consists of simply removing the area of abnormal skin, either using a diathermy loop or laser instrument.

Unfortunately, cervical cancer remains the most common of gynaecological cancers. The most common type is squamous cell carcinoma and around 4,000 new cases (all types) are diagnosed in England and Wales every year. As many as 50 per cent of the women affected may die from the disease within ?ve years. Cervical cancer is staged clinically in four bands according to how far it has extended, and treatment is determined by this staging. Stage I involves only the mucosal lining of the cervix and cone BIOPSY may be the best treatment in young women wanting children. In Stage IV the disease has spread beyond the cervix, uterus and pelvis to the URINARY BLADDER or RECTUM. For most women, radiotherapy or radical Wertheim’s hysterectomy – the latter being preferable for younger women – is the treatment of choice if the cancer is diagnosed early, both resulting in survival rates of ?ve years in 80 per cent of patients. Wertheim’s hysterectomy is a major operation in which the uterus, cervix, upper third of vagina and the tissue surrounding the cervix are removed together with the LYMPH NODES draining the area. The ovaries may be retained if desired. Patients with cervical cancer are treated by radiotherapy, either because they present too late for surgery or because the surgical skill to perform a radical hysterectomy is not available. These operations are best performed by gynaecological oncologists who are gynaecological surgeons specialising in the treatment of gynaecological tumours. The role of CHEMOTHERAPY in cervical and uterine cancer is still being evaluated.

Prolapse of the uterus is a disorder in which the organ drops from its normal situation down into the vagina. First-degree prolapse is a slight displacement of the uterus, second-degree a partial displacement and third-degree when the uterus can be seen outside the VULVA. It may be accompanied by a CYSTOCOELE (the bladder bulges into the front wall of the vagina), urethrocoele (the urethra bulges into the vagina) and rectocoele (the rectal wall bulges into the rear wall of the vagina). Prolapse most commonly occurs in middle-aged women who have had children, but the condition is much less common now than in the past when prenatal and obstetric care was poor, women had more pregnancies and their general health was poor. Treatment is with pelvic exercises, surgical repair of the vagina or hysterectomy. If the woman does not want or is not ?t for surgery, an internal support called a pessary can be ?tted – and changed periodically.

Vertical section of female reproductive tract (viewed from front) showing sites of common gynaecological disorders.

Hysterectomy Many serious conditions of the uterus have traditionally been treated by hysterectomy, or removal of the uterus. It remains a common surgical operation in the UK, but is being superseded in the treatment of some conditions, such as persistent MENORRHAGIA, with endometrial ablation – removal of the lining of the uterus using minimally invasive techniques, usually using an ENDOSCOPE and laser. Hysterectomy is done to treat ?broids, cancer of the uterus and cervix, menorrhagia, ENDOMETRIOSIS and sometimes for severely prolapsed uterus. Total hysterectomy is the usual type of operation: it involves the removal of the uterus and cervix and sometimes the ovaries. After hysterectomy a woman no longer menstruates and cannot become pregnant. If the ovaries have been removed as well and the woman had not reached the menopause, hormone replacement therapy (HRT – see MENOPAUSE) should be considered. Counselling helps the woman to recover from the operation which can be an emotionally challenging event for many.... uterus, diseases of

Gamma Linolenic Acid (gla)

A polyunsaturated fatty acid; an essential ingredient in the body’s production of prostaglandins. Present naturally in mother’s milk. The body produces GLA from linoleic acid present in food as an essential fatty acid (EFA). Vital to growth, cell structure and cardiac health. Sources: Evening Primrose oil; Sunflower seed oil, Borage and Blackcurrant. Preparations from the fermentation of rotten carrots. Helps lower blood pressure and prevent cholesterol build-up in the blood. ... gamma linolenic acid (gla)

Malabar Nut

Adhatoda beddomei

Acanthaceae

San:Vasaka, Vasa;

Hin:Adusa; Mal:Chittadalotakam;

Tam:Adutota; Tel:Addasaramu

Importance: Malabar nut or Adhatoda is a large evergreen glabrous perennial shrub, 1.2m in height. It is cultivated for medicinal uses, fencing, manure and as an ornamental plant in pots also. The shrub is the source of the drug vasaka well known in the indigenous systems of medicines for bronchitis. Vasaka leaves, flowers, fruits and roots are extensively used for treating common cold, cough, whooping cough, chronic bronchitis and asthma. It has sedative, expectorant, antispasmodic and anthelmintic actions. The juice of the leaves cures vomiting, thirst, fever, dermatosis, jaundice, phthisis, haematenesis and diseases due to the morbidity of kapha and pitta. The leaf juice is especially used in anaemia and haemorrhage, in traditional medicine. Flowers and leaves are considered efficacious against rheumatic painful swellings and form a good application to scabies and other skin complaints. Many ayurvedic medicines are traditionally prepared out of vasaka like vasarishtam, vasakasavam and vasahareethaki which are effective in various ailments of respiratory system. The drug VASA prepared from this plant forms an ingredient of preparations like Valiya rasnadi kasayam, Chyavanaprasam, Gulgulutiktakam ghrtam, etc. The alkaloid vasicinone isolated from the plant is an ingredient in certain allopathic cough syrups also.

Distribution: Vasaka is distributed all over India upto an altitude of 2000m. This plant grows on wasteland and sometimes it is cultivated also.

Botany: Adhatoda beddomei C.B.Clarke Syn. Justicia beddomei (Clark) Bennet belongs to the family Acanthaceae. This is a large glabrous shrub. Leaves are opposite, ovate, lanceolate and short petioled upto 15cm long, 3.75cm broad, main nerves about 8 pairs. Flowers are white with large bracts, flower heads short, dense or condensed spikes. Fruits are capsules with a long solid base.

Another plant Adhatoda zeylanica Medicus, syn. Adhatoda vasica Nees, Justicia adhatoda Linn. of the same genus is a very closely related plant which is most commonly equated with the drug VASA. This is seen growing wild almost throughout India while A. beddomei is seen more under cultivation. The latter is called Chittadalodakam because of its smaller stature, smaller leaves and flowers.

Agrotechnology: Vasaka is seen almost in all types of climate. It prefers loamy soils with good drainage and high organic content. It can be grown well both in hilly and plain lands. Commercial propagation is by using 15-20cm long terminal cuttings. This is either grown in polybags first, then in the field or planted directly. The plant is cultivated as a pure crop or mixed with plantation crops. The land is ploughed repeatedly to a good tilth and the surface soil is broken upto a depth of 15cm and mixed with fertilizers. The beds are prepared with 1m breadth and 3-4m length. The cuttings are planted during April-May into the beds at a spacing of 30x30cm. FYM is given at 5-10t/ha in the first year. Regular irrigation and weeding are necessary. Harvesting is at the end of second or third year. Roots are collected by digging the seedbeds. Stems are cut 15cm above the root. Stems and roots are usually dried and stored.

Properties and activity: Leaves yield essential oil and an alkaloid vasicine. Roots contain vasicinol and vasicinone. Roots also contain vasicoline, adhatodine, anisotine and vasicolinone. Several alkaloids like quinazoline and valicine are present in this plant.

The plant is bitter, astringent, refrigerant, expectorant, diuretic, antispasmodic, febrifuge, depurative, styptic and tonic. Vasicine is bronchodilator, respiratory stimulant and hypotensive in action, uterine stimulant, uterotonic, abortifacient comparable with oxytocin and methyligin. Uterotonic action of vasicine is mediated through the release of prostaglandins.... malabar nut

Non-steroidal Anti-inflammatory Drugs (nsaids)

These act by inhibiting the formation of PROSTAGLANDINS which are mediators of INFLAMMATION. They act both as ANALGESICS to relieve pain, and as inhibitors of in?ammation. Aspirin is a classic example of such a compound. Newer compounds have been synthesised with the aim of producing fewer and less severe side-effects. They are sometimes preferred to aspirin for the treatment of conditions such as RHEUMATOID ARTHRITIS, OSTEOARTHRITIS, sprains, strains and sports injuries. Their main side-effects are gastrointestinal: gastric ulcers and gastric haemorrhage may result (see STOMACH, DISEASES OF). This is because prostaglandins are necessary for the production of the mucous protective coat in the stomach and, when the production of prostaglandin is inhibited, the protection of the stomach is compromised. NSAIDs should therefore be used with caution in patients with DYSPEPSIA and gastric ulceration. The various nonsteroidal anti-in?ammatory drugs di?er little from each other in e?cacy, although there is considerable variation in patient response. Ibuprofen is one of the ?rst choices in this group of drugs as it combines good e?cacy with a low incidence of side-effects and administration is only required twice daily. Other drugs in this series include diclofenac, fenbufen, fenclofenac, fenoprofen, feprazone, ?urbiprofen, indomethacin, indoprofen, ketoprofen, ketorolac, naproxen, piroxicam, sulindac, tiaprofenic acid and tolmetin.... non-steroidal anti-inflammatory drugs (nsaids)

Prostaglandin Drugs

Synthetically produced prostaglandins.

Dinoprostone is used with oxytocin for induction of labour.

Gemeprost softens and helps to dilate the cervix prior to inducing an abortion.

Alprostadil is used to treat newborn infants awaiting surgery for some congenital heart diseases.... prostaglandin drugs

Induction

n. 1. (in obstetrics) the starting of labour by artificial means. It is carried out using such drugs as *prostaglandins to prime the cervix and/or *amniotomy prior to synthetic *oxytocin (Syntocinon), which stimulate uterine contractions. Induction of labour is carried out if the wellbeing or life of mother or child is threatened by continuance of the pregnancy. 2. (in anaesthesia) initiation of *anaesthesia. General anaesthesia is usually induced by the intravenous injection of short-acting *anaesthetics, e.g. thiopental.... induction

Zingiber Officinale

Rosc.

Family: Zingiberaceae.

Habitat: Native to Southeast Asia; now cultivated mainly in Kerala, Andhra Pradesh, Uttar Pradesh, West Bengal, Maharashtra.

English: Ginger.

Ayurvedic: Fresh rhizome— Aardraka, Aadrikaa, Shrngibera, shrngavera, Katubhadra. Dried rhi- zome—Shunthi, Naagara, Naagaraa, Naagaraka, Aushadha, Mahaushad- ha, Vishvaa, Vishvabheshaja, Vishvaaushadha.

Unani: Fresh rhizome—Zanjabeel- e-Ratab, Al-Zanjabeel. Dried rhizome—zanjabeel, Zanjabeel-e- yaabis.

Siddha: Fresh rhizome—Inji, Allam, Lokottai. Dried rhizome— chukku, Sunthi.

Action: Rhizome—antiemetic, antiflatulent, hypocholesterolaemic, anti-inflammatory, antispasmodic, expectorant, circulatory stimulant, diaphoretic, increases bioavailabil- ity of prescription drugs. Used for irritable bowel and diarrhoea, colds and influenza. Showed encouraging results in migraine and cluster headache (J Ethnophar- macol, 1990, 29, 267-273; Aust J Med Herbalism, 1995, 7/3, 6978; Natural Medicines Comprehensive Database, 2007.) The Ayurvedic Pharmacopoeia of India recommends dried rhizomes in dyspepsia, loss of appetite, tympanitis, anaemia, rheumatism, cough and dyspnoea; fresh rhizomes in constipation, colic, oedema and throat infections.

Key application: For dyspepsia and prevention of motion sickness (German Commission E); vomiting of pregnancy, anorexia, bronchitis and rheumatic complaints (The British Herbal Compendium); as a post-operative antiemetic. (ESCOP).

The rhizome contains an essential oil containing monoterpenes, mainly geranial and neral; and sesquiterpenes, mainly beta-sesquiphellandrene, beta- bisabolene, ar-curcumene and alpha- zingiberene; pungent principles, consisting of gingerols, shogaols and related phenolic ketone derivatives. Other constituents include diarylheptenones, diterpenes, gingesulphonic acid and monoacyldigalactosyl glycerols.

Gingerol and shogaol have been shown to suppress gastric contractions. Both fresh and dried rhizomes suppress gastric secretion and reduce vomiting. Gingerol and shogaol have gained importance due to their sedative, anti-inflammatory, antipyretic, analgesic, hypotensive and hepatopro- tective activities.

Cardiotonic effects of ginger has been attributed to 6-and 8-shagaols and gingerols. (Antithrombotic effects remain unconfirmed.) Antimigraine effect is due to ginger's ability to decrease platelet aggregation. It also acts as a potent inhibitor of prostaglandins which enhance release of substance P from trigeminal fibers. (PDR, 2004.)

Indian ginger is considered only second to Jamaican in quality.

There are three main types of Indian ginger—Cochin ginger (light brown or yellowish grey; Calicut ginger from Malabar (orange or reddish brown, resembling African ginger) and Kolkata ginger (greyish brown to greyish blue).... zingiber officinale

Black Currant

Ribes nigrum L. German: Schwarze Ribsel. French: Bassis. Spanish: Grosellero. Italian: Grosularia nera. Garden fruit. Leaves, fruit.

Action: febrifuge (mild), astringent, diuretic, anti-rheumatic. Fruits are a rich source of Vitamin C, and have a Vitamin P effect. Anti-inflammatory for rheumatic disorders and gout. Nerve tonic. Hypotensor. Mild antispasmodic. Cooling.

Uses: As a tea in early stages of fevers until deeper-acting and more specific treatment is prescribed. Capillary fragility. High blood pressure (fruit). Sore throat (tea used as a gargle). Irritable bowel. Renal calculi, oliguria, renal colic.

Combination: equal parts: with Agrimony and German Chamomile for diverticulosis.

Preparations: Leaves: 1oz to 1 pint boiling water; infuse 15 minutes. One-half-1 cup freely.

Fruits: Black currant syrup, BPC.

Note: Seeds are twice as rich in gamma linolenic acid than an equivalent amount in Evening Primrose oil. Assists production of prostaglandins that control blood pressure and regulate metabolism. ... black currant

Castor Oil Plant

Palma Christi. Ricinus communis L. Part used: oil expressed cold drawn from the seeds without the aid of heat. Versatile agent for skin diseases. “Biochemical precursor of prostaglandins . . . a trigger mechanism to immune system T-cells in the skin causing them to activate a local immune system reaction through the lymphatics.” (Harvey Grady, Edgar Cayce Foundation, Virginia Beach, Va., USA)

Action: anti-allergenic, galactagogue. Canary Island nursing mothers bind leaves to the breast to increase secretion of milk. Vitality of cells is upgraded by contact with the oil. Oral contraceptive. (V.J. Brondegaard, Plants Med. 23, 167, 1973) A traditional purgative.

Uses: Internal. Rarely used, except for varied forms of allergy (penicillin, hay fever, etc): 5 drops oil in honey, 3-4 times daily. Mouth ulcers, smear with oil. Large doses avoided.

Topical. Anti-fungal, emollient, anodyne.

Application to warts, corns, bunions, skin disorders, psoriasis, eczema, nail infection, bedsores, pigmented mole, ringworm, itch, ear-infection in children (drops), leg ulcers – dab with smear for pain relief, rodent ulcers made bearable, gangrene (with tincture Myrrh drops). Oil massaged into scalp for 20 minutes daily for falling hair. Eyelids, to soothe and heal. Age spots: brown patches on face, arms or hands have been known to disappear when persevering with a smear of each – Castor oil and Bicarbonate of Soda.

Preparations: Internal use: oil – 5 to 20ml, as prescribed.

External use: Zinc and Castor oil cream, or ointment. Or, Castor oil only.

Castor oil pack, to stimulate the immune system: apply soft pad of material saturated with Castor oil; hold in position with elastic bandage for skin diseases, pains of arthritis or rheumatism; lacerated and well-sutured wounds that refuse to heal. Renew oil when pad becomes dry. Oil may be used as a vehicle for eye drops. ... castor oil plant

Laminaria

n. an osmotic dilator applied to the cervix before surgically induced abortion in the second trimester (15–23 weeks of pregnancy). Pretreatment with prostaglandins can also be used, but laminaria is preferred after 18 weeks gestation in order to avoid trauma to the cervix and uterus.... laminaria

Nitric Oxide

an important member of the group of gaseous mediators, which – together with amine mediators (e.g. adrenaline, noradrenaline, histamine, acetylcholine) and lipid mediators (e.g. prostaglandins) – produce many physiological responses (e.g. smooth muscle relaxation). Nitric oxide is involved in the manifestations of sepsis and septic shock. Formula: NO.... nitric oxide

Linseed

Flaxseed. Linum usitatissimum L. German: Flachs. French: Lin. Italian: Lino usuale. Chinese: Hu-ma-esze. Indian: Tesimosina. Arabian: Bazen. Part used: oil from the seeds (Linseed oil), seeds.

Constituents: oil, mucilage, protein.

Action: demulcent, emollient, anti-cough, nutrient body-builder, antispasmodic (stomach and bowel). Source of polyunsaturated fatty acids, mucins and minerals. Expectorant. Bulk laxative and bowel lubricant. Rich in linoleic acid for breaking down cholesterol deposits, and to produce specific types of prostaglandins. Linseed is around six times richer in Omega-3 (the polyunsaturate present in fish oil) than most fish.

Uses: Its healing mucilage is beneficial for inflammation of the digestive and respiratory tracts, and of the gall duct. To soothe irritable mucous membranes. Spasmodic cough, bronchial asthma, bronchitis. To reduce the risk of atherosclerosis and thrombosis. Heart disease. Persistent constipation.

Preparations: Average dose: 3-6 grams or equivalent. Thrice daily.

Tea: 2-3 teaspoons to cupful boiling water; infuse 15 minutes. Drink without filtering, with honey for sweetening if necessary. One-third-1 cup.

Cold tea for stomach disorders: Half a teaspoon crushed Linseed to cup water soaked overnight. Drink next morning. Heat if desired.

Tincture: 1-2 teaspoons in water.

Poultice: Crushed seeds. Half fill small muslin bag with seeds; immerse in boiling water until swollen seeds fill the bag; apply to abscesses, boils, or to relieve chest pain.

Linseed oil. An ingredient of liniments for burns and scalds.

Linusit: organically cultivated golden Linseed.

Diet: 3 tablespoons crushed Flaxseed daily ensures adequate supply of Omega-3 fatty acids, sprinkled on breakfast cereal, or as an ingredient of muesli. Also increase fluid intake.

Capsules. Emulsified Linseed oil. 1,000mg organic cold-pressed Linseed oil: 1-5 daily. (Bio-Care) LION CLEANSING HERBS. Elder leaf 8 per cent, Fennel 18 per cent, Frangula 8 per cent, Ispaghula 8 percent, Mate 8 per cent, Senna leaf 50 per cent. Non-persistent constipation. (Potter’s) ... linseed

Nonsteroidal Anti-inflammatory Drugs

A group of drugs, also known as NSAIDs that produce analgesia (pain relief) and reduce inflammation in joints and soft tissues such as muscles and ligaments.

Nonsteroidal anti-inflammatory drugs are widely used to relieve symptoms caused by types of arthritis, such as rheumatoid arthritis, osteoarthritis, and gout. They do not cure or halt the progress of disease. NSAIDs are also used in the treatment of back pain, menstrual pain, headaches, pain after minor surgery, and soft tissue injuries.

The drugs reduce pain and inflammation by blocking the production of prostaglandins (chemicals that cause inflammation and trigger transmission of pain signals to the brain).

NSAIDs may cause a wide range of side effects, the most important of which are nausea, indigestion, bleeding from the stomach, and, sometimes, peptic ulcer.... nonsteroidal anti-inflammatory drugs

Semen

(seminal fluid) n. the fluid ejaculated from the penis at sexual climax. Each ejaculate may contain 300–500 million spermatozoa suspended in a fluid secreted by the *prostate gland and *seminal vesicles with a small contribution from *Cowper’s glands. It contains fructose, which provides the spermatozoa with energy, and *prostaglandins, which affect the muscles of the uterus and may therefore assist transport of the spermatozoa. —seminal adj.... semen

Thromboxane

A2 (TXA2) a substance related to prostaglandins that is released by platelets activated by local tissue injury and promotes blood clotting and vasconstriction. See platelet activation. Compare prostacyclin.... thromboxane

Vasodilatation

n. an increase in the diameter of blood vessels, especially arteries. This results from local vasodilator hormones (e.g. *prostaglandins) or activation of the *vasomotor centre in the brain, which bring about relaxation of the arterial walls and a consequent lowering of blood pressure.... vasodilatation

Irritable Bowel Syndrome (ibs)

Previously known as “mucous colitis”, “spastic colon”. Believed to be associated with psychomatic rather than allergic phenomena. Food is said to be responsible for one-third cases. X-ray fails to reveal evidence; prostaglandins implicated. Females more susceptible than men. Cow’s milk and antigens in beef can precipitate.

Symptoms. Spastic colon: colon held in spasm. The two main symptoms are abdominal pain and altered bowel habit. Pain relieved on going to stool or on passing wind. Diarrhoea with watery stools on rising may alternate with constipation. Sensation that the bowel is incompletely emptied. Flatulence. Passing of mucus between stools. The chronic condition may cause anaemia, weight loss and rectal blood calling for treatment of the underlying condition.

Indicated: astringents, demulcents, antispasmodics.

Treatment. If possible, start with 3-day fast.

Alternatives. Teas. (1) Combine equal parts; Agrimony (astringent), Hops (colon analgesic), Ephedra (anti-sensitive). (2) Combine equal parts; Meadowsweet (astringent) and German Chamomile (nervine and anti-inflammatory). Dose: 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup freely, as tolerated. Bilberry tea. 2 tablespoons fresh or dried Bilberries in 1 pint water simmered 10 minutes. Half-1 cup freely.

Note: Old European: Chamomile and Caraway seed tea. 1 cup morning and evening.

Decoction. Formula. Tormentil root 2; Bistort root 2; Valerian root 1. Dose: 2 teaspoons to each cup water simmered 20 minutes. Half-1 cup 3-4 times daily.

Tablets/capsules. Calamus. Cramp bark. Goldenseal. Slippery Elm, Cranesbill.

Formula. Cranesbill 2; Caraway 2; Valerian half. Dose: Powders: 750mg or half a teaspoon). Liquid Extracts: 1-2 teaspoons. Tinctures: 2-4 teaspoons. Thrice daily.

Practitioner. RX tea: equal parts herbs Peppermint, Balm and German Chamomile. Infuse 1-2 teaspoons in cup boiling water and add 3 drops Tincture Belladonna.

Formula. Tinctures. Black Catechu 2; Cranesbill 1; Hops quarter. Dose: 1-2 teaspoons in water or honey, thrice daily.

Psyllium seeds (Ispaghula). 2-5 teaspoons taken with sips of water, or as Normacol, Isogel, etc. For pain in bowel, Valerian.

Fenugreek seeds. 2 teaspoons to cup water simmered 10 minutes. Half-1 cup freely. Consume seeds. Cinnamon, tincture or essence: 30-60 drops in water 3-4 times daily.

Menstrual related irritable bowel. Evening Primrose.

Irritable Bowel Syndrome, with neurosis. Treat thyroid gland (Bugleweed, Kelp, etc).

With severe nerve stress: add CNS (central nervous system) relaxant (Hops, Ladies Slipper, Roman Chamomile)

Oil of Peppermint. A simple alternative. 3-5 drops in teaspoon honey, or in enteric-coated capsule containing 0.2ml standardised Peppermint oil B.P., (Ph.Eur.)

Intestinal antispasmodics: Valerian, Chamomile, Balm, Rosemary.

Diet. “People with IBS should stop drinking coffee as it can induce a desire to defecate.” (Hallamshire Hospital Research Team)

Dandelion coffee. Fenugreek tea. Carrot juice. Bananas mashed into a puree with Slippery Elm powder. Yoghurt. Gluten-free diet.

Supplements. Calcium lactate tablets: 2 × 300mg thrice daily at meals. Floradix. Lactobacillus acidophilus to counteract toxic bacteria. Vitamin C (2-4g). Zinc. Linusit.

Note: Serious depression may underlay the condition. Anti-depressants sometimes relieve symptoms dramatically.

Chronic cases. Referral to Gastrology Outpatient Department. ... irritable bowel syndrome (ibs)

Aspirin

(acetylsalicylic acid) n. a drug that relieves pain and also reduces inflammation and fever. Largely superseded by modern anti-inflammatory agents (see NSAID), aspirin is now most commonly taken regularly in low doses as an *antiplatelet drug. In this role it reduces the risk of vascular thrombosis that may lead to events such as heart attack or stroke. Aspirin works by inhibiting the production of *prostaglandins; it may irritate the lining of the stomach, causing nausea, vomiting, pain, and bleeding. High doses cause dizziness, disturbed hearing, mental confusion, and overbreathing (see salicylism). Aspirin has been implicated as a cause of *Reye’s syndrome and should therefore not be given to children below the age of 16 years unless specifically indicated by a physician. See also analgesic.... aspirin

Carcinoid

n. a tumour of the *argentaffin cells in the glands of the intestine (see apudoma). Carcinoids typically occur in the tip of the appendix and are among the commonest tumours of the small intestine. They may also occur in the rectum and other parts of the digestive tract and in the bronchial tree (bronchial carcinoid adenoma). Carcinoids sometimes produce 5-hydroxytryptamine (serotonin), prostaglandins, and other physiologically active substances, which are inactivated in the liver. If a gastrointestinal tumour has spread to the liver, excess amounts of these substances are released into the systemic circulation and the carcinoid syndrome results – flushing, headache, diarrhoea, bronchial constriction causing asthma-like attacks, and in some cases damage to the right side of the heart associated with fibrosis of the tricuspid valve. Bronchial carcinoids can give rise to the syndrome without metastasizing.... carcinoid

Nsaid

(nonsteroidal anti-inflammatory drug) any one of a large group of drugs used for pain relief, particularly in rheumatic disease associated with inflammation but also in dysmenorrhoea and metastatic bone disease. NSAIDs act by inhibiting the cyclo-oxygenase enzymes (COX-1 and COX-2) responsible for controlling the formation of *prostaglandins, which are important mediators of inflammation. They include *aspirin, *ibuprofen, *ketoprofen, and *naproxen. Adverse effects include gastrointestinal bleeding and ulceration. Some NSAIDs act by selectively inhibiting COX-2 and are therefore less likely to cause gastric side-effects (see COX-2 inhibitor).... nsaid

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