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These compounds inactivated this heme-containing enzyme in a manner that met the criteria for a mechanism-based inhibitor as defined by Silverman (44) discount cafergot master card pain treatment wellness center. However order cafergot without a prescription knee pain treatment ligament, the inactivated enzyme spontaneously lost In Vitro Study of Drug-Metabolizing Enzymes 259 the heme adducts over several hours with a return of enzymatic activity and native heme generic cafergot 100 mg mastercard who pain treatment guidelines, thus qualifying as “reversible inactivation best buy cafergot knee pain treatment urdu. The heme adducts decomposed (became dealkylated) over time except under acidic con- ditions (53). However, Silverman noted that no period of time is defined for how long an enzyme-inactivator complex must persist for the inactivator to be classified as irreversible (44). In such cases, the inter- actions can persist for some time after cessation of the perpetrator drug. The kinetics of metabolism-dependent irreversible or quasi-irreversible inhibition can be complex (46) and are covered in chapter 11 of this book. The kinetics of metabolism-dependent inhibition caused by metabolites that function as direct-acting inhibitors (e. Therefore, when further examination of such inhibition is warranted, the inhibitory metabolite itself should be investigated. All of these designs offer certain advantages, but all have certain drawbacks as well, and most are intended to be used during drug discovery or early drug development. These may offer some advantages over fluorogenic substrates, but they have not been widely utilized (66,67) and appear more suited for screening during early discovery. Most of these substrates are not amenable to rapid analytical methods that make use of plate readers. Because of this limitation of chromatographic-based separations, several groups have developed radiometric assays based on radiolabeled conventional substrates, often with an extraction step, followed by scintillation counting (26,68–70). Test article interference is seldom a problem with radiometric methods, but their sensitivity varies with the specific activity of the substrate, which may necessitate the use of undesirably high protein concentrations and/or lengthy incubation times. In addition, radiometric methods are undesirable from a waste management per- spective. Two types of cocktail approach are used: one involves preincubation pooling of multiple marker substrates; the other involves postincubation pooling of multiple samples that were incubated with individual marker substrates. These problems are solved by incubating the marker substrates individually and pooling the samples after the incubations are terminated. However, a disadvantage of such postincubation pooling is that the samples become significantly diluted depending on the number of samples pooled. This controversy is partly because the principles of Michaelis- Menten enzyme kinetics (pure thoughts) are often applied to these (impure) systems. The advantages and disadvantages of each system are highlighted in the following sections. Another advantage is that the same sample of pooled human liver microsomes (and often the same experimental conditions, i. This is an important consideration because the enzyme that converts a drug to an inhibitory metabolite may not be the one that is inhibited (covered in detail below). A potential disadvantage of using pooled human liver microsomes is that these microsomes contain a large amount of lipid and protein that can decrease the free concentration of drug in the medium. However, to various degrees, this is a disad- vantage of all available in vitro systems. This disadvantage can be largely overcome by using highly sensitive analytical methods (e. Another potential disad- vantage is that human liver microsomes are an exhaustible resource; therefore, each batch of microsomes is slightly different, although the variability can be minimized by pooling samples from a large number of individuals and by preparing large batches with careful selection of individual samples. Indeed, when these measures are taken, pooled human liver microsomes may be one of the most consistent in vitro systems, with a well-designed pool lasting for four years or more (sufficient for 200 definitive studies, one per week or more). While the differences are sometimes artifacts of incubation conditions (especially those that are likely to violate the assumptions of the Michaelis-Menten equation), some differences appear to reflect genuine differences in the kinetics of reactions catalyzed by recombinant enzymes, purified enzymes, and human liver microsomes (Table 4). Constants are shown Æ standard m error (rounded to 2 significant figures, with standard error values rounded to the same degree of accuracy as the constant), and were calculated using GraFit software, which utilized rates of product formation (triplicate data) at 13 substrate concentrations. The cause of this difference remains unclear, but it was postulated that it reflects differences in the access of diclofenac to an effector-binding site or differences in active site conformation. The Ki values in Supersomes were found to be within a factor of 3 of the values for human liver microsomes with the exception of fluvoxamine, ketoconazole, and piroxicam (in which case the Ki values were 9-, 5. Ki values can also be estimated in vivo, but the study design is more involved than that typically used to evaluate the inhibitory 268 Ogilvie et al. In vivo Ki values can be determined in animals because it is possible to infuse a victim drug directly into the hepatic portal vein to accurately determine clearance, and subsequently to administer a wide range of bolus intravenous doses of a perpetrator drug in order to achieve a range of steady- state plasma concentrations. This approach was used in rats to determine that omeprazole inhibits the metabolism of diazepam with an in vivo Ki value of 21 mM (95), which is comparable to the in vitro Ki value determined in both rat liver microsomes and rat hepatocytes by a variety of experimental approaches (e. Furthermore, human hep- atocytes do not offer many of the advantages afforded by human liver microsomes. In contrast to human liver microsomes, human hepatocytes are difficult to pool in sufficiently large quantities to permit a detailed analysis of the kinetics of each marker substrate. In hepatocytes, a portion of the metabolite formed from various maker substrates may be conjugated, which further complicates the analysis of enzyme kinetics. It is not practical to prepare a pool of human hepatocytes that might support inhibition studies for a year or more, which can easily be accomplished with pooled human liver microsomes. Finally, in contrast to the situation with microsomes, cell viability is an issue with hepatocytes. In addition to being plagued with the same problems as noted for isolated hepatocytes, liver slices cannot be pooled, and even precision-cut liver slices (*20 cells thick) present a barrier to drug, metabolite, nutrient, and oxygen diffusion. It is possible, there- fore, that an inhibitor may not reach the same cells as those reached by the marker substrate, which will lead to an underestimation of inhibitory potential (102). Reactions can be terminated with an appropriate volume (usually an equal volume) of an organic solvent that is compatible with the analytical method to be used. In an automated system, it is most convenient to include the internal standard (preferably deuterated forms of the marker metabolite) at an appropriate concentration in the stop reagent. As mentioned in previous sections, microsomal protein concentrations and incubation times must be chosen in such a way that initial rate conditions are achieved and nonspecific binding to microsomal protein and lipids is minimized. The use of nearly uniform incubation conditions mini- mizes interassay differences in drug candidate metabolic stability and non- specific binding. The use of highly sensitive analytical methods also allows for a short incubation time with marker substrate (e. A similar effect is observed with long substrate incubation times when the drug candidate is rapidly converted to less 270 Ogilvie et al. In Vitro Study of Drug-Metabolizing Enzymes 271 inhibitory metabolites (inhibitor depletion). For Ki determinations, a common substrate concentration scheme is Km/3, Km,3Km,6Km, and 10Km. Assuming that the Km for the reaction has been accurately determined, this range of substrate concentrations will provide an adequate spread of data on an Eadie- Hofstee plot to readily observe the mechanism of direct inhibition. In such cases, it becomes necessary to choose alternate concentrations so that no fewer than five concentrations are used in a Ki determination.

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Renal function Periodically * If renal function deteriorates therapy may need to be stopped generic cafergot 100 mg free shipping pain treatment center of greater washington. Renal impairment may lead to high antimony plasma levels and increased renal and cardiotoxicity buy cheap cafergot 100 mg on line pain medication for dogs teeth. Other: Anorexia 100 mg cafergot with mastercard pain management in uti, vomiting purchase line cafergot pain medication for old dogs, nausea, malaise, arthralgia and myalgia, headache, lethargy, and pancreatitis. Action in case of Antidote: Dimercaprol has been reported to be effective as a chelating agent in overdose the treatment of intoxication with antimony compounds (see the Dimercaprol monograph). This assessment is based on the full range of preparation and administration options described in the monograph. It acts as a sulfur-donating substrate for the enzyme rhodanese, which catalyses the conversion of cyanide to relatively non-toxic thiocyanate, and thus accelerates the detoxification of cyanide. Pre-treatment checks * It is important to be aware whether any cyanide antidote therapy has been given in the pre- hospital setting as repeat doses of some antidotes can cause serious side-effects. Mild poisoning (nausea, dizziness, drowsiness, hyperventilation, anxiety): * Observe. Severe poisoning (coma, fixed dilated pupils, cardiovascular collapse, respiratory failure, cyanosis): If dicobalt edetate is available: As well as other supportive measures: * Give 300mg (20mL) of 1. If a second dose of dicobalt edetate is given, there is "risk of cobalt toxicity but only if the diagnosis is not cyanide poisoning. Technical information Incompatible with Hydroxocobalamin Compatible with Not relevant pH 7--9 Sodium content Contains sodium, but not relevant in an emergency situation. This assessment is based on the full range of preparation and administration options described in the monograph. Add the required dose to at least 50mL of compatible infusion fluid (usually 100mL NaCl 0. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Technical information Incompatible with No information Compatible with Flush: NaCl 0. From a microbiological point of view, preparation prepared infusionsshould be used immediately: however,theymay be storedat 2--8 C and infused (at room temperature) within 24 hours. Monitoring Measure Frequency Rationale Seizure frequency Throughout treatment * Monitor for reduction in the frequency and severity to and severity ensure therapeutic effect. Plasma valproate If poor compliance is * Not routinely monitored as dosage is usually level suspected or side- established by overall situation and seizure control. Ammonia levels If mental confusion * Moderatehyperammonaemiaoccursfrequentlyandis develops and before usuallytransient. Thereis noneedtostoptherapyifthe initiation if urea cycle patient is asymptomatic. Pregnancy If pregnancy * Sodium valproate may be teratogenic; pregnancy suspected should be discussed with a specialist. Additional information Common and Immediate: Rash and other hypersensitivity reactions have been reported. Rarely severe liver damage, pancreatitis (signs: nausea, vomiting, acute abdominal pain), drowsiness, encephalopathy, #Na, anaemia, leucopenia, pancytopenia, toxic epidermal necrolysis, Stevens--Johnson syndrome, erythema multiforme. Action in case of Symptoms of overdose are unlikely at levels up to 5--6 times the maximum overdose therapeutic plasma levels. If symptoms do occur, stop administration and give supportive therapy as appropriate. This assessment is based on the full range of preparation and administration options described in the monograph. Starch, etherified See products listed in Table S3 below (other products may be available) * Etherifiedstarch preparationsareplasmavolumeexpanders. They are not a substitute for whole blood or plasma and have no oxygen-carrying capacity; blood products should be given as soon as available if appropriate. Pre-treatment checks * Do not give to patients likely to develop circulatory overload, e. Prolonged infusion should be avoided where possible because of the risk of depletion of plasma proteins, electrolytes and coagulation factors. Follow imme- diately by the administration of appropriate isotonic replacement fluids, dosed according to the needs of the patient. Inspect visually for particulate matter or discoloration prior to administration and discard if present. Somemanufacturersrecommend that owing to the risk of anaphylaxis, the first 10--20mL should be given slowly and the patient observed closely. Inspect visually for particulatematter or discoloration prior to administration and discard if present. Follow immediately by the administration of appropriate isotonic replacement fluids. Technical information Incompatible with No information Compatible with Flush: NaCl 0. Serum osmolality * Particularly with hypertonic solutions and in diabetic patients. Additional information Common and serious Immediate: Anaphylactoid and other hypersensitivity reactions have been undesirable effects reported. Common: Pruritus with prolonged administration -- may not occur until weeks after the last infusion and may persist for several months. Dilutional effects: may result in a dilution of blood components and #haematocrit. Significant drug * Etherified starches may "levels or effect (or "side-effects) of heparins (may interactions extend bleeding time). This assessment is based on the full range of preparation and administration options described in the monograph. T able S 3 urth ertech n ical in form ation ofsom e eth erified starch - con tain in g fl uids S tarch type H etastarch entastarch etrastarch ypertoni c B rand: eneri c S - steri l em oh es em oh es V enofundi n V olulyte V oluv en yperH S P ercentag e: V olum e: Na ( m m ol ) K ( m m ol ) M g ( m m ol ) C ( m m ol ) A cetate( m m ol ) pH M ol. Pre-treatment checks Streptokinase is contraindicated in the following: * Existing or recent internal haemorrhages, all forms of #blood coagulability, in particular spontaneous fibrinolysis and extensive clotting disorders. Use of an alternative non-antigenic thrombolytic is recommended for repeat thrombolysis after this time. Consider prophylactic administra- tion of parenteral corticosteroid when used systemically. Clearance of thoracic empyema and pleural effusion (unlicensed): 250000 units intrapleu- rally as a single dose or once or twice daily for 3--5 days. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present.

Their verdict was unanimous: although the collection was interesting and the seminar work showed a student’s ability in research buy cheap cafergot 100 mg pain management during shingles, the topic itself had no philological value buy cafergot 100mg line pain medication for arthritis in dogs. Both the collection and Folklore 46Folklore 46Folklore 46Folklore 46Folklore 46 http://www purchase cafergot paypal pain treatment in shingles. Although presented to me very politely and amiably purchase cheap cafergot pain management treatment plan, this conclusion caused me a profound psychological trauma. For six months I could write nothing at all, and then I switched abruptly from folklore to literary studies. My emigra- tion in 1991 caused me to return to the path of folklore studies, but one angle of it, namely medical proverbs, remained previously sealed for me and thus my father must be again mentioned. He carried our collection in his immi- grant luggage; he even brought along my old seminar paper. For thirty years he tried to persuade me to publish our collection, occasionally encountering “explosions” from myself. He refused to publish it under his own name, al- though I ardently suggested that he do so and while I said “never”, he still waited patiently. Then, suddenly, the situation changed when two years ago, in one of our numerous fervent debates on medical proverbs it struck me that my father was growing old. This understanding changed the whole perspective of the issue so I was not about to deprive him of one of the few pleasures remain- ing to him. The fear that he might not see this work published, and I would blame myself for it, was bitterer than the memory of my failure so long ago. And so I agreed to publish the book of medical proverbs, with the proviso that he typed it out himself on the computer and as my father was still not really computer literate the task was enormous. But he accomplished it, and even added many Jewish proverbs himself and so the upshot is that our book has been published. And my paper on medical proverbs can be viewed as one of the confirmations of the wise folk sayings – “Never say never”. But the difference should be defined as not all the proverbs used by medical practitioners are medical in content; and medical content does not automati- cally imply the use of these items in medicine. Medical proverbs and proverbial sayings uttered by people constitute pithy observations, opinions and advices across a whole array of human existence, covering life, death, illnesses, and relations of doctors and patients. Elmquist introduced the notions of indirect and direct references to physiologi- cal matters in proverbs and proverbial sayings, limiting his research to the latter group (Elmquist 1934: 75). In principle, I accept this dichotomy, although Elmquist’s examples of indirect references to physiological matters are, I be- 112 www. I see no physiological significance in such prov- erbs as “A new broom sweeps clean” or “Coming events cast their shadows before” (Elmquist 1934: 75). To my mind, the narrow cluster of medical prov- erbs includes those about illness, pain, doctors, patients, folk healers, healthy and unhealthy habits, medication, and diagnostic and prognostic proverbs, while a broad cluster also encompasses proverbs and sayings about life and death, general ideas about age and so on. To the best of my knowledge, the collections of medical proverbs are not limited to the narrow group, which is as it should be. The borders between health and illness, age and illness, and even life and death, are permeable and cannot be sealed. It has been noted that the prov- erbs’ reflection of the “actual healing art is poor” (Garrison, 1928: 984; Anony- mous 1914: 875) and that they “are not particularly enlightening from the scientific point of view” (Mieder 1993: 153). For all that medical proverbs were and remain in demand, as they are perceived as a true reflection of people’s worldview and a source of good counsel (Zakharov & Zhungietu 1975: 5–6). Latin medical proverbs are known from late Antiquity while collections of medical proverbs exist since the Middle Ages (Mieder 1993: 152–153). Medical proverbs might equally be included in general collections as separate chapters (Dal’ 1957). Past and present collections of such proverbs have been compiled by medical doctors and/or by specialists in humanities (folklorists, linguists, etc. Vladimir Dal’, who was both a physician and a great linguist) or in a single team of a physi- cian or a biologist and a folklorist (Fialkov & Fialkova 2009; Zakharov & Zhungietu 1975). In other cases, the work can be accomplished by physicians and psychologists themselves (Dudnikov 1969; Kadymov 1971; Zhitnikova & Polivanova 2001) or by a folklorist with no medical education (Sysoev 2007). The intended readership of such publications varies between the general pub- lic and medical personnel. With the former, the aim of publication is usually to disseminate medical information in a popular form easy to remember (Kadymov 1971; Sysoev 2007; Zakharov & Zhungietu 1975); with the latter, it is to pro- vide doctors and psychologists (both at the clinic and in their teaching activi- ties) with lively material to facilitate their communication with patients or with an audience (Dunaevskii 1965; Zhitnikova & Polivanova 2001). Which- ever audience is targeted does not influence the type of the material, although it becomes more important in the case of analyses (Zhitnikov & Polivanova 2001). Others, although deprived of medical content, are nevertheless an integral part of medical discourse. An Folklore 46Folklore 46Folklore 46Folklore 46Folklore 46 113 Larisa Fialkova example is, “When you hear hoofbeats, think horses, not zebras”. Yet as shown by Alan Dundes and colleagues, it is used in a number of variations by doctors in their papers published in professional medical journals. Hoofbeats in this context are deciphered as symptoms of a disorder presaging common diseases (horses) or rare and/or exotic ones (zebras). Here we have a clear example of an in-group proverb which, taken out of professional discourse, loses its medical character entirely. So to my mind the notion “diagnostic”, applied to this proverb by Dundes and colleagues is inaccurate (Dundes et al. This term should be reserved for proverbs with obvious medical diag- nostic content such as “If he has blue veins on the nose, he’ll never wear his wedding clothes” (Elmquist 1934: 79–80), Nebo zhelteet k dozhdiu, chelovek – k bolezni (‘The sky turns yellow before rain, a person – before illness’), Gde kashel’ – tam i khvor’ (‘The cough comes with the illness’) (Fialkov & Fialkova 2009: 74, 86). But the proverb about the horses and zebras suits another para- digm, namely, informal medical discourse (Stoianova 2007). Proverbs are often used as a clinical test for schizophrenia, as well as apha- sia and Alzheimer’s disease. The rationale rests on patients’ impaired abstract mental abilities, that is, their capacity or failure to distinguish a proverb’s metaphoric form from its literal meaning. The test uses both the multiple- choice and the free-answer techniques, the former consisting of 40 items, each with four possible answers; the latter comprises 12 items, scaled in order of difficulty. The free-answer test is more reliable, especially with the high intel- ligence group (Gorham 1956). Other authors have attempted to improve the test’s reliability by including the factor of familiarity/non-familiarity with the proverbs (Ulatowska et al. Wolfgang Mieder pointed out that the items in the proverbs test are extracted from their context, which is of crucial importance for their understanding (Mieder 2004: 142). I would like to add that to my knowledge the papers on the application of the proverbs test in psychiatry published in medical journals carry no references whatsoever to research of proverbs in folklore. This indicates that the tests are designed by people whose under- standing of the proverbs is that of the lay public, not of professionals. A context-related approach to proverbs can be found in the writings of psy- chiatric and/or geriatric social workers, whose daily contact with patients re- quires mobilization of informal resources. Proverbs are important for gaining information about the patients’ mental state when open discussion is suppressed by cultural norms, as in the case of Israeli Bedouins, and/or for facilitating of contact among the patients themselves or between them and the staff. Some of them have evident medical content: “An apple a day keeps a doctor away”, “An ounce of prevention is worth a pound of cure” (Jackson 1995: 8), “After much patience and frustration the situation will lead to the grave” (Al-Krenawi: 2000: 99).

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In spasmodic conditions of the stomach and bowels with tympanites discount cafergot 100 mg mastercard pain treatment guidelines 2014, in the absence of active inflammation it is a remedy long used generic 100 mg cafergot mastercard midwest pain treatment center wausau wi. In accumulations of gas in the stomach or bowels it has been used to purchase cafergot overnight treatment pain during menstruation, the best advantage generic cafergot 100 mg amex laser pain treatment for dogs. In spasmodic bronchial affections, in whooping cough, and in asthma it was a favorite with the older doctors. In the bronchial catarrhs of the aged and infants it has been given with advantage, especially if nervous depression was present. A three-grain pill was the celebrated “Keeley cure” for la grippe, and those who have used the remedy in epidemic influenza are usually enthusiastic in its praise. It has been recommended during the progress of low fevers, where the nervous system is greatly debilitated, as in typhus, typhoid and typho- pneumonia. Wherever the nervous system has received the effect of a protracted prostrating disease, it can be given with advantage. Murawieff Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 217 advised it in both acute and chronic pulmonary disease, through its influence upon the nervous system. Probably it influences the circulatory and respiratory functions, supporting them under the strain of protracted inflammation. The remedy has been used in stomach disease, diarrhea, in dysentery, and in cholera. When the nervous system is enfeebled in hysteria, and in delirium tremens, it is a good remedy. In chlorosis, anemia with nervous phenomena, in leucorrhea and gleet, it is to be advised. In one case, there was contraction of muscles of the shoulders with inability to raise the arms, with severe neuralgic pain, weakness of the nervous system, and violent attacks of the heart. There were rheumatic pains in the feet and lower part of the legs which prevented the patient from walking except with the aid of a crutch. There was gradual improvement, and the patient ultimately made a satisfactory recovery. Cowen gives manaca in fifteen-drop doses, with salicylate of sodium in acute rheumatism. Hopkins gives manaca in muscular rheumatism in four-drop doses every two or three hours. Therapy—This agent operates upon the stomach and digestive apparatus directly, influencing the tone of the glandular organs of the entire digestive tract. It is a stomachic tonic of considerable power, exercising its best influence when the apparatus is impaired by protracted disease. Under these circumstances it is also a stimulant and astringent to the secreting surfaces, correcting excessive night sweats common to such a condition, controlling the diarrhea and dysentery where there are relaxed and atonic mucous membranes. In that form of catarrhal gastritis, where there is a sense of fullness in the stomach after eating even a little food, it improves the digestion and relieves the distress, and where there is marked debility improves the tone of all the organs. Dragging pains in the lower abdomen—great weight; a sensation of hardness extending into the vagina; irregular lochial or menstrual discharge; general plethora; constant headaches, with soreness and pain in the top head. Accompanying these symptoms there is a sore spot on the top of the head which is hot, and where if continued the hair becomes stiff and brittle. It resembles an anemic headache as it is more or less constant, unless relieved by the recumbent position or by a position in which the hips are raised and the Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 219 head lowered. It is indicated in uterine tumors, of somewhat speedy growth, and in hypertrophy of the uterus. It influences cell proliferation in hypertrophy, assisting in the reduction of size of an enlarged organ and in the restoration of a correct position, normal function and normal size. One patient had a sensation of much weight in the lower abdomen with a sensation of hardness extending down into the vagina, pressure in the rectum, hard and enlarged cervix, greatly enlarged womb, constant sensations of desire to pass urine with no relief when passed. Another case of hypertrophy, resulting from a miscarriage, was as satisfactorily cured. Cases of subinvolution, following a poor getting up, after labor, were satisfactorily cured with this remedy alone. The agent must be given immediately following confinement in those cases where convalescence threatens to be protracted. One young lady, severely injured by falling from a carriage, had severe uterine inflammation, which left chronic enlargement, as its result. The organ was enlarged to six times its usual size, though she was only eighteen years old. Prior to the use of this remedy, for uterine disorders, it was recommended as one that influences the chylopoietic viscera. It has found a place in the treatment of diseases of the liver or spleen, in that form known as ague cake, resulting in obesity, dropsical affections and constipation. Therapy—This agent is, used for the specific purpose of reducing unhealthy fat in excessive adiposity. If given in doses of from one-half to two drams, three or four times daily, it has reduced excessively fat patients in a satisfactory manner without interfering in any way with the normal health functions. Wilhite, in New Preparations, 1878, gave his observations as follows: “From our study of the drug we do not believe fucus to be a reducer of the adipose tissue of healthy subjects. It is mostly on those cold, torpid individuals with a cold, clammy skin, loose and flabby rolls of fat, with relaxed pendulous abdomen, that fucus will display its powers to the best advantage. With such the remedy acts beneficially by overcoming this torpid and morbid tendency, thus reducing the size by toning up the vascular and sympathetic systems. Possibly it also acts upon the starchy matters of the food in some manner, so as to prevent their easy change into fat when introduced into the human economy. It has little or no influence in the reduction of the fleshiness of persons of active habits, or of those of the sanguine temperament In these cases strict regulation of the diet affords the only prospects of relief, but owing to the keenness of the appetite usually present, this regulation is rarely enforced. Fucus shows its most decided influence upon women in whom there exist menstrual derangements as menorrhagia and leucorrhea, owing to a general atonic and flabby condition of the uterine tissues. In such cases an improvement in the local derangements usually precedes the general reduction of fat and the improved tonicity of the general system. Fucus is advised as a specific remedy in the treatment of both exophthalmic and simple goitre. It is of service in desquamative nephritis, and in irritation and inflammation of the bladder. When general muscular Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 221 relaxation is present, it is of service in the treatment of menstrual derangements. Therapy—A sedative remedy in acute inflammation or irritation of the urinary tract. Given in fever it impresses the temperature favorably, stimulates the excretion of all urinary constituents and the fever is shortened by its use. It is useful in dysuria if from acute inflammation, and it is an excellent remedy for suppression when nephritis has occurred from septic causes. It is useful in strangury in vesical irritation from uterine disorder and in the cystic and prostatic irritation of old men.

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