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In five cases where he used it cyclophosphamide 50 mg mastercard, the temperature dropped suddenly so that within four days it was normal order cyclophosphamide 50 mg fast delivery. In the earlier stages he gave thirty grains on the first day; twenty-five the next; twenty the next and so on down until ten cyclophosphamide 50 mg fast delivery. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 110 The successful use of this common remedy, in the treatment of epilepsy has been reported, since our first edition. Persistent cases have been treated, with ten minim doses of a strong fluid extract, increased to forty minims. The action of emetine or alcresta ipecac should be at once determined for the above conditions. It is given by some physicians in small doses for this purpose, and by others in full doses to prompt emesis. It has controlled postpartum hemorrhage, menorrhagia, metrorrhagia, epistaxis and hmmoptysis, and will exercise a beneficial influence in hematuria. Specific Symptomatology—The most direct indication for the use of this agent is a dragging sensation in the extreme lower abdomen, and inclination to pull up, to hold up, or support the abdominal pelvic contents. In women suffering from pelvic engorgement and uterine prolapsus, with disordered menstruation, one drop of the tincture or fluid extract every two or three hours will relieve that sensation permanently. Therapy—Homeopathists believe helonias to be particularly suitable for female disorders, where there is feeble constitution, where the nervous system is weakened and the patient is easily fatigued. It is peculiarly Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 111 tonic. Where disorders of the stomach are present with uterine or kidney disease, it should exercise a direct action. Where malpositions occur from weakness—loss of tone—where there is dragging sensation constantly present in the lower abdomen, or at the menstrual epoch, it is directly indicated. For the case of the worn mother who watches over the care of her charge, as well as for the young girl budding into womanhood, carefully and properly selected, this remedy will certainly give satisfactory results. It is a pure and active restorative; is nutritious and promotes secretion; it promotes normal activity of the glandular organs. When glandular action is prevented, from the influence of uterine or renal disease, it is especially serviceable. It will cure amenorrhea, menorrhagia, some cases of leucorrhea, and the dragging down sensations in the lower abdomen, which results from simple displacements. It will also relieve erratic pains of stomach and gastric disorders which depend upon or accompany this condition. If these disorders are present with threatened abortion, the remedy should be combined with viburnum, and both be given in full doses to prevent that condition. It, however, works more perfectly in combination with aletris farinosa and cimicifuga in atonic conditions, while caulophyllum and viburnum act best where irritable conditions are present. In addition, it is a general tonic improving the character of all the organs in their functional operations, and especially improving the tone of the digestive apparatus. It is a liver remedy of rare value, in many cases accomplishing most satisfactory results when there is deficient or perverted action. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 112 Munn of Connecticut used it for many years with very satisfactory results. From another observation its influence would be improved in certain cases by the addition of phytolacca and where there is marked toxemia by echinacea. If the sensation of dragging and weight occurs in the male from cystic disorder, the relief is fully as satisfactory. The general action of the agent in these cases is that of a tonic to the genito-urinary apparatus. It quickly overcomes the phosphatic diathesis, and in urinary irritability is serviceable, especially if from atonic causes. It is useful in impotence, and its properties as an aphrodisiac have been often noted. Physiological Action—Drastic cathartic and violent local irritant, alterative, diuretic, diaphoretic and expectorant. This agent stimulates the chylopoietic system, favorably influencing all of those organs which are supplied by the solar plexus of the great sympathetic. Specific Symptomatology—The conditions to which chelidonium are especially applicable are found in fully developed abdominal plethora, inefficient functional action of the glandular organs of the abdominal cavity, and imperfect, sluggish and deficient circulation of the tissues, glands and organs of this cavity. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 113 This agent operates in harmony with leptandra, podophyllum, iris versicolor, chionanthus and sodium phosphate, in the three following important conditions: Diminished secretion of bile, evidenced by grayish, clay-colored, or very light yellow stools, which will usually float. There may be no evidences of absorption of bile into the blood—no jaundice; or there may be absorption of the bile and jaundice, with its whole train of symptoms, with dark green and fetid stools and dolic; or there may be the above grayish, clay-colored stools and jaundice, with bile in the urine, which is dark yellow or red, very acid, charged with an excess of uric acid crystals.

The risk of congen- ital anomalies following use during the first trimester is unknown order 50 mg cyclophosphamide overnight delivery, but use during the Special considerations 69 second and third trimesters is associated with a significant risk of fetal-neonatal compli- cations generic cyclophosphamide 50mg otc. The complications include: oligohydramnios cyclophosphamide 50 mg online, fetal/neonatal renal failure, and decreased calcification of the cranium (Friedman and Polifka, 2006). Cardiac arrhythmias Fortunately, life-threatening cardiac arrhythmias are uncommon during pregnancy. However, certain less serious arrhythmias may actually be increased in frequency during pregnancy (Brown and Wendel, 1989). Paroxysomal supraventricular tachycardia Paroxysmal supraventricular tachycardia occurs among 1–2 per 500 young women, and frequently occurs in those without overt heart disease (Brown and Wendel, 1989). Pregnancy may increase risk for this type of arrhythmia (Meller and Goldman, 1982; Szekely and Snaith, 1953). If vagal stim- ulation is unsuccessful, verapamil at 5–10 mg intravenously will prove successful in most cases in pregnant women. Recently adenosine, in a dose of 6 mg given as a rapid intravenous bolus, has been recommended for the treatment of supraventricular tachycardia. As previously mentioned, there is little information regarding the safety of this agent during pregnancy. However, there are several reports regarding its efficacy in pregnant women (Afridi et al. Electrical cardioversion should be reserved for patients with cardiac decompensation in whom medical therapy has failed. Patients with frequent recurrences of this arrhythmia can usually be treated with dig- italis and/or verapamil, quinidine, and propranolol as needed (Brown and Wendel, 1989; Zipes, 1988). Atrial fibrillation Atrial fibrillation is uncommon in pregnant women, and this event points to underlying cardiac or thyroid disease. Mitral valve disease, secondary to rheumatic heart disease, is the most commonly encountered underlying cause of atrial fibrillation in the pregnant patient. Chronic atrial fibrillation treatment is generally directed at slowing the ventric- ular rate through medical therapy, with such medications as digitalis, with or without verapamil or propranolol (Brown and Wendel, 1989). Electrical cardioversion is indicated for significant cardiac decompensation and has been utilized in pregnant women without apparent adverse effects (Schroeder and Harrison, 1971). Ventricular tachycardia is a life-threatening arrhythmia as it may lead to ventricular fibrillation, cardiac decompensation, and death. Fortunately, this arrhythmia is rarely encountered during pregnancy, especially in the absence of specific cardiac disease such as myocardial infarction. Therapy consists primarily of electric cardioversion, especially if the patient is hemodynamically unstable. Lidocaine, pro- cainamide, or bretylium may be used to prevent recurrence of tachycardia. Treatment is primarily electrical cardioversion followed by lidocaine or bretylium to prevent further fibrillation. Special considerations 71 Hypertension Hypertension is one of the most common medical complications encountered during pregnancy and presents as chronic hypertension, pregnancy-induced hypertension, or preeclampsia. In the case of chronic hypertension, an underlying and potentially cor- rectable etiology should be ruled out. No unanimity of opinion has been reached regarding the most appropriate antihypertensive for use during pregnancy or the efficacy of such treatment with regard to pregnancy out- come. Methyldopa (Aldomet) is one of the most commonly used antihypertensives in preg- nant women. Beta-adrenergic blockers such as atenolol, propranolol, or labetolol, as well as the cal- cium channel blockers and the centrally acting agent, clonidine, can also be used during pregnancy to treat hypertensions. However, no scientific evidence indicates that they offer any advantage over methyldopa during pregnancy. A variety of thiazide diuretics may also be utilized as an adjunct in the treatment of hypertension. However, they should not be initiated after 20 weeks gestation because they may interfere with the ‘normal’ pregnancy expansion of blood volume and thus pla- cental perfusion. The treatment goal of medical therapy is to achieve a diastolic blood pressure less than 110 mmHg, and in the range of 90–100 mmHg. Caution must be exercised at the lower range to ensure adequate placental perfusion. Diuretics are generally contraindicated in women with preeclampsia because they may significantly interfere with utero-placental blood flow by further decreasing intravascu- lar volume. Prophylaxis of subacute bacterial endocarditis Pregnant women with significant cardiac lesions should receive antibiotic prophylaxis for invasive procedures, including vaginal and Caesarean delivery, as prophylaxis for endocarditis (see Box 3.

Eczema (Atopic dermatitis)— A long-term skin disorder that involves scaly and itchy rashes cheap cyclophosphamide 50 mg with visa. Endogenous—Caused by factors within the body 50mg cyclophosphamide for sale, resulting from conditions within the organism buy cheap cyclophosphamide 50 mg line. Endometriosis—A female health disorder that occurs when cells from the lining of the womb (uterus) grow in other areas of the body. This can lead to pain, irregular bleeding, and problems getting pregnant (infertility). Epidemiologists—Scientists who investigate and describe the causes and spread of disease, and develop the means for prevention or control. They respond to disease outbreaks, determining their causes and helping to contain them. Epinephrine—A hormone with neurotransmitters made in the inner core of the adrenals that help you focus and problem-solve. It creates amounts of glucose and fatty acids that can be used by the body as fuel in times of stress or danger when increased alertness or exertion is required. It is responsible for the growth of the womb (uterus), breast development, fallopian tubes, and vagina, and plays a role in the distribution of body fat in women. It is used to treat breast tenderness, cysts, cancer, fibroids, endometriosis, endometrial cancer, hot flashes, and symptoms in women who are experiencing or have experienced menopause. Fibromyalgia—A common syndrome in which a person has long-term, body-wide pain and tenderness in the joints, muscles, tendons, and other soft tissues. Fibromyalgia has also been linked to fatigue, sleep problems, headaches, depression, and anxiety. Free T3 (Free triiodothyronine)—A free T3 (fT3) test is used to assess thyroid function. It is ordered primarily to help diagnose hyperthyroidism and may be ordered to help monitor the status of a person with a known thyroid disorder. Free T4 (Free thyroxine)— The free T4 (fT4) test is thought by many to be a more accurate reflection of thyroid hormone function and aid in the diagnosis of female infertility. Glandular therapy—A technique that is useful to treat hormonal problems by alternative healers but lacks randomized trial data. Generally the historical motive was to support the weak gland of the patient with an analogous animal gland rich in specific nutrients. Glucocorticoids—Made in the outside portion (the cortex) of the adrenal gland, glucocorticoids regulate the metabolism of glucose and are chemically classed as steroids. Hawthorne effect—The phenomenon in which subjects in behavioral studies change their performance in response to being observed. Hippocampus—The main home for memory formation and storage in the brain, found under the frontal part of the cerebral cortex. It is the brain region responsible for memory, with its high number of cortisol receptors. Hyperarousal—The scientific term for “stressed out,” meaning that the body’s alarm system never shuts off. Hypercortisolism—Known as Cushing’s syndrome, hypercortisolism is a disorder that occurs when your body is exposed to high levels of the hormone cortisol. It can also occur if you take too much cortisol or other steroid hormones precursors. Hyperplasia may be a sign of abnormal or precancerous changes, particularly atypical hyperplasia of the endometrium. Blood pressure is a measurement of the force against the walls of your arteries as your heart pumps blood through your body. Hypervigilance— Abnormally increased arousal, responsiveness to stimuli, and scanning of the environment for threats. Hypocortisolism—Also known as low cortisol, hypocortisolism occurs when your adrenal glands are unable to make a normal amount of the main stress hormone, cortisol. Hypoglycemia—The depletion of feel-good neurotransmitters that occurs when your blood sugar (glucose) is too low. Hypopituitarism—When the pituitary does not make normal amounts of some or all of its hormones— including the hormones that control the ovaries, thyroid, and adrenals—as a result of head injury, brain surgery, radiation, stroke, or a problem called Sheehan’s syndrome, which is when a woman bleeds severely during childbirth. Hypothalamus—An area of the brain that produces hormones that control body temperature, hunger, moods, sex drive, sleep, and the release of hormones from many glands, especially the pituitary gland. Hypothyroidism—An underactive thyroid, characterized by fatigue, weight gain, and mood problems. Kanchanar guggulu—A substance used for the thyroid but not supported by the best evidence (randomized trials). Leptin—A hormone that controls hunger, metabolism, and the utilization of food as fuel or fat.