The effect of vitamin D on the severity of dysmenorrhea and menstrual blood loss: a randomized clinical trial.

BACKGROUND: Primary dysmenorrhea is considered as one of the women's main problems during reproductive age. The present study aimed to investigate the effect of vitamin D on the severity of dysmenorrhea and menstrual blood loss. METHODS: This double-blind, randomized, placebo-controlled trial, was performed on 84 single female college students between 18 and 25 years old who living in dormitories. Students with primary dysmenorrhea and vitamin D deficiency were divided into experimental (n = 42) and control (n = 42) groups. Five days before the putative beginning of their next menstrual cycle, the experimental group received 300,000 IU vitamin D (50,000 IU, two tablets every 8 h), and the control group received a placebo (oral paraffin). The effects of the supplement on the severity of dysmenorrhea and menstrual blood loss were evaluated one cycle before and during two successive cycles. Using the visual analog scale (VAS), verbal multidimensional scoring system (VMS), and pictorial blood assessment chart (PBLAC) questionnaires. Fisher's exact, Chi-square, independent sample t-test and repeated measurements were used. RESULTS: In total, 78 of the 84 students completed the study (39 students per group). The intervention resulted in a significant reduction in the mean scores of both the VAS and VMS in the experimental group, in the first and second menstrual cycles (p < 0.001, p < 0.001, respectively), but not in the means score of PBLAC. Mefenamic acid consumption at the first and second menstruation period, in the experimental group was lower than the control group (p = 0.009, p < 0.001, respectively). CONCLUSIONS: The results indicate that vitamin D supplementation could decrease the severity of primary dysmenorrhea and the need to consume pain-relief medications. Contrariwise vitamin D supplementation had no significant effect on menstrual blood loss. TRIAL REGISTRATION: This trial was registered in the Iranian Registry of Clinical Trials with code IRCT201305212324N on 18/1/2014. URL of registry: https://en.irct.ir/trial/1964 .

Interventions to prevent or treat heavy menstrual bleeding or pain associated with intrauterine-device use.

BACKGROUND: Heavy menstrual bleeding and pain are common reasons women discontinue intrauterine device (IUD) use. Copper IUD (Cu IUD) users tend to experience increased menstrual bleeding, whereas levonorgestrel IUD (LNG IUD) users tend to have irregular menstruation. Medical therapies used to reduce heavy menstrual bleeding or pain associated with Cu and LNG IUD use include non-steroidal anti-inflammatory drugs (NSAIDs), anti-fibrinolytics and paracetamol. We analysed treatment and prevention interventions separately because the expected outcomes for treatment and prevention interventions differ. We did not combine different drug classes in the analysis as they have different mechanisms of action. This is an update of a review originally on NSAIDs. The review scope has been widened to include all interventions for treatment or prevention of heavy menstrual bleeding or pain associated with IUD use. OBJECTIVES: To evaluate all randomized controlled trials (RCTs) that have assessed strategies for treatment and prevention of heavy menstrual bleeding or pain associated with IUD use, for example, pharmacotherapy and alternative therapies. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and CINAHL to January 2021. SELECTION CRITERIA: We included RCTs in any language that tested strategies for treatment or prevention of heavy menstrual bleeding or pain associated with IUD (Cu IUD, LNG IUD or other IUD) use. The comparison could be no intervention, placebo or another active intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, and extracted data. Primary outcomes were volume of menstrual blood loss, duration of menstruation and painful menstruation. We used a random-effects model in all meta-analyses. Review authors assessed the certainty of evidence using GRADE. MAIN RESULTS: This review includes 21 trials involving 3689 participants from middle- and high-income countries. Women were 18 to 45 years old and either already using an IUD or had just had one placed for contraception. The included trials examined NSAIDs and other interventions. Eleven were treatment trials, of these seven were on users of the Cu IUD, one on LNG IUD and three on an unknown type. Ten were prevention trials, six focused on Cu IUD users, and four on LNG IUD users. Sixteen trials had high risk of detection bias due to subjective assessment of pain and bleeding. Treatment of heavy menstrual bleeding Cu IUD Vitamin B1 resulted in fewer pads used per day (mean difference (MD) -7.00, 95% confidence interval (CI) -8.50 to -5.50) and fewer bleeding days (MD -2.00, 95% CI -2.38 to -1.62; 1 trial; 110 women; low-certainty evidence) compared to placebo. The evidence is very uncertain about the effect of naproxen on the volume of menstruation compared to placebo (odds ratio (OR) 0.09, 95% CI 0.00 to 1.78; 1 trial, 40 women; very low-certainty evidence). Treatment with mefenamic acid resulted in less volume of blood loss compared to tranexamic acid (MD -64.26, 95% CI -105.65 to -22.87; 1 trial, 94 women; low-certainty evidence). However, there was no difference in duration of bleeding with treatment of mefenamic acid or tranexamic acid (MD 0.08 days, 95% CI -0.27 to 0.42, 2 trials, 152 women; low-certainty evidence). LNG IUD The use of ulipristal acetate in LNG IUD may not reduce the number of bleeding days in 90 days in comparison to placebo (MD -9.30 days, 95% CI -26.76 to 8.16; 1 trial, 24 women; low-certainty evidence). Unknown IUD type Mefenamic acid may not reduce volume of bleeding compared to Vitex agnus measured by pictorial blood assessment chart (MD -2.40, 95% CI -13.77 to 8.97; 1 trial; 84 women; low-certainty evidence). Treatment of pain Cu IUD Treatment with tranexamic acid and sodium diclofenac may result in little or no difference in the occurrence of pain (OR 1.00, 95% CI 0.06 to 17.25; 1 trial, 38 women; very low-certainty evidence). Unknown IUD type Naproxen may reduce pain (MD 4.10, 95% CI 0.91 to 7.29; 1 trial, 33 women; low-certainty evidence). Prevention of heavy menstrual bleeding Cu IUD We found very low-certainty evidence that tolfenamic acid may prevent heavy bleeding compared to placebo (OR 0.54, 95% CI 0.34 to 0.85; 1 trial, 310 women). There was no difference between ibuprofen and placebo in blood volume reduction (MD -14.11, 95% CI -36.04 to 7.82) and duration of bleeding (MD -0.2 days, 95% CI -1.40 to 1.0; 1 trial, 28 women, low-certainty evidence). Aspirin may not prevent heavy bleeding in comparison to paracetamol (MD -0.30, 95% CI -26.16 to 25.56; 1 trial, 20 women; very low-certainty evidence). LNG IUD Ulipristal acetate may increase the percentage of bleeding days compared to placebo (MD 9.50, 95% CI 1.48 to 17.52; 1 trial, 118 women; low-certainty evidence). There were insufficient data for analysis in a single trial comparing mifepristone and vitamin B. There were insufficient data for analysis in the single trial comparing tranexamic acid and mefenamic acid and in another trial comparing naproxen with estradiol. Prevention of pain Cu IUD There was low-certainty evidence that tolfenamic acid may not be effective to prevent painful menstruation compared to placebo (OR 0.71, 95% CI 0.44 to 1.14; 1 trial, 310 women). Ibuprofen may not reduce menstrual cramps compared to placebo (OR 1.00, 95% CI 0.11 to 8.95; 1 trial, 20 women, low-certainty evidence). AUTHORS' CONCLUSIONS: Findings from this review should be interpreted with caution due to low- and very low-certainty evidence. Included trials were limited; the majority of the evidence was derived from single trials with few participants. Further research requires larger trials and improved trial reporting. The use of vitamin B1 and mefenamic acid to treat heavy menstruation and tolfenamic acid to prevent heavy menstruation associated with Cu IUD should be investigated. More trials are needed to generate evidence for the treatment and prevention of heavy and painful menstruation associated with LNG IUD.

Effect of fennel on primary dysmenorrhea: a systematic review and meta-analysis.

BACKGROUND: One of the most common complaints for women is dysmenorrhea. Several studies investigated the treatment effects of medicinal plants on primary dysmenorrhea. OBJECTIVES: This systematic review and meta-analysis investigates the effect of Foeniculum vulgare (Fennel) on pain in primary dysmenorrhea in comparison to non-steroidal anti-inflammatory drugs such as mefenamic acid. METHODS: PubMed, EMBASE, EBSCO Web of Science, Scopus, Cochrane library, Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, ProQuest, ISI Web of Science, Google Scholar, Magiran, SID, Iran Medex, and Irandoc were searched up to January 2019. Quality assessment of clinical trials was conducted using Jadad scoring system. Totally, 12 studies were entered in the meta-analysis. I 2 was calculated to determine heterogeneity. Fixed effects and/or random effects models were applied. RESULTS: Meta-analysis of these trials showed that F. vulgare intake decreased significantly the intensity of dysmenorrhea compared to the placebo (SMD -0.632; CI: -0.827 to -0.436; p<0.001; heterogeneity p=0.807; I 2=0%; fixed effect model; seven articles). However, the effect of Mefenamic acid with F. vulgare was not different from each other (SMD=-0.214; CI: -0.446 to 0.017; p=0.07; heterogeneity p=0.58; I 2=0%; fixed effect model; six trials). CONCLUSION: The F. vulgare alleviates dysmenorrhea. Regarding the same effect of F. vulgare with NSAIDs, it is highly recommend to the women suffered from dysmenorrhea specifically the ones who have high tendency toward herbal medicine.

Randomized, double-blind, placebo-controlled clinical trial studying the effects of Turmeric in combination with mefenamic acid in patients with primary dysmenorrhoea.

Primary dysmenorrhea (PDM) is one of the common complaints in women. This study aimed to assess the effects of turmeric and mefenamic acid and a combination compared with placebo on PDM. This clinical trial was conducted on dormitory students with PDM. Subjects completed the visual analog scale (VAS) before randomization. One hundred twenty-eight patients, randomly assigned to one of following groups: Turmeric group (n=32), mefenamic acid group (n=32), turmeric and mefenamic acid group (n=32), and placebo group (n=32). Turmeric and mefenamic acid were administrated in 500mg and 250mg, respectively. Pain severity was assessed in the baseline and the end line by VAS. Statistical analysis was performed using SPSS software. The combination of turmeric and mefenamic acid, dramatically, alleviated pain in comparison to other groups. Our results illustrated that combination of turmeric and mefenamic acid would be better in pain alleviation in PDM.

A double-blind controlled crossover study to investigate the efficacy of salix extract on primary dysmenorrhea.

OBJECTIVES: Primary dysmenorrhea in the absence of pelvic pathology is a common gynecologic disorder affecting the quality of life of women of reproductive age. This study evaluates the effect of salix extract on primary dysmenorrhea. DESIGN: This study was a randomized crossover clinical trial. SETTING: The study population included 96 female students with level two or three of primary dysmenorrhea: 48 students in the treatment group (sequence I) followed by control (sequence II) and 48 students in control group (sequence I) followed by treatment (sequence II). INTERVENTIONS: The intervention was salix capsule (400 mg daily) and the active control was mefenamic acid capsule (750 mg daily) as. MAIN OUTCOMES: Pain intensity, measured by the visual analog scale (VAS), amount of bleeding, and severity of dysmenorrhea symptoms were outcomes. Generalized estimating equations were used for data analysis. RESULTS: The demographic and menstrual characteristics of the students were homogenous between the groups. The results showed that the students in mefenamic acid group had a significantly higher level of VAS than the students in the salix group over time (1.61 ± 0.06, P < 0.001). The estimated odds of the bleeding level in the salix and mefenamic acid group were not significantly different (P = 0.31). In average, 77.39%±16.18 of the students in salix group showed no symptoms followed by 22.18%±14.08 of the students who experienced mild symptoms. Averagely, 44.58%±20.16 of the students in the mefenamic acid group had mild symptoms followed by moderate symptoms (28.12%±15.29). CONCLUSIONS: Salix extract significantly decreased dysmenorrhea in comparison to mefenamic acid, as the standard treatment of dysmenorrhea.

Comparison of the effect of honey and mefenamic acid on the severity of pain in women with primary dysmenorrhea.

BACKGROUND AND OBJECTIVE: Primary dysmenorrhea starts simultaneously with menstruation or before it and usually continues for 48-72 h. As a prevalence disorder, it affects about 80-97% of women in the reproductive age. The conventional treatment modalities of primary dysmenorrhea are associated with complications and side effects. In addition, there is a lack of knowledge of the effect of honey on the treatment of primary dysmenorrhea. The objective of this study is to investigate the effect of honey on the severity of pain in women with dysmenorrhea. METHODS: A randomized crossover clinical trial was conducted on 56 female students. Subjects were randomly assigned to two groups. Groups I and II received honey and mefenamic acid in the 'first treatment period', respectively. In the 'second treatment period', the intervention methods were reversed between the groups. Samples recorded the severity of pain during the first 3 days of menstruation. RESULTS: There were no significant differences in the most severe level of pain in the first and second months of the first treatment period, and the first and second months of the second treatment period between the groups. CONCLUSIONS: Honey and the mefenamic acid capsules led to the same amount of pain relief in women with primary dysmenorrhea. Honey is suggested to be used for pain relief due to its lower side effects and pharmacological complications.

Comparison the effect of mefenamic acid and Teucrium polium on the severity and systemic symptoms of dysmenorrhea.

BACKGROUND: Primary dysmenorrhea is a prevalent problem and its effects decrease the quality of life in many women across the world. The aim of this study was to research the effect of Teucrium polium compared to mefenamic acid on primary dysmenorrhea. MATERIALS AND METHODS: This triple-blind, randomized, clinical trial study was performed on 70 single female students between 20 and 30 years old educating in Shahid Beheshti University (Tehran, Iran) from October 2014 to February 2014.They were allocated randomly into two groups: In T. polium group (n = 35) who took 250 mg of T. polium powder q6h for the first 3 days of menstruation for two cycles. The second group (n = 35) received 250 mg mefenamic acid,. Dysmenorrhea severity was determined by visual analog scale (VAS). RESULTS: There were no differences between two groups for demographic or descriptive variables. Comprising the VAS showed that the participants in T. polium and mefenamic acid groups had lower significant pain in the 1st and the 2nd months after the treatment (P < 0.05). No side effects were reported in the T. polium and Mefenamic Acid groups. CONCLUSION: T. polium was as effective as mefenamic acid in decreasing the pain severity in primary dysmenorrhea.

The effect of valeric on anxiety severity in women undergoing hysterosalpingography.

AIM & SCOPE: Hysterosalpingography (HSG) is the radiographic evaluation of the uterine cavity and fallopian tubes, which is generally assumed as a stressful and painful procedure. This study aims to determine effect of oral Valeric capsules on anxiety severity in women under Hysterosalpingography. METHOD & EXAMINATION: This study, as a double-blind clinical trial, was conducted on 64 infertile women undergoing hysterosalpingography, who referred to radiology ward at Comprehensive Women's hospital. To measure anxiety, visual analog anxiety scale was used 90 minutes before starting procedure, individuals in intervention group (n=32) received a single dose (1,500 mg) of 3 Valeric capsules, together with routine prophylaxy, where routine prophylaxis contains Mefenamic acid 250mg capsules in 30 minutes before procedure, and the same capsules were prescribed to placebo group (n=32) with the same instruction. Anxiety severity before and once 90 minutes after intervention in both groups were measured and compared. RESULTS: There was no difference on anxiety severity before intervention in both groups (p=0.26), and the groups were homogeneous; after intervention, a significant difference on anxiety severity was reported in both groups (p<0/0001), and anxiety score in intervention group compared to placebo reduced statistically. CONCLUSION: Present study indicated that Valeric was effective on reducing anxiety in women undergoing hysterosalpingography.

The effect of mefenamic acid and ginger on pain relief in primary dysmenorrhea: a randomized clinical trial.

PURPOSE: The aim of the study was to compare the effect of mefenamic acid and ginger on pain management in primary dysmenorrhea. METHODS: One hundred and twenty-two female students with moderate to severe primary dysmenorrhea were randomly allocated to the ginger and mefenamic groups in a randomized clinical trial. The mefenamic group received 250 mg capsules every 8 h, and the ginger group received 250 mg capsules (zintoma) every 6 h from the onset of menstruation until pain relief lasted 2 cycles. The intensity of pain was assessed by the visual analog scale. Data were analyzed by descriptive statistics, t test, Chi-square, Fisher exact test and repeated measurement. RESULTS: The pain intensity in the mefenamic and ginger group was 39.01 ± 17.77 and 43.49 ± 19.99, respectively, in the first month, and 33.75 ± 17.71 and 38.19 ± 20.47, respectively, in the second month (p > 0.05). The severity of dysmenorrhea, pain duration, cycle duration and bleeding volume was not significantly different between groups during the study. The menstrual days were more in the ginger group in the first (p = 0.01) and second cycle (p = 0.04). Repeated measurement showed a significant difference in pain intensity within the groups by time, but not between groups. CONCLUSION: Ginger is as effective as mefenamic acid on pain relief in primary dysmenorrhea. Ginger does not have adverse effects and is an alternative treatment for primary dysmenorrhea.

Comparison of the effects of Matricaria chamomila (Chamomile) extract and mefenamic acid on the intensity of premenstrual syndrome.

The study aimed to compare the effects of Chamomile Extract and Mefenamic acid (MA) on the intensity of Premenstrual syndrome (PMS) symptoms. This study was a clinical randomized double blind trial, carried out with 90 students living in the dorms of Iran. The participants filled the daily forms about the intensity of PMS for two consecutive months. Once the definitive diagnosis of PMS was made, the participants were divided into two groups, each receiving either Chamomile capsule 100 mg or MA 250 mg three times a day. Intensity reduction of emotional symptoms was significantly higher among Chamomile Extract-users (30.1 ± 26.6 and 33.4 ± 25.3 percent) than that among MA-users (11.6 ± 25.7 and 10.7 ± 26.8 percent) after two cycles intervention (p < 0.001). Intensity reduction of physical symptoms was not significantly different (p > 0.05) among groups. Consumption of Chamomile seems to be more effective than MA in relieving the intensity of PMS associated symptomatic psychological pains.

The effect of an Iranian herbal drug on primary dysmenorrhea: a clinical controlled trial.

Our objective was to examine the effect of an Iranian herbal drug in the treatment of primary dysmenorrhea. A randomized, double-blind, placebo-controlled pilot trial among 180 female students at Isfahan University dormitory aged 18 to 27 who suffered from primary dysmenorrhea was undertaken. The participants were randomly divided into three groups: herbal drug, mefenamic acid, and placebo. The herbal drug group was given 500 mg of highly purified saffron, celery seed, and anise (SCA) extracts three times a day for three days, starting from the onset of bleeding or pain. Participants were followed for two to three cycles from the beginning of menstruation through the three days of bleeding. Main outcome measures were the severity and duration of pain at 2 and 3 months. A visual analogue scale was used to record pain. There were statistically significant reductions in pain scores and pain duration scores in the groups that took SCA (P < . 001) and mefenamic acid (P < . 01). The decrease in pain score was reflected by a significant reduction in other drug use among the treatment groups compared with the women in the placebo group. The magnitude of the reduction was significantly greater in the SCA group than in the mefenamic acid and placebo groups. Both drugs effectively relieved menstrual pain as compared with the placebo. More clinical trials are needed to establish the efficacy of this herbal drug.

Comparison of effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary dysmenorrhea.

OBJECTIVES: To compare the effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary dysmenorrhea. METHODS: This was a double-blind comparative clinical trial conducted from September 2006 to February 2007. Participants were 150 students (18 years old and over) with primary dysmenorrhea from the dormitories of two medical universities who were alternately divided into three equal groups. Students in the ginger group took 250 mg capsules of ginger rhizome powder four times a day for three days from the start of their menstrual period. Members of the other groups received 250 mg mefenamic acid or 400 mg ibuprofen capsules, respectively, on the same protocol. A verbal multidimensional scoring system was used for assessing the severity of primary dysmenorrhea. Severity of disease, pain relief, and satisfaction with the treatment were compared between the groups after one menstruation. RESULTS: There were not significant differences between groups in baseline characteristics, p > 0.05. At the end of treatment, severity of dysmenorrhea decreased in all groups and no differences were found between the groups in severity of dysmenorrhea, pain relief, or satisfaction with the treatment, p > 0.05. No severe side effects occurred. CONCLUSION: Ginger was as effective as mefenamic acid and ibuprofen in relieving pain in women with primary dysmenorrhea. Further studies regarding the effects of ginger on other symptoms associated with dysmenorrhea and efficacy and safety of various doses and treatment durations of ginger are warranted.

Comparison of the effectiveness of fennel and mefenamic acid on pain intensity in dysmenorrhoea.

A study in Kerman, Islamic Republic of Iran in 2002 compared the effectiveness of fennel and mefenamic acid on pain relief in primary dysmenorrhoea. Two groups of high-school girls (mean age 13 years) suffering dysmenorrhoea were randomized to receive fennel extract (n = 55) or mefenamic acid (n = 55) for 2 months. In the fennel group, 80% of girls and in the mefenamic acid group, 73% of girls showed complete pain relief or pain decrease, while 80% in the fennel group and 62% in the mefenamic acid group no longer needed to rest. There was no significant difference between the 2 groups in the level of pain relief.

Evaluation of the bioactivity of triterpene mixture isolated from Carmona retusa (Vahl.) Masam leaves.

The major constituent of Carmona retusa (Vahl.) Masam. leaves is an intractable mixture of triterpenes, namely alpha-amyrin (43.7%), beta-amyrin (24.9%), and baurenol (31.4%). At a dosage of 100mg/kg mouse, the triterpene mixture exhibited 51% analgesic activity but only showed 20% anti-inflammatory activity. Kruskal-Wallis one-way analysis of variance by ranks showed that the triterpene mixture is as active as mefenamic acid, a commercially available analgesic, at alpha = 0.01. The charcoal tracing test showed a 29% anti-diarrheal activity for the triterpene mixture, which increased to 55% at a dosage of 250 mg/kg mouse. At the higher dosage, the triterpene mixture differed significantly from its solvent control at alpha = 0.01. Results of the micronucleus test showed that the triterpene mixture did not exhibit mutagenic nor anti-mutagenic activity at alpha = 0.001. There was no significant decrease in blood glucose levels (bgl) in alloxan-induced diabetic mice after administration of the triterpene mixture. The triterpene mixture was inactive against Escherichia coli and possessed moderate activities against Staphylococcus aureus, Candida albicans, and Trichophyton mentagrophytes.

Comparison of fennel and mefenamic acid for the treatment of primary dysmenorrhea.

OBJECTIVES: To compare the effect of Foeniculum vulgare variety dulce (Sweet Fennel) vs. mefenamic acid for the treatment of primary dysmenorrhea. METHODS: A cohort of seventy women, 15-24 years old from a local university and high-school, who complained of dysmenorrhea were enrolled in this study. Ten cases were excluded due to evidence of secondary dysmenorrhea. The remaining 60 patients were graded mild, moderate and severe on the basis of a verbal multidimensional scoring system. Thirty patients with mild dysmenorrhea were also excluded from the study. Each of the 30 cases with moderate to severe dysmenorrhea was evaluated for three cycles. In the first cycle no medication was given (control cycle), in the second cycle the cases were treated by mefenamic acid (250 mg q6h orally) and in the third cycle, essence of Fennel's fruit with 2% concentration (25 drops q4h orally), was prescribed at the beginning of the cycle. These cycles were compared day by day for the effect, potency, time of initiation of action and also complications associated with each treatment modality, by using a self-scoring system. Intensity of pain was reported by using a 10-point linear analog technique. Statistical analyses were performed by the independent sample t-test, paired t-test and repeated measurement analysis method. RESULTS: In the study group the mean age of menarche was 12.5+/-1.3 years, the mean duration of menstruation was 6.6+/-1.4 days with the mean cycle days of 27+/-3. The findings observed during menses were as follows: headache in 26.7%, nausea in 63.3%, vomiting in 23.3%, diarrhea in 33.3%, fatigue in 93.3% and leaving the daily tasks undone was reported in 86.9% of the cases. Both of the drugs effectively relieved menstrual pain as compared with the control cycles (P<0.001). The mean duration of initiation of action was 67.5+/-46.06 min for mefenamic acid and 75+/-48.9 min for fennel. The difference was not statistically significant (P=0.57). Mefenamic acid had a more potent effect than fennel on the second and third menstrual days (P<0.05), however, the difference on the other days was not significant. No complication was reported in mefenamic acid treated cycles, but five cases (16.6%) withdrew from the study due to fennel's odor and one case (3.11%) reported a mild increase in the amount of her menstrual flow. CONCLUSIONS: The essence of fennel can be used as a safe and effective herbal drug for primary dysmenorrhea, however, it may have a lower potency than mefenamic acid in the dosages used for this study.

[The effect of mefenamic acid on the immunity indices and hemostatic system in cancer patients and on the cathepsin D-like protease activity in the tissues in cancer of the large intestine]. / Vliianie mefenaminovoi kisloty na pokazateli immuniteta, sistemu gemostaza onkologicheskikh bol'nykh i na aktivnost' proteazy, podobnoi katepsinu D, v tkani raka tolstoi kishki.

The study of the effect of sodium mefenaminate on radiation resistance of rats yielded positive results. Clinical investigations showed mefenamic acid to decrease the activity of cathepsin D-like protease in colonic cancer tissue. The acid failed to affect the proteolytic activity of the normal mucosa. It revealed an immunomodulating activity and influenced the hemostatic system which usually manifested itself in amelioration of hypercoagulation.

[Use of mefenamic acid as a connective tissue stabilizer in treating arthropathic psoriasis]. / Primenenie mefenamovoi kisloty kak stabilizatora soedinitel'noi tkani v lechenii artropaticheskogo psoriaza.

The findings of biochemical studies, carried out in 30 patients suffering from psoriatic arthropathy, are analyzed. The parameters examined are: the blood and urine glycosaminoglycans, urine hydroxyproline levels, and blood hyaluronate glycan hydrolase and N-acetyl-B-D-glucosaminidase activities, i. e. the matrix and collagen metabolites as the indicators of the connective tissue destruction and lysosomal enzymes activation responsible, among other factors, for this destruction. The studies have revealed a correlation between the enzymic activity augmentation and the levels of the connective tissue degradation products and the dissemination and severity of the skin and articular processes. The patients have been treated with mefenamic acid, an enzymic activity inhibitor. The therapy has been effective in 76% of patients; 13% of these have developed a remission shortly after therapy (in 46.7 days on an average). The therapy has alleviated both skin and articular symptoms; a tendency to normalization of the biochemical characteristics has been observed. A continuous course of therapy has not been associated with side effects. The author recommends this pathogenetically based and confirmed by laboratory investigations method to be included into a complex of therapeutic measures for patients with psoriatic arthropathy.

[The treatment of psoriatic arthropathy with a combination of mefenamic and aminocaproic acids]. / Lechenie psoriaticheskoi artropatii sochetaniem mefenamovoi i aminokapronovoi kislot.

Studies of the connective tissue status, lysosomal enzymes and kallikrein-kinin system activities in 30 patients with psoriatic arthropathy have revealed an increased level of the connective tissue matrix and collagen metabolites, elevated activities of proteoglycan-destroying hydrolases and of kallikrein and its precursor. The detected shifts correlated with the severity of the skin and articular processes. Besides the traditional local and fortifying therapy, the patients have been administered mefenamic acid (connective tissue stabilizer) and aminocaproate (tissue protease and kinin system inhibitor). Such treatment has been effective in 76% of the patients. The mean length of treatment has made up 42.3 days. The drugs have had a positive effect on both the skin and articular processes. A tendency to normalization of the biochemical characteristics has been observed. The suggested scheme of therapy is recommended for practice.

Transcutaneous electrical nerve stimulation following appendicectomy: the placebo effect.

A controlled trial was undertaken to compare the efficacy of transcutaneous electrical nerve stimulation (TENS) with standard intramuscular opiate analgesia in the management of postoperative pain following appendicectomy. Consecutive patients undergoing emergency appendicectomy were randomised into control, sham TENS and active TENS groups. There was a significant decrease in pain severity and analgesic intake in both active and sham TENS groups when compared with the control group (P less than 0.01). No difference was demonstrated in pain severity between active and sham TENS groups but the active TENS group required slightly less analgesia. These results suggest that the major benefit of TENS in the postappendicectomy patient is due to its 'placebo effect' and its use in this situation cannot be recommended.

Rat pleurisy induced by kaolin or croton oil: time course of fluid accumulation and white cell migration.

Rat pleurisy was induced by intrapleural injection of 0.1 ml of 1% kaolin or 1% croton oil, and the time courses of pleural fluid accumulation and white cell migration were examined. Peak pleural fluid accumulation was observed at respectively 5 and 16 h after the inciter injection. Migration of white cells into the pleural cavity showed a peak at respectively 7 or 24 h after each inciter. Polymorphonuclear leukocytes were predominant in pleural cells of kaolin pleurisy at 3 h, while in croton-oil pleurisy the major white cells were mononuclear cells and lymphocytes at 3 h, and polymorphonuclear leukocytes appeared later around 16 h. Pretreatment with several agents modified both types of induced pleurisy. Kaolin pleurisy at 3 h was suppressed by indomethacin, mefenamic acid, paramethasone, bromelain and soy-bean trypsin inhibitor, while croton oil pleurisy at 3 h was suppressed significantly by indomethacin and paramethasone.