By T. Ningal. University of South Carolina, Spartanburg.

The full moon also with some persons and the new moon with other order cytoxan 50 mg with amex medicine 54 092, has an unfavorable erect cheap cytoxan 50mg with amex medicine grace potter lyrics. Or should we regard such a chronic disease as not being psoric, because the patient cannot remember, that he at sometime, all the way back to his birth, has had several or more (intolerably voluptuously) itching pustules of itch on his skin, or (since the itch-disease is considered as something disgraceful) is not willing to acknowledge it? Since at all times, all the innumerable chronic diseases resulting from an acknowledged preceding itch (when this has not been cured) are ineradicable through the vital force, and advance in their equable course as psoric ailments, and are continually aggravated: so long as the doubters of the psora doctrine cannot show me any other source which is at least as probable for a (non-veneric) ailment, which, despite of favorable external conditions, correct diet, good morality and vigorous bodily constitution, nevertheless increases every year, without any preceding infection from itch so far as memory goes: so long I have on my side an overpowering analogous probability, i. To prove the psoric nature of these chronic diseases without acknowledged infection, we do not even need the fact that the anti-psoric remedies prove effectual therein; this serves only like the proof to a correctly solved mathematical problem. Now since, in addition, the other remedies, although also selected according to the similarity of their symptoms, do not by far yield so durable and thorough a cure in such chronic diseases, as those which are recognized as anti-psoric, and which are selected in as Homoeopathic a manner, because these more than the others are adequate to the whole extent of the endless number of symptoms of the great psora malady: I do not see why men will deny to the latter the title of the especially anti-psoric remedies, unless this springs from dogmatism. And just as little is there any good reason for contradicting me, when I (Organon, ¤73,) explain the acute diseases which return from time to time; e. These, nevertheless, have their source in a latent psora, because their customary return cannot be prevented by anything but a final cure with anti-psoric remedies. We now proceed to the medical Homoeopathic treatment of the illimitably large number of chronic diseases, which, after the above gained knowledge of their threefold nature, has not, indeed, become easy, but - what without this knowledge was before impossible - has at last become Possible, since the homoeopathically specific remedies for each one of these three different miasmata have in great part been discovered. The first two miasmata, which cause by far the smaller part of the chronic diseases, the venereal chancre-disease (syphilis) and the figwart-disease (sycosis), with their sequelae, we will treat first, in order that we may have a free path to the therapeutics of the immeasurably greater number of the various chronic diseases which spring from Psora. First, then, concerning sycosis, as being that miasma which has produced by far the fewest chronic diseases, and has only been dominant from time to time. This figwart-disease, which in later times, especially during the French war, in the years 1809-1814, was so widely spread, but which has since showed itself more and more rarely, was treated almost always, in an inefficient and injurious manner, internally with mercury, because it was considered homogeneous with the venereal chancre-disease; but the excrescences on the genitals were treated by Allopathic physicians always in the most violent external way by cauterizing, burning and cutting, or by ligatures. These excrescences usually first manifest themselves on the genitals, and appear usually, but not always, attended with a sort of gonorrhoea* from the urethra, several days or several weeks, even many weeks after infection through coition; more rarely they appear dry and like warts, more frequently soft, spongy, emitting a specifically fetid fluid (sweetish and almost like herring- brine), bleeding easily, and in the form of a coxcomb or a cauliflower (brassica botrytes). These, with males, sprout forth on the glans and on, or below, the prepuce, but with women, on the parts surrounding the pudenda; and the pudenda themselves, which are then swollen, are covered often by a great number of them. When these are violently removed, the natural, proximate effect is, that they will usually come forth again, usually to be subjected again, in vain, to a similar, painful, cruel treatment. But even if they could be rooted out in this way, it would merely have the consequence, that the figwart-disease, after having been deprived of the, local symptom which acts vicariously for the internal ailment, would appear in other and much worse ways, in secondary ailments; for the figwart-miasm, which in the whole organism, has been in no way diminished, either by the external destruction of the above-mentioned excrescences, or by the mercury which has been used internally, and which is in no way appropriate to sycosis. Besides the undermining of the general health by mercury, which in this disease can only do injury, and which is given mostly in very large doses and in the most active preparations, similar excrescent then break out in other parts of the body, either whitish, spongy, sensitive, flat elevations, in the cavity of the mouth on the tongue, the palate and the lips, or as large, raised, brown and dry tubercles in the axillae, on the neck, on the scalp, etc. They yield either to a dose of one drop of fresh parsley-juice, when this is indicated by a frequent urgency to urinate, or a small dose of cannabis, of cantharides, or of the copaiva balm, according to their different constitution and the other ailments attending it. These should, however, be always used in the higher and dynamizations (potencies), unless a psora, slumbering in the body of the patient, has been developed by means of a strongly affecting, irritating or weakening treatment by Allopathic physicians. In such a case frequently secondary gonorrhoeas remain, which can only be cured by an anti- psoric treatment. It is not necessary to use any external application, except in the most inveterate and difficult cases, when the larger figwarts may be moistened. But if the patient was at the same time affected with another chronic ailment, as is usual after the violent treatment of figwarts by Allopathic physicians, then we often find developed psora** complicated with sycosis, when the psora, as is often the case, was latent before in the patient. At times, when a badly treated case of venereal chancre disease had preceded, both these miasmata are conjoined in a threefold complication with syphilis. Then it is necessary first to come to the assistance of the most afflicted part, the psora, with the specific anti-psoric remedies given below, and then to make use of the remedies for sycosis, before the proper dose of the best preparation of mercury, as will be described below, is given against the syphilis; the same alternating treatment may be continued, until a complete cure is effected. Only, each one of these three kinds of medicine must be given the proper time to complete its action. The second chronic miasma, which is more widely spread than the figwart-disease, and which for three and a half [now four] centuries has been the source of many other chronic ailments, is the miasm of the venereal disease proper, the chancre-disease (syphilis). This disease only causes difficulties in its cure, if it is entangled (complicated) with a psora that has been already far developed - with sycosis it is complicated but rarely, but then usually at the same time with psora. When syphilis is still alone and attended with its associated local symptom, the chancre, or at least if this has been removed by external applications, it is still associated with the other local symptom, which in a similar manner acts vicariously for the internal disorder, the bubo. The chancre appears, after an impure coition, usually between the seventh and fourteenth days, rarely sooner or later, mostly on the member infected with the miasma, first as a little pustule, which changes into an impure ulcer with raised borders and stinging pains, which if not cured remains standing on the same place during manÕs lifetime, only increasing with the years, while the secondary symptoms of the venereal disease, syphilis, cannot break out as long as it exists. In order to help in such a case, the Allopathic physician destroys this chancre, by means of corroding, cauterizing and desiccating substances, wrongly conceiving it to be a sore arising merely from without through a local infection, thus holding it to be a merely local ulcer, such also it is declared to be in their writings. They falsely suppose, that when it appears, no internal venereal disease is as yet to be thought of, so that when locally exterminating the chancre, they suppose that they remove all the venereal disease from the patient at once, if only he will not permit this ulcer to remain too long in its place, so that the absorbent vessels do not get time to transfer the poison into the internal organism, and so cause by delay a general infection of the system with syphilis.

Most supraventricular tachyarrhythmias seeninotherwise healthy patients are caused by the mechanism of reentry 50 mg cytoxan mastercard medications management. The five general categories of reentrantsupraventricular arrhyth- mias are listedinTable 1 order cytoxan 50mg mastercard treatment junctional rhythm. Since the beta pathway conducts more rapidly thandoes the alpha pathway, a normal atrial impulse reaches the ventricles via the beta pathway. Most patients with suchbypass tracts do not have overt Wolff-Parkinson–White syndrome, however. Instead, they have concealed bypass tracts, that is, bypass tracts that are incapable of conducting in the antegrade direction (from the atrium to the ventricles), and therefore never display delta waves. Concealed bypass tracts are able to conduct electrical im- pulses only in the retrograde direction (from the ventricles to the atrium). Intra-atrial reentry differs from automatic tachycardiabecause of its sudden onset and termi- nation,and,like all reentrant arrhythmias, it can be induced by pacing. Thus, the bypass tract may be able to conduct the impulse retrogradely back to the atrium. If so, a reentrant impulse may be established, which trav- els antegradely down the normal conducting system and retrogradely up the bypass tract. In atrial flutter, the atrial activity isregular, in excess of 220 beats/min,and usually displays a typical sawtooth pattern (Figure 1. Note the randomly irregular ventricular re- sponse and the absenceofdiscrete P waves. In atrial fibrillation, the atrial activity is continuousand chaotic, and discrete P waves cannot be distinguished (Figure 1. The ventricular response is completely irregular, reflecting the chaotic nature of the atrial activity. Triggered supraventricular tachyarrhythmias The only supraventricular tachycardia commonly attributed to trig- gered activity is that seenwith digitalis toxicity. In fact, the presenceofatrial 26 Chapter 1 tachycardia with block should always make one consider the possi- bility of digitalis toxicity. Atrial flutter and atrial fibrillationcanusually be distinguished by simple inspection. Automatic ventricular tachyarrhythmias Abnormal automaticity accounts for a relatively small proportion of ventricular tachyarrhythmias. As is the case with automatic atrial arrhythmias, automatic ventricular arrhythmias are usually associ- atedwith acute medical conditions, suchasmyocardial ischemia, acid–base disturbances, electrolyte abnormalities, and highadren- ergic tone. Automatic ventricular arrhythmias are most often seen in patients with acute myocardial ischemiaorinfarction,orsome other acute medical illness. Most arrhythmias occurring within the first few hours of an acute myocardial infarction are thought to be automatic. Once the ischemic tissue dies or stabilizes, however, the substrate for automaticity is nolonger present. Ingeneral, the treatmentofautomatic ventricular arrhythmias consists of treating the underlying illness. Reentrant ventricular tachyarrhythmias Most ventricular arrhythmias are reentrant in mechanism. While the conditions producing automatic ventricular arrhythmias are usually temporary in nature (e. Because the intra- atrial reentrant circuit can be located anywhere within the atria, the P-wave morphology can have any configuration. Reentrant circuits within the ventricular myocardium usually arise after scar tissue develops, a conditionmost commonly seenin patients who have myocardial infarctionsorcardiomyopathy. Once the scar tissue gives rise to a reentrant circuit, the circuit persists, and the potential for a ventricular arrhythmiaalways exists. Reentrantventricular arrhythmias are seen only rarely in individuals who have normal ventricles. Most antiarrhythmic drugs affect the ventricular myocardium and,accordingly, most are used to treat ventricular tachyarrhyth- mias. Channelopathic ventricular tachyarrhythmias Channelopathies probably account for several distinctive types of ventricular tachyarrhythmias, at least twoofwhich have now been Mechanismsofcardiac tachyarrhythmias 29 well characterized. These are the ventricular arrhythmias dueto triggered activity and Brugadasyndrome.

This may explain why perfusates of the lateral ventricle cytoxan 50 mg on line medicine during the civil war, obtained during kindled seizures induced by the stimulation of the amygdala 50mg cytoxan fast delivery treatment pancreatitis, showed elevated glutamate levels, but only after very intense neuronal disharges. Kindling induced by the intraventricular injection of folic acid in rats produced significant increases in cortical glutamate and aspartate, but only the latter correlated directly with increased spiking. With kindling induced by electrical stimulation of the frontal cortex the only change observed alongside the increase in after-discharge was a reduction in glutamine, although this could reflect its utilisation in providing the extra glutamate required for spiking and epileptic activity. In fact pyridoxal phosphate deficiency has been shown to be the cause of convulsions in children. These discharges have also been seen in the few humans on which the drugs have been tested unsuccessfully. The normal control pattern (phase a) quickly takes on an arousal state (phase b, 2±5 min). This gives way to waves of steadily increasing amplitude but low frequency (2 Hz) for 8±18 min (phase c) on which a few spikes gradually appear at 20 min (phase d). Spikes gradually predominate after some 26 min (phase e) until they group to give a full ictal seizure at 30 min (phase f). Records from the screw electrodes (a) showed the expected progressive change from wave-like (i) to spiking (ii) similar to phases c and d in Fig. Inhibition of glutamate release was thought to be the mode of action of lamotrigine. But it now seems likely that the actual block of sodium channels is its primary action (see later). Generally a reduction in monoamine function facilitates experimentally induced seizures (see Meldrum 1989) while increasing it reduces seizure susceptibility. The variability of the procedures used and results obtained do not justify more detailed analysis here. Some mention should perhaps be made of dopamine, considering its role in the control of motor function. How the drugs currently available for the treatment of epilepsy may utilise these mechanisms will now be considered. The decision on which drug to use depends not only on their proven efficacy in a particular type of epilepsy (some drugs are inactive in certain forms) but also what side-effects they have Ð many are sedative Ð how they interact with other drugs and how often they need to be taken. Compliance is a problem over a long period if dosing is required more than once a day. Only the latter have been developed chemically to modify the known synaptic function of the amino acids. It was largely replaced in 1932 by phenytoin for the management of tonic±clonic seizures and partial and secondary epilepsy. These remained, apart from the introduction of the benzodiazepines, the mainstay of therapy until the last decade. They were introduced solely on their ability to control experimentally induced seizures. Studies in cultured spinal cord neurons (Macdonald and McLean 1986) have shown that concentrations of phenytoin equivalent to those occurring clinically do not affect the resting membrane potential or the shape of a single-action potential but reduce the rapid discharge induced by depolarising the neuron, while leaving the first action potential intact (Fig. It is believed to block voltage-dependent sodium channels (not those mediating the synaptic currents) after their activation, i. Currently there are no clinically useful drugs that act as glutamate receptor antagonists seizures and clinically in focal and generalised epilepsy. Also, since they act only on the inactivated channel, they will not affect normal neuronal function, which is why in the experimental study, the first action potential remains unaltered. Neither compound is of any value against absence seizures and may exacerbate them. Experimentally it has no effect on the voltage-gated sodium channels affected by phenytoin but has been reported to suppress the transient T-type calcium currents in the thalamic neurons which are the origin of the 2±3 Hz spike and wave discharge characteristic of this form of epilepsy (see Mody 1998 for detail). Since these discharges are thought to arise from oscillations in excitability induced by changes in the T-type calcium current (see section above on the origin of absence seizures), this would obviously be a neat explanation of its efficacy in that condition. Unfortunately some workers have not been able to repeat this finding at clinically equivalent concentrations and consider ethosuximide to reduce a special persistent Na‡ channel and a Ca2‡-activated K‡ channel. Note that while the structures of phenytoin and ethosuximide are similar and also close to that of phenobarbitone, they are effective in different forms of epilepsy. Phenobarbitone may be as effective as phenytoin and carbamazepine in partial and generalised tonic±clonic seizures but its other central effects such as sedation, depression, listlessness and cognitive impairment mar its usefulness. Clonazepam, a typical 1:4 benzodiazepine, is effective in absence seizures, myoclonic jerks and tonic±clonic seizures and given intravenously it attenuates status epilepticus.

The manufacturer reports that embryotoxic and terato- genic effects have been observed in mice 50 mg cytoxan with visa treatment yeast infection child, rats discount cytoxan 50mg overnight delivery symptoms vaginitis, and rabbits. Two case reports of congenital anomalies after first-trimester combination chemotherapy (Garrett, 1974; Mennuti et al. Chemotherapy with mechlorethamine and other drugs that were discontinued prior to 132 Antineoplastic drugs during pregnancy conception did not increase the frequency of congenital anomalies among more than 40 infants above the 3. No birth defects were reported among the children of 12 women treated with mechlorethamine and other antineoplastic agents during pregnancy in one series (Aviles et al. Increased frequencies of congenital anomalies were found among the offspring of pregnant rodents that were given mechlorethamine in doses several times those normally used in humans (Beck et al. Somatic chromosome breaks have been observed among embryos of pregnant animals who received this agent during gestation (Soukup et al. The relevance of this finding to human reproduction is unknown because gonadal cell lines were not ana- lyzed. It is also used for treatment of chronic myelocytic leukemia, melanoma, osteosarcoma, soft tissue sarcoma, and thyroid cancers. The manufacturer reports that oral melphalan is teratogenic and embryolethal in animals. Although there are no stud- ies of the use of this drug during pregnancy in humans, its strong mutagenic and cyto- toxic actions suggest that it is a likely human teratogen and should be avoided during pregnancy. As with most antineoplas- tics, no epidemiological studies have been published of pregnancy outcome after the use of this agent during human pregnancy. None of four fetuses exposed in the first trimester developed malformations (Doll et al. One case was reported of fetal growth retardation associated with use of the drug in the latter half of pregnancy (Stevens and Fisher, 1965). An increased frequency of congenital anomalies and growth stunting was reported among the offspring of pregnant rodents that received this agent during preg- nancy (Korogodina and Kaurov, 1984; Murphy et al. A patient received carmustine throughout pregnancy and delivered a normal neonate (Schapira and Chudley, 1984). Carmustine must be suspected of being teratogenic because of its Alkylating agents 133 biochemical action (an alkylating agent). Rodents exposed to carmustine at several times the usual human dose during embryogenesis had increased frequency of birth defects (Wong and Wells, 1989). Otherwise, little information is published about the use of this agent during pregnancy in humans or animals. Antimetabolites Antimetabolites can be divided into three groups: folate antagonists, purine antagonists, and pyrimidine antagonists (Box 7. This antineoplastic agent was previously used as an abortifa- cient, but is no longer widely used as an antineoplastic or abortifacient. This finding is relevant to other folate antagonist antineoplastics that are commonly used. The precise risk of congenital anomalies following maternal exposure to this agent is unknown but is likely high (Warkany, 1978). Malformations of the skull, face, eye, and abdominal wall were described among rodents born to mothers that were administered large doses of the aminopterin during pregnancy (Baranov, 1966; Puchkov, 1967). Even at doses lower than those used in humans, malformations were observed in rabbits (Goeringer and DeSesso, 1990). As a group, folate antagonists appear to carry a substantially higher risk of congenital anomalies than other antineoplastic agents. Therefore, folate antagonists are uniformly contraindicated for use during pregnancy (Doll et al. It is used to treat a number of neoplasms, including acute leukemia, lymphoma, trophoblas- tic tumors, and carcinomas of the breast, cervix, ovary, bladder, kidney, prostate, lung, and 134 Antineoplastic drugs during pregnancy testicles. It is also used to treat nonneoplastic diseases: rheumatoid arthritis, psoriasis, and ectopic pregnancy. Methotrexate is particularly toxic to trophoblastic cells and is used fre- quently as an abortifacient. It has been used successfully to treat ectopic pregnancies (Grainger and Seifer, 1995; Schink, 1995) and to induce abortion (Hausknecht, 1995). Methotrexate is associated with a pattern of malformations similar to those in the aminopterin syndrome (Warkany, 1978).