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Clinical use of prostaglandins in perspective.


 Clinical studies throughout the world will probably result in the use of prostaglandins (PGs) in the near future for treatment of some cardiovascular, gastrointestinal, and respiratory diseases in addition to their present use in gynecology and obstetrics. The discovery in 1971 that acetylsalicylic acid and a series of other nonsteroidal anti-inflammatory drugs inhibit the biosynthesis of PGs provided an explanation for the analgetic, antipyretic, and anti-inflammatory activity of these drugs and formed a rational base for their use in a variety of pathological situations believed to involve PGs. The most important indications for the use of PGs in human reproduction include induction of labor; cervical priming; termination of pregnancy in the 2nd or 1st trimester; management of fetal death, missed abortion, intrauterine death near term, hydatidiform mole, and anencephaly; and postpartum hypotonus. 1 of the main contributions of PGs in obstetrics is their ability to stimulate the uterus throughout pregnancy and their suitability in cases in which the uterus is not receptive to oxytocin. Work is underway to develop more satisfactory routes of administration, perhaps vaginally, to achieve more satisfactory control of side effects, and to increase the duration of action through development and substitution of synthetic androgens. PG biosynthesis inhibitors have been used successfully in treatment of premature labor in some cases. PGs of the E series have been used for temporary treatment of cardiac malfunction such as transposition of the main arteries or pulmonary atresia, the vasodilating PGs such as PGI2 or PGE1 have been used in peripheral vascular disease such as arteriosclerosis obliterans and Raynaud's disease, and are currently under investigation in the treatment of pulmonary hypertension, spontaneous angina, and toxemia. Prostacyclin has recently become available in Great Britain as an antiaggregating agent for use during charcoal hemoperfusion, hemodialysis, and extracorporeal circulation in open heart surgery. The antisecretory activity of PGs, partially mediated through a stimulation of mucus secretion, has led to their use in treatment of stomach ulcers. Clinical application of PGs in respiratory problems has not progressed far, but recently synthesized analogues could become useful in treatment of some asthmatic disorders.
