ABSTRACT
Cleopatra VII (69-30 BC), the last Ptolemaic ruler of Egypt, is probably best known for her love affairs with Julius Caesar (100-44 BC) and Marcus Antonius (83-30 BC). Rightly or wrongly she became the epitome of shrewd seduction, leading brave Roman commanders on a path to debauchery and destruction. Among the seductive strategies attributed to her is the ingestion of small amounts of turpentine [the resin of the terebinth tree (Pistacia terebinthus)] or of derived oil (Oleum terebinthinae) with the purpose of conferring to her urine a more pleasant scent reminding of violets. Turpentine components are metabolized among other compounds to ionones and irones, which - renally excreted - are responsible for the flowery scent. Having obviously worked with great generals, the strategy is said to have been embraced for everyday use by many affluent Roman women. Complicating the issue somewhat is the fact that juniper berries (Fructus juniperi) and derived oil (Oleum juniperi) containing many of the same terpenoids as turpentine have a similar effect on urine. The purpose of this contribution is to briefly review the pharmacology of turpentine and juniper derived compounds assumed to be responsible for altering the scent of urine and to examine the origin and veracity of the mentioned habit. While the effect of ingested turpentine on the scent of urine is well documented our attempts at identifying Greek or Latin authors mentioning its intentional use for this explicit purpose (by Cleopatra or anybody else) failed.
Subject(s)
Juniperus/chemistry , Norisoprenoids/history , Turpentine/history , Urine/chemistry , Egypt , Famous Persons , Female , Fruit , History, Ancient , Humans , Norisoprenoids/urine , Odorants , Turpentine/metabolismSubject(s)
Hiccup/etiology , Aged , Amines/administration & dosage , Anti-Ulcer Agents/administration & dosage , Anticonvulsants/administration & dosage , Chronic Disease , Cyclohexanecarboxylic Acids/administration & dosage , Diagnosis, Differential , Dose-Response Relationship, Drug , Drug Administration Schedule , Drug Therapy, Combination , Gabapentin , Hiccup/drug therapy , Humans , Male , Omeprazole/administration & dosage , Pregabalin , Recurrence , gamma-Aminobutyric Acid/administration & dosage , gamma-Aminobutyric Acid/analogs & derivativesABSTRACT
The efficacy of cisapride, omeprazole, and baclofen (COB) for treatment of idiopathic chronic hiccup (ICH). was proven in several studies. The combination is considered, at present, to be "therapy of choice" for this condition. Substituting gabapentin for baclofen in baclofen resistant ICH cases can occasionally be successful. We present here cases where gabapentin was used successfully in combination with cisapride and omeprazole (COG/one patient) or as an "add-on" with cisapride, omeprazole, and baclofen (COBG/three patients). We conclude that, with baclofen and gabapentin, we are in possession of two substances that are, as a part of a combination therapy, quite effective for ICH. Because of the far more extensive experience with baclofen, we use it as a first-line therapy, together with omeprazole and cisapride. In cases where the results are not entirely satisfactory, the addition of gabapentin should be considered.
